T2-weighted MR imaging in the assessment of cirrhotic liver.
OBJECTIVE
To assess if T2-weighted magnetic resonance (MR) imaging provides added diagnostic value in combination with dynamic gadolinium-enhanced MR imaging in the detection and characterization of nodular lesions in cirrhotic liver.


METHODS
Two readers retrospectively and independently analyzed 54 MR imaging studies in 52 patients with cirrhosis. In session 1, readers reviewed T1-weighted and dynamic gadolinium-enhanced images. In session 2, readers reviewed T1-weighted, dynamic gadolinium-enhanced, and respiratory-triggered T2-weighted fast spin-echo images. Readers identified and characterized all focal lesions by using a scale of 1-4 (1, definitely benign; 4, definitely malignant). Multireader correlated receiver operating characteristic (ROC) analysis was employed to assess radiologist performance in session 2 compared with session 1. The difference in the areas under the ROC curves for the two sessions was tested. In a third session, readers assessed conspicuity of biopsy-proved lesions on T2-weighted MR images by using a scale of 1-3 (1, not seen; 3, well seen) and identified causes of reduced conspicuity.


RESULTS
Two additional benign lesions were detected by each reader in session 2. Fifty-five lesions had pathologic verification, including 32 malignant, three high-grade dysplastic, and 20 benign nodules. There was no significant difference in the area under the ROC curves between the two sessions (P =.48). Thirty-two lesions were inconspicuous on T2-weighted MR images because of parenchymal heterogeneity, breathing artifacts (particularly in patients with ascites), and lesion isointensity with liver parenchyma. T2-weighted MR imaging was useful in the evaluation of cysts and lymph nodes.


CONCLUSIONS
T2-weighted MR imaging does not provide added diagnostic value in the detection and characterization of focal lesions in cirrhotic liver.
Hussain
Hero K
HK
Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, MRI B2B311, Ann Arbor, MI 48109-0030, USA. hhussain@umich.edu
Syed
Ibrahim
I
Nghiem
Hanh V
HV
Johnson
Timothy D
TD
Carlos
Ruth C
RC
Weadock
William J
WJ
Francis
Isaac R
IR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology; D008115:Liver Regeneration / Q000502:physiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA