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Small (<= 2 cm) Hepatic Lesions in Colorectal Cancer Patients: Detection and Characterization on Mangafodipir Trisodium–Enhanced MRI

Kyoung Won Kim1, Ah Young Kim, Tae Kyoung Kim, Seong Ho Park, Hyun Jin Kim, Young Kyung Lee, Mi-Suk Park, Hyun Kwon Ha, Pyo Nyun Kim, Jin Cheon Kim and Moon-Gyu Lee

1 All authors: Department of Radiology, University of Ulsan-Asan Medical Center, 388-1, Pungnap-dong, Songpa-ku, Seoul 138-736, Korea.



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  		Fig. 1A. —57-year-old woman with hepatic metastasis from colorectal carcinoma. CT scan during portal venous phase shows hypoattenuating mass (arrow) with faint peritumoral rim enhancement (arrowhead) in left lobe of liver.

 


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  		Fig. 1B. —57-year-old woman with hepatic metastasis from colorectal carcinoma. HASTE T2-weighted MR image shows lesion with intermediate high signal intensity.

 


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  		Fig. 1C. —57-year-old woman with hepatic metastasis from colorectal carcinoma. Fast low-angle shot (FLASH) T1-weighted image 30 min after administration of mangafodipir trisodium (MnDPDP) shows no enhancement of lesion. Also, peritumoral rim enhancement is not seen.

 


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  		Fig. 1D. —57-year-old woman with hepatic metastasis from colorectal carcinoma. FLASH T1-weighted image 2 hr after administration of MnDPDP also shows no intratumoral or peritumoral enhancement. Final histopathologic diagnosis was single liver metastasis from colorectal carcinoma.

 


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  		Fig. 2A. —54-year-old man with hepatic metastasis from colorectal carcinoma. Helical CT scan during portal venous phase shows hypoattenuating nodule (arrow) that is too small to characterize in right lobe of liver.

 


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  		Fig. 2B. —54-year-old man with hepatic metastasis from colorectal carcinoma. HASTE T2-weighted MR image shows lesion with intermediate high signal intensity.

 


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  		Fig. 2C. —54-year-old man with hepatic metastasis from colorectal carcinoma. On fast low-angle shot T1-weighted image at 2 hr after administration of mangafodipir trisodium, intense peritumoral rim enhancement (arrowhead) is seen that is suggestive of hepatic metastasis. Final histopathologic diagnosis was single liver metastasis from colorectal carcinoma.

 


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  		Fig. 3A. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. Helical CT scan during hepatic arterial phase shows small hypoattenuating nodule (arrow) in liver segment IV.

 


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  		Fig. 3B. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. Helical CT scan during hepatic arterial phase also shows poorly defined lesion (arrowheads) with faint high attenuation in segment V.

 


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  		Fig. 3C. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. Lesion in segment IV is seen as hypoattenuation (arrow) on CT scan during portal venous phase.

 


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  		Fig. 3D. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. Lesion in segment V is seen as faint low attenuation (arrowheads) on CT scan during portal venous phase.

 


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  		Fig. 3E. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. True fast imaging with steady-state free precession (FISP) T2-weighted MR image shows segment IV lesion with bright high signal intensity (arrow), suggestive of hepatic cyst.

 


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  		Fig. 3F. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. True FISP T2-weighted MR image shows segment V lesion with intermediate high signal intensity (arrowhead), suggestive of malignancy.

 


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  		Fig. 3G. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. On fast low-angle shot (FLASH) T1-weighted image at 2 hr after administration of mangafodipir trisodium (MnDPDP), lesion in segment IV (arrow) shows no enhancement.

 


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  		Fig. 3H. —49-year-old man with hepatic cyst and metastasis from colorectal carcinoma. On FLASH T1-weighted image at 2 hr after administration of MnDPDP, lesion in segment V (arrowhead) also shows no enhancement. Histopathologic diagnoses were hepatic cyst for segment IV lesion and hepatic metastasis for segment V lesion.

 


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  		Fig. 4A. —57-year-old woman with small hepatic metastases from colorectal carcinoma. Helical CT scan during portal venous phase shows no definite focal lesion in liver.

 


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  		Fig. 4B. —57-year-old woman with small hepatic metastases from colorectal carcinoma. HASTE T2-weighted MR image also shows no definite focal lesion or signal change in liver.

 


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  		Fig. 4C. —57-year-old woman with small hepatic metastases from colorectal carcinoma. On fast low-angle shot T1-weighted image at 2 hr after administration of mangafodipir trisodium, two tiny nodules (arrowheads) are seen in segment VII of liver. Final histopathologic diagnoses of surgically resected specimen were two small hepatic metastases.

 

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