title: Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging.
abstract: OBJECTIVE
  To prospectively compare accuracy of dynamic contrast material-enhanced thin-section multi-detector row helical computed tomography (CT), high-spatial-resolution three-dimensional (3D) dynamic gadolinium-enhanced magnetic resonance (MR) imaging, and superparamagnetic iron oxide (SPIO)-enhanced MR imaging with optimized gradient-echo (GRE) sequence for depiction of hepatic lesions; surgery and histologic analysis were the reference standard.
  
  
  METHODS
  Local ethics committee approval was granted, and written informed consent was obtained. Fifty-eight patients (45 men, 13 women; age range, 47-82 years) with hepatic metastases were imaged with multi-detector row CT (3.2-mm section thickness), 3D dynamic gadolinium-enhanced MR imaging (2.5-mm effective section thickness), and SPIO-enhanced MR by using an optimized T2-weighted GRE sequence. Images were reviewed independently by two blinded observers who identified and localized lesions with a four-point confidence scale. Accuracy of each technique was measured with alternative free-response receiver operating characteristic analysis. Results were correlated with findings at surgery with intraoperative ultrasonography or histopathologic examination. Statistical differences among techniques for each observer were measured.
  
  
  RESULTS
  Accuracy values for each observer for all metastases (n = 215) and 1.0-cm or smaller metastases (n = 80), respectively, follow: For CT, those for reader 1 were 0.82 and 0.65; for reader 2, 0.81 and 0.68. For gadolinium-enhanced MR imaging, those for reader 1 were 0.92 and 0.79; for reader 2, 0.90 and 0.76. For SPIO-enhanced MR imaging, those for reader 1 were 0.92 and 0.83; for reader 2, 0.92 and 0.81. For all metastases for both observers, there was no significant difference between MR techniques, but both were significantly more accurate than CT (P < .01). For metastases 1.0 cm or smaller and one observer, there was no significant difference between MR techniques, but both were more accurate than CT (P < .01); for the other observer, SPIO-enhanced MR imaging was more accurate than gadolinium-enhanced MR imaging (P < .05) and CT (P < .02), but there was no significant difference between gadolinium-enhanced MR imaging and CT (P = .2).
  
  
  CONCLUSIONS
  Accuracy for gadolinium-enhanced MR imaging and SPIO-enhanced MR imaging was similar. Both techniques were significantly more accurate than CT.
authors.affiliation: MRI Department, Clinical Radiology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, England. janice.ward@leedsth.nhs.uk
authors.forename: Janice
authors.initials: J
authors.lastname: Ward
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Robinson
authors.forename: J Ashley
authors.initials: JA
authors.lastname: Guthrie
authors.forename: Susan
authors.initials: S
authors.lastname: Downing
authors.forename: Daniel
authors.initials: D
authors.lastname: Wilson
authors.forename: J Peter A
authors.initials: JP
authors.lastname: Lodge
authors.forename: K Rajedra
authors.initials: KR
authors.lastname: Prasad
authors.forename: Giles J
authors.initials: GJ
authors.lastname: Toogood
authors.forename: Judith I
authors.initials: JI
authors.lastname: Wyatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005189:False Positive Reactions; D005260:Female; D005682:Gadolinium; D006498:Hepatectomy; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed
chemical_list: D005682:Gadolinium