title: Thioguanin-induced nodular regenerative hyperplasia of the liver-ROC analysis of different MR techniques.
abstract: The aim of this study was to evaluate the diagnostic value of different magnetic resonance (MR) techniques for the diagnosis of nodular regenerative hyperplasia (NRH). Thirty-one patients with inflammatory bowel disease, who received 6-thioguanin, underwent liver biopsy and liver MRI on a 1.5-T MR system, with gadolinium and superparamagnetic iron oxide particles (SPIO). MR imaging (MRI) was evaluated independently as well as in consensus by two blinded readers, who received the following image sets: pre-contrast; pre-contrast and gadolinium-enhanced; pre-contrast and SPIO-enhanced and all images. The results were correlated with histopathology and diagnostic efficacy parameters were calculated. NRH was found in 13/31 patients. The set "all images" showed the highest sensitivity (84.6%), accuracy (77.4%) and negative predictive value (86.7%). However, results for gadolinium were only slightly inferior. The highest specificity (76.5%) was found for SPIO. The A(z) values of both readers were highest for gadolinium (mean A(z) = 0.824). It can be concluded that gadolinium-enhanced and SPIO-enhanced MRI enable an accurate diagnosis of NRH. Since gadolinium-enhanced MRI is very sensitive, it should be used for screening high-risk patients. SPIO-enhanced MRI is less sensitive, but more specific. The combination of both guarantees a high sensitivity and specificity and, therefore, is the diagnostic procedure of choice.
authors.affiliation: Institute of Clinical Radiology, Munich University Hospitals - Grosshadern, Germany. Christoph.Zech@med.uni-muenchen.de
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Zech
authors.forename: Julia
authors.initials: J
authors.lastname: Seiderer
authors.forename: Walter
authors.initials: W
authors.lastname: Reinisch
authors.forename: Thomas
authors.initials: T
authors.lastname: Ochsenkuhn
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schima
authors.forename: Joachim
authors.initials: J
authors.lastname: Diebold
authors.forename: Fritz
authors.initials: F
authors.lastname: Wrba
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D003287:Contrast Media / Q000008:administration & dosage; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced* / Q000175:diagnosis; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D007501:Iron; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008115:Liver Regeneration / Q000187:drug effects*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D010087:Oxides; D013866:Thioguanine / Q000627:therapeutic use*
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D009942:Organometallic Compounds; D010087:Oxides; C064572:gadobenic acid; D008536:Meglumine; D007501:Iron; D013866:Thioguanine; C065507:ferumoxides; D019786:Gadolinium DTPA; D052203:Ferrosoferric Oxide