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Detection of Malignant Hepatic Tumors

Comparison of Gadolinium-and Ferumoxide-Enhanced MR Imaging

¹ Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu City, Gifu 500-8705, Japan.
² Department of Radiology, Kyoto University Faculty of Medicine, Sakyo-ku, Kyoto 606-8501, Japan.
³ Department of Radiology, Yamaguchi University School of Medicine, Ube City, Yamaguchi 755-8505, Japan.
⁴ Department of Radiology, Osaka City University Hospital, Abeno-ku, Osaka 545-8586, Japan.

OBJECTIVE. The purpose of our study was to compare how well gadolinium-enhanced and ferumoxide-enhanced MR imaging reveal malignant hepatic tumors.

SUBJECTS AND METHODS. Both gadolinium-enhanced and ferumoxide-enhanced MR imaging were separately performed in 53 patients with a total of 87 malignant hepatic tumors (57 hepatocellular carcinomas, 28 metastases, two cholangiocarcinomas). Thirty-one of the 53 patients had hepatic cirrhosis. Images were reviewed by three independent off-site observers. Observer performance was evaluated by means of sensitivity, specificity, and receiver operating characteristic curve analyses.

RESULTS. Gadolinium-enhanced MR imaging outperformed ferumoxide-enhanced MR imaging in sensitivity (81% versus 62%, p < 0.01) for malignant-tumor detection. Specificity was comparable (94%) between the two types of MR imaging. Area under receiver operating characteristic curve (A_z) value was significantly higher with gadolinium-enhanced MR imaging than with ferumoxide-enhanced MR imaging in patients overall (A_z = 0.896 versus 0.805, p < 0.001), in patients with cirrhosis (A_z = 0.907 versus 0.807, p < 0.001), and in patients without cirrhosis (A_z = 0.899 versus 0.834, p < 0.01). The superiority was enhanced in the subset of patients with cirrhosis.

CONCLUSION. Gadolinium-enhanced MR imaging outperforms ferumoxide-enhanced MR imaging in revealing malignant hepatic tumors. Gadolinium-enhanced MR imaging is recommended, particularly for patients with cirrhosis.

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