title: Characterization of hepatocellular tumors: value of mangafodipir-enhanced magnetic resonance imaging.
abstract: OBJECTIVE
  To assess the value of mangafodipir trisodium-enhanced MR imaging for characterization of hepatocellular lesions.
  
  
  METHODS
  Magnetic resonance images of 41 patients with 48 histopathologically proven hepatocellular lesions (20 cases of focal nodular hyperplasia [FNH], 4 adenomas, 15 hepatocellular carcinomas [HCCs], 7 regenerative nodules, and 2 others) were retrospectively studied. Magnetic resonance imaging was performed on a 1.5-T unit (Vision, Siemens, Erlangen, Germany; ACS-NT, Philips, Best, The Netherlands) using T2-weighted, fat-saturation, turbo spin echo imaging and T1-weighted gradient echo imaging before and 20 minutes after infusion of 5 micromol/kg mangafodipir (Amersham Health, Oslo, Norway). Qualitative analysis by 4 blinded independent readers included assessment of unenhanced images and, in a second step, assessment of unenhanced and contrast-enhanced images together. Lesions were classified as benign or malignant using a 5-point scale, and readers made a specific diagnosis.
  
  
  RESULTS
  For characterization of hepatocellular lesions, mangafodipir-enhanced imaging was significantly superior to unenhanced imaging (P < 0.05). On receiver operating characteristic analysis, the area under the curve was 0.768 (95% confidence interval: 0.633-0.903) for unenhanced images and 0.866 (95% confidence interval: 0.767-0.966) for evaluation of unenhanced and contrast-enhanced images together (P < 0.05). Analysis of enhancement patterns aided in characterization and classification of tumors.
  
  
  CONCLUSIONS
  Administration of mangafodipir improves the differentiation between adenoma or HCC and "nonsurgical" lesions (FNH or regenerative nodules). The accuracy for arriving at a specific diagnosis is higher when unenhanced and mangafodipir-enhanced images are considered together than for unenhanced MR images alone.
authors.affiliation: Department of Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Martina
authors.initials: M
authors.lastname: Scharitzer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schima
authors.forename: Ewald
authors.initials: E
authors.lastname: Schober
authors.forename: Peter
authors.initials: P
authors.lastname: Reimer
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Helmberger
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Holzknecht
authors.forename: Alfred
authors.initials: A
authors.lastname: Stadler
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ba-Ssalamah
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wrba
mesh_terms: D018248:Adenoma, Liver Cell / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D017352:Echo-Planar Imaging; D004492:Edetic Acid / Q000031:analogs & derivatives*; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D007262:Infusions, Intravenous; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D008115:Liver Regeneration / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011732:Pyridoxal Phosphate / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D011732:Pyridoxal Phosphate; D004492:Edetic Acid; C060076:N,N'-bis(pyridoxal-5-phosphate)ethylenediamine-N,N'-diacetic acid