Mangafodipir trisodium-enhanced MRI for the detection and characterization of focal hepatic lesions: is delayed imaging useful?
OBJECTIVE
To investigate the usefulness of early and delayed hepatic MRI after mangafodipir trisodium (Mn-DPDP) administration for the detection and characterization of focal hepatic lesions.


METHODS
Forty-five patients (31 males and 14 females, mean age = 61 years) with a total of 113 hepatic lesions (mean size = 3.5 cm) were included in this study (15 with hepatocellular carcinoma (HCC, N = 35), 20 with hepatic metastasis (N = 63), five with hemangioma (N = 10), three with cholangiocarcinoma (CC, N = 3), and two with liver abscess (N = 2)). T1-weighted gradient-echo MR images were obtained before and after Mn-DPDP administration, with a mean 18-hour delayed imaging. A qualitative analysis (including the size and signal intensity (SI)) and quantitative analysis (including enhancement and lesion-liver contrast-to-noise ratio (CNR)) were performed on pre- and postcontrast early and delayed MR images.


RESULTS
Compared to postcontrast early imaging, 17 (48.6%) of 35 HCCs showed higher SI, 16 (45.7%) showed no SI change, and two (5.7%) showed lower SI on delayed imaging. All 63 metastases, 10 hemangiomas, three CCs, and two abscesses showed no SI change. On delayed imaging, ring enhancement was noted in 53 metastases (84.1%), three hemangiomas (30.0%), and one abscess (50.0%), but was not seen in HCCs or CCs. Eight metastases (12.7%) also showed ring enhancement on postcontrast early imaging. No newly detected hepatic lesions were revealed on postcontrast delayed MR images compared to postcontrast early images. Regarding CNR, the HCCs showed a significant increase in CNR from postcontrast early to delayed images after administration of Mn-DPDP (P < 0.01). However, none of the metastases, hemangiomas, CCs, and abscesses showed a significant increase of CNR from postcontrast early to delayed images.


CONCLUSIONS
Postcontrast delayed MR images after Mn-DPDP administration were helpful in distinguishing hepatocellular from nonhepatocellular lesions, but were not useful for lesion detection and had limited utility for lesion characterization, since benign and malignant hepatic lesions looked the same.
Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. jjckor@paran.com
Jae-Joon
JJ
Chung
Myeong-Jin
MJ
Kim
Ki Whang
KW
Kim
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D018281:Cholangiocarcinoma / Q000175:diagnosis*; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004492:Edetic Acid / Q000031:analogs & derivatives*; D005260:Female; D006391:Hemangioma / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008100:Liver Abscess / Q000175:diagnosis; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011732:Pyridoxal Phosphate / Q000031:analogs & derivatives*; D013997:Time Factors
D003287:Contrast Media; D011732:Pyridoxal Phosphate; D004492:Edetic Acid; C060076:N,N'-bis(pyridoxal-5-phosphate)ethylenediamine-N,N'-diacetic acid