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Preoperative Detection of Hepatocellular Carcinoma: Ferumoxides-Enhanced Versus Mangafodipir Trisodium—Enhanced MR Imaging

¹ All authors: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.

OBJECTIVE. The purpose of our study was to compare the diagnostic accuracy and lesion conspicuity of ferumoxides-enhanced MR imaging with those of mangafodipir trisodium—enhanced MR imaging for the preoperative detection of hepatocellular carcinoma.

SUBJECTS AND METHODS. Twenty-one patients with 39 hepatocellular carcinomas underwent ferumoxides-enhanced and mangafodipir trisodium—enhanced MR imaging. The diagnosis was established by pathologic examination after surgical resection in all patients. Five MR sequences were obtained 30 min after ferumoxides administration, and two MR sequences were obtained before and 15 min after mangafodipir trisodium administration. Three observers independently interpreted both MR images of all sequences on a segment-by-segment basis. The diagnostic accuracy of MR imaging was assessed using receiver operating characterizing analysis. Lesion (hepatocellular carcinoma > 10 mm in diameter)-to-liver contrast-to-noise ratio was calculated on MR images.

RESULTS. Ferumoxides-enhanced MR imaging (A_z = 0.971) was significantly more accurate (p < 0.05) than mangafodipir trisodium—enhanced MR imaging (A_z = 0.950). The mean sensitivity of ferumoxides-enhanced MR imaging (86%) was significantly greater (p < 0.05) than that of mangafodipir trisodium—enhanced MR imaging (44%) in lesions smaller than 10 mm. The mean lesion-to-liver contrast-to-noise ratio of hepatocellular carcinoma on ferumoxides-enhanced MR imaging (13.7 ± 8.8) was significantly greater than on mangafodipir trisodium—enhanced MR imaging (5.4 ± 5.1) (p < 0.01).

CONCLUSION. Ferumoxides-enhanced MR imaging has superior diagnostic accuracy in lesions smaller than 10 mm and superior lesion conspicuity compared with mangafodipir trisodium—enhanced MR imaging for the preoperative detection of hepatocellular carcinoma.

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