Detection of hepatocellular carcinoma arising in cirrhotic livers: comparison of gadolinium- and ferumoxides-enhanced MR imaging.
OBJECTIVE
We prospectively compared the detectability of hepatocellular carcinoma (HCC) arising in cirrhotic livers using dynamic gadolinium-enhanced fast low-angle shot (FLASH), ferumoxides-enhanced T2-weighted turbo spin-echo, and ferumoxides-enhanced T2*-weighted FLASH MR imaging.


METHODS
Fifty-three patients with HCC (32 men and 21 women) who were 33-86 years old (mean, 63 years old) were enrolled in a prospective MR study to assess hepatic lesions using both gadopentetate dimeglumine and ferumoxides. Dynamic gadolinium-enhanced imaging was obtained before and 30, 60, and 180 sec after rapid bolus injection of gadopentetate dimeglumine (0.1 mmol/kg). Ferumoxides-enhanced T2-weighted turbo spin-echo imaging and ferumoxides-enhanced T2*-weighted FLASH imaging were performed between 30 min and 2 hr after i.v. infusion of ferumoxides (10 micromol/kg). Images were analyzed qualitatively and quantitatively. A receiver operating characteristic curve study was performed to compare the diagnostic value of gadolinium-enhanced imaging with that of ferumoxides-enhanced imaging for the detection of HCC.


RESULTS
Quantitative analysis revealed a significantly higher percentage of signal-intensity loss and higher liver-lesion contrast-to-noise ratio on ferumoxides-enhanced T2*-weighted FLASH imaging than on ferumoxides-enhanced T2-weighted turbo spin-echo imaging. The percentage of signal-intensity loss and liver-lesion contrast-to-noise ratio on ferumoxides-enhanced images was significantly higher in patients with mild liver cirrhosis (Child's class A) than in patients with severe liver cirrhosis (Child's class C). Qualitative analysis showed that dynamic gadolinium-enhanced images revealed significantly higher lesion conspicuity than did ferumoxides-enhanced T2-weighted turbo spin-echo images. According to receiver operating characteristic analysis, dynamic gadolinium-enhanced FLASH imaging achieved the highest sensitivity, and ferumoxides-enhanced T2*-weighted FLASH imaging was the second most sensitive. We found that ferumoxides-enhanced turbo spin-echo imaging was the least valuable technique for revealing HCC lesions. Gadolinium-enhanced imaging revealed more HCC lesions than did ferumoxides-enhanced imaging, particularly for lesions smaller than 2 cm in diameter.


CONCLUSIONS
Ferumoxides-enhanced imaging revealed fewer findings, such as lesion conspicuity of HCCs arising in cirrhotic livers, than did gadolinium-enhanced FLASH imaging.
Tang
Y
Y
Department of Radiology, Kumamoto University School of Medicine, Japan.
Yamashita
Y
Y
Arakawa
A
A
Namimoto
T
T
Mitsuzaki
K
K
Abe
Y
Y
Katahira
K
K
Takahashi
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D003287:Contrast Media; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D019786:Gadolinium DTPA; D006801:Humans; D007501:Iron; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010087:Oxides; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors; D014463:Ultrasonography
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D007501:Iron; C065507:ferumoxides; D019786:Gadolinium DTPA; D052203:Ferrosoferric Oxide