Differentiation between small hepatic hemangiomas and metastases on MR images: importance of size-specific quantitative criteria.

Itoh, Kyo; Saini, Sanjay; Hahn, Peter F.; Imam, Nehala; Ferrucci, J T

doi:10.2214/ajr.155.1.2112865

Cited by 50 publications

(22 citation statements)

References 12 publications

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“…Nas imagens ponderadas em T2, Itoh et al (23) mostraram que à medida que o tamanho da lesão diminui, a separação entre hemangiomas e metástases torna-se mais difícil com base apenas nos valores da RLF. Para aumentar a acurácia diagnósti-ca no grupo de lesões menores que 2,0 cm, os autores propuseram a utilização de um valor de corte da RLF de 2,5, em vez do valor de 3,5 utilizado nos grupos de lesões com maiores dimensões.…”

Section: Discussionunclassified

“…No trabalho de Ohtomo et al (24) , 15 das 16 lesões erroneamente diagnosticadas utilizando como parâmetro valores de tempos de relaxação T2 superiores a 80 ms (em campo magné-tico de 1,5 T) eram hemangiomas com dimensões menores que 2,0 cm. Nesses trabalhos, os autores correlacionam a dificuldade encontrada na caracterização quantitativa de lesões menores que 2,0 cm a medidas de sinal imprecisas decorrentes de efeito de volume parcial (23,24) . Em muitas séries, os autores excluem da análise quantitativa nódulos ≤ 1,0 cm, tanto para o estudo dos valores de relaxação T2 (6,7,10) como da RLF (7) .…”

Section: Discussionunclassified

“…Como já anteriormente salientado por outros autores (23,24) , esta menor eficácia da RLF na caracterização de pequenas lesões poderia ser decorrente de medidas incorretas (subestimadas) da intensidade do sinal dessas lesões, devido ao fenômeno de volume parcial. A comparação de uma intensidade de sinal subestimada em uma lesão pequena (que seria causada pela "contaminação" do sinal da lesão pelo sinal do fígado adjacente) com a intensidade de sinal do parênquima hepático poderia refletir um valor de RLF menor do que o real.…”

Section: Discussionunclassified

“…Esta maior sensibilidade pode, às vezes, criar um problema no que concerne à caracterização tecidual, pois lesões muito pequenas e de etiologias diferentes podem não apresentar aspectos morfológicos suficientemente distintos para possibilitar a sua diferenciação. Vá-rios autores relataram dificuldades na caracterização de pequenos hemangiomas, quer com o uso de parâmetros quantitativos (valores do tempo de relaxação T2 e da RLF) (23,24) quer com o uso do meio de contraste paramagnético (14) . Alguns autores acreditam que os valores de corte dos parâmetros quantitativos utilizados para caracterizar hemangiomas menores que 2,0 cm devem ser diferentes daqueles utilizados para caracterizar lesões maiores, com a finalidade de aumentar a sensibilidade no diagnóstico de pequenas lesões (23) .…”

Section: Artigo Originalunclassified

“…Vá-rios autores relataram dificuldades na caracterização de pequenos hemangiomas, quer com o uso de parâmetros quantitativos (valores do tempo de relaxação T2 e da RLF) (23,24) quer com o uso do meio de contraste paramagnético (14) . Alguns autores acreditam que os valores de corte dos parâmetros quantitativos utilizados para caracterizar hemangiomas menores que 2,0 cm devem ser diferentes daqueles utilizados para caracterizar lesões maiores, com a finalidade de aumentar a sensibilidade no diagnóstico de pequenas lesões (23) . Muitos trabalhos que estudaram a caracterização quantitativa de hemangiomas e lesões hepáticas malignas excluíram da análise lesões menores que 1,0 cm (6,7,10) e até lesões menores que 2,0 cm (20) , justificando que medidas quantitativas em pequenas lesões podem ser imprecisas e degradar a utilidade dos parâmetros quantitativos na caracterização lesional.…”

Section: Artigo Originalunclassified

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Ressonância magnética dos hemangiomas hepáticos: avaliação das características morfológicas e quantitativas

2003

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INTRODUÇÃOHemangioma é o tumor hepático benigno mais comum, com incidência, em estudos de autópsias, variando entre 0,4% e 20%(1-3) , e sua diferenciação com tumores hepáticos malignos primários e secundá-rios é um dilema clínico comum. Na últi-ma década, a ressonância magnética (RM) se estabeleceu como método de imagem confiável na caracterização do hemangio- Magnetic resonance imaging of hepatic hemangiomas: morphologic and quantitative characteristics. OBJECTIVE: To evaluate the qualitative (morphological) and quantitative characteristics of hepatic hemangiomas with magnetic resonance imaging. MATERIAL AND METHODS: Twenty-seven patients with 57 hemangiomas were prospectively studied with magnetic resonance imaging using a system operating at 1.5 T. T1-and T2-weighted spin-echo images were obtained, including heavily T2-weighted images with TE of 160 ms. The morphological characteristics of the hemangiomas were studied and the lesions were classified as typical or atypical. Quantitative parameters (T2 relaxation time, simplified T2 index and lesion/liver signal intensity ratio) were also calculated. The values obtained for typical and atypical hemangiomas were compared as well as for the hemangiomas measuring ≤ 2.0 cm and > 2.0 cm. RESULTS: 78.9% of hemangiomas showed typical morphological features. There was no difference between the quantitative values for typical and atypical hemangiomas. There was not significant difference in T2 relaxation times and values of simplified T2 index in hemangiomas measuring ≤ 2.0 cm and > 2.0 cm. Lesion/liver signal intensity ratios showed significant differences between the two groups. T2 relaxation times, the simplified T2 index and the lesion/liver signal intensity ratios correctly characterized 96.5%, 93%, and 89.5% of the hemangiomas, respectively. CONCLUSION: Quantitative analysis of hepatic hemangiomas is a simple technique that in conjunction with morphological evaluation provides a more reliable characterization of these tumors. RESSONÂNCIA MAGNÉTICA DOS HEMANGIOMAS HEPÁTICOS: AVALIAÇÃO DAS CARACTERÍSTICAS MORFOLÓGICAS E QUANTITATIVAS*

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Ressonância magnética dos hemangiomas hepáticos: avaliação das características morfológicas e quantitativas

2003

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MRI of focal nodular hyperplasia (FNH) with gadobenate dimeglumine (Gd‐BOPTA) and SPIO (ferumoxides): An intra‐individual comparison

Grazioli

Morana

Kirchin

et al. 2003

Magnetic Resonance Imaging

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Purpose:To compare the efficacy of two different MR contrast agents for the detection and diagnosis of focal nodular hyperplasia (FNH). Materials and Methods:Fifty patients with 83 FNH lesions detected on spiral CT were studied in two different MRI sessions with Gd-BOPTA (MultiHance) and ferumoxides (Endorem®). MRI with Gd-BOPTA was performed precontrast (T1wGRE and T2wTSE sequences) and during the dynamic and late (1-3 hours) phases after injection (T1wGRE sequences only). MRI with ferumoxides (T1wGRE and T2wTSE sequences) was performed before and at least 30 minutes after injection. Hyper-or isointensity of FNH in the late phase was considered typical for Gd-BOPTA, while isointensity or lesion hypointensity was considered typical for ferumoxides.Results: With Gd-BOPTA, 83 FNH lesions (100%) appeared hyperintense during the arterial phase of dynamic MRI. All but one lesion was iso-or slightly hyperintense in the portal-venous and equilibrium phases. In the late phase, 81 FNH lesions were hyper-or isointense to the surrounding parenchyma, with two lesions appearing slightly hypointense. With ferumoxides, a significant (P Ͻ 0.001) number (21/83, 25.3%) of FNH lesions (mean diameter ϭ 16.8 Ϯ 6.6 mm) were not visible. Of the visible FNH lesions, 38/62 were slightly hyperintense, and 24/62 were isointense to the surrounding parenchyma on the T2wTSE images. On the T1wGRE images, 42/62 lesions were isointense, 19/62 were slightly hyperintense, and one lesion was slightly hypointense. Seventeen lesions in 12 patients with previous neoplasia were all detected after Gd-BOPTA administration, whereas only nine of these 17 lesions (52.9%) were detected after ferumoxide administration. Two of these nine lesions showed atypical enhancement features. Conclusion:Gd-BOPTA-enhanced MRI is significantly better than ferumoxide-enhanced MRI for the identification and characterization of FNH.

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Mn‐DPDP enhancement patterns of hepatocellular lesions on MR images

Vogl¹,

Hamm²,

Schnell³

et al. 1993

Magnetic Resonance Imaging

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The recently developed paramagnetic hepatobiliary contrast agent manganese dipyridoxyl diphosphate (DPDP) was evaluated in eight patients. Pathologic diagnoses included five hepatocellular carcinomas, two cirrhoses, and one focal nodular hyperplasia. T1-weighted spin-echo and gradient-echo images were obtained after intravenous injection of 5 or 10 mumol/kg Mn-DPDP; these were compared with unenhanced T1-weighted spin-echo and gradient-echo images and T2-weighted spin-echo images. In all patients with lesions of hepatocellular origin, focal areas of increased enhancement were seen in the lesions after administration of Mn-DPDP. In the cirrhotic livers, these areas corresponded to foci of hepatic regeneration. In all patients, the signal-to-noise ratio in normal liver tissue increased significantly after injection of Mn-DPDP. Signal intensity in the six primary liver tumors was further increased, so that they appeared hyperintense relative to surrounding liver tissue on all T1-weighted images. Conspicuity and demarcation of all lesions were improved on Mn-DPDP-enhanced images.

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Differentiation between small hepatic hemangiomas and metastases on MR images: importance of size-specific quantitative criteria.

Cited by 50 publications

References 12 publications

Ressonância magnética dos hemangiomas hepáticos: avaliação das características morfológicas e quantitativas

Ressonância magnética dos hemangiomas hepáticos: avaliação das características morfológicas e quantitativas

MRI of focal nodular hyperplasia (FNH) with gadobenate dimeglumine (Gd‐BOPTA) and SPIO (ferumoxides): An intra‐individual comparison

Mn‐DPDP enhancement patterns of hepatocellular lesions on MR images

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