title: Superparamagnetic iron oxide-enhanced MR imaging for focal hepatic lesions: a comparison with CT during arterioportography plus CT during hepatic arteriography.
abstract: BACKGROUND
  We aimed to evaluate the efficacy of a breath-hold superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging protocol for the detection of focal hepatic lesions, in comparison with a non-breath-hold SPIO-enhanced imaging protocol and computed tomography during arterioportography (CTAP) plus CT during hepatic arteriography (CTHA).
  
  
  METHODS
  Findings of SPIO-enhanced MR imaging and CTAP/CTHA for 24 hepatic metastases in 17 patients and 29 HCCs in 21 patients were analyzed. All patients underwent breath-hold SPIO-enhanced MR imaging (1.5 tesla), breath-hold plus non-breath-hold SPIO-enhanced MR imaging, and CTAP plus CTHA prior to partial hepatectomy or laparoscopic ablation therapy. Histopathology for lesion characterization and intraoperative ultrasound for lesion detection were available for all patient. Breath-hold SPIO-enhanced MR imaging consisted of T2-weighted single-short fast spin echo (FSE), T2-weighted (T2W) FSE, T2*-weighted gradient echo (GRE), and T1-weighted GRE. For the non-breath-hold imaging protocol, respiratory-triggered, fat-suppressed T2W-FSE was added to the breath-hold MR imaging protocol. Double phase CTAP plus CTHA was performed on an angio-CT system. To compare the three imaging protocols, three radiologists performed blind film reading, and all data, on a hepatic segment-to-segment basis, were entered for alternative free-response receiver-operating characteristic (AFROC) analysis.
  
  
  RESULTS
  ROC analysis showed that there was no significant difference in the area under the AFROC curve (A1) value for metastases and HCCs among the three protocols; the breath-hold SPIO-enhanced MR imaging protocol, non-breath-hold MR imaging protocol, and CTAP plus CTHA. The breath-hold SPIO-enhanced MR imaging protocol showed a sensitivity, specificity, and accuracy equivalent to the non-breath-hold MR imaging protocol and CTAP plus CTHA.
  
  
  CONCLUSIONS
  As a preoperative test, SPIO-enhanced MR imaging could have the potential to replace CTAP plus CTHA in a certain clinical setting.
authors.affiliation: Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tanimoto
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shinmoto
authors.forename: Seishi
authors.initials: S
authors.lastname: Nakatsuka
authors.forename: Shigeo
authors.initials: S
authors.lastname: Okuda
authors.forename: Sachio
authors.initials: S
authors.lastname: Kuribayashi
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000556:secondary; D001943:Breast Neoplasms / Q000175:diagnosis / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000556:secondary; D003287:Contrast Media / Q000008:administration & dosage*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D007262:Infusions, Intravenous; D007501:Iron / Q000008:administration & dosage; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000556:secondary; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage; D011172:Portography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000556:secondary; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D010087:Oxides; D007501:Iron; D052203:Ferrosoferric Oxide