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MR characterisation of dysplastic nodules and hepatocarcinoma in the cirrhotic liver with hepatospecific superparamagnetic contrast agents: pathological correlation in explanted livers

Caratterizzazione RM dei noduli displasici e dell’epatocarcinoma nel fegato cirrotico con mezzi di contrasto superparamagnetici epatospecifici: correlazione anatomo-patologica nei fegati espiantati

  • Abdominal Radiology/Radiologia Addominale
  • Published:
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Abstract

Purpose

The authors sought to evaluate the potential of magnetic resonance (MR) imaging with superparamagnetic iron oxide (SPIO) contrast material for identifying, characterising and differentiating dysplastic nodules (DN) and hepatocellular carcinoma (HCC) in the cirrhotic liver by correlating the results with pathological findings on the explanted liver.

Material and methods

MR imaging was used to study the liver of 400 cirrhotic patients awaiting liver transplantation, 31 of whom were selected to receive a liver. Of these 31 patients, we included in the study 22 patients (mean age 53 years; range 46–57 years) who underwent liver transplantation within 12–24 h after MR examination. Patients were studied with a 1.5-T device, and scans were acquired before and after the administration of paramagnetic contrast material. For every lesion, we recorded signal intensity on unenhanced baseline T1- and T2-weighted images and enhancement pattern after SPIO administration. Histological examination of the entire liver provided the definitive diagnosis of the lesions.

Results

Histological examination identified 59 lesions: 14 HCC, 4 HCC-DN, 39 DN, and 2 cystoadenomas. Among the 14 HCC, three were well differentiated, eight were moderately differentiated and three were poorly differentiated. Of the 39 DN, 28 were low-grade and 11 high-grade lesions. Unenhanced baseline MR imaging correctly identified and characterised 20 lesions, equal to 33.90% of all lesions: 6 HCC, 12 DN and 2 DN with a subfocus of HCC. SPIO-enhanced MR imaging showed greater sensitivity detecting and characterising 45 lesions, equal to 76.27% of all lesions identified at histology: 14 HCC, 27 DN and 4 DN with subfocus of HCC. SPIO administration improved the sensitivity of MR imaging in lesion detection and characterisation by 42.37%. False negative results with SPIO-enhanced MR imaging occurred in 12 DN (31%), which histological examination revealed to be low-grade DN with a diameter <1 cm.

Conclusions

SPIO-enhanced MR imaging proved to be of value in detecting and characterising lesions in the cirrhotic liver, allowing differentiation of DN from HCC and providing an early diagnosis of neoplastic degeneration of DN.

Riassunto

Obiettivo

Obiettivo di questo studio è stato valutare le potenzialità della risonanza magnetica (RM) eseguita con mezzo di contrasto (MdC) superparamagnetico (superparamagnetic iron oxide particles, SPIO) nell’identificazione, caratterizzazione e diagnosi differenziale tra noduli displasici (ND) ed epatocarcinoma (HCC) nel fegato cirrotico, confrontando i risultati della RM con quelli dell’esame anatomo-patologico eseguito su fegato espiantato.

Materiali e metodi

Abbiamo studiato con RM il fegato di 400 pazienti cirrotici in attesa di trapianto, 31 dei quali selezionati per reperimento d’organo da trapiantare. Dei 31 pazienti selezionati per il trapianto d’organo, sono stati inclusi nello studio 22 pazienti, di età media di 53 anni (range 46–57 anni), sottoposti a trapianto di fegato a distanza di circa 12–24 ore dall’esecuzione dell’esame RM. I pazienti inclusi nello studio sono stati sottoposti ad esame RM con un apparecchio da 1,5 T. Sono state eseguite scansioni prima e dopo somministrazione endovenosa di MdC SPIO. Per ogni lesione identificata è stata indicata l’intensità di segnale nelle sequenze di base pesate in T1 e in T2 ed il comportamento dopo iniezione di MdC SPIO. La diagnosi definitiva delle lesioni è stata effettuata con l’esame istologico di tutto il fegato espiantato.

Risultati

Con l’esame istologico sono state identificate 59 lesioni: 14 HCC, 4 HCC-ND, 39 ND, 2 cistoadenomi. Dei 14 HCC, 3 sono risultati ben differenziati, 8 moderatamente differenziati, 3 scarsamente differenziati. Dei 39 ND, 28 erano a basso grado di malignità e 11 ad alto grado di malignità. Con l’esame RM di base abbiamo identificato e caratterizzato correttamente 20 lesioni, pari al 33,90% delle lesioni complessivamente individuate, di cui 6 HCC, 12 ND e 2 ND con foci di HCC. L’esame RM, eseguito dopo somministrazione di MdC SPIO, ha mostrato una maggiore sensibilità identificando e caratterizzando complessivamente 45 lesioni, pari al 76,27% delle lesioni totali individuate con l’esame istologico: 14 HCC, 27 ND e 4 ND con foci di HCC. Dopo la somministrazione di MdC SPIO la sensibilità della RM nella identificazione e caratterizzazione delle lesioni è aumentata rispetto alle immagini di base del 42,37%. I falsi negativi con la RM-SPIO sono stati 12 noduli displasici, pari al 31%, che all’esame istologico sono risultati essere ND a basso grado di malignità e con diametro inferiore al cm.

Conclusioni

La RM con utilizzo di MdC SPIO, nella nostra esperienza è risultata utile nella identificazione e caratterizzazione delle lesioni epatiche nel fegato cirrotico mostrandosi in grado di differenziare i noduli displasici dagli HCC e ha consentito una diagnosi precoce della trasformazione carcinomatosa dei noduli displasici.

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Authors and Affiliations

  1. Dipartimento di Diagnostica per Immagini, Università degli Studi di Foggia, Viale Luigi Pinto 1, 71100, Foggia, Italy

    L. Macarini, P. Milillo, A. Cascavilla, G. Scalzo, L. Stoppino & R. Vinci

  2. P.O. S. Giacomo, Unità operativa di Radiodiagnostica, Monopoli, Bari, Italy

    G. Moretti & G. Ettorre

  3. Cattedra di Radiodiagnostica, Azienda Policlinico di Catania “Gaspare Rodolico”, Università degli Studi di Catania, Catania, Italy

    L. Macarini, P. Milillo, A. Cascavilla, G. Scalzo, L. Stoppino, R. Vinci, G. Moretti & G. Ettorre

  4. Via F. Chieffi 40, 70051, Barletta, Italy

    P. Milillo

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  1. L. Macarini
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Macarini, L., Milillo, P., Cascavilla, A. et al. MR characterisation of dysplastic nodules and hepatocarcinoma in the cirrhotic liver with hepatospecific superparamagnetic contrast agents: pathological correlation in explanted livers. Radiol med 114, 1267–1282 (2009). https://doi.org/10.1007/s11547-009-0464-9

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  • DOI: https://doi.org/10.1007/s11547-009-0464-9

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