Mangafodipir trisodium‐enhanced MRI for the detection and characterization of focal hepatic lesions: Is delayed imaging useful?

Abstract

Purpose:To investigate the usefulness of early and delayed hepatic MRI after mangafodipir trisodium (Mn-DPDP) administration for the detection and characterization of focal hepatic lesions. Materials and Methods:Forty-five patients (31 males and 14 females, mean age ϭ 61 years) with a total of 113 hepatic lesions (mean size ϭ 3.5 cm) were included in this study (15 with hepatocellular carcinoma (HCC, N ϭ 35), 20 with hepatic metastasis (N ϭ 63), five with hemangioma (N ϭ 10), three with cholangiocarcinoma (CC, N ϭ 3), and two with liver abscess (N ϭ 2)). T1-weighted gradient-echo MR images were obtained before and after Mn-DPDP administration, with a mean 18-hour delayed imaging. A qualitative analysis (including the size and signal intensity (SI)) and quantitative analysis (including enhancement and lesionliver contrast-to-noise ratio (CNR)) were performed on preand postcontrast early and delayed MR images.Results: Compared to postcontrast early imaging, 17 (48.6%) of 35 HCCs showed higher SI, 16 (45.7%) showed no SI change, and two (5.7%) showed lower SI on delayed imaging. All 63 metastases, 10 hemangiomas, three CCs, and two abscesses showed no SI change. On delayed imaging, ring enhancement was noted in 53 metastases (84.1%), three hemangiomas (30.0%), and one abscess (50.0%), but was not seen in HCCs or CCs. Eight metastases (12.7%) also showed ring enhancement on postcontrast early imaging. No newly detected hepatic lesions were revealed on postcontrast delayed MR images compared to postcontrast early images. Regarding CNR, the HCCs showed a significant increase in CNR from postcontrast early to delayed images after administration of Mn-DPDP (P Ͻ 0.01). However, none of the metastases, hemangiomas, CCs, and abscesses showed a significant increase of CNR from postcontrast early to delayed images. Conclusion:Postcontrast delayed MR images after Mn-DPDP administration were helpful in distinguishing hepatocellular from nonhepatocellular lesions, but were not useful for lesion detection and had limited utility for lesion characterization, since benign and malignant hepatic lesions looked the same.

Manganese‐enhanced MRI of salivary glands and head and neck tumors in living subjects

“…First, ME‐MRI can potentially be applied for examination of neoplastic and nonneoplastic inflammatory diseases of salivary glands when manganese is administered judiciously in doses clinically proven to cause little or no cardiac and neurotoxicity. Indeed, studies have demonstrated that Mn‐based contrast agents can be safely used for diagnosis of hepatic lesions and bile duct leaks for MR cholangiopancreatography (23, 24). Second, given that maximal contrast enhancement of salivary gland tissues was observed at 24 h after MnCl 2 administration, perhaps delayed imaging could be considered for clinical ME‐MRI studies.…”

“…Second, given that maximal contrast enhancement of salivary gland tissues was observed at 24 h after MnCl 2 administration, perhaps delayed imaging could be considered for clinical ME‐MRI studies. Additional diagnostic utility of delayed MR imaging has been previously suggested with Mn‐containing contrast agents for clinical liver imaging (24). Third, the ability of ME‐MRI to monitor tumor and normal tissues using ME‐MRI is particularly relevant in head and neck oncology.…”

Robotic liver surgery: technical aspects and review of the literature

“…Moreover, this technique has interesting perspectives for differentiation of hepatic lesions based on their vascular pattern. Well-differentiated hepatocarcinomas (HCC) are hyperfluorescent, while poorly-differentiated HCCs and colorectal metastases are hypofluorescent (30,33). In adjunction to preoperative imaging, this method could increase accuracy of lesion detection, or even distinction between benign and malignant masses.…”

Clinical Application of Fluorescence Imaging of Liver Cancer Using Indocyanine Green

“…The existence of impaired bile excretion in HCC and in noncancerous tissues surrounding the cancer had been suggested by the results of magnetic resonance imaging with a bile-excreted contrast medium [22]. Moreover, Kitao et al demonstrated reduced expression of organic anion transporting polypeptide 8, which is involved in the cellular uptake of contrast media, in poorly differentiated HCC compared with that in well-differentiated HCC [23], and the differences between the enhancement patterns of well-and poorly differentiated HCC by ICG fluorescence imaging may also be attributable to a similar mechanism.…”