Optimal TE for SPIO-Enhanced Gradient-Recalled Echo MRI for the Detection of Focal Hepatic Lesions
Myeong-Jin Kim1,2,3,
Joo Hee Kim1,3,
Jin Young Choi1,
Sung Ho Park1,
Jae-Joon Chung1,4,
Ki Whang Kim1,3 and
Donald G. Mitchell5
1 Department of Diagnostic Radiology, Yonsei University College of Medicine,
Seodaemun-ku Shinchon-dong 134, Seoul 120-752, Republic of Korea.
2 Brain Korea 21 Project for Medical Science and Institute of Gastroenterology,
Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of
Korea.
3 Institute of Radiological Science, Severance Hospital, Yonsei University
College of Medicine, Seoul, Republic of Korea.
4 Department of Diagnostic Radiology, NHIC Ilsan Hospital, Gyonggi-do,
Korea.
5 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia,
PA.
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Fig. 1 —Bar graph shows mean signal difference-to-noise ratios (SDNR)
of lesions on gradient-recalled MRI by lesion type. Mean SDNR of
cholangiocarcinomas (CCC) was highest at TE of 18 milliseconds and that of
cysts was highest at TE of 22.5 milliseconds. Mean SDNR of epithelioid
hemangioendotheliomas (EHE), focal eosinophilic infiltrations (FEI),
hepatocellular carcinomas (HCC), hemangiomas (HMG), and metastases (Mets) was
highest at TE of 13.5 milliseconds.
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Fig. 2A —68-year-old man with hepatocellular carcinoma (HCC) and
cirrhosis. Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo
images obtained with TEs of 9 (A), 13.5 (B), 18 (C), and
22.5 (D) milliseconds. Signal intensities of both HCC (arrow)
and liver gradually decreased as TE was lengthened, but signal decrease of
liver was more prominent between images obtained with TEs of 9 and 13.5
milliseconds. Signal difference-to-noise ratio was highest at TE of 13.5
milliseconds.
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Fig. 2B —68-year-old man with hepatocellular carcinoma (HCC) and
cirrhosis. Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo
images obtained with TEs of 9 (A), 13.5 (B), 18 (C), and
22.5 (D) milliseconds. Signal intensities of both HCC (arrow)
and liver gradually decreased as TE was lengthened, but signal decrease of
liver was more prominent between images obtained with TEs of 9 and 13.5
milliseconds. Signal difference-to-noise ratio was highest at TE of 13.5
milliseconds.
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Fig. 2C —68-year-old man with hepatocellular carcinoma (HCC) and
cirrhosis. Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo
images obtained with TEs of 9 (A), 13.5 (B), 18 (C), and
22.5 (D) milliseconds. Signal intensities of both HCC (arrow)
and liver gradually decreased as TE was lengthened, but signal decrease of
liver was more prominent between images obtained with TEs of 9 and 13.5
milliseconds. Signal difference-to-noise ratio was highest at TE of 13.5
milliseconds.
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Fig. 2D —68-year-old man with hepatocellular carcinoma (HCC) and
cirrhosis. Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo
images obtained with TEs of 9 (A), 13.5 (B), 18 (C), and
22.5 (D) milliseconds. Signal intensities of both HCC (arrow)
and liver gradually decreased as TE was lengthened, but signal decrease of
liver was more prominent between images obtained with TEs of 9 and 13.5
milliseconds. Signal difference-to-noise ratio was highest at TE of 13.5
milliseconds.
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Fig. 3A —40-year-old woman with hemangioma. Superparamagnetic iron
oxide (SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds.
Signal intensity (SI) of both hemangioma (arrow) and liver decreased
as TE was lengthened, but loss of SI of lesion is more prominent because
contrast agent is pooling in lesion; hence, lesion conspicuity is decreased on
images obtained with longer TEs.
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Fig. 3B —40-year-old woman with hemangioma. Superparamagnetic iron
oxide (SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds.
Signal intensity (SI) of both hemangioma (arrow) and liver decreased
as TE was lengthened, but loss of SI of lesion is more prominent because
contrast agent is pooling in lesion; hence, lesion conspicuity is decreased on
images obtained with longer TEs.
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Fig. 3C —40-year-old woman with hemangioma. Superparamagnetic iron
oxide (SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds.
Signal intensity (SI) of both hemangioma (arrow) and liver decreased
as TE was lengthened, but loss of SI of lesion is more prominent because
contrast agent is pooling in lesion; hence, lesion conspicuity is decreased on
images obtained with longer TEs.
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Fig. 3D —40-year-old woman with hemangioma. Superparamagnetic iron
oxide (SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds.
Signal intensity (SI) of both hemangioma (arrow) and liver decreased
as TE was lengthened, but loss of SI of lesion is more prominent because
contrast agent is pooling in lesion; hence, lesion conspicuity is decreased on
images obtained with longer TEs.
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Fig. 4A —51-year-old man with metastasis from rectal carcinoma.
Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo images
obtained with TEs of 9 (A), 13.5 (B), 18 (C), and 22.5
(D) milliseconds. There is no remarkable signal loss in small
metastasis (arrow) on images obtained with longer TEs, and lesion
conspicuity is comparable in all images; however, lesion looks smaller as TEs
are increased.
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Fig. 4B —51-year-old man with metastasis from rectal carcinoma.
Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo images
obtained with TEs of 9 (A), 13.5 (B), 18 (C), and 22.5
(D) milliseconds. There is no remarkable signal loss in small
metastasis (arrow) on images obtained with longer TEs, and lesion
conspicuity is comparable in all images; however, lesion looks smaller as TEs
are increased.
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Fig. 4C —51-year-old man with metastasis from rectal carcinoma.
Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo images
obtained with TEs of 9 (A), 13.5 (B), 18 (C), and 22.5
(D) milliseconds. There is no remarkable signal loss in small
metastasis (arrow) on images obtained with longer TEs, and lesion
conspicuity is comparable in all images; however, lesion looks smaller as TEs
are increased.
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Fig. 4D —51-year-old man with metastasis from rectal carcinoma.
Superparamagnetic iron oxide (SPIO)-enhanced gradient-recalled echo images
obtained with TEs of 9 (A), 13.5 (B), 18 (C), and 22.5
(D) milliseconds. There is no remarkable signal loss in small
metastasis (arrow) on images obtained with longer TEs, and lesion
conspicuity is comparable in all images; however, lesion looks smaller as TEs
are increased.
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Fig. 5A —46-year-old man with hepatocellular carcinoma (HCC).
Superparamagnetic iron oxide (SPIO)-enhanced steady-state gradient-recalled
echo images obtained with TEs of 9 (A), 13.5 (B), 18 (C),
and 22.5 (D) milliseconds. Signal intensity of small HCC is markedly
decreased as TE increases due to contrast uptake within lesion and prominent
susceptibility effect; hence, lesion is poorly shown on images obtained with
longer TE.
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Fig. 5B —46-year-old man with hepatocellular carcinoma (HCC).
Superparamagnetic iron oxide (SPIO)-enhanced steady-state gradient-recalled
echo images obtained with TEs of 9 (A), 13.5 (B), 18 (C),
and 22.5 (D) milliseconds. Signal intensity of small HCC is markedly
decreased as TE increases due to contrast uptake within lesion and prominent
susceptibility effect; hence, lesion is poorly shown on images obtained with
longer TE.
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Fig. 5C —46-year-old man with hepatocellular carcinoma (HCC).
Superparamagnetic iron oxide (SPIO)-enhanced steady-state gradient-recalled
echo images obtained with TEs of 9 (A), 13.5 (B), 18 (C),
and 22.5 (D) milliseconds. Signal intensity of small HCC is markedly
decreased as TE increases due to contrast uptake within lesion and prominent
susceptibility effect; hence, lesion is poorly shown on images obtained with
longer TE.
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Fig. 5D —46-year-old man with hepatocellular carcinoma (HCC).
Superparamagnetic iron oxide (SPIO)-enhanced steady-state gradient-recalled
echo images obtained with TEs of 9 (A), 13.5 (B), 18 (C),
and 22.5 (D) milliseconds. Signal intensity of small HCC is markedly
decreased as TE increases due to contrast uptake within lesion and prominent
susceptibility effect; hence, lesion is poorly shown on images obtained with
longer TE.
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Fig. 6A —68-year-old man with two hepatocellular carcinomas (HCCs)
(Edmondson grade 2) and cirrhosis. Superparamagnetic iron oxide
(SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds
and unenhanced T2-weighted fast spin-echo image (TR/TE, 6,000/105) (E).
Nodular HCC at lateral segment of liver (arrows) shows gradual signal
decrease as TE increases. Another small HCC (Edmondson grade 1-2) at medial
segment (arrowhead, E) was depicted on unenhanced T2-weighted
fast spin-echo image only.
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Fig. 6B —68-year-old man with two hepatocellular carcinomas (HCCs)
(Edmondson grade 2) and cirrhosis. Superparamagnetic iron oxide
(SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds
and unenhanced T2-weighted fast spin-echo image (TR/TE, 6,000/105) (E).
Nodular HCC at lateral segment of liver (arrows) shows gradual signal
decrease as TE increases. Another small HCC (Edmondson grade 1-2) at medial
segment (arrowhead, E) was depicted on unenhanced T2-weighted
fast spin-echo image only.
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Fig. 6C —68-year-old man with two hepatocellular carcinomas (HCCs)
(Edmondson grade 2) and cirrhosis. Superparamagnetic iron oxide
(SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds
and unenhanced T2-weighted fast spin-echo image (TR/TE, 6,000/105) (E).
Nodular HCC at lateral segment of liver (arrows) shows gradual signal
decrease as TE increases. Another small HCC (Edmondson grade 1-2) at medial
segment (arrowhead, E) was depicted on unenhanced T2-weighted
fast spin-echo image only.
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Fig. 6D —68-year-old man with two hepatocellular carcinomas (HCCs)
(Edmondson grade 2) and cirrhosis. Superparamagnetic iron oxide
(SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds
and unenhanced T2-weighted fast spin-echo image (TR/TE, 6,000/105) (E).
Nodular HCC at lateral segment of liver (arrows) shows gradual signal
decrease as TE increases. Another small HCC (Edmondson grade 1-2) at medial
segment (arrowhead, E) was depicted on unenhanced T2-weighted
fast spin-echo image only.
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Fig. 6E —68-year-old man with two hepatocellular carcinomas (HCCs)
(Edmondson grade 2) and cirrhosis. Superparamagnetic iron oxide
(SPIO)-enhanced gradient-recalled echo images obtained with TEs of 9
(A), 13.5 (B), 18 (C), and 22.5 (D) milliseconds
and unenhanced T2-weighted fast spin-echo image (TR/TE, 6,000/105) (E).
Nodular HCC at lateral segment of liver (arrows) shows gradual signal
decrease as TE increases. Another small HCC (Edmondson grade 1-2) at medial
segment (arrowhead, E) was depicted on unenhanced T2-weighted
fast spin-echo image only.
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