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Comparison of Superparamagnetic Iron Oxide–Enhanced and Gadobenate Dimeglumine–Enhanced Dynamic MRI for Detection of Small Hepatocellular Carcinomas

Young Kon Kim1, Chong Soo Kim1, Young Hwan Lee2, Hyo Sung Kwak3 and Jeong Min Lee4

1 Department of Diagnostic Radiology, Chonbuk National University Hospital, Conju, Korea.
2 Department of Diagnostic Radiology, Wonkwang University School of Medicine, Iksan, Korea.
3 Department of Diagnostic Radiology, Korean Keyryong Army Hospital, Daejeon, Korea.
4 Department of Radiology, Seoul National University Hospital and College of Medicine, 28, Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea.



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  		Fig. 1A. —55-year-old man with hepatocellular carcinoma. Arterial phase 3D dynamic image after administration of gadobenate dimeglumine shows small nodular enhancing masses (solid arrows). Incidental small cyst is also noted (open arrow).

 


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  		Fig. 1B. —55-year-old man with hepatocellular carcinoma. Equilibrium phase MR image obtained 3 min after injection of gadobenate dimeglumine shows that lesions have iso- or low-intensity signal (arrows) relative to surrounding liver parenchyma.

 


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  		Fig. 1C. —55-year-old man with hepatocellular carcinoma. Superparamagnetic iron oxide (SPIO)–enhanced breath-hold T2*-weighted fast image obtained with steady-state free precession shows only one high-signal-intensity lesion (arrow).

 


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  		Fig. 1D. —55-year-old man with hepatocellular carcinoma. Respiratory-triggered T2-weighted turbo spin-echo image enhanced with SPIO also shows only one high-signal-intensity lesion (solid arrow). Small cysts (open arrow) are also depicted.

 


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  		Fig. 2A. —47-year-old man with hepatocellular carcinoma of 0.9 cm diameter in liver segment V. Arterial phase 3D dynamic MR image after administration of gadobenate dimeglumine reveals no liver mass.

 


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  		Fig. 2B. —47-year-old man with hepatocellular carcinoma of 0.9 cm diameter in liver segment V. Equilibrium phase MR image obtained 3 min after injection of gadobenate dimeglumine also shows no liver mass.

 


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  		Fig. 2C. —47-year-old man with hepatocellular carcinoma of 0.9 cm diameter in liver segment V. Superparamagnetic iron oxide–enhanced breath-hold T2*-weighted fast image obtained with steady-state free precession depicts tumor as area of high signal intensity (arrow). Presence of tumor was confirmed at pathology.

 


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  		Fig. 3A. —60-year-old man with liver cirrhosis and nodular hepatocellular carcinoma (not shown). Superparamagnetic iron oxide–enhanced breath-hold T2*-weighted fast image obtained with steady-state free precession shows nodular high signal intensity (arrow) in hepatic dome that was regarded as true lesion by all observers.

 


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  		Fig. 3B. —60-year-old man with liver cirrhosis and nodular hepatocellular carcinoma (not shown). Gadobenate dimeglumine–enhanced arterial phase MR image shows no visible lesion. No evidence of hepatic lesion was seen in that area on 6-month follow-up images (not shown).

 


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  		Fig. 4A. —55-year-old man with pathologically confirmed hepatocellular carcinoma in right hepatic lobe (not shown). Three-dimensional arterial phase MR image obtained after administration of gadobenate dimeglumine shows bright nodular enhancement (arrow) in left lobe.

 


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  		Fig. 4B. —55-year-old man with pathologically confirmed hepatocellular carcinoma in right hepatic lobe (not shown). Equilibrium phase MR image obtained 3 min after injection of gadobenate dimeglumine also shows no liver mass.

 


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  		Fig. 4C. —55-year-old man with pathologically confirmed hepatocellular carcinoma in right hepatic lobe (not shown). Superparamagnetic iron oxide–enhanced breath-hold T2*-weighted fast image obtained with steady-state free precession shows no visible mass. Lesion corresponding to region of bright nodular enhancement on dynamic arterial phase image was not found on intraoperative sonography and was regarded as perfusion anomaly.

 

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