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Comparison of Mangafodipir Trisodium- and Ferucarbotran-Enhanced MRI for Detection and Characterization of Hepatic Metastases in Colorectal Cancer Patients

Hyoung Jung Kim1,2, Kyoung Won Kim1, Jae Ho Byun1, Hyung Jin Won1, Yong Moon Shin1, Pyo Nyun Kim1, Moo-Song Lee3 and Moon-Gyu Lee1

1 Department of Radiology, University of Ulsan–Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.
2 Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, South Korea.
3 Department of Preventive Medicine, University of Ulsan–Asan Medical Center, Seoul, South Korea.


Figure 1
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  		Fig. 1A —60-year-old man with small hepatic metastasis from colorectal carcinoma. T1-weighted MR image (TR/TE, 149/4.1; flip angle, 80°) shows hypointense lesion (arrow) in hepatic segment II.

 

Figure 2
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  		Fig. 1B —60-year-old man with small hepatic metastasis from colorectal carcinoma. On T2-weighted MR image (infinite/134; flip angle, 150°), lesion (arrow) is markedly hyperintense.

 

Figure 3
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  		Fig. 1C —60-year-old man with small hepatic metastasis from colorectal carcinoma. T1-weighted MR image (149/4.1; flip angle, 80°) taken 2 hr after administration of mangafodipir trisodium shows hypointense lesion with peripheral rim enhancement (arrow). Observer 1 interpreted this lesion as probably benign and observer 2, as possibly malignant; consensus interpretation determined this lesion to be malignant. Final histopathologic diagnosis was metastatic mucinous adenocarcinoma from colorectal carcinoma.

 

Figure 4
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  		Fig. 2A —55-year-old man with small hepatic metastasis from colorectal carcinoma. On T1-weighted (TR/TE, 149/4.1; flip angle, 80°) (A) and T2-weighted (infinite/134; flip angle, 150°) (B) MR images, lesion is not conspicuous.

 

Figure 5
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  		Fig. 2B —55-year-old man with small hepatic metastasis from colorectal carcinoma. On T1-weighted (TR/TE, 149/4.1; flip angle, 80°) (A) and T2-weighted (infinite/134; flip angle, 150°) (B) MR images, lesion is not conspicuous.

 

Figure 6
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  		Fig. 2C —55-year-old man with small hepatic metastasis from colorectal carcinoma. On T1-weighted dynamic-phase MR image (149/4.1; flip angle, 80°) after administration of ferucarbotran, peripheral rim enhancement (arrow) is evident.

 

Figure 7
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  		Fig. 2D —55-year-old man with small hepatic metastasis from colorectal carcinoma. On T2*-weighted accumulation-phase image (149/10; flip angle, 30°), lesion (arrow) is hyperintense. It was proven histopathologically to be metastasis.

 

Figure 8
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  		Fig. 3A —Previous surgical site on mangafodipir trisodium-enhanced MR image in 57-year-old man. T1-weighted MR image (TR/TE, 149/4.1; flip angle, 80°) shows hypointense lesion (arrow) at hepatic segment IV.

 

Figure 9
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  		Fig. 3B —Previous surgical site on mangafodipir trisodium-enhanced MR image in 57-year-old man. On T2-weighted MR image (infinite/134; flip angle, 150°), lesion is seen as slightly hyperintense (arrow).

 

Figure 10
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  		Fig. 3C —Previous surgical site on mangafodipir trisodium-enhanced MR image in 57-year-old man. T1-weighted MR image (149/4.1; flip angle, 80°) obtained 2 hr after mangafodipir trisodium injection shows peripheral rim enhancement (arrow) with hypointense center. Lesion was interpreted to be metastasis but was found to be site of previous surgery for hepatic metastasis from colorectal carcinoma. Lesion showed no interval change on follow-up CT 6 months later.

 

Figure 11
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  		Fig. 4A —Hepatic metastasis on ferucarbotran-enhanced MRI in 65-year-old man. T1-weighted MR image (TR/TE, 149/4.1; flip angle, 80°) shows moderately hypointense lesion (arrow).

 

Figure 12
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  		Fig. 4B —Hepatic metastasis on ferucarbotran-enhanced MRI in 65-year-old man. On T2-weighted MR image (infinite/134; flip angle, 150°), lesion is seen as slightly hyperintense (arrow).

 

Figure 13
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  		Fig. 4C —Hepatic metastasis on ferucarbotran-enhanced MRI in 65-year-old man. Dynamic T1-weighted MR image (149/4.1; flip angle, 80°) obtained after ferucarbotran injection shows clustered and hypointense lesions with rim enhancements (arrow).

 

Figure 14
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  		Fig. 4D —Hepatic metastasis on ferucarbotran-enhanced MRI in 65-year-old man. T2*-weighted MR image (149/10; flip angle, 30°) definitely shows hyperintense lesion (arrow) that was interpreted as benign lesion such as hepatic abscess. On follow-up CT 3 months later, diameter of lesion and level of carcinoembryonic antigen were markedly increased. Lesion was found to be metastasis.

 

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