Advertisement

European Radiology

, Volume 15, Issue 5, pp 895–903 | Cite as

Detection of hepatocellular carcinoma: comparison of Gd-DTPA- and ferumoxides-enhanced MR imaging

  • G. SimonEmail author
  • T. M. Link
  • K. Wörtler
  • F. Doebereiner
  • E. Schulte-Frohlinde
  • H. Daldrup-Link
  • M. Settles
  • E. J. Rummeny
Hepatobiliary-Pancreas

Abstract

The aim was to compare the diagnostic performance of dynamic Gd-DTPA- and ferumoxides-enhanced MRI for hepatocellular carcinoma (HCC). Twenty-five patients with chronic hepatitis or liver cirrhosis underwent both dynamic gadopentetate- and ferumoxides-enhanced MRI studies of the liver for HCC detection on the same day. MR data of both studies were retrospectively and independently analyzed. Two observers determined in consensus the grade of diffuse fibrotic liver changes (mild, moderate or severe) and the number of focal lesions. HCCs were confirmed by histology (n=22) and/or follow-up studies for at least six months (n=64). Differences in results obtained from both MR data sets were tested for significance with the McNemar’s test (p<0.05). Ferumoxides-enhanced MR images detected 84 of 99 hepatic lesions, including 82 of 86 HCCs and 2 false positive, nonmalignant lesions, while Gd-DTPA-enhanced MR images detected 92 of 99 hepatic lesions, including 81 of 86 HCCs and 11 false positive, nonmalignant lesions. Sensitivity of MRI for detection of HCCs was not significantly different between ferumoxides-enhanced (95.3%; p>0.05) and Gd-DTPA-enhanced scans (94.2%). Gd-DTPA- and ferumoxides-enhanced MRI perform equally well for HCC detection. The majority of small hypervascular hepatic lesions, detected on dynamic Gd-DTPA-enhanced MRI but not on ferumoxides-enhanced MRI, represent no HCCs.

Keywords

Liver Neoplasm Magnetic resonance imaging Contrast agents 

References

  1. 1.
    Peterson M, Baron R, Murakami T (1996) Hepatic malignancies: usefulness of acquisition of multiple arterial and portal venous phase images at dynamic gadolinium-enhanced MR imaging. Radiology 201:337–345Google Scholar
  2. 2.
    Rode A, Bancel B, Douek P et al. (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25:327–336Google Scholar
  3. 3.
    Krinsky GA, Lee VS, Theise ND et al. (2001) Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology 219:445–454PubMedGoogle Scholar
  4. 4.
    Lim JH, Cho JM, Kim EY, Park CK (2000) Dysplastic nodules in liver cirrhosis: evaluation of hemodynamics with CT during arterial portography and CT hepatic arteriography. Radiology 214:869–874Google Scholar
  5. 5.
    Krinsky GA, Theise ND, Rofsky NM, Mizrachi H, Tepperman LW, Weinreb JC (1998) Dysplastic nodules in cirrhotic liver: arterial phase enhancement at CT and MR imaging—a case report. Radiology 209:461–464Google Scholar
  6. 6.
    Yu J-S, Kim KW, Jeong M-G, Lee JT, Yoo HS (2000) Nontumorous hepatic arterial–portal venous shunts: MR imaging findings. Radiology 217:750–756Google Scholar
  7. 7.
    Lim JH, Choi D, Cho SK et al. (2001) Conspicuity of hepatocellular nodular lesions in cirrhotic livers at ferumoxides-enhanced MR imaging: importance of Kupffer cell number. Radiology 220:669–676Google Scholar
  8. 8.
    (1995) Terminology of nodular hepatocellular lesions. International Working Party. Hepatology 22:983–993Google Scholar
  9. 9.
    Elizondo G, Weissleder R, Stark DD et al. (1990) Hepatic cirrhosis and hepatitis: MR imaging enhanced with superparamagnetic iron oxide. Radiology 174:797–801PubMedGoogle Scholar
  10. 10.
    Lucidarme O, Baleston F, Cadi M et al. (2003) Non-invasive detection of liver fibrosis: is superparamagnetic iron oxide particle-enhanced MR imaging a contributive technique? Eur Radiol 13:467–474. Epub 2002 Sep 13Google Scholar
  11. 11.
    Colombo M (1999) Natural history and pathogenesis of hepatitis C virus related hepatocellular carcinoma. J Hepatol 31:25–30Google Scholar
  12. 12.
    Lencioni R, Pinto F, Armillotta N et al. (1997) Intrahepatic metastatic nodules of hepatocellular carcinoma detected at lipiodol-CT: imaging-pathologic correlation. Abdom Imaging 22:253–258Google Scholar
  13. 13.
    Pauleit D, Textor J, Bachmann R et al. (2002) Hepatocellular carcinoma: detection with gadolinium- and ferumoxides-enhanced MR imaging of the liver. Radiology 222:73–80PubMedGoogle Scholar
  14. 14.
    Tang Y, Yamashita Y, Arakawa A et al. (1999) Detection of hepatocellular carcinoma arising in cirrhotic livers: comparison of gadolinium- and ferumoxides-enhanced MR imaging. Am J Roentgenol 172:1547–1554Google Scholar
  15. 15.
    Nakamura H, Ito N, Kotake F, Mizokami Y, Matsuoka T (2000) Tumor-detecting capacity and clinical usefulness of SPIO-MRI in patients with hepatocellular carcinoma. J Gastroenterol 35:849–855Google Scholar
  16. 16.
    Vogl TJ, Hammerstingl R, Schwarz W et al. (1996) Superparamagnetic iron oxide-enhanced versus gadolinium-enhanced MR imaging for differential diagnosis of focal liver lesions. Radiology 198:881–887PubMedGoogle Scholar
  17. 17.
    Ward J, Guthrie JA, Scott DJ et al. (2000) Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis. Radiology 216:154–162PubMedGoogle Scholar
  18. 18.
    Kwak HS, Lee JM, Kim CS (2004) Preoperative detection of hepatocellular carcinoma: comparison of combined contrast-enhanced MR imaging and combined CT during arterial portography and CT hepatic arteriography. Eur Radiol 14:447–457. Epub 2003 Oct 3CrossRefPubMedGoogle Scholar
  19. 19.
    Bhartia B, Ward J, Guthrie JA, Robinson PJ (2003) Hepatocellular carcinoma in cirrhotic livers: double-contrast thin-section MR imaging with pathologic correlation of explanted tissue. Am J Roentgenol 180:577–584Google Scholar
  20. 20.
    Yamamoto H, Yamashita Y, Yoshimatsu S et al. (1995) Hepatocellular carcinoma in cirrhotic livers: detection with unenhanced and iron oxide-enhanced MR imaging. Radiology 195:106–112PubMedGoogle Scholar
  21. 21.
    Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS (1997) Small arterial–portal venous shunts: a cause of pseudolesions at hepatic imaging. Radiology 203:737–742Google Scholar
  22. 22.
    Kim T, Choi B, Han J, Chung J, Park J, Han M (1998) Nontumorous arterioportal shunt mimicking hypervascular tumor in cirrhotic liver: two-phase spiral CT findings. Radiology 208:597–603PubMedGoogle Scholar
  23. 23.
    Shimizu A, Ito K, Koike S, Fujita T, Shimizu K, Matsunaga N (2003) Cirrhosis or chronic hepatitis: evaluation of small (<=2-cm) early-enhancing hepatic lesions with serial contrast-enhanced dynamic MR imaging. Radiology 226:550–555Google Scholar
  24. 24.
    Yu JS, Kim KW, Kim EK, Lee JT, Yoo HS (1999) Contrast enhancement of small hepatocellular carcinoma: usefulness of three successive early image acquisitions during multiphase dynamic MR imaging. Am J Roentgenol 173:597–604Google Scholar
  25. 25.
    Reimer P, Balzer T (2003) Ferucarbotran (Resovist): a new clinically approved RES-specific contrast agent for contrast-enhanced MRI of the liver: properties, clinical development, and applications. Eur Radiol 13:1266–1276. Epub 2002 Nov 1PubMedGoogle Scholar
  26. 26.
    Vogl TJ, Schwarz W, Blume S et al. (2003) Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US. Eur Radiol 13:262–272. Epub 2002 Sep 10PubMedGoogle Scholar
  27. 27.
    Weishaupt D, Willmann JK, Lutz AM, Marincek B (2004) Resovist for imaging of hepatocellular carcinoma in the cirrhotic liver. Eur Radiol 14:C5–C6Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • G. Simon
    • 1
    • 2
    Email author
  • T. M. Link
    • 1
    • 2
  • K. Wörtler
    • 1
  • F. Doebereiner
    • 1
  • E. Schulte-Frohlinde
    • 1
  • H. Daldrup-Link
    • 1
    • 2
  • M. Settles
    • 1
    • 2
  • E. J. Rummeny
    • 1
  1. 1.Department of RadiologyTechnical University MunichMunichGermany
  2. 2.UCSF-RadiologySan FranciscoUSA

Personalised recommendations