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Using Superparamagnetic Iron Oxide–Enhanced MRI to Differentiate Metastatic Hepatic Tumors and Nonsolid Benign Lesions

¹ All authors: Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 5650871 Japan.

View larger version (121K): [in a new window]   Fig. 1A. —Cyst (arrow) in 60-year-old man with preoperative examination of colon cancer using superparamagnetic iron oxide–enhanced MRI (category 5). Ferumoxides-enhanced T2-weighted gradient-echo image shows cyst as isointense to liver parenchyma because liver parenchyma decreased in signal after contrast administration and cyst has long T1 values, suppressing T2 contrast, and does not show high intensity in parameter.

View larger version (137K): [in a new window]   Fig. 1B. —Cyst (arrow) in 60-year-old man with preoperative examination of colon cancer using superparamagnetic iron oxide–enhanced MRI (category 5). Ferumoxides-enhanced T1-weighted gradient-echo image shows cyst as low intensity relative to liver parenchyma because liver parenchyma increased in signal after contrast administration and cyst did not. This signal-intensity pattern of category 5 is characteristic of cyst.

View larger version (115K): [in a new window]   Fig. 2A. —Cyst (arrow) in 54-year-old woman with preoperative examination for breast cancer using superparamagnetic iron oxide–enhanced MRI (category 3). Ferumoxides-enhanced T2-weighted gradient-echo image shows large cyst, 35 mm in diameter, as high intensity because T2 value of large cyst with large amount of serous fluid and without partial volume effect is long.

View larger version (121K): [in a new window]   Fig. 2B. —Cyst (arrow) in 54-year-old woman with preoperative examination for breast cancer using superparamagnetic iron oxide–enhanced MRI (category 3). Ferumoxides-enhanced T1-weighted gradient-echo image depicts cyst as low intensity. This signal-intensity pattern is classified as category 3, which is considered to be metastasis; however, this cyst is atypical.

View larger version (135K): [in a new window]   Fig. 3A. —Hemangioma (arrow) in 62-year-old man with preoperative examination of colon cancer using superparamagnetic iron oxide–enhanced MRI (category 2). Ferumoxides-enhanced T2-weighted gradient-echo image depicts hemangioma as high intensity relative to liver parenchyma that deceased in signal after contrast administration.

View larger version (128K): [in a new window]   Fig. 3B. —Hemangioma (arrow) in 62-year-old man with preoperative examination of colon cancer using superparamagnetic iron oxide–enhanced MRI (category 2). Ferumoxides-enhanced T1-weighted gradient-echo image shows that hemangioma is enhanced as isointense relative to liver parenchyma and cannot be seen. This signal-intensity pattern of category 2 is characteristic for hemangioma.

View larger version (139K): [in a new window]   Fig. 4A. —Metastatic tumor (arrow) in 59-year-old woman with follow-up examination of colon cancer using superparamagnetic iron oxide–enhanced MRI (category 3). Ferumoxides-enhanced T2-weighted gradient-echo image depicts metastasis as high intensity relative to liver parenchyma that decreased in signal after contrast administration.

View larger version (152K): [in a new window]   Fig. 4B. —Metastatic tumor (arrow) in 59-year-old woman with follow-up examination of colon cancer using superparamagnetic iron oxide–enhanced MRI (category 3). Ferumoxides-enhanced T1-weighted gradient-echo image shows metastasis as low intensity relative to liver parenchyma. This signal-intensity pattern of category 3 is characteristic for solid lesion, indicating metastatic liver tumor.

View larger version (147K): [in a new window]   Fig. 5A. —Metastasis in 54-year-old woman with follow-up examination of mesenteric leiomyosarcoma using superparamagnetic iron oxide–enhanced MRI (category 5). Ferumoxides-enhanced T2-weighted gradient-echo image cannot show small metastasis because it may be isointense because of partial volume effect.

View larger version (167K): [in a new window]   Fig. 5B. —Metastasis in 54-year-old woman with follow-up examination of mesenteric leiomyosarcoma using superparamagnetic iron oxide–enhanced MRI (category 5). Ferumoxides-enhanced T1-weighted gradient-echo image shows metastasis (arrow) as low intensity relative to liver parenchyma. This signal intensity pattern is classified as category 5, which is considered to be cyst; however, this metastasis is atypical.

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