title: Preoperative detection of hepatic metastases: comparison of diffusion-weighted, T2-weighted fast spin echo and gadolinium-enhanced MR imaging using surgical and histopathologic findings as standard of reference.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively compare the respective sensitivities of diffusion-weighted (DW), T2-weighted fast spin-echo (T2WFSE) and gadolinium chelate-enhanced MR imaging in the preoperative detection of hepatic metastases using intraoperative ultrasonographic and histopathologic findings as the standard of reference.
  
  
  METHODS
  Twenty-seven patients with 64 surgically and histopathologically proven hepatic metastases had MR imaging of the liver, including DW, T2WFSE and dynamic gadolinium chelate-enhanced MR imaging. Images from each MR sequence were separately analyzed by two readers with disagreements resolved by consensus readings. The findings on MR images were compared with intraoperative ultrasonographic and histopathologic findings on a lesion-by-lesion basis to determine the sensitivity of each MR sequence. Statistical review of the lesion-by-lesion analysis was performed with the McNemar test.
  
  
  RESULTS
  DW, T2WFSE and gadolinium chelate-enhanced MR imaging allowed the depiction of 54/64 (84.4%; 95% CI: 73.1-92.2%), 44/64 (68.8%; 95% CI: 55.9-79.8%), and 51/64 (79.7%; 95% CI: 67.8-88.7%) hepatic metastases respectively. DW MR images allowed depiction of significantly more hepatic metastases than did T2WFSE and was equivalent to gadolinium chelate-enhanced MR imaging (P=.002 and P=.375, respectively).
  
  
  CONCLUSIONS
  DW MR imaging is superior to T2WFSE imaging and equivalent to gadolinium chelate-enhanced MR imaging for the preoperative detection of hepatic metastases. Further studies however are needed to determine at what extent DW MR imaging can be used as an alternative to gadolinium chelate-enhanced MR imaging for the preoperative depiction of hepatic metastases.
authors.affiliation: Department of Abdominal Imaging, Unité 965 INSERM/Paris7, Hôpital Lariboisière-AP-HP and Université Diderot-Paris 7, 2, rue Ambroise Paré, 75475 Paris Cedex 10, France. philippe.soyer@lrb.aphp.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Soyer
authors.forename: Mourad
authors.initials: M
authors.lastname: Boudiaf
authors.forename: Vinciane
authors.initials: V
authors.lastname: Placé
authors.forename: Marc
authors.initials: M
authors.lastname: Sirol
authors.forename: Karine
authors.initials: K
authors.lastname: Pautrat
authors.forename: Alexandre
authors.initials: A
authors.lastname: Vignaud
authors.forename: Fabrice
authors.initials: F
authors.lastname: Staub
authors.forename: Djamel
authors.initials: D
authors.lastname: Tiah
authors.forename: Lounis
authors.initials: L
authors.lastname: Hamzi
authors.forename: Florent
authors.initials: F
authors.lastname: Duchat
authors.forename: Yann
authors.initials: Y
authors.lastname: Fargeaudou
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006571:Heterocyclic Compounds; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate