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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.

View larger version (132K): [in a new window]   Fig. 1A. —69-year-old man with well-differentiated hepatocellular carcinoma (arrow, A and D) and severe cirrhosis. Gadolinium-enhanced hepatic arterial phase (A), equilibrium phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (5000/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images fail to show tumor in B and C. Note that lesion conspicuity is better in A than in D, because of hepatic nodularity, ferumoxide uptake in tumor, and decreased ferumoxides uptake in liver due to cirrhosis.

View larger version (126K): [in a new window]   Fig. 1B. —69-year-old man with well-differentiated hepatocellular carcinoma (arrow, A and D) and severe cirrhosis. Gadolinium-enhanced hepatic arterial phase (A), equilibrium phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (5000/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images fail to show tumor in B and C. Note that lesion conspicuity is better in A than in D, because of hepatic nodularity, ferumoxide uptake in tumor, and decreased ferumoxides uptake in liver due to cirrhosis.

View larger version (134K): [in a new window]   Fig. 1C. —69-year-old man with well-differentiated hepatocellular carcinoma (arrow, A and D) and severe cirrhosis. Gadolinium-enhanced hepatic arterial phase (A), equilibrium phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (5000/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images fail to show tumor in B and C. Note that lesion conspicuity is better in A than in D, because of hepatic nodularity, ferumoxide uptake in tumor, and decreased ferumoxides uptake in liver due to cirrhosis.

View larger version (131K): [in a new window]   Fig. 1D. —69-year-old man with well-differentiated hepatocellular carcinoma (arrow, A and D) and severe cirrhosis. Gadolinium-enhanced hepatic arterial phase (A), equilibrium phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (5000/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images fail to show tumor in B and C. Note that lesion conspicuity is better in A than in D, because of hepatic nodularity, ferumoxide uptake in tumor, and decreased ferumoxides uptake in liver due to cirrhosis.

View larger version (129K): [in a new window]   Fig. 2A. —75-year-old man with histologically proven liver metastases from colon carcinoma (arrows, A—D). Gadolinium-enhanced hepatic arterial phase (A), portal venous phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (3529/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images reveal that tumors (arrows) show ring enhancement characteristic of liver metastases in A, although lesion conspicuity is comparable with gadolinium-enhanced and ferumoxide-enhanced MR images.

View larger version (133K): [in a new window]   Fig. 2B. —75-year-old man with histologically proven liver metastases from colon carcinoma (arrows, A—D). Gadolinium-enhanced hepatic arterial phase (A), portal venous phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (3529/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images reveal that tumors (arrows) show ring enhancement characteristic of liver metastases in A, although lesion conspicuity is comparable with gadolinium-enhanced and ferumoxide-enhanced MR images.

View larger version (148K): [in a new window]   Fig. 2C. —75-year-old man with histologically proven liver metastases from colon carcinoma (arrows, A—D). Gadolinium-enhanced hepatic arterial phase (A), portal venous phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (3529/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images reveal that tumors (arrows) show ring enhancement characteristic of liver metastases in A, although lesion conspicuity is comparable with gadolinium-enhanced and ferumoxide-enhanced MR images.

View larger version (164K): [in a new window]   Fig. 2D. —75-year-old man with histologically proven liver metastases from colon carcinoma (arrows, A—D). Gadolinium-enhanced hepatic arterial phase (A), portal venous phase gradient-recalled echo (TR/TE, 150/1.6) (B), ferumoxide-enhanced respiratory-triggered T2-weighted fast spin-echo (3529/80) (C), and breath-hold T2*-weighted gradient-recalled echo (150/10) (D) axial MR images reveal that tumors (arrows) show ring enhancement characteristic of liver metastases in A, although lesion conspicuity is comparable with gadolinium-enhanced and ferumoxide-enhanced MR images.

View larger version (47K): [in a new window]   Fig. 3. —Bar chart shows values of area under receiver operating characteristic curve (Az values) that describe performance of three observers and pooled data for gadolinium-enhanced MR imaging (striped bar) and ferumoxide-enhanced MR imaging (black bar) in patients overall. Gadolinium-enhanced MR imaging gave significantly (p < 0.05) better data than did ferumoxide-enhanced MR imaging for all three observers and for pooled data.

View larger version (49K): [in a new window]   Fig. 4. —Bar chart shows values of area under receiver operating characteristic curve (Az values) that describe performance of three observers and pooled data for gadolinium-enhanced MR imaging (striped bar) and ferumoxide-enhanced MR imaging (black bar) in patients with cirrhosis. Gadolinium-enhanced MR imaging gave significantly (p < 0.05) better data than did ferumoxide-enhanced MR images for all three observers and for pooled data.

View larger version (47K): [in a new window]   Fig. 5. —Bar chart shows values of area under receiver operating characteristic curve (Az values) that describe performance of three observers and pooled data for gadolinium-enhanced MR imaging (striped bar) and ferumoxide-enhanced MR imaging (black bar) in patients without cirrhosis. Gadolinium-enhanced MR imaging gave significantly (p < 0.05) better data than did ferumoxide-enhanced MR images for observers 2 and 3 and for pooled data.

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