Preoperative Detection of Hepatocellular Carcinoma
Ferumoxides-Enhanced MR Imaging Versus Combined Helical CT During Arterial Portography and CT Hepatic Arteriography
Dongil Choi1,
Seung Hoon Kim1,
Jae Hoon Lim1,
Won Jae Lee1,
Hyun-Jung Jang1,
Soon Jin Lee1 and
Hyo Keun Lim1
1
All authors: Department of Radiology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710,
Korea.
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Fig. 1. —Graph shows composite receiver operating characteristic (ROC)
curves for pooled data reviewed by three observers. Curves indicate relative
accuracy with which hepatocellular carcinomas were detected on
ferumoxides-enhanced MR images of all five sequences (the area under the ROC
curve, [Az] = 0.964 ± 0.014) and combined CT during
arterial portography (CTAP) and CT hepatic arteriography (CTHA) images
(Az = 0.948 ± 0.017). Difference in mean areas
under the curves was not significant.
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Fig. 2A. —56-year-old man with 0.7-cm hepatocellular carcinoma in
segment VIII. CT during arterial portography image shows small poorly defined
area of portal perfusion defect (arrow).
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Fig. 2B. —56-year-old man with 0.7-cm hepatocellular carcinoma in
segment VIII. CT hepatic arteriography image shows small area of subtle high
attenuation (arrow) corresponding to lesion on CT during arterial
portography image (A).
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Fig. 2C. —56-year-old man with 0.7-cm hepatocellular carcinoma in
segment VIII. Ferumoxides-enhanced fatsuppressed respiratory-triggered fast
spin-echo images (TR/TE, 5000/18) (C) and T2*-weighted fast
multiplanar gradient-recalled acquisition in steady state images (130/8.4;
flip angle, 30°) (D) show discrete high-signal-intensity lesion
(arrows).
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Fig. 2D. —56-year-old man with 0.7-cm hepatocellular carcinoma in
segment VIII. Ferumoxides-enhanced fatsuppressed respiratory-triggered fast
spin-echo images (TR/TE, 5000/18) (C) and T2*-weighted fast
multiplanar gradient-recalled acquisition in steady state images (130/8.4;
flip angle, 30°) (D) show discrete high-signal-intensity lesion
(arrows).
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Fig. 3A. —52-year-old man with 1.5-cm well-differentiated
hepatocellular carcinoma in segment VI. CT during arterial portography image
shows oval fairly well-defined area of portal perfusion defect
(arrows).
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Fig. 3B. —52-year-old man with 1.5-cm well-differentiated
hepatocellular carcinoma in segment VI. CT hepatic arteriography image shows
area of subtle low-attenuation with irregular high-attenuation rim
(arrows) corresponding to lesion on CT during arterial portography
image (A). Numerous tiny low-attenuated nodules are regenerative
nodules of liver cirrhosis.
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Fig. 3C. —52-year-old man with 1.5-cm well-differentiated
hepatocellular carcinoma in segment VI. Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE; 4000/18) (C) and
T2*-weighted fast multiplanar gradient-recalled acquisition in
steady state images (130/8.4; flip angle, 30°) (D) show area of low
signal intensity (arrows) corresponding to lesion seen on CT during
arterial portography image (A) and CT hepatic arteriography image
(B). Numerous tiny low-signal-intensity nodules are regenerative
nodules. Larger nodule (arrows) that was proved hepatocellular
carcinoma is same signal intensity as cirrhotic regenerative nodules.
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Fig. 3D. —52-year-old man with 1.5-cm well-differentiated
hepatocellular carcinoma in segment VI. Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE; 4000/18) (C) and
T2*-weighted fast multiplanar gradient-recalled acquisition in
steady state images (130/8.4; flip angle, 30°) (D) show area of low
signal intensity (arrows) corresponding to lesion seen on CT during
arterial portography image (A) and CT hepatic arteriography image
(B). Numerous tiny low-signal-intensity nodules are regenerative
nodules. Larger nodule (arrows) that was proved hepatocellular
carcinoma is same signal intensity as cirrhotic regenerative nodules.
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Fig. 4A. —60-year-old man with two hepatocellular carcinomas measuring
0.6 cm and 0.3 cm in segment VIII. CT during arterial portography image shows
0.6-cm area of portal perfusion defect with irregular margin (arrow).
Low attenuation in posterior aspect of right lobe with irregular margin is
portal perfusion defect caused by perfusion abnormality.
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Fig. 4B. —60-year-old man with two hepatocellular carcinomas measuring
0.6 cm and 0.3 cm in segment VIII. CT hepatic arteriography image shows
discrete area of high attenuation (arrow) corresponding to lesion on
CT during arterial portography image (A). Note heterogeneous
opacification of posterior segment of right hepatic lobe, corresponding to
area of perfusion defect on CT during arterial portography image
(A).
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Fig. 4C. —60-year-old man with two hepatocellular carcinomas measuring
0.6 cm and 0.3 cm in segment VIII. Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE, 6000/18) (C) and proton
density-weighted fast multiplanar spoiled gradient-recalled echo images
(130/8.4; flip angle, 30°) (D) show discrete high-signal-intensity
lesion (arrows) corresponding to lesion seen on CT during arterial
portography image (A) and CT hepatic arteriography image (B).
Note another smaller high-signal-intensity 0.3-cm diameter lesion
(arrowheads) that was not found with either CT during arterial
portography (A) or CT hepatic arteriography (B).
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Fig. 4D. —60-year-old man with two hepatocellular carcinomas measuring
0.6 cm and 0.3 cm in segment VIII. Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE, 6000/18) (C) and proton
density-weighted fast multiplanar spoiled gradient-recalled echo images
(130/8.4; flip angle, 30°) (D) show discrete high-signal-intensity
lesion (arrows) corresponding to lesion seen on CT during arterial
portography image (A) and CT hepatic arteriography image (B).
Note another smaller high-signal-intensity 0.3-cm diameter lesion
(arrowheads) that was not found with either CT during arterial
portography (A) or CT hepatic arteriography (B).
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Fig. 5A. —59-year-old man with with 2.2-cm hepatocellular carcinoma in
segment V (not shown). Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE; 6000/18) (A) and
T2*-weighted fast multiplanar gradient-recalled acquisition in
steady state images (130/8.4; flip angle, 30°) (B) show discrete
small round high-signal-intensity lesion (arrows). Two observers
interpreted this lesion as small hepatocellular carcinoma.
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Fig. 5B. —59-year-old man with with 2.2-cm hepatocellular carcinoma in
segment V (not shown). Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE; 6000/18) (A) and
T2*-weighted fast multiplanar gradient-recalled acquisition in
steady state images (130/8.4; flip angle, 30°) (B) show discrete
small round high-signal-intensity lesion (arrows). Two observers
interpreted this lesion as small hepatocellular carcinoma.
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Fig. 5C. —59-year-old man with with 2.2-cm hepatocellular carcinoma in
segment V (not shown). Small lesion corresponding to hepatocellular carcinoma
seen on MR images is not shown on CT during arterial portography image
(C) and CT hepatic arteriography image (D). This false-positive
lesion on MR images is attributed to vessel. Hepatocellular carcinoma in
patient is not shown in this section.
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Fig. 5D. —59-year-old man with with 2.2-cm hepatocellular carcinoma in
segment V (not shown). Small lesion corresponding to hepatocellular carcinoma
seen on MR images is not shown on CT during arterial portography image
(C) and CT hepatic arteriography image (D). This false-positive
lesion on MR images is attributed to vessel. Hepatocellular carcinoma in
patient is not shown in this section.
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Fig. 6A. —48-year-old man with two hepatocellular carcinomas measuring
6.5 cm and 1.5 cm in segments V and VI. CT during arterial portography image
shows 6.5-cm round area of portal perfusion defect (arrows). Note
separate large irregular area of portal perfusion defect (arrowheads)
containing small hepatocellular carcinoma. It is probably caused by portal
vein obstruction or arterioportal shunt.
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Fig. 6B. —48-year-old man with two hepatocellular carcinomas measuring
6.5 cm and 1.5 cm in segments V and VI. CT hepatic arteriography image shows
6.5-cm round area (arrows) and large irregular area with
hyperattenuation (arrowheads) corresponding to those seen on CT
during arterial portography image (A). Note slight hyperperfusion at
corresponding area on CT during arterial portography image (A).
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Fig. 6C. —48-year-old man with two hepatocellular carcinomas measuring
6.5 cm and 1.5 cm in segments V and VI. Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE, 6000/18) (C) and proton
density-weighted fast multiplanar spoiled gradient-recalled echo images
(130/8.4; flip angle, 30°) (D) show discrete large round
high-signal-intensity lesion (arrows) corresponding to lesion seen on
CT during arterial portography image (A) and CT hepatic arteriography
image (B). Note another small ovoid high-signal-intensity 1.5-cm
diameter lesion (arrowheads) that is not visualized on CT during
arterial portography image (A) and CT hepatic arteriography image
(B).
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Fig. 6D. —48-year-old man with two hepatocellular carcinomas measuring
6.5 cm and 1.5 cm in segments V and VI. Ferumoxides-enhanced fat-suppressed
respiratory-triggered fast spin-echo (TR/TE, 6000/18) (C) and proton
density-weighted fast multiplanar spoiled gradient-recalled echo images
(130/8.4; flip angle, 30°) (D) show discrete large round
high-signal-intensity lesion (arrows) corresponding to lesion seen on
CT during arterial portography image (A) and CT hepatic arteriography
image (B). Note another small ovoid high-signal-intensity 1.5-cm
diameter lesion (arrowheads) that is not visualized on CT during
arterial portography image (A) and CT hepatic arteriography image
(B).
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