title: Diagnostic value of SPIO-mediated breath-hold, black-blood, fluid-attenuated, inversion recovery (BH-BB-FLAIR) imaging in patients with hepatocellular carcinomas.
abstract: OBJECTIVE
  We assessed the value of adding a breath-hold, black-blood, fluid-attenuated, inversion recovery (BH-BB-FLAIR) sequence with a small motion-probing gradient (b=10 s/mm(2)) using superparamagnetic iron oxide (SPIO) to our present studies that utilize SPIO to detect hepatocellular carcinoma (HCC). We used inversion recovery (IR) in a FLAIR sequence to suppress signals from cysts and a low b-value to suppress vessel signals and provide higher signal to noise than that using high b-value diffusion-weighted imaging. Use of SPIO is expected to reduce the signal in both normal liver parenchyma and in most benign lesions.
  
  
  METHODS
  In 19 patients, we reviewed 38 HCC nodules diagnosed by CT arterioportography (CTAP) and CT during hepatic arteriography (CTHA). We divided SPIO-mediated images into sets, those obtained with and without BH-BB-FLAIR. Six radiologists individually interpreted the 2 image sets and sorted them by their confidence levels for the presence of HCC, and we calculated the area under the receiver operating characteristic (ROC) curve (Az) for each image set.
  
  
  RESULTS
  On images obtained with BH-BB-FLAIR after SPIO administration, 33 of the 38 HCC nodules appeared as areas of high signal and cyst signal was extinguished. The ROC analysis showed significantly higher Az values in the set with BH-BB-FLAIR (0.89) than in the set without (0.83).
  
  
  CONCLUSIONS
  Adding BH-BB-FLAIR to existing SPIO-mediated imaging protocols improved detection of HCC nodules and added only 24 s to the scan time.
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, Shouwa-ku, Nagoya, Japan. matsu_masa@hotmail.com
authors.forename: Masaya
authors.initials: M
authors.lastname: Matsushima
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ikeda
authors.forename: Shigeki
authors.initials: S
authors.lastname: Itoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogawa
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Komada
authors.forename: Satoko
authors.initials: S
authors.lastname: Ishigaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kawai
authors.forename: Koujiro
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hiroko
authors.initials: H
authors.lastname: Satake
authors.forename: Shingo
authors.initials: S
authors.lastname: Iwano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000792:Angiography / Q000379:methods; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D003560:Cysts / Q000000981:diagnostic imaging / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005290:Ferric Compounds; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012119:Respiration; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D005290:Ferric Compounds; C000499:ferric oxide