title: Optimal pulse sequence for ferumoxides-enhanced MR imaging used in the detection of hepatocellular carcinoma: a comparative study using seven pulse sequences.
abstract: OBJECTIVE
  To identify the optimal pulse sequence for ferumoxides-enhanced magnetic resonance (MR) imaging in the detection of hepatocelluar carcinomas (HCCs).
  
  
  METHODS
  Sixteen patients with 25 HCCs underwent MR imaging following intravenous infusion of ferumoxides. All MR studies were performed on a 1.5-T MR system, using a phased-array coil. Ferumoxides (Feridex IV) at a dose of 15 micromol/Kg was slowly infused intravenously, and axial images of seven sequences were obtained 30 minutes after the end of infusion. The MR protocol included fast spin-echo (FSE) with two echo times (TR3333-8571/TE18 and 90-117), singleshot FSE (SSFSE) with two echo times (TRinfinity/TE39 and 98), T2*-weighted gradient- recalled acquisition in the steady state (GRASS) (TR216/TE20), T2*-weighted fast multiplanar GRASS (FMPGR) (TR130/TE8.4-9.5), and T2*-weighted fast multiplanar spoiled GRASS (FMPSPGR) (TR130/TE8.4-9.5). Contrast-to-noise ratios (CNRs) of HCCs determined during the imaging sequences formed the basis of quantitative analysis, and images were qualitatively assessed in terms of lesion conspicuity and image artifacts. The diagnostic accuracy of all sequences was assessed using receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  Quantitative analysis revealed that the CNRs of T2*-weighted FMPGR and T2*-weighted FMPSPGR were significantly higher than those of the other sequences, while qualitative analysis showed that image artifacts were prominent at T2*-weighted GRASS imaging. Lesion conspicuity was statistically significantly less clear at SSFSE imaging. In term of lesion detection, T2*-weighted FMPGR, T2*- weighted FMPSPGR, and proton density FSE imaging were statistically superior to the others.
  
  
  CONCLUSIONS
  T2*-weighted FMPGR, T2*- weighted FMPSPGR, and proton density FSE appear to be the optimal pulse sequences for ferumoxidesenhanced MR imaging in the detection of HCCs.
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. shkim@smc.samsung.co.kr
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lim
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Lee
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Jang
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Lim
authors.forename: Soon Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Cho
authors.forename: Seung Kwon
authors.initials: SK
authors.lastname: Kim
authors.forename: Gab Chul
authors.initials: GC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D003911:Dextrans; D017352:Echo-Planar Imaging; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D007089:Image Enhancement; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide