title: Detection of hepatocellular carcinoma by ferumoxides-enhanced MR imaging in cirrhosis: Incremental value of dynamic gadolinium-enhancement.
abstract: OBJECTIVE
  To investigate the incremental value of dynamic gadolinium-enhancement performed immediately after ferumoxides-enhanced magnetic resonance (MR) imaging on the detection of hepatocellular carcinoma in patients with cirrhosis.
  
  
  METHODS
  We retrospectively reviewed MR scans of 62 cirrhotic patients over a two-year period. Sequences included ferumoxides-enhanced T2-weighted fast spin echo followed by dynamic gadolinium-enhanced T1-weighted spoiled gradient echo. Two readers independently documented the presence of hepatocellular carcinoma on a three-point confidence scale, without and with gadolinium-enhanced images. The presence or absence of hepatocellular carcinoma was established by histopathology (58 patients) or follow-up imaging (four patients) over a mean period of nine months.
  
  
  RESULTS
  A total of 71 hepatocellular carcinomas were found in 42 patients. There was no statistically significant difference in sensitivity for the diagnosis of hepatocellular carcinoma without vs. with gadolinium-enhanced images (68% vs. 74% for reader 1 and 62% vs. 73% for reader 2, respectively, P > 1.3). However, both readers showed a lower mean confidence for tumor detection without vs. with gadolinium-enhanced images (2.3 vs. 2.7 for reader 1, 2.3 vs. 2.9 for reader 2, P < 0.01).
  
  
  CONCLUSIONS
  In our study, the addition of dynamic gadolinium-enhancement to ferumoxides-enhanced MR imaging did not improve hepatocellular carcinoma detection, but the addition of gadolinium-enhancement is recommended if ferumoxides-enhanced imaging is used because it increased reader confidence.
authors.affiliation: Department of Radiology, University of California, San Francisco, San Francisco, California 94143, USA. Aliya.Qayyum@radiology.ucsf.edu
authors.forename: Aliya
authors.initials: A
authors.lastname: Qayyum
authors.forename: Ruedi F
authors.initials: RF
authors.lastname: Thoeni
authors.forename: Fergus V
authors.initials: FV
authors.lastname: Coakley
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Jeff P
authors.initials: JP
authors.lastname: Guay
authors.forename: Linda D
authors.initials: LD
authors.lastname: Ferrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis*; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D019786:Gadolinium DTPA; D006801:Humans; D007501:Iron; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; C064925:gadodiamide; D007501:Iron; C065507:ferumoxides; D019786:Gadolinium DTPA; D052203:Ferrosoferric Oxide