Preoperative Depiction of Hepatocellular Carcinoma: Ferumoxides-enhanced MR Imaging versus Triple-Phase Helical CT

Kang, Bo Kiung; Lim, Jae Hoon; Kim, Seung Hoon; Choi, Dongil; Lim, Hyo Keun; Lee, Won Jae; Lee, Soon Jin

doi:10.1148/radiol.2261011827

Cited by 82 publications

(48 citation statements)

References 31 publications

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“…Upon review of the image, the observers were aware that sensitivity was calculated with the number of lesions assigned a confidence level of 3 or 4. In clinical practice at our institution, nodules that became enhanced in the arterial phase and had a washout pattern in the portal or equilibrium phase with or without capsular enhancement at triple-phase MDCT were considered HCC [4,[16][17][18][19]. The criteria for HCC on gadoxetic acid-enhanced MR images were similar to the criteria for the triple-phase dynamic CT pattern: enhancement in the arterial phase and a washout pattern in the portal or 3-min late phase that revealed the mixed enhancing features of both equilibrium phase and hepatobiliary phase images as hepatocyte-related enhancement starts approximately 1 min after intravenous injection of gadoxetate disodium [20].…”

Section: Image Analysismentioning

confidence: 99%

Small (≤2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT

Hwang

Kim²,

Lee³

et al. 2012

BJR

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Objectives: To compare the diagnostic performance of gadoxetic acid-enhanced MRI using 3.0 T with that of multiphasic 64-multirow detector CT (MDCT) for the detection of small (#2 cm) hepatocellular carcinoma (HCC) in patients with chronic liver disease. Methods: A total of 54 patients (44 men, 10 women; age range, 33-81 years) with 59 HCCs (#2 cm in diameter) who underwent both multiphasic (arterial, portal venous, equilibrium) 64-MDCT and gadoxetic acid-enhanced 3.0 T MRI were enrolled in this study. Two observers independently and randomly reviewed the MR and CT images on a lesion-by-lesion basis. The diagnostic performance of these techniques for the detection of HCC was assessed by alternative free-response receiver operating characteristic (ROC) analysis, in addition to evaluating the sensitivity and positive predictive value. Results: For each observer, the areas under the ROC curve were 0.874 and 0.863 for MRI, respectively, as opposed to 0.660 and 0.687 for CT, respectively. The differences between the two techniques were statistically significant for each observer (p,0.001). The sensitivities (89.8% and 86.4%) of MRI for both observers were significantly higher than those (57.6% and 61.0% for each observer, respectively) of MDCT. No significant difference was seen between the positive predictive values for the two techniques (p.0.05). Conclusion: Gadoxetic acid-enhanced 3.0 T MRI shows a better diagnostic performance than that of 64-MDCT for the detection of small (#2 cm) HCCs in patients with chronic liver disease. Hepatocellular carcinoma (HCC) is associated with underlying chronic liver disease in more than 90% of cases, and constitutes the leading cause of death in patients with chronic liver disease [1,2]. Therefore, early detection and accurate assessment of small HCC are of great importance when planning the most appropriate therapeutic approach. The efficacy of various treatments and the survival of patients with small HCC are much more successful than those for patients with larger tumours. The typical imaging feature of HCC on one or two dynamic studies, including either CT scanning, contrast-enhanced ultrasound or MRI, has been used to establish the diagnosis of HCC according to the size of the lesion (1-2 cm or .2 cm in diameter) in patients with chronic liver disease [3,4]. With a state-of-the-art imaging technique, the detection of smaller lesions in the liver may be possible. However, there is still great difficulty in the characterisation of hypervascular nodules ,2 cm in diameter, which often have non-specific imaging characteristics [5].The use of multirow detector CT (MDCT), which has advantages that include greater speed, thinner slices and multiphasic scanning, has improved the chance of detecting HCC [6,7]. The diagnostic performance of liver MRI for detecting and characterising focal hepatic lesions has also been improved with the development of MRI technologies and MR contrast media [8,9]. Recently, a widely used liver-specific contrast agent, gadolinium ethoxybenzyl diethylenet...

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Section: Image Analysismentioning

confidence: 99%

Small (≤2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT

Hwang

Kim²,

Lee³

et al. 2012

BJR

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“…Moreover, several investigators reported that ferumoxide-enhanced MRI appeared to be superior to CTAP and dual-or triplephase helical CT to detect hepatocellular carcinoma (16,22,23). In addition, Reimer et al reported that the ferucarbotran-enhanced MRI appeared to be superior to the dual-or triple-phase helical CT images for the detection of hepatic lesions (20).…”

Section: Discussionmentioning

confidence: 99%

“…First, a well-differentiated hepatocellular carcinoma may result in the active uptake of ferucarbotran particles, which results in iso-or hypointensity on ferucarbotran-enhanced images. Previous studies (16,19) have pointed out that a variety of hepatic tumors, such as focal nodular hyperplasia, regenerative nodule, hepatic adenoma, dysplastic nodule, and well-differentiated hepatocellular carcinomas can display a variable uptake of SPIO, since these tumors contain a variable number of Kupffer's cells. Therefore, it may be difficult to distinguish well-differentiated hepatocellular carcinoma from other benign hepatic tumors.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a nodule of mixed attenuation located at the hepatic arterial and portal venous phases displayed a low attenuation on the delayed phase. Moreover, a nodule size larger than 2 cm provided low attenuation on the portal venous and delayed phases, without definite enhancement on the arterial phase, and was similarly regarded as hepatocellular carcinoma (4,6,16).…”

Section: Image Analysismentioning

confidence: 99%

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Comparison of Ferucarbotran-Enhanced MRI and Triple-Phase MDCT for the Detection of Hepatocellular Carcinoma in Advanced Liver Cirrhosis

Jeon

Kim

Choi

et al. 2008

J Korean Radiol Soc

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Purpose:To compare the diagnostic performance of ferucarbotran-enhanced MRI at 1.5-T with triple-phase multidetector-row helical CT (MDCT) to detect hepatocellular carcinoma in patients with advanced liver cirrhosis. Materials and Methods: Twenty patients with advanced liver cirrhosis (Child's class B:C = 8:12) underwent ferucarbotran-enhanced MRI and triple-phase MDCT prior to liver transplantation. The mean time interval between the two imaging techniques was 18 days (range, 1 35 days). Three radiologists independently reviewed both images on a lesion-by-lesion basis and interpreted them for comparison with the pathologic findings of the explanted livers. As well, the sensitivity and an alternative-free response receiver operating characteristics (ROC) analysis was used to evaluate the diagnostic performance of each technique. Results: The mean area under the ROC curve (Az) was significantly higher for the triple-phase MDCT (0.766) compared to the ferucarbotran-enhanced MRI (0.675) (p < 0.001). Similarly, the mean sensitivity of the triple-phase MDCT (60.3%) exceeded the ferucarbotran-enhanced MRI (43.1%). The results indicate that the triple-phase MD-CT provides significantly greater mean sensitivity than the ferucarbotran-enhanced MRI (p < 0.001). Conclusion:The triple-phase MDCT provided a better diagnostic performance and higher sensitivity than the ferucarbotran-enhanced MRI for the detection of hepatocellular carcinomas in patients with advanced liver cirrhosis.

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“…SPIO-enhanced MR imaging has been reported to be useful for the detection of both metastatic (1,2) and primary (3,4) liver tumors.…”

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confidence: 99%

Hemodynamic characterization of focal hepatic lesions: Role of ferucarbotran‐enhanced dynamic MR imaging using T2‐weighted multishot spin‐echo echo‐planar sequence

Hori

Murakami

Kim

et al. 2006

Magnetic Resonance Imaging

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Purpose:To investigate the role of ferucarbotran-enhanced dynamic MR imaging using multishot spin-echo echo-planar sequence in the evaluation of hemodynamics of focal hepatic lesions. Materials and Methods:Sixty-three focal hepatic lesions (24 benign and 39 malignant) from 53 consecutive patients who underwent both ferucarbotran-enhanced MR imaging and dynamic computed tomography (CT) were included in this study. MR imaging was performed with a 1.5-T scanner with a phased-array coil. T2-weighted multishot spin-echo echo-planar sequences (TR/TE ϭ 1714 -2813/80 msec) were obtained during a single breathhold before and 15, 60, 120, 180, and 600 seconds after intravenous injection of ferucarbotran. The enhancement patterns of lesions were classified into three categories by a study coordinator on the basis of dynamic CT images as hypervascular, hypovascular, and hemangioma type. The study coordinator created mean contrast-to-noise ratio of lesions vs. time curves for each enhancement pattern for quantitative analyses. Moreover, three radiologists separately and blindly reviewed MR images, and then assigned three confidence scores for the three enhancement patterns to each lesion. Sensitivity, specificity, and receiver operating characteristic analyses were performed. Results:Quantitative analyses showed characteristic enhancement curves for each enhancement pattern. Mean sensitivities/specificities were 0.816/0.882, 0.897/0.863, and 0.800/0.989 for hypervascular, hypovascular, and hemangioma types, respectively. Mean areas under the receiver operating characteristic curve were 0.886 for hypervascular type and 0.913 for hypovascular type. Conclusion:Ferucarbotran-enhanced dynamic MR imaging can be used to successfully characterize the hemodynamics of focal hepatic lesions.

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Preoperative Depiction of Hepatocellular Carcinoma: Ferumoxides-enhanced MR Imaging versus Triple-Phase Helical CT

Abstract: Ferumoxides-enhanced MR imaging is superior to triple-phase helical CT for the preoperative depiction of HCC.

Cited by 82 publications

References 31 publications

Small (≤2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT

Small (≤2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT

Comparison of Ferucarbotran-Enhanced MRI and Triple-Phase MDCT for the Detection of Hepatocellular Carcinoma in Advanced Liver Cirrhosis

Hemodynamic characterization of focal hepatic lesions: Role of ferucarbotran‐enhanced dynamic MR imaging using T2‐weighted multishot spin‐echo echo‐planar sequence

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