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Detection of Hepatic Lesions in Candidates for Surgery

Comparison of Ferumoxides-Enhanced MR Imaging and Dual-Phase Helical CT

David A. Bluemke1, Erik K. Paulson2, Michael A. Choti3, Salvatore DeSena1 and Pierre A. Clavien4

1 The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287.
2 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
3 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
4 Department of Surgery, Duke University Medical Center, Durham, NC 27710.



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  		Fig. 1A. —58-year-old man with colon cancer. CT scan of upper portion of liver shows poorly defined area of decreased attenuation in segment II (arrow).

 


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  		Fig. 1B. —58-year-old man with colon cancer. Enhanced MR image shows multiple lesions that were confirmed by sonography and surgical biopsy. Unenhanced MR images (not shown) also showed obvious metastasis, but lesion definition was improved on enhanced MR imaging. Incomplete fat suppression is present anteriorly near dome of liver. Most conspicuous level on CT image is shown, although differences in anatomic levels between A and B are caused by breath-holding examination with helical CT compared with non—breath-holding MR imaging. Hepatic infusion pump was placed because of multiple metastatic lesions in both lobes of liver.

 


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  		Fig. 2A. —52-year-old woman with colon cancer. CT scan at level of diaphragm shows large area of decreased attenuation during arterial (not shown) and portal phases of imaging. Apex of perfusion abnormality was convex and was interpreted as metastatic lesion.

 


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  		Fig. 2B. —52-year-old woman with colon cancer. CT scan at lower liver level than A also shows focal lesion interpreted as possible metastasis.

 


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  		Fig. 2C. —52-year-old woman with colon cancer. Unenhanced MR image at same level as A shows no abnormality. Enhanced MR image (not shown) was also normal at this level.

 


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  		Fig. 2D. —52-year-old woman with colon cancer. Enhanced MR image at same level as B shows no abnormality. Surgery showed no metastatic lesions in liver at these locations, and reason for perfusion abnormality could not be determined. Elsewhere in liver, three hemangiomas (0.5-2 cm) were found at surgery.

 

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