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Detection of Malignant Hepatic Tumors with Ferumoxides-Enhanced MRI: Comparison of Five Gradient-Recalled Echo Sequences with Different TEs

Masayuki Matsuo1, Masayuki Kanematsu1, Kyo Itoh2, Takamichi Murakami3, Yoji Maetani2, Hiroshi Kondo1, Satoshi Goshima1, Nobuo Kako1, Hiroaki Hoshi1, Junji Konishi2, Noriyuki Moriyama4 and Hironobu Nakamura3

1 Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
2 Department of Nuclear Medicine, Kyoto University Faculty of Medicine, Kyoto 606-8501, Japan.
3 Department of Radiology, Osaka University School of Medicine, Osaka 565-0871, Japan.
4 Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan.



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  		Fig. 1. —Bar chart shows mean lesion-to-liver contrast-to-noise ratios in hepatocellular carcinomas (first group) and metastases (second group). In hepatocellular carcinomas, mean lesion-to-liver contrast-to-noise ratio with gradient-recalled echo sequence (at TE of 1.4 msec) showed negative value and was significantly lower (p < 0.05) than sequences with gradient-recalled echo at TE of 4.2 msec or longer and sequences with fast spin-echo (FSE). For metastases, mean lesion-to-liver contrast-to-noise ratio with gradient-recalled echo sequence at TE of 1.4 msec also showed negative value and was significantly lower (p <.05) than sequences with gradient-recalled echo at TE of 6 msec or longer and sequences with fast spin echo.

 


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  		Fig. 2A. —73-year-old man with poorly differentiated hepatocellular carcinoma in cryptogenic cirrhosis. Axial T1-weighted gradient-recalled echo image (TR/TE, 150/1.4) shows 2-cm area of mild hypointensity (arrow) in segment IVa.

 


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  		Fig. 2B. —73-year-old man with poorly differentiated hepatocellular carcinoma in cryptogenic cirrhosis. Axial T1-weighted gradient-recalled echo image (150/4.2) shows no finding corresponding to hepatocellular carcinoma.

 


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  		Fig. 2C. —73-year-old man with poorly differentiated hepatocellular carcinoma in cryptogenic cirrhosis. Axial T2*-weighted gradient-recalled echo image (150/6) shows hepatocellular carcinoma as area of mild hyperintensity (arrow).

 


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  		Fig. 2D. —73-year-old man with poorly differentiated hepatocellular carcinoma in cryptogenic cirrhosis. Axial T2*-weighted gradient-recalled echo image (150/8) shows hepatocellular carcinoma as area of moderate hyperintensity (arrow).

 


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  		Fig. 2E. —73-year-old man with poorly differentiated hepatocellular carcinoma in cryptogenic cirrhosis. Axial T2*-weighted gradient-recalled echo image (150/10) shows hepatocellular carcinoma as area of moderate hyperintensity (arrow).

 


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  		Fig. 2F. —73-year-old man with poorly differentiated hepatocellular carcinoma in cryptogenic cirrhosis. Axial T2-weighted fast spin-echo image (4,286/80) shows hepatocellular carcinoma as area of moderate hyperintensity (arrow).

 


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  		Fig. 3A. —68-year-old man with liver metastasis from duodenal carcinoma. Axial T1-weighted gradient-recalled echo image (TR/TE, 150/1.4) shows 2.5-cm area of moderate hypointensity (arrow) in segment IVa.

 


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  		Fig. 3B. —68-year-old man with liver metastasis from duodenal carcinoma. Axial T1-weighted gradient-recalled echo image (150/4.2) shows metastasis as area of virtually isointensity with circumferential subtle hyperintensity (arrow).

 


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  		Fig. 3C. —68-year-old man with liver metastasis from duodenal carcinoma. Axial T2*-weighted gradient-recalled echo image (150/6) shows metastasis as area of subtle hyperintensity (arrow).

 


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  		Fig. 3D. —68-year-old man with liver metastasis from duodenal carcinoma. Axial T2*-weighted gradient-recalled echo images (150/8, D; 150/10, E) show metastasis as area of mild hyperintensity (arrow).

 


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  		Fig. 3E. —68-year-old man with liver metastasis from duodenal carcinoma. Axial T2*-weighted gradient-recalled echo images (150/8, D; 150/10, E) show metastasis as area of mild hyperintensity (arrow).

 


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  		Fig. 3F. —68-year-old man with liver metastasis from duodenal carcinoma. Axial T2-weighted fast spin-echo image (4,286/80) shows metastasis as area of moderate hyperintensity (large arrow). Note tiny hepatic cysts (small arrows) that are not visible in A–E.

 


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  		Fig. 4. —Bar chart shows mean sensitivities of each sequence for hepatocellular carcinomas (group on left), metastases (center), and tumors overall (group on right). For hepatocellular carcinomas, metastases, and tumors overall, sensitivity was higher (p < 0.05) with gradient-recalled echo at TEs of 6, 8, and 10 msec and fast spin-echo (FSE) sequences than with gradient-recalled echo sequences at TEs of 1.4 and 4.2 msec. For metastases and tumors overall, sensitivity was higher (p < 0.05) with gradient-recalled echo sequence at TE of 8 msec than with gradient-recalled echo at TE of 6 msec and fast spin-echo sequences.

 


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  		Fig. 5. —Bar chart shows mean specificities of each sequence for hepatocellular carcinomas (group on left), metastases (center), and tumors overall (group on right). Specificity was comparably high with all sequences in hepatocellular carcinomas, metastases, and tumors overall, with no significant difference. FSE = fast spin echo.

 


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  		Fig. 6. —Bar chart shows mean area under receiver operator characteristics curve (Az) values of each sequence for hepatocellular carcinomas, metastases, and tumors overall. For hepatocellular carcinomas, metastases, and tumors overall, Az was greater (p < 0.05) with gradient-recalled echo at TEs of 6, 8, and 10 msec and fast spin-echo (FSE) sequences than with gradient-recalled echo sequence at TE of 1.4 msec. For hepatocellular carcinomas and tumors overall, Az was greater (p < 0.05) with gradient-recalled echo at TEs of 6, 8, and 10 msec and fast spin-echo sequences than with gradient-recalled echo sequence at TE of 4.2 msec.

 

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