Detection of malignant hepatic tumors with ferumoxide-enhanced MR imaging: usefulness of multishot and single-shot fast spin echo sequences

Detection of hepatic VX2 carcinomas with ferucarbotran-enhanced magnetic resonance imaging in rabbits: Comparison of nine pulse sequences

OBJECTIVE

To compare the diagnostic performance of a variety of magnetic resonance imaging (MRI) sequences, in order to identify the most effective ferucarbotran-enhanced sequence for the detection of multiple small hepatic VX2 carcinomas in rabbits.

METHODS

Fifteen rabbits with experimentally induced 135 VX2 carcinomas in the liver underwent ferucarbotran-enhanced MRI using the following nine pulse sequences: a fat-suppressed fast spin-echo (FSE) sequence with two echo times (TE) (proton density- and T2-weighted images), four different T2*-weighted fast multiplanar GRASS (gradient-recalled acquisition in the steady state) (FMPGR) with the combination of three TEs (9, 12, 15 ms, respectively) and two flip angles (20 degrees , 80 degrees, respectively), T2*-weighted fast multiplanar spoiled GRASS (FMPSPGR), T1-weighted FMPSPGR, and dynamic T1-weighted FMPSPGR. All images were reviewed by three radiologists with quantitative and qualitative analysis.

RESULTS

Tumor-to-liver contrast-to-noise ratio of the proton density-weighted FSE sequence was significantly higher than those of the others (p<0.05). The lesion conspicuities of proton density- and T2-weighted FSE and T2*-weighted FMPGR (TE/flip angle, 9/20 degrees and 12/20 degrees ) images were better and the image artifacts of T2*-weighted FMPGR (TE/flip angle, 15/20 degrees and 12/80 degrees ) and T2*-weighted FMPSPGR images were more prominent than those of the others (p<0.05). The lesion detection in T2- and proton density-weighted FSE and T2*-weighted FMPGR (TE/flip angle, 12/20 degrees ) images were superior to those of the others and for the detection of very small hepatic tumors of less than 5 mm, the sensitivities of these sequences were less than 30%.

CONCLUSION

Ferucarbotran-enhanced T2- and proton density-weighted FSE and T2*-weighed FMPGR (TE/flip angle, 12/20 degrees ) images were found to be the most effective pulse sequences for the detection of multiple small hepatic VX2 carcinomas but these sequences were limited in the detection of very small hepatic tumors of less than 5 mm in size.

Gradient- and spin-echo T2-weighted imaging for SPIO-enhanced detection and characterization of focal liver lesions

PURPOSE

To evaluate superparamagnetic iron oxide (SPIO)-enhanced breathhold T2-weighted GRASE imaging in detection and characterization of focal liver lesions.

MATERIALS AND METHODS

In 30 patients (including 20 with cirrhosis) with 39 malignant and 25 benign lesions, gradient- and spin-echo (GRASE) images with two echo times (75 and 90 msec; GRASE75 and GRASE90) were obtained prior to and following administration of SPIO, and compared with respiratory-triggered and breathhold fast spin-echo (RT-FSE and BH-FSE) images. Two readers evaluated image quality and reviewed 240 liver segments for sensitivity and specificity. Signal-to-noise ratio (SNR), and its reduction in liver and spleen after administration of SPIO, and lesion-to-liver contrast-to-noise ratio (CNR) were measured.

RESULTS

Compared with RT-FSE and BH-FSE, GRASE reduced scan time by 77% to 82% and 21% to 27%, respectively. The image qualities with BH-FSE and GRASE75 were higher than with BH-FSE and GRASE90. BH-FSE showed higher specificity than RT-FSE and GRASE90, but otherwise there were no significant differences between pulse sequences for sensitivity or specificity. The mean SNR and CNR of the lesions with RT-FSE were significantly higher than with the other methods. SPIO-induced signal reduction of liver SNR was smallest with BH-FSE.

CONCLUSION

GRASE is faster and more sensitive to SPIO than FSE, but its sensitivity and specificity were slightly inferior to those of BH-FSE. Image quality is a current limitation.

Imaging liver metastases: review and update

The radiologic diagnosis of liver metastasis involves detection, characterization, and tumor staging. Knowledge of the histopathologic changes that occur with metastases provides the best approach to the accurate interpretation of radiologic imaging findings, and in particular, radiologists need to choose appropriate imaging methods based on such knowledge. Because the majority of metastases are hypovascular, the merits of the routine acquisition of hepatic arterial dominant-phase images by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) are disputable. Hepatic arterial dominant-phase images may be obtained when hypervascular tumors are suspected or three-dimensional CT angiography is necessary. And, imaging during the portal venous phase is essential for detecting metastases, evaluating intrahepatic vessel invasion, and for assessing intratumoral necrosis or fibrosis. Equilibrium- to delayed-phase imaging 3-5 min after contrast administration may improve the detection of intratumoral fibrosis, and occasionally lead to more accurate tissue characterization. MRI offers diagnostic information on vascularity, amount of free water, hemorrhage, fibrosis, necrosis, and water molecule diffusion in metastases. And, liver-specific contrast agents like superparamagnetic iron oxide, liposoluble gadolinium chelate, and manganese may improve the MRI-based diagnosis of liver metastases.

Focal liver lesions: Breathhold gradient- and spin-echo T2-weighted imaging for detection and characterization

PURPOSE

To evaluate breathhold gradient- and spin-echo (GRASE) T2-weighted imaging for the detection and characterization of focal liver lesions.

MATERIALS AND METHODS

Two GRASE sequences with different echo times (75 and 90 msec, GRASE75 and GRASE90) were compared with respiratory-triggered fast spin-echo (SE) and breathhold fast SE in 64 patients with 103 malignant and 51 benign lesions. Compared with respiratory-triggered and breathhold fast SE, GRASE reduced scan time by 77% to 82% and 21% to 27%, respectively. Two independent readers evaluated image quality and reviewed 504 liver segments on a segment-by-segment basis. Observer performance was evaluated with receiver operating characteristic (ROC) curve analysis. The signal-to-noise ratio (SNR) of liver and spleen, and lesion-to-liver contrast-to-noise ratio (CNR) were also measured.

RESULTS

The overall quality of the GRASE images was higher than that of the respiratory-triggered and breathhold fast SE images, although signal inhomogeneities were more frequently observed with GRASE. No significant difference in the values of the area under the ROC curve (Az) for malignant lesion detection was found. The mean SNR and CNR were highest for respiratory-triggered fast SE.

CONCLUSION

T2-weighted breathhold GRASE has the potential to provide faster liver imaging.