Detection of malignant hepatic lesions before orthotopic liver transplantation: accuracy of ferumoxides-enhanced MR imaging.
OBJECTIVE
The purpose of this study was to evaluate the diagnostic accuracy of ferumoxides-enhanced MR imaging for screening malignant hepatic lesions before orthotopic liver transplantation.


METHODS
The study comprised 48 patients who underwent MR imaging within 6 months before transplantation. Imaging techniques included unenhanced and ferumoxides-enhanced T1-weighted gradient-echo and T2-weighted fast spin-echo sequences and ferumoxides-enhanced T2(*)-weighted gradient-echo sequences. Qualitative and quantitative analyses were performed; the gold standard was the histopathologic reports of explanted livers.


RESULTS
Twenty patients had malignant hepatic lesions, and 24 hepatocellular carcinomas were histopathologically proven. The mean area under the receiver operating characteristic curve and the mean sensitivity were significantly greater for the image sets with ferumoxides-enhanced gradient-echo sequences than for those without these sequences. The mean sensitivity and specificity of all sequences were 85% and 74% on a per-patient basis, respectively. The mean contrast-to-noise ratio was significantly greater for the ferumoxides-enhanced T2(*)-weighted gradient-echo sequences than for any other sequences and for the ferumoxides-enhanced T1-weighted gradient-echo sequences than for unenhanced sequences and the ferumoxides-enhanced T2-weighted fast spin-echo sequences.


CONCLUSIONS
Ferumoxides-enhanced gradient-echo sequences improved the diagnostic accuracy and the sensitivity for detecting malignant hepatic lesions in patients with end-stage cirrhosis of the liver. However, the specificity was not improved even after the administration of ferumoxides because of the false-positive lesions that were mainly the result of fibrotic changes.
Mori
Kensaku
K
Department of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilias University of Munich, Marchioninistr. 15, D-81377 Munich, Germany.
Scheidler
Juergen
J
Helmberger
Thomas
T
Holzknecht
Nicolaus
N
Schauer
Rolf
R
Schirren
Carl Albrecht
CA
Bittmann
Iris
I
Dugas
Martin
M
Reiser
Maximilian
M
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D003911:Dextrans; D003951:Diagnostic Errors; D005260:Female; D052203:Ferrosoferric Oxide; D005682:Gadolinium; D006801:Humans; D007501:Iron; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012372:ROC Curve; D012680:Sensitivity and Specificity
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D005682:Gadolinium; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide