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Preoperative Detection of Hepatocellular Carcinoma: Ferumoxides-Enhanced Versus Mangafodipir Trisodium—Enhanced MR Imaging

¹ All authors: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.

View larger version (9K): [in a new window]   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 (area under ROC curve [Az] = 0.971 ± 0.013) and mangafodipir trisodium—enhanced () MR images of all four sequences (Az = 0.950 ± 0.016). Difference in mean areas under curves was significant (p < 0.05).

View larger version (162K): [in a new window]   Fig. 2A. —36-year-old woman with 0.7-and 0.6-cm hepatocellular carcinomas in liver segment VII. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 6000/17) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.2; flip angle, 30°) (B) MR images show two small discrete high-signal-intensity lesions (arrows).

View larger version (163K): [in a new window]   Fig. 2B. —36-year-old woman with 0.7-and 0.6-cm hepatocellular carcinomas in liver segment VII. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 6000/17) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.2; flip angle, 30°) (B) MR images show two small discrete high-signal-intensity lesions (arrows).

View larger version (144K): [in a new window]   Fig. 2C. —36-year-old woman with 0.7-and 0.6-cm hepatocellular carcinomas in liver segment VII. Corresponding lesions are not found on unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo (C) and mangafodipir trisodium—enhanced inphase T1-weighted fast multiplanar spoiled gradient-recalled echo (200/4.2; flip angle, 90°) (D) MR images.

View larger version (154K): [in a new window]   Fig. 2D. —36-year-old woman with 0.7-and 0.6-cm hepatocellular carcinomas in liver segment VII. Corresponding lesions are not found on unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo (C) and mangafodipir trisodium—enhanced inphase T1-weighted fast multiplanar spoiled gradient-recalled echo (200/4.2; flip angle, 90°) (D) MR images.

View larger version (165K): [in a new window]   Fig. 3A. —37-year-old woman with 3-cm hepatocellular carcinoma in liver segment V. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 5714/18) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (B) MR images show discrete high-signal-intensity lesion (arrows).

View larger version (178K): [in a new window]   Fig. 3B. —37-year-old woman with 3-cm hepatocellular carcinoma in liver segment V. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 5714/18) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (B) MR images show discrete high-signal-intensity lesion (arrows).

View larger version (158K): [in a new window]   Fig. 3C. —37-year-old woman with 3-cm hepatocellular carcinoma in liver segment V. Unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (200/4.2; flip angle, 90°) shows discrete high-signal-intensity lesion (arrows).

View larger version (150K): [in a new window]   Fig. 3D. —37-year-old woman with 3-cm hepatocellular carcinoma in liver segment V. Mangafodipir trisodium—enhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo MR image shows homogeneous enhancement of lesion (arrows).

View larger version (146K): [in a new window]   Fig. 4A. —44-year-old man with 2.5-cm hepatocellular carcinoma in liver segment V (not shown). Mangafodipir trisodium—enhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (TR/TE, 200/4.2; flip angle, 90°) shows small enhancing lesion (arrows) in subcapsular portion of segment VI. Lesion was interpreted as hepatocellular carcinoma by two observers.

View larger version (141K): [in a new window]   Fig. 4B. —44-year-old man with 2.5-cm hepatocellular carcinoma in liver segment V (not shown). Corresponding lesion is not seen on unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo (B), ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (5714/18) (C), or T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (D) MR images.

View larger version (136K): [in a new window]   Fig. 4C. —44-year-old man with 2.5-cm hepatocellular carcinoma in liver segment V (not shown). Corresponding lesion is not seen on unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo (B), ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (5714/18) (C), or T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (D) MR images.

View larger version (160K): [in a new window]   Fig. 4D. —44-year-old man with 2.5-cm hepatocellular carcinoma in liver segment V (not shown). Corresponding lesion is not seen on unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo (B), ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (5714/18) (C), or T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (D) MR images.

View larger version (133K): [in a new window]   Fig. 5A. —46-year-old man with 1.3-cm hepatocellular carcinoma in liver segment V. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 7500/17) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.2; flip angle, 30°) (B) MR images show discrete high-signal-intensity lesion (arrows).

View larger version (132K): [in a new window]   Fig. 5B. —46-year-old man with 1.3-cm hepatocellular carcinoma in liver segment V. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 7500/17) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.2; flip angle, 30°) (B) MR images show discrete high-signal-intensity lesion (arrows).

View larger version (112K): [in a new window]   Fig. 5C. —46-year-old man with 1.3-cm hepatocellular carcinoma in liver segment V. Unenhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (200/4.2; flip angle, 90°) shows ill-defined lesion (arrows) that is isointense to surrounding liver parenchyma.

View larger version (115K): [in a new window]   Fig. 5D. —46-year-old man with 1.3-cm hepatocellular carcinoma in liver segment V. Mangafodipir trisodium—enhanced in-phase T1-weighted fast multiplanar spoiled gradient-recalled echo MR image shows subtle enhancement of lesion (arrows).

View larger version (156K): [in a new window]   Fig. 6A. —60-year-old man with 2.2-cm well-differentiated hepatocellular carcinoma in liver segment VIII. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 5000/18) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (B) MR images show lesion (arrows) that is subtly isointense to surrounding liver parenchyma.

View larger version (145K): [in a new window]   Fig. 6B. —60-year-old man with 2.2-cm well-differentiated hepatocellular carcinoma in liver segment VIII. Ferumoxides-enhanced proton density—weighted fat-suppressed respiratory-triggered fast spin-echo (TR/TE, 5000/18) (A) and T2*-weighted fast multiplanar gradient-recalled acquisition in steady state (130/8.4; flip angle, 30°) (B) MR images show lesion (arrows) that is subtly isointense to surrounding liver parenchyma.

View larger version (160K): [in a new window]   Fig. 6C. —60-year-old man with 2.2-cm well-differentiated hepatocellular carcinoma in liver segment VIII. Unenhanced out-of-phase T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (200/2.2; flip angle, 90°) shows discrete high-signal-intensity lesion (arrows).

View larger version (163K): [in a new window]   Fig. 6D. —60-year-old man with 2.2-cm well-differentiated hepatocellular carcinoma in liver segment VIII. Mangafodipir trisodium—enhanced out-of-phase T1-weighted fast multi-planar spoiled gradient-recalled echo MR image shows homogeneous enhancement of lesion (arrows).

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