Validation study of perfusion parameter in hypervascular hepatocellular carcinoma and focal nodular hyperplasia using dynamic susceptibility magnetic resonance imaging with super-paramagnetic iron oxide: comparison with single level dynamic CT arteriography

Abstract

Background: Dynamic susceptibility contrast MR imaging (DSC-MRI) offers direct evaluation of neovascularity. Ferucarbotran does not accumulate in the interstitial space, instead remaining in the intravascular space during early phase imaging. We investigate tracer kinetic analysis with DSC-MRI with ferucarbotran and single level CT during hepatic arteriography (SL-CTHA) in assessment of hypervascular hepatocellular lesions and evaluate the usefulness of DSC-MRI with ferucarbotran.Methods: Six patients having hypervascular hepatocellular carcinoma (HCC) and 3 patients having focal nodular hyperplasia (FNH) were included in the study. SL-CTHA was performed with the infusion of 3 mL of contrast media at a rate of 1 mL/s and scanned at a rate of 0.8 second per rotation. DSC-MRI was acquired with the echo-planar method at 1.5T system. A total dose of 1.4 mL (0.5 mol Fe/L) of ferucarbotran was used. Ferucarbotran was injected at a rate of 2 mL/s with 40 mL of physiological saline.Imaging was obtained at a temporal resolution of 1.2 or 0.46 seconds in 5 and 4 patients, respectively. For both CT and MRI modalities, a model-free analysis method was used to derive region of interest-based perfusion parameters. Plasma flow, distribution volume (DV) of contrast agent and estimated mean transit time (EMTT) were estimated.Results: A strong correlation was obtained with plasma flow (r=0.8231, P=0.0064) between DSC-MRI and SL-CTHA. No significant correlation was obtained for DV and EMTT between DSC-MRI and SL-CTHA.All perfusion parameters showed no significant difference between SL-CTHA and DSC-MRI in FNH. On the other hand, in HCC, DV and EMTT showed significant differences (P=0.046 and 0.046), and plasma flow showed no significant difference between DSC-MRI and SL-CTHA.Conclusions: This pilot study demonstrates the possibility of quantitative analysis of liver tumor using superparamagnetic iron oxide (SPIO)-based agent and highlights the potential for SPIO-based agent in more precisely assessing the perfusion characteristic of hypervascular liver tumors than by using extracellular contrast media.

A case study of glycogen storage disease type Ia presenting with multiple hepatocellular adenomas: an analysis by gadolinium ethoxybenzyl-diethylenetriamine-pentaacetic acid magnetic resonance imaging

“…Approximately 90% of FNH and some HCA cases show hyperintensity in the HBP. The signal of FNH on T2WI imaging is close to that of normal liver parenchyma and often associated with a central scar (14). Intratumoral fat deposition and the atoll sign are typical features in HCAs but seldom observed in FNH (11).…”

The feasibility of superparamagnetic iron oxide–enhanced magnetic resonance imaging for assessing liver lesions in patients with contraindications for iodine CT contrast media or gadolinium-based MR contrast media: a retrospective case-control study

“…Pre-contrast MRI included T1-weighted images (in and opposed phase) and T2-weighted images. As previously reported, a total volume of 1.3-mL SPIO (36.2-mg Fe) was injected via the cubital vein at a rate of 3 mL per second, followed by 40-mL saline at the same speed ( 14 , 15 ). The scanning of perfusion study was started at 4 s after the beginning of SPIO injection, scanning took 50 s, and a hundred phases were obtained.…”

“…In such cases, the evaluation of tumor blood flow is a significant clue to decide the therapeutic strategy. We have previously evaluated the blood flow of HCC or hepatocellular nodules by SPIO and reported its effectiveness (13)(14)(15). On the other hand, the better or equal detection of the metastatic lesion with SPIO-enhanced MRI has been reported than with enhanced CT or enhanced MR using nonspecific extracellular contrast media (10,(16)(17)(18).…”

IONPs-Based Medical Imaging in Cancer Care: Moving Beyond Traditional Diagnosis and Therapeutic Assessment

“…As a sensitive mean of detecting vascular changes, IONPs-enhanced SWI-MRI has been successfully translated to clinical research. 90 , 91 Some preclinical and clinical trials have indicated a close relationship between BV/VD and histologic results. 89 , 90 , 92 However, the morphological parameters of vessels may not reflect the real growth activity of tumor cells since the metabolic shift could compensate for the reduced vascular supply.…”