title: Qualitative and quantitative image analysis of CT and MR imaging in patients with neuroendocrine liver metastases in comparison to (68)Ga-DOTATOC PET.
abstract: OBJECTIVE
  To compare lesion conspicuity in patients with liver metastases arising from gastroenteropancreatic neuroendocrine tumors (GEP-NETs) using MRI, PET and CT.
  
  
  METHODS
  16 patients with GEP-NETs were evaluated using non-contrast MRI, contrast-enhanced (CE) MRI using Gd-EOB-DTPA and CE-(68)Ga-DOTATOC PET. Quantitative analyses were performed by two blinded readers using ROI-analyses quantifying contrast ratios (CR) between normal liver-tissue and GEP-NET-metastases. Qualitative analyses were performed evaluating primary visibility and spatial detectability of all lesions.
  
  
  RESULTS
  103 of the same liver metastases were detected on all modalities. Qualitatively, lesion conspicuity was superior on CE-MRI imaging compared to non-contrast MR-sequences (T2, DWI, fl2D, fl3D), as well as arterial- and portal-venous phase CT. Concerning detectability of lesions, CE-MRI was superior to all other modalities. The quantitative ROI-analysis demonstrated improved CR for DWI compared to all other non-contrast MR-sequences (p<0.001). CE-MRI presented with higher CR-values compared to CE-(68)Ga-DOTATOC PET/CT (p<0.001).
  
  
  CONCLUSIONS
  Anatomic imaging using non contrast MRI with fl2D-and fl3D-sequences in combination with the molecular imaging modality (68)Ga-DOTATOC PET is optimal for the assessment of liver lesions in GEP-NET-patients. Even though CE-MRI was superior to non-contrast MRI, non-contrast MRI is sufficient to detect and quantify liver metastases in daily routine, especially in combination with DW-Imaging.
authors.affiliation: University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology, INF 110, 69120 Heidelberg, Germany; German Cancer Research Center (dkfz), Clinical Cooperations Unit Nuclear Medicine, INF 280, 69120 Heidelberg, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Flechsig
authors.affiliation: University Hospital Heidelberg, Department of Nuclear Medicine, INF 400, 69120 Heidelberg, Germany; Rinecker Proton Therapy Center, Schäftlarnstraße 133, 81371 Munich, Germany.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Zechmann
authors.affiliation: University Hospital Heidelberg, Department of Nuclear Medicine, INF 400, 69120 Heidelberg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Schreiweis
authors.affiliation: University Hospital Heidelberg, Department of Nuclear Medicine, INF 400, 69120 Heidelberg, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kratochwil
authors.affiliation: University Hospital Heidelberg, Department of Nuclear Medicine, INF 400, 69120 Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rath
authors.affiliation: Department of Radiology, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Schwartz
authors.affiliation: German Cancer Research Center (dkfz), Department of Radiology, INF 280, 69120 Heidelberg, Germany.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology, INF 110, 69120 Heidelberg, Germany; German Cancer Research Center (dkfz), Clinical Cooperations Unit Nuclear Medicine, INF 280, 69120 Heidelberg, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: University Hospital Heidelberg, Department of Nuclear Medicine, INF 400, 69120 Heidelberg, Germany; German Cancer Research Center (dkfz), Clinical Cooperations Unit Nuclear Medicine, INF 280, 69120 Heidelberg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Haberkorn
authors.affiliation: University Hospital Heidelberg, Department of Nuclear Medicine, INF 400, 69120 Heidelberg, Germany; Department of Radiology, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, 630 West 168th Street, New York, NY 10032, USA; German Cancer Research Center (dkfz), Clinical Cooperations Unit Nuclear Medicine, INF 280, 69120 Heidelberg, Germany. Electronic address: frederik@egiesel.com.
authors.forename: Frederik L
authors.initials: FL
authors.lastname: Giesel
mesh_terms: D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D015282:Octreotide / Q000031:analogs & derivatives*; D009942:Organometallic Compounds; D010190:Pancreatic Neoplasms / Q000473:pathology*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013274:Stomach Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: C499142:Ga(III)-DOTATOC; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D015282:Octreotide
keywords: Computed tomography; Gastroenteropancreatic neuroendocrine tumors; Magnetic resonance imaging; Metastasis; Positron emission tomography