Double-contrast magnetic resonance imaging of hepatocellular carcinoma after transarterial chemoembolization.
BACKGROUND
The purpose of this study was to assess the accuracy of double-contrast magnetic resonance (MR) imaging for the treatment response evaluation of hepatocellular carcinoma (HCC) in cirrhotic liver after transarterial chemoembolization (TACE).


METHODS
Twenty-two patients with 30 HCC nodules treated by TACE underwent double-contrast MR imaging 1 month after treatment. MR images were obtained before and after the sequential administration of superparamagnetic iron oxide (SPIO) and gadopentetate dimeglumine contrast agent within the same imaging session. Two observers retrospectively assessed all treated nodules for evidence of residual viable tumor after TACE. The diagnostic performance of gadolinium-enhanced, SPIO-enhanced, and double-contrast enhanced images was calculated. Histopathological and angiographical findings served as standard of reference. Receiver operating characteristic curves and areas under the curves (A (z)) were calculated.


RESULTS
Double-contrast technique (A (z) = 0.95) was significantly (p = 0.036) more accurate than SPIO-enhanced technique (A (z) = 0.92) and gadolinium-enhanced technique (p = 0.005) (A (z) = 0.81) in viable tumor detection after TACE. Double-contrast technique was significantly more sensitive (92%) than SPIO-enhanced technique (80%) and gadolinium-enhanced technique (68%). Kappa values for interobserver agreement ranged from 0.67 to 0.87 and were significantly different from zero (all p < 0.001).


CONCLUSIONS
Compared to gadolinium-enhanced and SPIO-enhanced techniques, double-contrast technique significantly improves the detection of viable tumor in HCC after TACE.
Bolog
Nicolae
N
Department of Magnetic Resonance, Institute of Diagnostic Radiology, Zurich, Switzerland.
Pfammatter
Thomas
T
Müllhaupt
Beat
B
Andreisek
Gustav
G
Weishaupt
Dominik
D
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012372:ROC Curve; D018709:Statistics, Nonparametric
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; C097921:ferumoxtran-10; D007501:Iron; D019786:Gadolinium DTPA; D052203:Ferrosoferric Oxide