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Diagnosis of Hepatic Metastasis: Comparison of Respiration-Triggered Diffusion-Weighted Echo-Planar MRI and Five T2-Weighted Turbo Spin-Echo Sequences

¹ Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany.
² Siemens Medical Solutions, Erlangen, Germany.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —54-year-old woman with neuroendocrine carcinoma of small bowel. Both observers correctly identified 12-mm metastatic lesion (short arrow) on all images and detected 4- and 5-mm metastatic lesions (long arrows, D and E) only with diffusion-weighted single-shot echo-planar sequence. Small cyst (arrowhead) has markedly high signal intensity in D that fades out in E, whereas metastatic lesions retain their high signal intensity. Cyst has high apparent diffusion coefficient (ADC) and is clearly visible in F, whereas metastatic lesions have low ADC similar to that of hepatic parenchyma. T2-weighted fat-suppressed HASTE MR image.

View larger version (91K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —54-year-old woman with neuroendocrine carcinoma of small bowel. Both observers correctly identified 12-mm metastatic lesion (short arrow) on all images and detected 4- and 5-mm metastatic lesions (long arrows, D and E) only with diffusion-weighted single-shot echo-planar sequence. Small cyst (arrowhead) has markedly high signal intensity in D that fades out in E, whereas metastatic lesions retain their high signal intensity. Cyst has high apparent diffusion coefficient (ADC) and is clearly visible in F, whereas metastatic lesions have low ADC similar to that of hepatic parenchyma. T2-weighted fat-suppressed breath-hold turbo spin-echo MR image.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —54-year-old woman with neuroendocrine carcinoma of small bowel. Both observers correctly identified 12-mm metastatic lesion (short arrow) on all images and detected 4- and 5-mm metastatic lesions (long arrows, D and E) only with diffusion-weighted single-shot echo-planar sequence. Small cyst (arrowhead) has markedly high signal intensity in D that fades out in E, whereas metastatic lesions retain their high signal intensity. Cyst has high apparent diffusion coefficient (ADC) and is clearly visible in F, whereas metastatic lesions have low ADC similar to that of hepatic parenchyma. T2-weighted fat-suppressed respiration-triggered turbo spin-echo MR image.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —54-year-old woman with neuroendocrine carcinoma of small bowel. Both observers correctly identified 12-mm metastatic lesion (short arrow) on all images and detected 4- and 5-mm metastatic lesions (long arrows, D and E) only with diffusion-weighted single-shot echo-planar sequence. Small cyst (arrowhead) has markedly high signal intensity in D that fades out in E, whereas metastatic lesions retain their high signal intensity. Cyst has high apparent diffusion coefficient (ADC) and is clearly visible in F, whereas metastatic lesions have low ADC similar to that of hepatic parenchyma. Diffusion-weighted respiration-triggered single-shot echo-planar MR image, b = 50 s/mm2.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —54-year-old woman with neuroendocrine carcinoma of small bowel. Both observers correctly identified 12-mm metastatic lesion (short arrow) on all images and detected 4- and 5-mm metastatic lesions (long arrows, D and E) only with diffusion-weighted single-shot echo-planar sequence. Small cyst (arrowhead) has markedly high signal intensity in D that fades out in E, whereas metastatic lesions retain their high signal intensity. Cyst has high apparent diffusion coefficient (ADC) and is clearly visible in F, whereas metastatic lesions have low ADC similar to that of hepatic parenchyma. Diffusion-weighted respiration-triggered single-shot echo-planar MR image, b = 600 s/mm2.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —54-year-old woman with neuroendocrine carcinoma of small bowel. Both observers correctly identified 12-mm metastatic lesion (short arrow) on all images and detected 4- and 5-mm metastatic lesions (long arrows, D and E) only with diffusion-weighted single-shot echo-planar sequence. Small cyst (arrowhead) has markedly high signal intensity in D that fades out in E, whereas metastatic lesions retain their high signal intensity. Cyst has high apparent diffusion coefficient (ADC) and is clearly visible in F, whereas metastatic lesions have low ADC similar to that of hepatic parenchyma. Diffusion-weighted respiration-triggered single-shot echo-planar MR image ADC map.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. T2-weighted fat-suppressed HASTE MR image.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. T2-weighted fat-suppressed breath-hold MR image.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. T2-weighted breath-hold STIR MR image.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. T2-weighted respiration-triggered turbo spin-echo MR image.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. T2-weighted respiration-triggered STIR MR image.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. Diffusion-weighted respiration-triggered single-shot echo-planar MR image, b = 50 s/mm2.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2G —61-year-old woman with breast cancer. Because of low lesion-to-liver contrast and interfering high signal intensity of intrahepatic vessels, 7- and 11-mm metastatic lesions (arrows) were frequently missed by observers on T2-weighted turbo spin-echo images (A–E). F and G clearly show both lesions. Diffusion gradient with b value of 600 s/mm2 (G) induces increased background noise but suppresses signal intensity of bile ducts. Thus metastatic lesions remain only hyperintense structures within hepatic parenchyma. Diffusion-weighted respiration-triggered single-shot echo-planar MR image, b = 600 s/mm2.

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