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Detection of Malignant Hepatic Lesions Before Orthotopic Liver Transplantation: Accuracy of Ferumoxides-Enhanced MR Imaging

Kensaku Mori1, Juergen Scheidler2, Thomas Helmberger1, Nicolaus Holzknecht1, Rolf Schauer3, Carl Albrecht Schirren4, Iris Bittmann5, Martin Dugas6 and Maximilian Reiser1

1 Department of Clinical Radiology, Klinikum Grosshadern, Ludwig Maximilias University of Munich, Marchioninistr. 15, D-81377 Munich, Germany.
2 Department of Radiology, Radiologisches Zentrum Munchen-Pasing, Pippingerstr. 25, D-81245 Munich, Germany.
3 Department of Surgery, Klinikum Grosshadern, Ludwig Maximilias University of Munich, D-81377 Munich, Germany.
4 Department of Medicine II, Klinikum Grosshadern, Ludwig Maximilias University of Munich, D-81377 Munich, Germany.
5 Institute of Pathology, Ludwig Maximilias University of Munich, D-81377 Munich, Germany.
6 Department of Medical Informatics, Biometrics, and Epidemiology, Klinikum Grosshadern, Ludwig Maximilias University of Munich, D-81377 Munich, Germany.



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  		Fig. 1A. —47-year-old man with solitary hepatocellular carcinoma related to viral hepatitis type C—induced cirrhosis. Two of three observers missed lesion on image set 4. Transverse unenhanced T1-weighted gradient-echo MR image (TR/TE, 140/4.1) shows no focal lesion.

 


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  		Fig. 1B. —47-year-old man with solitary hepatocellular carcinoma related to viral hepatitis type C—induced cirrhosis. Two of three observers missed lesion on image set 4. Transverse unenhanced T2-weighted fast spin-echo MR image (3300/138) (B) and transverse ferumoxides-enhanced T2-weighted fast spin-echo MR image (3300/138) (C) show no focal lesion. Note severe motion-related artifacts (arrows).

 


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  		Fig. 1C. —47-year-old man with solitary hepatocellular carcinoma related to viral hepatitis type C—induced cirrhosis. Two of three observers missed lesion on image set 4. Transverse unenhanced T2-weighted fast spin-echo MR image (3300/138) (B) and transverse ferumoxides-enhanced T2-weighted fast spin-echo MR image (3300/138) (C) show no focal lesion. Note severe motion-related artifacts (arrows).

 


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  		Fig. 1D. —47-year-old man with solitary hepatocellular carcinoma related to viral hepatitis type C—induced cirrhosis. Two of three observers missed lesion on image set 4. Transverse ferumoxides-enhanced T1-weighted gradient-echo MR image (140/4.1) shows lesion with decreased signal loss. Lesion (arrow) is 1.5 cm in diameter in segment VII.

 


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  		Fig. 1E. —47-year-old man with solitary hepatocellular carcinoma related to viral hepatitis type C—induced cirrhosis. Two of three observers missed lesion on image set 4. Transverse ferumoxides-enhanced T2*-weighted gradient-echo MR image (140/10) shows best contrast between lesion and surrounding liver (arrow). Note fibrotic changes of decreased signal loss (arrowheads) caused by severe cirrhosis.

 


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  		Fig. 1F. —47-year-old man with solitary hepatocellular carcinoma related to viral hepatitis type C—induced cirrhosis. Two of three observers missed lesion on image set 4. Photomicrograph of histologic specimen from nodule shows moderately differentiated hepatocellular carcinoma with tubercular sinusoidal structure (H and E, x50). Insert (lower right) shows foci of clear cell differentiation (H and E, x200).

 


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  		Fig. 2A. —40-year-old man with fibrotic lesion in alcohol-induced cirrhosis. Two of three observers recognized lesion as possibly malignant on image set 4. Transverse unenhanced T1-weighted gradient-echo MR image (TR/TE, 140/4.1) (A), transverse unenhanced T2-weighted fast spin-echo MR image (3300/138) (B), and transverse ferumoxides-enhanced T2-weighted fast spin-echo MR image (3300/138) (C) show no focal lesion.

 


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  		Fig. 2B. —40-year-old man with fibrotic lesion in alcohol-induced cirrhosis. Two of three observers recognized lesion as possibly malignant on image set 4. Transverse unenhanced T1-weighted gradient-echo MR image (TR/TE, 140/4.1) (A), transverse unenhanced T2-weighted fast spin-echo MR image (3300/138) (B), and transverse ferumoxides-enhanced T2-weighted fast spin-echo MR image (3300/138) (C) show no focal lesion.

 


View larger version (154K):

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  		Fig. 2C. —40-year-old man with fibrotic lesion in alcohol-induced cirrhosis. Two of three observers recognized lesion as possibly malignant on image set 4. Transverse unenhanced T1-weighted gradient-echo MR image (TR/TE, 140/4.1) (A), transverse unenhanced T2-weighted fast spin-echo MR image (3300/138) (B), and transverse ferumoxides-enhanced T2-weighted fast spin-echo MR image (3300/138) (C) show no focal lesion.

 


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  		Fig. 2D. —40-year-old man with fibrotic lesion in alcohol-induced cirrhosis. Two of three observers recognized lesion as possibly malignant on image set 4. Transverse ferumoxides-enhanced T1-weighted gradient-echo MR image (140/4.1) (D) and transverse ferumoxides-enhanced T2*-weighted gradient-echo MR image (140/10) (E) show masslike lesion with decreased signal loss. Lesion (arrows) is 4.5 cm in diameter in segment VIII.

 


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  		Fig. 2E. —40-year-old man with fibrotic lesion in alcohol-induced cirrhosis. Two of three observers recognized lesion as possibly malignant on image set 4. Transverse ferumoxides-enhanced T1-weighted gradient-echo MR image (140/4.1) (D) and transverse ferumoxides-enhanced T2*-weighted gradient-echo MR image (140/10) (E) show masslike lesion with decreased signal loss. Lesion (arrows) is 4.5 cm in diameter in segment VIII.

 


View larger version (157K):

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  		Fig. 2F. —40-year-old man with fibrotic lesion in alcohol-induced cirrhosis. Two of three observers recognized lesion as possibly malignant on image set 4. Photomicrograph of histologic specimen from lesion shows cirrhotic liver with dense fibrous stroma, proliferation of bile ducts, and mild chronic inflammation. (H and E, x50)

 

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