Characterization of hepatocellular tumors: value of mangafodipir-enhanced magnetic resonance imaging.
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.
Scharitzer
Martina
M
Department of Radiology, Medical University of Vienna, Vienna, Austria.
Schima
Wolfgang
W
Schober
Ewald
E
Reimer
Peter
P
Helmberger
Thomas K
TK
Holzknecht
Nicolaus
N
Stadler
Alfred
A
Ba-Ssalamah
Ahmed
A
Weber
Michael
M
Wrba
Friedrich
F
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
D003287:Contrast Media; D011732:Pyridoxal Phosphate; D004492:Edetic Acid; C060076:N,N'-bis(pyridoxal-5-phosphate)ethylenediamine-N,N'-diacetic acid