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Hepatic MR Imaging Using Ferumoxides

Prospective Evaluation with Surgical and Intraoperative Sonographic Confirmation in 25 Cases

Steven S. Raman1, David S. K. Lu1, Sloane C. Chen1, James Sayre1, Fred Eilber2 and James Economou2

1 Department of Radiology, UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095-1721.
2 Department of Surgery, UCLA, Los Angeles, CA 90095-1721.



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  		Fig. 1A. —51-year-old man with hepatocellular carcinoma. Unenhanced turbo spin-echo T2-weighted MR images (TR/TE, 5085/102) obtained using 0.2-T scanner shows contour of large primary hepatocellular carcinoma as difficult to see.

 


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  		Fig. 1B. —51-year-old man with hepatocellular carcinoma. Ferumoxides-enhanced turbo spin-echo T2-weighted MR image (5085/102) obtained using 0.2-T scanner shows large primary mass to be confined to left lateral segment. Note falciform ligament (black arrows). Main mass shows mild signal loss due to ferumoxides up-take, rendering margins of mass distinct from surrounding fat. Smaller lesion (white arrow) is better defined within caudate lobe. No tumor was present in medial segment at surgery.

 


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  		Fig. 2A. —77-year-old man with colon cancer. Unenhanced turbo spin-echo T2-weighted MR image (TR/TE, 5200/102) obtained using 0.2-T scanner shows questionable metastatic lesion (arrow) in right anterior lobe.

 


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  		Fig. 2B. —77-year-old man with colon cancer. Ferumoxides-enhanced turbo spin-echo T2-weighted MR image (5200/102) obtained using 0.2-T scanner conclusively shows single 1.5-cm metastatic lesion (arrow).

 


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  		Fig. 3A. —62-year-old woman with ovarian cancer. Unenhanced turbo spin-echo T2-weighted MR image (TR/TE, 4633/102) obtained using 0.2-T scanner shows that two simple cysts (arrows) are higher in signal than three metastases (arrowheads) in right posterior lobe.

 


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  		Fig. 3B. —62-year-old woman with ovarian cancer. Ferumoxides-enhanced turbo spin-echo T2-weighted MR image (4633/102) obtained using 0.2-T scanner shows relative signal increase in metastatic lesions (arrowheads) compared with A. This figure shows unenhanced T2-weighted sequences are helpful to help distinguish solid and nonsolid lesions. Simple cysts (arrows) retain high signal.

 


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  		Fig. 4A. —66-year-old woman with ovarian cancer. Unenhanced turbo spin-echo T2-weighted MR image (TR/TE, 4100/99) obtained using 1.5-T scanner shows right-lobe hemangioma (short arrow) that is higher in signal intensity compared with metastatic lesion (long arrow) in left lobe.

 


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  		Fig. 4B. —66-year-old woman with ovarian cancer. Ferumoxides-enhanced turbo spin-echo T2-weighted MR image (4700/99) obtained using 1.5-T scanner shows hemangioma (short arrow) retains high signal intensity but metastatic lesion (long arrow) is also now high in signal intensity.

 


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  		Fig. 5. —69-year-old woman with ovarian cancer. Ferumoxides-enhanced turbo spin-echo T2-weighted MR image (TR/TE, 4700/99) obtained using 1.5-T scanner shows small medial-dome lesion (segment VII, straight arrow). Lesion was not shown at surgery, because of difficulty dissecting through dense adhesions, or at intraoperative sonography, because acoustic attenuation from fatty liver made it difficult to visualize. Adjacent metastatic lesion (curved arrow) confirmed at surgery is well defined.

 


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  		Fig. 6. —60-year-old-man with colon cancer. Ferumoxides-enhanced turbo spin-echo T2-weighted MR image (TR/TE, 4200/99) obtained using 1.5-T scanner shows a peripheral wedge-shaped high signal area (arrow) that was known preoperatively to be site of prior metastatic resection. Area had decreased in size since prior surgery. No tumor was found here at surgery and intraoperative sonography.

 

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