Liver Lesion Characterization: The Wrong Choice of Contrast Agent Can Mislead the Diagnosis of Hemangioma

Pradella, Silvia; Lucarini, Silvia; Colagrande, Stefano

doi:10.2214/ajr.12.8951

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…2) which confirms earlier findings by Gupta and Pradella et al. (16,17). In these cases the diagnostic value of T2W images is reduced, as mucinous CRLM and hemangiomas have a comparatively high signal on T2W images.…”

Section: Discussionsupporting

confidence: 92%

“…The main reason for the relatively low specificity of MRI was due to difficulties to differentiate between CRLM and hemangiomas, representing 20 of 27 false positive findings. The reason for the difficulties of MRI to correctly characterize hemangiomas in these cases is probably related to a false washout in the hemangiomas, which appear iso- or hypo-intense compared to the surrounding hepatocytes which already have a considerable uptake of Gd-EOB-DTPA (16,17). Differentiation was particularly challenging in the simultaneous presence of mucinous CRLM and hemangiomas (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic performance of CT, MRI and PET/CT in patients with suspected colorectal liver metastases: the superiority of MRI

et al. 2016

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of CT, MRI and PET/CT in patients with suspected colorectal liver metastases: the superiority of MRI

et al. 2016

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“…The reason for the difficulties to distinguish between hemangiomas and CRLM was probably the suboptimal hemodynamic characteristics of Gd-EOB-DTPA for characterization of those lesions ( Figure 9). Gd-EOB-DTPA is rapidly taken up by the hepatocytes while contrast uptake into the hemangioma occurs significantly slower [106,107]. This might give the impression of a pseudo washout or missing contrast uptake into the lesion due to the relatively low signal intensity within the lesion compared to the surrounding hepatocytes which might mimic CRLM.…”

Section: The Multimodality Approach To Crlm or One-stop Shopping?mentioning

confidence: 99%

Impact of Contrast-Enhanced Intraoperative Ultrasound on Operation Strategy in Case of Colorectal Liver Metastasis

et al. 2012

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Background Surgical treatment is the only option for long-term survival in patients with colorectal liver metastasis (CRLM). Contrast-enhanced CT and MRI are usually used for preoperative liver imaging. The initial surgical strategy for liver resection is based upon these findings. Further optimization of the surgical strategy by contrast-enhanced intraoperative ultrasound (CE-IOUS) might further improve the surgical outcome. Purpose To evaluate the current impact of CE-IOUS with SonoVue® on the initial surgical strategy for CRLM. Material and Methods Eighty-six consecutive patients undergoing open liver resection for CRLM were evaluated retrospectively over a 2.5-year period. The patients underwent 97 operations. Preoperative staging was performed with contrast-enhanced CT in all patients and MRI was available in 66 of 86 patients. CE-IOUS was performed in all patients according to a standardized examination technique. Curved array and linear transducers were used. CRLM were identified in venous phase as hypovascular lesions. CE-IOUS findings were compared with preoperative staging. Results Combined CT/MRI identified preoperatively 328 CRLM (mean 3.4, range 0-14). Seventy-two additional lesions (18%) were identified in 38 patients during the operation. Intraoperatively 41 additional CRLM in 20 patients were identified by inspection, palpation, and CE-IOUS (10%), and another 31 CRLM in 17 patients were identified by CE-IOUS alone (8%). All additional CRLM detected by CE-IOUS were confirmed by histology if resection was performed. CE-IOUS changed planned operation strategy in 29.9% of operations. A larger resection was necessary in 13.4% of the cases, reduced liver resection was found sufficient in 11.3%, and 5.2% were found inoperable. For patients diagnosed preoperatively with solitary lesions CE-IOUS changed operation strategy in 19% and radical tumor resection would have failed in 4.8% without CE-IOUS. Conclusion CE-IOUS is essential to ensure optimal and complete tumor resection both in patient with solitary CRLM and multiple metastases.

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“…All six hemangiomas which concurred with mucinous CRLM were interpreted as CRLM while none was FP in the MDCT set. The reason for the difficulties of MRI to correctly characterize hemangiomas in general is probably related to a false washout in hemangiomas that appear iso- or hypo-intense compared to the surrounding hepatocytes which already show a considerable uptake of Gd-EOB-DTPA (25,26). In the DWI sets, where this problem does not occur because no Gd-EOB-DTPA is applied, fewer FP findings were observed.…”

Section: Discussionmentioning

confidence: 99%

Preoperative detection of colorectal liver metastases: DWI alone or combined with MDCT is no substitute for Gd-EOB-DTPA-enhanced MRI

et al. 2019

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Background Magnetic resonance imaging (MRI) with hepatocyte specific contrast has the highest sensitivity for colorectal liver metastases but comes at high costs and long examination times. Purpose To evaluate if preoperative detection of colorectal liver metastases with less resource-consuming diffusion-weighted imaging (DWI) alone or in combination with multidetector computed tomography (MDCT) can compete with gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. Material and Methods Forty-four patients with 123 colorectal liver metastases received MDCT and Gd-EOB-DTPA-enhanced MRI including DWI before liver resection for colorectal liver metastases. Five image sets were evaluated by two radiologists. The DWI set consisted of DWI, ADC map, coronal, axial T2-weighted single-shot sequences. The DWI-T2F set contained additionally respiratory-triggered T2-weighted TSE-SPIR sequences. The MDCT set consisted of four-phase MDCT, the MDCT-DWI set also contained DWI. The CE-MRI set contained all MRI sequences including Gd-EOB-DTPA. Reference standards was histopathology and follow-up. Results CE-MRI set had highest sensitivity ( P ≤ 0.013) with 95% compared to 72%, 73%, 73%, and 87% the for DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The CE-MRI set had the highest sensitivity ( P≤0.012) for colorectal liver metastases <10 mm with 87% compared to 55%, 52%, 23%, and 58% for the DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The MDCT-DWI set improved sensitivity overall and in size-dependent subgroup analyses compared to the MDCT set ( P ≤ 0.031). The MDCT-DWI set showed the highest specificity of 98% followed by 98%, 98%, 95%, and 88% for the DWI set, DWI-T2W-FS set, MDCT set, and CE-MRI set, respectively. Conclusion The less resource and time-consuming DWI sets are inferior to Gd-EOB-DTPA-enhanced MRI for the detection of colorectal liver metastases. Gd-EOB-DTPA-enhanced MRI with its excellent sensitivity should be the preferred preoperative modality when meticulous lesion identification is essential. Combination of DWI with MDCT improved significantly sensitivity compared to each modality alone.

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Liver Lesion Characterization: The Wrong Choice of Contrast Agent Can Mislead the Diagnosis of Hemangioma

Cited by 9 publications

References 3 publications

Diagnostic performance of CT, MRI and PET/CT in patients with suspected colorectal liver metastases: the superiority of MRI

Diagnostic performance of CT, MRI and PET/CT in patients with suspected colorectal liver metastases: the superiority of MRI

Impact of Contrast-Enhanced Intraoperative Ultrasound on Operation Strategy in Case of Colorectal Liver Metastasis

Preoperative detection of colorectal liver metastases: DWI alone or combined with MDCT is no substitute for Gd-EOB-DTPA-enhanced MRI

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