title: Differentiation of well-differentiated hepatocellular carcinomas from other hepatocellular nodules in cirrhotic liver: value of SPIO-enhanced MR imaging at 3.0 Tesla.
abstract: OBJECTIVE
  To determine the diagnostic value of superparamagnetic iron oxide (SPIO)-enhanced MRI for the differentiation of well-differentiated hepatocellular carcinomas (WD-HCCs) from other hepatocellular nodules in cirrhotic liver.
  
  
  METHODS
  This study included 114 patients with 216 histologically confirmed hepatocellular nodules, i.e., 23 dysplastic nodules (DNs), 37 WD-HCCs, and 156 moderately or poorly differentiated HCCs (MD-/PD HCCs), who underwent SPIO-enhanced MRI at 3.0T. MRI included T2-weighted fast-spin echo and T2*-weighted gradient recalled echo (GRE) sequences before and after administration of ferucarbotran. The contrast-to-noise ratio (CNR) of the lesion was calculated. Reviewers analyzed signal intensity (SI) of the nodules and their enhancement features on SPIO-enhanced images. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the diagnosis of WD-HCC were also calculated.
  
  
  RESULTS
  The mean CNR of WD-HCC was significantly higher than that of DN on T2*-weighted image. Incomplete high SI on SPIO-enhanced T2*-weighted images were seen in 56.8% of WD-HCC. The most prevalent enhancement features of WD-HCCs on SPIO-enhanced T2*-weighted images, were iso SI with high SI foci [32.5% (12/37)] and homogenous subtle high SI [24.3% (9/37)]. Alternatively, 22 of 23 DNs (95.7%) showed low- or iso SI, and 145 of 156 (94.9%) MD-/PD HCCs showed strong high SI. When iso SI with high SI foci or subtle homogenous high SI nodule was considered as diagnostic criteria for WD-HCC, we could identify 56.8% of the WD-HCCs but only 4.4% of the DNs and 3.2% of the MD-/PD HCCs.
  
  
  CONCLUSIONS
  WD-HCCs have characteristic enhancement features that differentiate them from DNs and MD-/PD HCCs on SPIO-enhanced 3.0T MRI. The lesion conspicuity was better on T2*-weighted images than that on T2-weighted images.Inc.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea.
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Park
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Se Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Samuel
authors.initials: S
authors.lastname: Chang
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D003911:Dextrans; D003937:Diagnosis, Differential; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide