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Preoperative Detection of Malignant Hepatic Tumors

Comparison of Combined Methods of MR Imaging with Combined Methods of CT

¹ Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
² Department of Radiology, Osaka University Medical School, Osaka 565-0871, Japan.

View larger version (134K): [in a new window]   Fig. 1A. —73-year-old man with poorly differentiated hepatocellular carcinoma that was histologically diagnosed after core and aspiration biopsy. CT during arterial portography image (A), first-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced hepatic arterial phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5714/80) (D), and ferumoxides-enhanced breath-hold T2-weighted gradient-recalled echo MR image (150/10) (E) show poorly differentiated hepatocellular carcinoma (arrows). Note that lesion conspicuity on D is comparable with that on A.

View larger version (125K): [in a new window]   Fig. 1B. —73-year-old man with poorly differentiated hepatocellular carcinoma that was histologically diagnosed after core and aspiration biopsy. CT during arterial portography image (A), first-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced hepatic arterial phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5714/80) (D), and ferumoxides-enhanced breath-hold T2-weighted gradient-recalled echo MR image (150/10) (E) show poorly differentiated hepatocellular carcinoma (arrows). Note that lesion conspicuity on D is comparable with that on A.

View larger version (140K): [in a new window]   Fig. 1C. —73-year-old man with poorly differentiated hepatocellular carcinoma that was histologically diagnosed after core and aspiration biopsy. CT during arterial portography image (A), first-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced hepatic arterial phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5714/80) (D), and ferumoxides-enhanced breath-hold T2-weighted gradient-recalled echo MR image (150/10) (E) show poorly differentiated hepatocellular carcinoma (arrows). Note that lesion conspicuity on D is comparable with that on A.

View larger version (130K): [in a new window]   Fig. 1D. —73-year-old man with poorly differentiated hepatocellular carcinoma that was histologically diagnosed after core and aspiration biopsy. CT during arterial portography image (A), first-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced hepatic arterial phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5714/80) (D), and ferumoxides-enhanced breath-hold T2-weighted gradient-recalled echo MR image (150/10) (E) show poorly differentiated hepatocellular carcinoma (arrows). Note that lesion conspicuity on D is comparable with that on A.

View larger version (126K): [in a new window]   Fig. 1E. —73-year-old man with poorly differentiated hepatocellular carcinoma that was histologically diagnosed after core and aspiration biopsy. CT during arterial portography image (A), first-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced hepatic arterial phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5714/80) (D), and ferumoxides-enhanced breath-hold T2-weighted gradient-recalled echo MR image (150/10) (E) show poorly differentiated hepatocellular carcinoma (arrows). Note that lesion conspicuity on D is comparable with that on A.

View larger version (141K): [in a new window]   Fig. 2A. —49-year-old man with surgically resected liver metastasis from colonic carcinoma. CT during arterial portography image (A), second-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced portal venous phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced proton density—weighted spin-echo MR image (2000/80) (D), and ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5454/80) (E) show liver metastasis (arrows) from colonic carcinoma. First-phase CT hepatic arteriogram and unenhanced MR images (not shown) failed to depict tumor. Note that lesion conspicuity is better on A than on C-E.

View larger version (143K): [in a new window]   Fig. 2B. —49-year-old man with surgically resected liver metastasis from colonic carcinoma. CT during arterial portography image (A), second-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced portal venous phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced proton density—weighted spin-echo MR image (2000/80) (D), and ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5454/80) (E) show liver metastasis (arrows) from colonic carcinoma. First-phase CT hepatic arteriogram and unenhanced MR images (not shown) failed to depict tumor. Note that lesion conspicuity is better on A than on C-E.

View larger version (144K): [in a new window]   Fig. 2C. —49-year-old man with surgically resected liver metastasis from colonic carcinoma. CT during arterial portography image (A), second-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced portal venous phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced proton density—weighted spin-echo MR image (2000/80) (D), and ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5454/80) (E) show liver metastasis (arrows) from colonic carcinoma. First-phase CT hepatic arteriogram and unenhanced MR images (not shown) failed to depict tumor. Note that lesion conspicuity is better on A than on C-E.

View larger version (140K): [in a new window]   Fig. 2D. —49-year-old man with surgically resected liver metastasis from colonic carcinoma. CT during arterial portography image (A), second-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced portal venous phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced proton density—weighted spin-echo MR image (2000/80) (D), and ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5454/80) (E) show liver metastasis (arrows) from colonic carcinoma. First-phase CT hepatic arteriogram and unenhanced MR images (not shown) failed to depict tumor. Note that lesion conspicuity is better on A than on C-E.

View larger version (140K): [in a new window]   Fig. 2E. —49-year-old man with surgically resected liver metastasis from colonic carcinoma. CT during arterial portography image (A), second-phase CT hepatic arteriogram (B), breath-hold gadolinium-enhanced portal venous phase gradient-recalled echo MR image (TR/TE, 150/1.6) (C), ferumoxides-enhanced proton density—weighted spin-echo MR image (2000/80) (D), and ferumoxides-enhanced respiratory-triggered fast spin-echo MR image (5454/80) (E) show liver metastasis (arrows) from colonic carcinoma. First-phase CT hepatic arteriogram and unenhanced MR images (not shown) failed to depict tumor. Note that lesion conspicuity is better on A than on C-E.

View larger version (108K): [in a new window]   Fig. 2F. —49-year-old man with surgically resected liver metastasis from colonic carcinoma. Photograph of resected specimen shows liver metastasis from colonic carcinoma (size, 5 x 7 mm).

View larger version (15K): [in a new window]   Fig. 3. —Receiver operating characteristic curves (generated from composite data) show confidence of three observers for detection of malignant hepatic tumors in 33 patients with unenhanced and gadolinium-enhanced MR imaging () (Az = 0.950); combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging () (Az = 0.962); and combined helical CT during arterial portography and biphasic CT during hepatic arteriography ([UNK]) (Az = 0.959).

View larger version (16K): [in a new window]   Fig. 4. —Receiver operating characteristic curves (generated from composite data) show confidence of three observers for detection of malignant hepatic tumors in 22 patients with hepatocellular carcinoma (n = 21) or cirrhosis (n = 1) with unenhanced and gadolinium-enhanced MR imaging () (Az = 0.949); combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging () (Az = 0.953); and combined helical CT during arterial portography and biphasic CT during hepatic arteriography ([UNK]) (Az = 0.959).

View larger version (14K): [in a new window]   Fig. 5. —Receiver operating characteristic curves (generated from composite data) show confidence of three observers for detection of malignant hepatic tumors in 11 patients with metastases (n = 8) or healthy liver (n = 3) with unenhanced and gadolinium-enhanced MR imaging () (Az = 0.944); combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging () (Az = 0.977); and combined helical CT during arterial portography and biphasic CT during hepatic arteriography ([UNK]) (Az = 0.952).

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