title: Detection of small hypervascular hepatocellular carcinomas in cirrhotic patients: comparison of superparamagnetic iron oxide-enhanced MR imaging with dual-phase spiral CT.
abstract: OBJECTIVE
  To compare the performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) maging at 1.5T and dual-phase spiral computed tomography (CT) for the depiction of small hypervascular hepatocellular carcinomas (HCCs).
  
  
  METHODS
  Forty-three patients with 70 small nodular HCCs (5-20 mm; mean, 13.7 mm) were examined. Diagnosis was based on the results of surgical biopsy in 22 patients and by the combined assessment of MR imaging, lipiodol CT, alpha feto-protein levels, and angiographic findings in 21. MR imaging consisted of respiratory-triggered turbo spin-echo T2-weighted imaging, T1-weighted fast low-angle shot, and T2* -weighted fast imaging with steady-state precession imaging before and after SPIO enhancement. CT imaging was performed with 5-mm collimation and 1:1.4 pitch, and began 30 and 65 secs after the injection of 150 mL of contrast medium at a rate of 3 mL/sec. Two blinded observers reviewed all images independently on a segment-by-segment basis. Diagnostic accuracy was evaluated using receiver operating characteristics(ROC) analysis.
  
  
  RESULTS
  The mean areas (Az) under the ROC curves were 0.85 for SPIOenhanced MR imaging and 0.79 for dual-phase spiral CT (p <.05). The mean sensitivity of SPIO-enhanced MR imaging was significantly higher than that of CT (p <.05), i.e. 70.6% for MR imaging and 58.1% for CT. MR imaging had higher false-positive rates than dual-phase spiral CT, but the difference was not statistically significant (3.7% vs 3.3%) (p >.05).
  
  
  CONCLUSIONS
  SPIO-enhanced MR imaging is more sensitive than dual-phase spiral CT for the depiction of small hypervascular hepatocellular carcinomas.
authors.affiliation: Department of Diagnostic Radiology, Seoul National University Hospital, Korea. leejm@radcom.snu.ac.kr
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Lee
authors.forename: In-Hwan
authors.initials: IH
authors.lastname: Kim
authors.forename: Hyo-Sung
authors.initials: HS
authors.lastname: Kwak
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Youk
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Han
authors.forename: Chong-Soo
authors.initials: CS
authors.lastname: Kim
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D003911:Dextrans; D052203:Ferrosoferric Oxide; D006801:Humans; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013535:Suspensions; D036542:Tomography, Spiral Computed
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D013535:Suspensions; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide