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Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection. Eur J Nucl Med Mol Imaging 2013; 41:649-58. [DOI: 10.1007/s00259-013-2654-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/28/2013] [Indexed: 12/13/2022]
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Chan VO, Das JP, Gerstenmaier JF, Geoghegan J, Gibney RG, Collins CD, Skehan SJ, Malone DE. Diagnostic performance of MDCT, PET/CT and gadoxetic acid (Primovist®)-enhanced MRI in patients with colorectal liver metastases being considered for hepatic resection: initial experience in a single centre. Ir J Med Sci 2012; 181:499-509. [DOI: 10.1007/s11845-012-0805-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/02/2012] [Indexed: 01/11/2023]
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Choi JY, Choi JS, Kim MJ, Lim JS, Park MS, Kim JH, Chung YE. Detection of hepatic hypovascular metastases: 3D gradient echo MRI using a hepatobiliary contrast agent. J Magn Reson Imaging 2010; 31:571-8. [DOI: 10.1002/jmri.22076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Schneider G, Altmeyer K, Kirchin MA, Seidel R, Grazioli L, Morana G, Saini S. Evaluation of a Novel Time-Efficient Protocol for Gadobenate Dimeglumine (Gd-BOPTA)-Enhanced Liver Magnetic Resonance Imaging. Invest Radiol 2007; 42:105-15. [PMID: 17220728 DOI: 10.1097/01.rli.0000251539.05400.06] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We sought to evaluate gadobenate dimeglumine for the detection and characterization of focal liver lesions in the unenhanced and already pre-enhanced liver. MATERIALS AND METHODS Sixty patients were evaluated prospectively. Unenhanced T1-weighted gradient echo (T1wGRE) and T2-weighted turbo spin echo (T2wTSE) images were acquired followed by contrast-enhanced T1wGRE images during the dynamic, equilibrium, and delayed phases after the bolus injection of 0.05 mmol/kg gadobenate dimeglumine. An identical series of dynamic images was then acquired after the delayed scan following a second 0.05 mmol/kg bolus of gadobenate dimeglumine. Images were evaluated randomly in 2 sessions by 3 independent blinded readers. Evaluated images in the first session comprised the unenhanced images, the first or second set of dynamic images, and the delayed images. The second session included the unenhanced images, the dynamic images not yet evaluated in the first session, and the delayed images. The 2 reading sessions were compared for lesion characterization and diagnosis, and kappa (kappa) values for interobserver agreement were determined. Quantitative evaluation of lesion contrast enhancement was also performed. RESULTS The enhancement behavior in the second dynamic series was similar to that in the first series, although pre-enhancement of the normal liver resulted in reduced lesion-liver contrast-to-noise ratios and the visualization of some lesions only on arterial phase images. Typical imaging features for the lesions included in the study were visualized clearly in both series. Strong agreement (kappa=0.56-0.89; all evaluations) between the 2 images sets was noted by all readers for differentiation of benign from malignant lesions and for definition of specific diagnosis, and between readers for diagnoses established based on images acquired in the unenhanced and pre-enhanced liver. CONCLUSION Dynamic imaging in the hepatobiliary phase gives similar information as dynamic imaging of the unenhanced liver. This might prove advantageous for screening protocols involving same session imaging of primary extrahepatic tumors and liver.
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Affiliation(s)
- Günther Schneider
- Department of Diagnostic and Interventional Radiology, University Hospital, Homburg/Saar, Germany.
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Lim JS, Kim MJ, Lee KY, Kim NK, Choi JS, Kim JH, Oh YT, Kim WH, Kim KW. Follow-up result afters negative findings on unenhanced hepatic MR imaging for hepatic metastasis from rectal cancer. Korean J Radiol 2006; 5:225-30. [PMID: 15637472 PMCID: PMC2698166 DOI: 10.3348/kjr.2004.5.4.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery. MATERIALS AND METHODS From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image. RESULTS During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%. CONCLUSION Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.
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Affiliation(s)
- Joon Seok Lim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
| | - Myeong-Jin Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
- Institute of Gastroenterology, Yonsei University College of Medicine, Korea
- Brain Korea 21 Project of Medical Science Yonsei University College of Medicine, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Jin-Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Joo Hee Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
| | - Young Taik Oh
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Gastroenterology Division, Yonsei University College of Medicine, Korea
| | - Ki Whang Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Korea
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Schnorr J, Wagner S, Abramjuk C, Drees R, Schink T, Schellenberger EA, Pilgrimm H, Hamm B, Taupitz M. Focal liver lesions: SPIO-, gadolinium-, and ferucarbotran-enhanced dynamic T1-weighted and delayed T2-weighted MR imaging in rabbits. Radiology 2006; 240:90-100. [PMID: 16684917 DOI: 10.1148/radiol.2393040884] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare a superparamagnetic iron oxide (SPIO), VSOP-C184, with a gadopentetate dimeglumine with regard to signal-enhancing effects on T1-weighted dynamic magnetic resonance (MR) images and with another SPIO contrast medium with regard to signal-reducing effects on delayed T2-weighted MR images. MATERIALS AND METHODS All experiments were approved by the responsible Animal Care Committee. Twenty rabbits (five for each contrast agent and dose) implanted with VX-2 carcinoma were imaged at 1.5 T. VSOP-C184 at 0.015 and 0.025 mmol Fe/kg was compared with gadopentetate dimeglumine at 0.15 mmol Gd/kg and ferucarbotran at 0.015 mmol Fe/kg. The imaging protocol comprised a T1-weighted dynamic gradient-echo (GRE) MR before injection and at 6-second intervals for up to 42 seconds after injection and a T2-weighted turbo spin-echo MR before and 5 minutes after injection. Images were evaluated quantitatively, and contrast media were compared by using nonparametric analysis of variance. RESULTS At dynamic T1-weighted GRE MR imaging with 0.015-mmol Fe/kg VSOP-C184, 0.025-mmol Fe/kg VSOP-C184, gadopentetate dimeglumine, and ferucarbotran, the median peak contrast-to-noise ratio (CNR) was 20.7 (25th percentile, 16.3; 75th percentile, 22.6), 24.2 (25th percentile, 19.3; 75th percentile, 28.5), 16.4 (25th percentile, 13.7; 75th percentile, 20.3), and 14.0 (25th percentile, 11.4; 75th percentile, 16.8), respectively. Both doses of VSOP-C184 yielded significantly higher CNR (P < .05) than the other two agents. At T2-weighted turbo spin-echo imaging with 0.015-mmol Fe/kg VSOP-C184, 0.025-mmol Fe/kg VSOP-C184, gadopentetate dimeglumine, and ferucarbotran, the median CNR was 15.0 (25th percentile, 13.4; 75th percentile, 21.3), 15.7 (25th percentile, 14.5; 75th percentile, 19.8), 11.3 (25th percentile, 8.2; 75th percentile, 12.2), and 15.7 (25th percentile, 12.5; 75th percentile, 22.4), respectively. There was no significant difference between VSOP-C184 and ferucarbotran; both had a significantly higher CNR than did gadopentetate dimeglumine. CONCLUSION VSOP-C184 produces higher liver-to-tumor contrast at dynamic T1-weighted imaging than does gadopentetate dimeglumine; at delayed T2-weighted imaging, the contrast is comparable to that achieved with ferucarbotran.
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Affiliation(s)
- Jörg Schnorr
- Department of Radiology, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, 10098 Berlin, Germany.
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Wersebe A, Wiskirchen J, Decker U, Schick F, Dietz K, Müller-Schimpfle M, Claussen CD, Pereira PL. Comparison of Gadolinium-BOPTA and Ferucarbotran-Enhanced Three-Dimensional T1-Weighted Dynamic Liver Magnetic Resonance Imaging in the Same Patient. Invest Radiol 2006; 41:264-71. [PMID: 16481909 DOI: 10.1097/01.rli.0000188359.72928.0f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We sought to compare signal changes using Ferucarbotran and gadobenate dimeglumine (Gd-BOPTA) in dynamic 3D T1-weighted (T1w) GRE imaging of the liver. MATERIAL AND METHODS Thirty patients were prospectively included in the study. All patients underwent 2 high-field magnetic resonance (MR) examinations: first with Gd-BOPTA (Gd) and then after a mean interval of 4 days with ferucarbotran (Feru). Dynamic MRI was obtained with a 3D T1w GRE sequence (TR 6.33, TE 2.31, flip angle 20 degrees ). Contrast enhanced scans were assessed before intravenous injection of the contrast agent (precontrast), and postcontrast during the arterial phase (30 seconds), portal venous phase (60 seconds), and equilibrium phase (120 seconds). The signal intensities (SIs) of liver, spleen, aorta, and portal vein were defined by region of interest measurements. Signal intensity changes (SICs) and percentage signal intensity change (PSIC) were calculated using the formulas SIC=(SI pre - SI post)/SI pre and PSIC=SIC x 100%. RESULTS Positive signal enhancement was observed after intravenous injection of Feru during all dynamic measurements, whereas the mean SI values were lower compared with Gd. During the portal venous phase the mean SI of Gd was up to a factor of 2.1 higher (portal vein). The widest difference of SIC was observed during the equilibrium phase for liver parenchyma (Gd, 1.03; Feru, 0.24). The dynamic signal courses were similar for liver, portal vein and aorta. Different signal courses were obtained for the spleen. CONCLUSIONS Feru-enhanced T1w dynamic images demonstrated significant signal increases for liver, vessels, and spleen but overall lower signal intensities than Gd-BOPTA. The dynamic signal courses of ferucarbotran were similar to that of Gd-BOPTA during ll perfusion phases except in the spleen. Thus, it may be possible to detect typical enhancement pattern of focal liver lesions with Feru-enhanced dynamic T1w MRI.
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Affiliation(s)
- Annika Wersebe
- Department of Diagnostic Radiology, University Hospital Tübingen, Germany.
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Tanimoto A, Kadoya M, Kawamura Y, Kuwatsuru R, Gokan T, Hirohashi S. Safety and efficacy of a novel hepatobiliary MR contrast agent, Gd-DTPA-DeA: Results of phase I and phase II clinical trials. J Magn Reson Imaging 2006; 23:499-508. [PMID: 16534755 DOI: 10.1002/jmri.20543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the safety, effective dose, and efficacy of a novel hepatobiliary MR contrast agent Gd-DTPA-DeA for imaging liver tumors, from the clinical phase I and phase II trials in Japan. MATERIALS AND METHODS In a phase I trial, 33 healthy volunteers were intravenously administered a single dose of 0.03-10 micromol/kg of Gd-DTPA-DeA. In a nationwide phase II trial, 80 patients suspected to have hepatic mass were divided into three dosing groups: 2.5, 5.0, or 7.5 micromol/kg. T1-weighted gradient echo images were obtained before and after Gd-DTPA-DeA administration at three time points. Liver signal-to-noise ratio (SNR) and lesion-liver contrast-to-noise ratio (CNR) were calculated at each time point. A reading committee evaluated the contrast, diagnostic, and overall efficacy using a five-point scale. RESULTS In a phase I trial, dosages up to 10 micromol/kg were well tolerated by healthy volunteers. In a phase II trial, the contrast, diagnostic, and overall efficacy increased dose-dependently. The overall efficacy was 63.0%, 85.2%, and 88.0%, for 2.5, 5, and 7.5 micromol/kg, respectively. Liver SNR and CNR increase was greater at late phase than at early phase. No serious adverse events occurred. CONCLUSION Gd-DTPA-DeA is a well-tolerated and promising contrast agent for liver MR imaging.
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Affiliation(s)
- Akihiro Tanimoto
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
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Tongdee R, Narra V, Oliveira E, Chapman W, Elsayes K, Brown J. Utility of 3D magnetic resonance imaging in preoperative evaluation of hepatobiliary diseases. HPB (Oxford) 2006; 8:311-7. [PMID: 18333142 PMCID: PMC2023902 DOI: 10.1080/13651820500338021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Three-dimensional (3D) imaging is playing an increasingly important role in modern diagnostic radiology. The recent improvements in magnetic resonance (MR) hardware, scanning protocols and 3D volumetric reconstruction software have facilitated great expansion of the role of 3D imaging for use in hepatobiliary surgery. In this review, we address the various 3D reconstruction techniques used in MRI and demonstrate the value of 3D imaging in preoperative evaluation of hepatobiliary diseases.
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Affiliation(s)
- R. Tongdee
- Mallinckrodt Institute of RadiologySt Louis MOUSA
| | - V.R. Narra
- Mallinckrodt Institute of RadiologySt Louis MOUSA
| | | | - W. Chapman
- Department of Surgery, Washington University School of Medicine and Barnes-Jewish HospitalSt Louis MOUSA
| | - K.M. Elsayes
- Mallinckrodt Institute of RadiologySt Louis MOUSA
| | - J.J. Brown
- Mallinckrodt Institute of RadiologySt Louis MOUSA
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Schima W, Kulinna C, Langenberger H, Ba-Ssalamah A. Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging 2005; 5 Spec No A:S149-56. [PMID: 16361131 PMCID: PMC1665297 DOI: 10.1102/1470-7330.2005.0035] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In contrast to other extrahepatic malignancies many colorectal cancers can be cured even when there is metastatic spread to the liver. The diagnosis of liver metastases relies totally on imaging to decide which patients may be surgical candidates. The diagnostic value of ultrasound with contrast agents, multidetector CT and MR imaging with non-specific gadolinium chelates and liver-specific contrast agent is discussed. Nowadays MDCT is the mainstay of staging and follow-up of these patients, because it provides good coverage of the liver and the complete abdomen and the chest in one session. MR imaging has been shown to be superior to helical CT in the preoperative assessment of colorectal liver metastases. Large studies are needed to define the role of MDCT vs. MRI staging in patients referred for resection of liver metastases.
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Affiliation(s)
- Wolfgang Schima
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 10-20, 1090 Vienna, Austria.
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Abstract
Imaging of the liver is performed most often to detect and characterize focal liver lesions. MR imaging has been the method of choice to assess focal liver lesions accurately. Nonspecific intravenous contrast agents have been used for routine abdominal MR imaging protocols including liver imaging. Over the last 10 to 15 years new contrast agents have been developed that combine the excellent contrast resolution of MR imaging with improved tissue specificity. This article reviews various contrast agents that are in clinical use for liver MR imaging and discusses their potential clinical role.
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Affiliation(s)
- N Cem Balci
- Department of Radiology, Saint Louis University, St. Louis, MO, USA.
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Scharitzer M, Schima W, Schober E, Reimer P, Helmberger TK, Holzknecht N, Stadler A, Ba-Ssalamah A, Weber M, Wrba F. Characterization of Hepatocellular Tumors. J Comput Assist Tomogr 2005; 29:181-90. [PMID: 15772534 DOI: 10.1097/01.rct.0000156397.51640.a1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the value of mangafodipir trisodium-enhanced MR imaging for characterization of hepatocellular lesions. MATERIALS AND METHODS Magnetic resonance images of 41 patients with 48 histopathologically proven hepatocellular lesions (20 cases of focal nodular hyperplasia [FNH], 4 adenomas, 15 hepatocellular carcinomas [HCCs], 7 regenerative nodules, and 2 others) were retrospectively studied. Magnetic resonance imaging was performed on a 1.5-T unit (Vision, Siemens, Erlangen, Germany; ACS-NT, Philips, Best, The Netherlands) using T2-weighted, fat-saturation, turbo spin echo imaging and T1-weighted gradient echo imaging before and 20 minutes after infusion of 5 micromol/kg mangafodipir (Amersham Health, Oslo, Norway). Qualitative analysis by 4 blinded independent readers included assessment of unenhanced images and, in a second step, assessment of unenhanced and contrast-enhanced images together. Lesions were classified as benign or malignant using a 5-point scale, and readers made a specific diagnosis. RESULTS For characterization of hepatocellular lesions, mangafodipir-enhanced imaging was significantly superior to unenhanced imaging (P < 0.05). On receiver operating characteristic analysis, the area under the curve was 0.768 (95% confidence interval: 0.633-0.903) for unenhanced images and 0.866 (95% confidence interval: 0.767-0.966) for evaluation of unenhanced and contrast-enhanced images together (P < 0.05). Analysis of enhancement patterns aided in characterization and classification of tumors. CONCLUSION Administration of mangafodipir improves the differentiation between adenoma or HCC and "nonsurgical" lesions (FNH or regenerative nodules). The accuracy for arriving at a specific diagnosis is higher when unenhanced and mangafodipir-enhanced images are considered together than for unenhanced MR images alone.
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Kim MJ, Kim JH, Lim JS, Oh YT, Chung JJ, Choi JS, Lee WJ, Kim KW. Detection and characterization of focal hepatic lesions: mangafodipir vs. superparamagnetic iron oxide-enhanced magnetic resonance imaging. J Magn Reson Imaging 2005; 20:612-21. [PMID: 15390224 DOI: 10.1002/jmri.20174] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To compare the mangafodipir-enhanced magnetic resonance (MR) and superparamagnetic iron oxide (SPIO)-enhanced images for their ability to detect and characterize focal hepatic lesions. MATERIALS AND METHODS Unenhanced, mangafodipir-enhanced, and SPIO-enhanced hepatic MR images obtained from 64 patients were analyzed. A total of 121 hepatic lesions were included: 66 hepatocellular carcinomas (HCCs), 26 metastases, 14 hemangiomas, 5 cysts, 3 cholangiocarcinomas, 4 focal nodular hyperplasias (FNHs), 2 abscesses, and 1 adenoma. Two radiologists independently reviewed the two sets of images in a random order: 1) the unenhanced and mangafodipir-enhanced images (the mangafodipir set) and 2) the unenhanced and SPIO-enhanced images (the SPIO set). This study compared the accuracy of lesion detection, the ability to distinguish between a benign and malignant lesion, and the ability to distinguish between the hepatocellular and nonhepatocellular origins of the lesions using the areas (Az) under the receiver operating characteristic (ROC) curve. RESULTS The overall accuracy for detecting focal lesions was significantly higher (P < 0.05) with the SPIO set (Az = 0.846 and 0.871 for readers 1 and 2, respectively) than with the mangafodipir set (Az = 0.716 and 0.766). Most of the lesions detected only with the SPIO-enhanced MR images by the readers were small HCCs. For lesions larger than 15 mm, the sensitivities of the two contrast enhancement techniques were similar for both readers. The accuracy of the mangafodipir and SPIO sets in distinguishing between benign and malignant lesions was comparable. The accuracy for distinguishing between the hepatocellular and nonhepatocellular origins of the lesions was significantly higher (P < 0.05) using the mangafodipir set (Az = 0.897 and 0.946) than using the SPIO set (Az = 0.741 and 0.833). CONCLUSION SPIO- and mangafodipir-enhanced images were comparable for detection of focal hepatic lesions other than small HCCs, which were better detected on the SPIO-enhanced images. Mangafodipir-enhanced images are likely better than the SPIO-enhanced images for distinguishing between focal liver lesions with a hepatocellular or nonhepatocellular origin.
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Affiliation(s)
- Myeong-Jin Kim
- Department of Diagnostic Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Schneider G, Reimer P, Mamann A, Kirchin MA, Morana G, Grazioli L. Contrast agents in abdominal imaging: current and future directions. Top Magn Reson Imaging 2005; 16:107-24. [PMID: 16314700 DOI: 10.1097/01.rmr.0000189025.80743.5c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Magnetic resonance imaging is an established imaging method for the evaluation of the abdomen. Accurate assessment of the liver, spleen, pancreas, bile ducts, vascular structures, and retroperitoneal organs (eg, the kidneys, the collecting system, and the adrenals) are possible on MR imaging. The intravenous administration of MR contrast agents can frequently improve the examination and provide more specific diagnoses. The advent of more specific, "hepatobiliary" contrast agents has further improved the differential diagnostic process, particularly for MR imaging of the liver. The availability of orally administered MR contrast agents has further extended the range of abdominal applications, making MR imaging of the small bowel and the colon established imaging procedures.
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Affiliation(s)
- Günther Schneider
- Department of Diagnostic and Interventional Radiology, University Hospital of Saarland, Homburg/Saar, Germany
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Bhattacharjya S, Bhattacharjya T, Baber S, Tibballs JM, Watkinson AF, Davidson BR. Prospective study of contrast-enhanced computed tomography, computed tomography during arterioportography, and magnetic resonance imaging for staging colorectal liver metastases for liver resection. Br J Surg 2004; 91:1361-9. [PMID: 15376205 DOI: 10.1002/bjs.4699] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study compared the value of contrast-enhanced helical computed tomography (CT), CT during arterioportography (CTAP), and contrast-enhanced magnetic resonance imaging (MRI) for staging patients with colorectal liver metastases. METHODS One hundred and twenty patients with known or suspected colorectal liver metastases were evaluated prospectively. MRI and CTAP were performed within 3 weeks of CT in patients with potentially resectable tumours. Results of imaging were compared with findings at surgery, intraoperative ultrasonography and histological examination. RESULTS Twenty patients were not considered for liver resection following CT. The remaining 100 patients underwent CT and CTAP, 85 of whom had CT, CTAP and MRI. The sensitivity and specificity were 73.0 and 96.5 per cent for CT, 87.1 and 89.3 per cent for CTAP, and 81.9 and 93.2 per cent for MRI. Positive predictive values were 89.7, 87.5 and 87.5 per cent respectively. Receiver-operator characteristic analysis gave an accuracy on a segment-by-segment analysis of 0.73 for CT, 0.87 for CTAP and 0.82 for MRI. Combining information from CT and CTAP, CT and MRI, or all three modalities, did not significantly increase the percentage of patients staged correctly (71, 72 and 76 per cent respectively). CONCLUSION The diagnostic accuracy of spiral CT, MRI and CTAP was similar. Combining modalities did not improve accuracy.
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Affiliation(s)
- S Bhattacharjya
- Department of Surgery, Royal Free Hospital, Royal Free and University College Medical School, London, UK
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Reimer P, Schneider G, Schima W. Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 2004; 14:559-78. [PMID: 14986050 DOI: 10.1007/s00330-004-2236-1] [Citation(s) in RCA: 210] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Revised: 12/18/2003] [Accepted: 12/19/2003] [Indexed: 12/27/2022]
Abstract
Hepatobiliary contrast agents with uptake into hepatocytes followed by variable biliary excretion represent a unique class of cell-specific MR contrast agents. Two hepatobiliary contrast agents, mangafodipir trisodium and gadobenate dimeglumine, are already clinically approved. A third hepatobiliary contrast agent, Gd-EOB-DTPA, is under consideration. The purpose of this review is to provide an overview on the properties, clinical development and application of these three hepatobiliary contrast agents. Bolus injectable paramagnetic hepatobiliary contrast agents combine established features of extracellular agents with the advantages of hepatocyte specificity. The detection and characterisation of focal liver disease appears to be improved compared to unenhanced MRI, MRI with unspecific contrast agents and contrast-enhanced CT. To decrease the total time spent by a patient in the MR scanner, it is advisable to administer the agent immediately after acquisition of unenhanced T1-w MRI. After infusion or bolus injection (with dynamic FS-T1-w 2D or 3D GRE) of the contrast agent, moderately and heavily T2w images are acquired. Post-contrast T1-w MRI is started upon completion of T2-w MRI for mangafodipir trisodium and Gd-EOB-DTPA as early as 20 min following injection, while gadobenate dimeglumine scans are obtained >60 min following injection. Post-contrast acquisition techniques with near isotropic 3D pulse sequences with fat saturation parallel the technical progress made by MSCT combined with an unparalleled improvement in tumour-liver contrast. The individual decision that hepatobiliary contrast agent one uses is partly based on personal preferences. No comparative studies have been conducted comparing the advantages or disadvantages of all three agents directly against each other.
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Affiliation(s)
- Peter Reimer
- Department of Radiology, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestrasse 90, 76133 Karlsruhe, Germany.
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Hussain HK, Syed I, Nghiem HV, Johnson TD, Carlos RC, Weadock WJ, Francis IR. T2-weighted MR imaging in the assessment of cirrhotic liver. Radiology 2004; 230:637-44. [PMID: 14739306 DOI: 10.1148/radiol.2303020921] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess if T2-weighted magnetic resonance (MR) imaging provides added diagnostic value in combination with dynamic gadolinium-enhanced MR imaging in the detection and characterization of nodular lesions in cirrhotic liver. MATERIALS AND METHODS Two readers retrospectively and independently analyzed 54 MR imaging studies in 52 patients with cirrhosis. In session 1, readers reviewed T1-weighted and dynamic gadolinium-enhanced images. In session 2, readers reviewed T1-weighted, dynamic gadolinium-enhanced, and respiratory-triggered T2-weighted fast spin-echo images. Readers identified and characterized all focal lesions by using a scale of 1-4 (1, definitely benign; 4, definitely malignant). Multireader correlated receiver operating characteristic (ROC) analysis was employed to assess radiologist performance in session 2 compared with session 1. The difference in the areas under the ROC curves for the two sessions was tested. In a third session, readers assessed conspicuity of biopsy-proved lesions on T2-weighted MR images by using a scale of 1-3 (1, not seen; 3, well seen) and identified causes of reduced conspicuity. RESULTS Two additional benign lesions were detected by each reader in session 2. Fifty-five lesions had pathologic verification, including 32 malignant, three high-grade dysplastic, and 20 benign nodules. There was no significant difference in the area under the ROC curves between the two sessions (P =.48). Thirty-two lesions were inconspicuous on T2-weighted MR images because of parenchymal heterogeneity, breathing artifacts (particularly in patients with ascites), and lesion isointensity with liver parenchyma. T2-weighted MR imaging was useful in the evaluation of cysts and lymph nodes. CONCLUSION T2-weighted MR imaging does not provide added diagnostic value in the detection and characterization of focal lesions in cirrhotic liver.
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Affiliation(s)
- Hero K Hussain
- Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, MRI B2B311, Ann Arbor, MI 48109-0030, USA.
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Affiliation(s)
- Riccardo Lencioni
- Division of Diagnostic and Interventional Radiology, Department of Oncology, Transplants, and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, I-56126 Pisa, Italy.
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Numminen K, Halavaara J, Tervahartiala P, Isoniemi H, Kivisaari L, Palomäki M, Höckerstedt K. Liver tumour MRI: what do we need for lesion characterization? Scand J Gastroenterol 2004; 39:67-73. [PMID: 14992564 DOI: 10.1080/00365520310007765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hepatic lesions constitute a daily challenge to radiology in clinical settings, and non-invasive methods are valuable in the characterization of these liver tumours. We undertook our investigation to assess the lesion characterization potential of MRI by evaluating several unenhanced MR sequences and the dynamic gadolinium (Gd)-enhanced technique. METHODS A total of 116 focal liver lesions in 116 patients were included in our retrospective study, and histological verification was available for 107 lesions. Nine haemangiomas had a follow-up of 2 years. The 1.5-T MR system was used. T1- and T2-weighted sequences and dynamic Gd-enhanced studies were evaluated by two individual readers as separate sequences and also collectively. Lesions were classified into benign or malignant, and a specific diagnosis was proposed. The McNemar test was used in statistical analysis, and interobserver variation was measured using kappa statistics. RESULTS Lesion classification into benign and malignant tumours (by evaluating all images in concert) was assessed in 83% and 89% of cases by readers 1 and 2, respectively. From single sequences, best lesion classification was achieved with Gd-enhanced T1 by both readers. The difference in classification was statistically significant when all sequences were evaluated in comparison with any single sequence alone (P = 0.02). Specific diagnosis was correctly determined using all sequences together in 60% and 71% of cases by readers 1 and 2, respectively. For individual sequences, correct diagnosis was most frequently proposed with a Gd-enhanced T1-weighted sequence by both readers (59% and 65% for readers 1 and 2, respectively). CONCLUSION Multisequential MRI using Gd-enhanced imaging performs extremely well in liver lesion classification, and with moderate ability to determine a specific diagnosis.
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Affiliation(s)
- K Numminen
- Dept. of Radiology, Helsinki University Central Hospital, Helsinki, Finland.
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Kim MJ, Kim JH, Chung JJ, Park MS, Lim JS, Oh YT. Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging. Radiology 2003; 228:719-26. [PMID: 12881583 DOI: 10.1148/radiol.2283020735] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare gadolinium- and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging for detection and characterization of focal hepatic lesions when different contrast agent administration sequences are used. MATERIALS AND METHODS Unenhanced, dynamic gadolinium-enhanced, and SPIO-enhanced hepatic MR images were obtained in 134 patients. SPIO-enhanced MR imaging was performed immediately after gadolinium-enhanced dynamic MR imaging in 50 patients, 1 day after gadolinium-enhanced dynamic MR imaging in 40 patients, and before gadolinium-enhanced dynamic MR imaging in 44 patients. Two radiologists independently reviewed the gadolinium image set (unenhanced and gadolinium-enhanced dynamic MR images) and the SPIO image set (unenhanced and SPIO-enhanced MR images) in random order. Lesion detection sensitivity and lesion characterization accuracy were compared by analyzing the area under the receiver operating characteristic curve (Az). RESULTS Overall lesion detection accuracy for pooled data was significantly higher with the SPIO set (Az = 0.903) than with the gadolinium set (Az = 0.857) (P <.05). When hypovascular lesions were excluded, the detection rate was similar with the two sets. When hepatocellular carcinomas were excluded, the detection rate was significantly higher with the SPIO set (P <.01). Readers were more accurate in differentiating benign from malignant lesions with the gadolinium set (Az = 0.915) than with the SPIO set (Az = 0.847) (P <.01). Detection accuracy tended to be better with the images obtained after the second contrast agent was used. CONCLUSION Hypovascular lesion detection was better with SPIO-enhanced MR images than with gadolinium-enhanced MR images. Detection and characterization of hypervascular lesions were improved with gadolinium-enhanced MR images.
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Affiliation(s)
- Myeong-Jin Kim
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Severance Hospital, and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Republic of Korea
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Bartolozzi C, Donati F, Cioni D, Procacci C, Morana G, Chiesa A, Grazioli L, Cittadini G, Cittadini G, Giovagnoni A, Gandini G, Maass J, Lencioni R. Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol 2003; 14:14-20. [PMID: 14730384 DOI: 10.1007/s00330-003-1966-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Accepted: 05/02/2003] [Indexed: 12/23/2022]
Abstract
The aim of this study was to compare unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT in the detection of hepatic colorectal metastases. Forty-four patients with hepatic colorectal metastases were examined with unenhanced and MnDPDP-enhanced MRI and with unenhanced and contrast-enhanced spiral CT. The MR examination protocol included baseline T1-weighted spin-echo (SE), T1-weighted gradient-recalled-echo (GRE), and T2-weighted fast-SE sequences; and T1-weighted SE and T1-weighted GRE sequences obtained 30-60 min after administration of 0.5 micromol/kg (0.5 ml/kg) mangafodipir trisodium (MnDPDP). Images were interpreted by three blinded readers. Findings at CT and MRI were compared with those at intraoperative US, which were used as term of reference. Intraoperative US detected 128 metastases. In a lesion-by-lesion analysis, the overall detection rate was 71% (91 of 128) for spiral CT, 72% (92 of 128) for unenhanced MRI, and 90% (115 of 128) for MnDPDP-enhanced MRI. MnDPDP-enhanced MRI was more sensitive than either unenhanced MRI ( p<0.0001) or spiral CT ( p=0.0007). In a patient-by-patient analysis, agreement with gold standard was higher for MnDPDP-enhanced MRI (33 of 44 cases) than for spiral CT (22 of 44 cases, p=0.0023) and unenhanced MRI (21 of 44 cases, p=0.0013). MnDPDP-enhanced MRI is superior to unenhanced MRI and spiral CT in the detection of hepatic colorectal metastases.
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Affiliation(s)
- Carlo Bartolozzi
- Department of Radiology, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
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Carlos RC, Kim HM, Hussain HK, Francis IR, Nghiem HV, Fendrick AM. Developing a prediction rule to assess hepatic malignancy in patients with cirrhosis. AJR Am J Roentgenol 2003; 180:893-900. [PMID: 12646426 DOI: 10.2214/ajr.180.4.1800893] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objectives of our study were to identify independent clinical, demographic, and MR imaging correlates of malignancy in patients with cirrhosis and to develop a predictive model based on identified correlates of malignancy. MATERIALS AND METHODS Sixty examinations of 58 patients with biopsy proof of lesions suggestive of hepatocellular carcinoma on MR imaging were retrospectively reviewed. The signal intensity of the lesion on T2-weighted imaging and dynamic gadolinium-enhanced imaging, the size of the lesion, and the number of suspicious lesions were recorded; in addition, patient age and sex, alpha-fetoprotein level, and hepatitis C viral genotype were noted. The association between malignancy and each predictor variable was evaluated using the chi-square test or the two-group t test. The final logistic regression model included the variables that were shown to have a significant association with malignancy and the clinically relevant predictors. We used the adjusted odds ratios to measure the strength of each association. The discriminant ability of the model for detecting hepatic malignancy was assessed using receiver operating characteristic curve analysis. RESULTS The prevalence of hepatic malignancy in our study population was 64%. The area under the receiver operating characteristic curve for the logistic regression model was 0.82. Venous washout (odds ratio = 9.2), alpha-fetoprotein level (odds ratio = 3.2), and number of lesions (odds ratio = 1.5) were significant predictors for malignancy (p < 0.05). When arterial enhancement and venous washout were either both present or both absent, alpha-fetoprotein level contributed little to the prediction of malignancy. CONCLUSION The MR characteristics of hepatic lesions during the dynamic venous phase in conjunction with the serum alpha-fetoprotein level and number of lesions are predictors of hepatic malignancy. The use of these predictors can facilitate explicit estimation of malignancy in individuals with underlying cirrhosis, potentially improving clinical decision-making.
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Affiliation(s)
- Ruth C Carlos
- Department of Radiology, MRI Section, University of Michigan, 1500 E. Medical Center Dr., UH B2B311, Ann Arbor, MI 48109-0030, USA
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Schneider G, Maas R, Schultze Kool L, Rummeny E, Gehl HB, Lodemann KP, Kirchin MA. Low-dose gadobenate dimeglumine versus standard dose gadopentetate dimeglumine for contrast-enhanced magnetic resonance imaging of the liver: an intra-individual crossover comparison. Invest Radiol 2003; 38:85-94. [PMID: 12544071 DOI: 10.1097/00004424-200302000-00003] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES Gadobenate dimeglumine (Gd-BOPTA) has a two-fold higher T1 relaxivity compared with gadopentetate dimeglumine (Gd-DTPA) and can be used for both dynamic and delayed liver MRI. This intraindividual, crossover study was conducted to compare 0.05 mmol/kg Gd-BOPTA with 0.1 mmol/kg Gd-DTPA for liver MRI. MATERIALS AND METHODS Forty-one patients underwent two identical MR examinations separated by >or= 72 hours. Precontrast T1-FLASH-2D and T2-TSE sequences and postcontrast T1-FLASH-2D sequences were acquired during the dynamic and delayed (1-2 hours) phases after each contrast injection. Images were evaluated on-site by two independent, blinded off-site readers in terms of confidence for lesion detection, lesion number, character and diagnosis, enhancement pattern, lesion-to-liver contrast, and benefit of dynamic and delayed scans. Additional on-site evaluation was performed of the overall diagnostic value of each agent. RESULTS Superior diagnostic confidence was noted by on-site investigators and off-site assessors 1 and 2 for 6, 4 and 2 patients with Gd-BOPTA, and for 3, 1 and 2 patients with Gd-DTPA, respectively. No consistent differences were noted for other parameters on dynamic phase images whereas greater lesion-to-liver contrast was noted for more patients on delayed images after Gd-BOPTA. More correct diagnoses of histologically confirmed lesions (n = 26) were made with the complete Gd-BOPTA image set than with the complete Gd-DTPA set (reader 1: 68% vs. 59%; reader 2: 78% vs. 68%). The overall diagnostic value was considered superior after Gd-BOPTA in seven patients and after Gd-DTPA in one patient. CONCLUSION The additional diagnostic information on delayed imaging, combined with the possibility to use a lower overall dose to obtain similar diagnostic information on dynamic imaging, offers a distinct clinical advantage for Gd-BOPTA for liver MRI.
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Affiliation(s)
- Gunther Schneider
- Department of Diagnostic Radiology, University Hospital, Kirrberger Strasse, Homburg/Saar, Germany.
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van Erkel AR, Pijl MEJ, van den Berg-Huysmans AA, Wasser MNJM, van de Velde CJH, Bloem JL. Hepatic metastases in patients with colorectal cancer: relationship between size of metastases, standard of reference, and detection rates. Radiology 2002; 224:404-9. [PMID: 12147835 DOI: 10.1148/radiol.2242011322] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the relationship between the size of hepatic metastases, the standard of reference, and the reported detection rate in patients with colorectal cancer. MATERIALS AND METHODS With use of a MEDLINE search (January 1994 to January 2001), articles were selected that contained original results on detection of hepatic metastases of colorectal cancer, categorized for size in at least two categories, with use of helical computed tomography (CT), helical CT at arterial portography, or magnetic resonance imaging. Results were compared with the size distribution of hepatic metastases in 47 consecutive patients with colorectal carcinoma, which were detected by using a combination of intraoperative ultrasonography (US) and palpation. RESULTS Seven studies met all predefined criteria. Four studies involved intraoperative US in all patients and demonstrated a significant negative correlation (-0.988) between detection rate and fraction of small metastases. These studies had a higher fraction and lower detection rate of small metastases and a lower overall detection rate. A majority (58% [145 of 252]) of metastases in the study population were smaller than 20 mm. CONCLUSION Few articles adequately describe the standard of reference and size distribution of hepatic lesions. Hepatic metastases of colorectal cancer are frequently smaller than 20 mm. When the standard of reference is suboptimal, many small metastases are excluded from analysis, and detection rates are therefore inflated.
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Affiliation(s)
- Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Kirchin MA, Spinazzi A. Low-dose gadobenate dimeglumine-enhanced MRI in the detection and characterization of focal liver lesions. Acad Radiol 2002; 9 Suppl 1:S121-6. [PMID: 12019846 DOI: 10.1016/s1076-6332(03)80416-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim JH, Kim MJ, Suh SH, Chung JJ, Yoo HS, Lee JT. Characterization of focal hepatic lesions with ferumoxides-enhanced MR imaging: utility of T1-weighted spoiled gradient recalled echo images using different echo times. J Magn Reson Imaging 2002; 15:573-83. [PMID: 11997899 DOI: 10.1002/jmri.10102] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate the different signal characteristics of focal hepatic lesions on ferumoxides-enhanced MR imaging, including T1-weighted spoiled gradient recalled echo (GRE) images using different echo times (TE) and T2- and T2*-weighted images. MATERIALS AND METHODS Ferumoxides-enhanced MR imaging was performed using a 1.5-T system in 46 patients who were referred for evaluation of known or suspected hepatic malignancies. One hundred and seven lesions (42 hepatocellular carcinomas [HCC], 40 metastases, 13 cysts, eight hemangiomas, three focal nodular hyperplasias [FNHs], and one cholangiocarcinoma) were evaluated. Postcontrast MR imaging included 1) T2-weighted FSE; 2) T2*-weighted GRE; 3) T1-weighted spoiled GRE using moderate (TE = 4.2-4.4 msec) TE; and 4) minimum (TE = 1.8-2.1 msec) TE. Signal intensities of the focal lesions were rated by two radiologists in conference as follows: hypointense, isointense or invisible, hyperintense, and markedly hyperintense. Lesion-to-liver contrast-to-noise ratio (C/N) was measured by one radiologist for a quantitative assessment. RESULTS On ferumoxides-enhanced FSE images, 92% of cysts were "markedly hyperintense" and most of the other lesions were "hyperintense", and the mean C/N of cysts was significantly higher than that of other focal lesions. T2*-weighted GRE images showed most lesions with similar hyperintensities and the mean C/N was not significantly different between any two types of lesion. T1-weighted GRE images using moderate TE showed all FNHsand hemangiomas, 29 (69%) HCCs and eight (20%) metastases as "hyperintense". On T1-weighted GRE images using minimum TE, however, all HCCs and metastasis except one were iso- or hypointense, while all of the FNHs and hemangiomas were hyperintense. Ring enhancement was highly suggestive of malignant lesions, and was more commonly seen on the minimum TE images than on the moderate TE images. CONCLUSION Addition of T1-weighted GRE images using minimum and moderate TE is helpful for characterizing focal lesions in ferumoxides-enhanced MR imaging.
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Affiliation(s)
- Joo Hee Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
In this article we describe state-of-the art techniques for magnetic resonance imaging of the liver. T1-weighted, T2-weighted, and heavily T2-weighted pulse sequences are discussed. Gadolinium-enhanced hepatic parenchymal imaging and magnetic resonance angiography are also described. A comprehensive MR imaging examination of the liver affords evaluation of focal and diffuse hepatic parenchymal disease, biliary disease, and vascular pathology.
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Affiliation(s)
- Adam R Fisher
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
For optimal detection and characterization of focal or diffuse liver disease, it is essential to obtain the most appropriate imaging test in the correct clinical setting. Access to clinical information and medical history is, therefore, essential. Moreover, familiarity with currently available modalities for imaging the liver [figure: see text] allows the optimal use of the technical advances in ultrasound imaging, CT scanning, MR imaging, and nuclear scintigraphy technology and contributes to improved diagnostic accuracy.
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Affiliation(s)
- Pablo R Ros
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
MR imaging with new liver-specific contrast agents will probably be the imaging modality used in the future to detect focal liver lesions. The detection of HCC will probably be improved by using specific hepatobiliary agents, but the exact technique remains to be determined. New liver-specific contrast can differentiate some benign lesions from malignant ones and can assist in making a final diagnosis. In certain circumstances, liver-specific contrast agents can be used to evaluate hepatic vessels, the biliary tract, and hepatic function. New applications are also expected.
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Affiliation(s)
- Hoon Ji
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Kehagias DT, Gouliamos AD, Smyrniotis V, Vlahos LJ. Diagnostic efficacy and safety of MRI of the liver with superparamagnetic iron oxide particles (SH U 555 A). J Magn Reson Imaging 2001; 14:595-601. [PMID: 11747012 DOI: 10.1002/jmri.1224] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic efficacy and safety of an intravenous injection of magnetic resonance imaging (MRI) contrast agent, SH U 555 A, in adult patients with known focal liver lesions. Pre- and post-contrast image sets were obtained in 19 patients after injection of SH U 555 A as a part of a phase III clinical trial (patients <60 kg body weight received 0.9 mL and patients >60 kg received 1.4 mL). Three blinded readers evaluated the post-contrast images. Blood pressure and heart rate were recorded and laboratory tests were performed at baseline, during and immediately after the procedure, and four and 24 hours after the MR procedure. On post-contrast MRI, there was statistically significant improvement in diagnostic confidence, visualization, delineation, and contrast between the lesions and the healthy parenchyma in comparison to precontrast. Twenty more lesions were detected on post-contrast images. The management in six patients (31.7%) was changed after post-contrast imaging. Changes in vital signs and laboratory tests were minimal and did not affect the patients' clinical condition. Only a moderate allergic reaction (diffuse erythematous rash) was recorded. SH U 555 A is an effective and safe contrast agent for MRI of the liver.
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Affiliation(s)
- D T Kehagias
- Department of Radiology, University of Athens, Areteion Hospital, Athens, Greece.
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Ward J, Robinson PJ. COMBINED USE OF MR CONTRAST AGENTS FOR EVALUATING LIVER DISEASE. Magn Reson Imaging Clin N Am 2001. [DOI: 10.1016/s1064-9689(21)00273-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Harisinghani MG, Jhaveri KS, Weissleder R, Schima W, Saini S, Hahn PF, Mueller PR. MRI contrast agents for evaluating focal hepatic lesions. Clin Radiol 2001; 56:714-25. [PMID: 11585393 DOI: 10.1053/crad.2001.0764] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) has become an important tool in the detection and characterization of focal hepatic lesions especially when other investigations such as ultrasound (US) and computed tomography (CT) are inconclusive. The purpose of this pictorial review is to briefly summarize the properties of various MRI contrast agents used in hepatic imaging and to highlight their role in evaluation of focal hepatic lesions.
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Affiliation(s)
- M G Harisinghani
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
Magnetic resonance (MR) imaging is finding an ever-growing role in the evaluation of a wide range of conditions in the abdomen. No longer confined to problem solving regarding abnormalities in solid organs, such as the liver and kidneys, MR imaging is increasingly being applied to the evaluation of the pancreatic and biliary ductal systems and even the bowel. Recent technical advances in hardware and software have allowed the acquisition of MR images that are largely free of artifact secondary to bowel peristalsis or respiratory motion; images providing excellent anatomic detail can now be obtained routinely. Faster sequences have reduced image acquisition time, thereby improving patient acceptance and allowing more efficient utilization of machine time. New three-dimensional sequences allow rapid image acquisition, reducing section misregistration and motion artifact while improving multiplanar reformations. The potential of MR imaging to provide functional and anatomic information is intriguing, and new techniques, including diffusion and perfusion imaging, are being evaluated. This review considers the advances in imaging hardware and pulse sequence design that underlie the increasing role of MR imaging in evaluation of the abdomen and discusses evolving clinical applications.
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Affiliation(s)
- M T Keogan
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02215, USA.
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Ferraris R, del Piano A, Galli JJ. Role of magnetic resonance imaging in the staging of gastrointestinal neoplasms. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:122-9. [PMID: 11398205 DOI: 10.1002/ssu.1025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A concise review is presented of the current applications and techniques of magnetic resonance imaging (MRI) in the field of diagnostic imaging of oncologic disease of the gastrointestinal tract, with a summary of the diagnostic possibilities of MRI in the various types of tumor pathology of the gastrointestinal tract. We conclude with a review of the specific situations in which MRI presents distinct advantages over other diagnostic imaging methods (such as computed tomography and ultrasound).
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Affiliation(s)
- R Ferraris
- Department of Radiology, Ospedale Cottolengo, Turin, Italy.
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Peña CS, Saini S, Baron RL, Hamm BA, Morana G, Caudana R, Giovagnoni A, Villa A, Carriero A, Mathieu D, Bourne MW, Kirchin MA, Pirovano G, Spinazzi A. Detection of malignant primary hepatic neoplasms with gadobenate dimeglumine (Gd-BOPTA) enhanced T1-weighted hepatocyte phase MR imaging: results of off-site blinded review in a phase-II multicenter trial. Korean J Radiol 2001; 2:210-5. [PMID: 11754328 PMCID: PMC2718123 DOI: 10.3348/kjr.2001.2.4.210] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of gadobenate dimeglumine (Gd-BOPTA) enhanced MR imaging for the detection of liver lesions in patients with primary malignant hepatic neoplasms. MATERIALS AND METHODS Thirty-one patients with histologically proven primary malignancy of the liver were evaluated before and after administration of Gd-BOPTA at dose 0.05 or 0.10 mmol/kg. T1-weighted spin echo (T1W-SE) and gradient echo (T1W-GRE) images were evaluated for lesion number, location, size and confidence by three off-site independent reviewers and the findings were compared to reference standard imaging (intraoperative ultrasound, computed tomography during arterial portography or lipiodol computed tomography). Results were analyzed for significance using a two-sided McNemar's test. RESULTS More lesions were identified on Gd-BOPTA enhanced images than on unenhanced images and there was no significant difference in lesion detection between either concentration. The largest benefit was in detection of lesions under 1 cm in size (7 to 21, 9 to 15, 16 to 18 for reviewers A, B, C respectively). In 68% of the patients with more than one lesion, Gd-BOPTA increased the number of lesions detected. CONCLUSION Liver MR imaging after Gd-BOPTA increases the detection of liver lesions in patients with primary malignant hepatic neoplasm.
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Affiliation(s)
- Constantino S. Peña
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Sanjay Saini
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Richard L. Baron
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213-2582, USA
| | - Bernd A. Hamm
- Department of Radiology, Charite Charite Hospital, Humboldt University, 10098, Berlin, Germany
| | - Giovanni Morana
- Istituto di Radiologia, Policlinico di Borgo Roma, 37134, Verona, Italy
| | - Roberto Caudana
- Istituto di Radiologia, Policlinico di Borgo Roma, 37134, Verona, Italy
| | - Andrea Giovagnoni
- Dipartimento di Scienze Mediche, Oncologiche e Radiologiche, Universita degli Studi di Modena e Reggio Emilia, 41100, Modena, Italy
| | - Andrea Villa
- Istituto di Radiologia, Policlinico San Matteo, 27100, Pavia, Italy
| | - Alessandro Carriero
- Istituto di Scienze Radiologiche e Formazione dell'Imagine, Ospedale Santissima Annunziata, 66100, Chieti, Italy
| | - Didier Mathieu
- Service de Radiologie, Hopital Henri Mondor, 94010, Creteil, France
| | - Michael W. Bourne
- Department of Diagnostic Radiology, University Hospital of Wales, Cardiff CF4 4XW, United Kingdom
| | - Miles A. Kirchin
- Medical and Regulatory Affairs, Bracco SpA, Via E. Folli 50, 20134, Milan, Italy
| | - Gianpaolo Pirovano
- Medical and Regulatory Affairs, Bracco SpA, Via E. Folli 50, 20134, Milan, Italy
| | - Alberto Spinazzi
- Medical and Regulatory Affairs, Bracco SpA, Via E. Folli 50, 20134, Milan, Italy
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Pirovano G, Vanzulli A, Marti-Bonmati L, Grazioli L, Manfredi R, Greco A, Holzknecht N, Daldrup-Link HE, Rummeny E, Hamm B, Arneson V, Imperatori L, Kirchin MA, Spinazzi A. Evaluation of the accuracy of gadobenate dimeglumine-enhanced MR imaging in the detection and characterization of focal liver lesions. AJR Am J Roentgenol 2000; 175:1111-20. [PMID: 11000175 DOI: 10.2214/ajr.175.4.1751111] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We evaluated the extent to which hepatic lesion characterization and detection is improved by using gadobenate dimeglumine for enhancement of MR images. MATERIALS AND METHODS Eighty-six patients were imaged before gadobenate dimeglumine administration, immediately after the 2 mL/sec bolus administration of a 0.05 mmol/kg dose (dynamic imaging), and at 60-120 min after the IV infusion at 10 mL/min of a further 0.05 nmol/kg dose (delayed imaging). The accuracy for lesion characterization was assessed for a total of 107 lesions. Sensitivity for lesion detection was assessed for a total of 149 lesions detected on either intra-operative sonography, iodized oil CT, CT during arterial portography, or follow-up contrast-enhanced CT as the gold standard. RESULTS The accuracy in differentiating benign from malignant liver lesions increased from 75% and 82% (the findings of two observers) on unenhanced images alone, to 89% and 80% on dynamic images alone (p<0.001, p = 0.8), and to 90.7% when combining the unenhanced and dynamic image sets (p<0.001, p = 0.023). Delayed images did not further improve accuracy (90% and 91%; p = 0.002, p< 0.05). A similar trend was apparent in terms of accuracy for specific diagnosis: values ranged from 49% and 62% on unenhanced images alone, to 76% and 70% on combined unenhanced and dynamic images (p<0.001, p = 0.06), and to 75% and 70% on inclusion of delayed images (p<0.001, p = 0.12). The sensitivity for lesion detection increased from 77% and 81% on unenhanced images alone, to 87% and 85% on combined unenhanced and dynamic images (p = 0.001, p = 0.267), and to 92% and 89% when all images were considered (p<0.001, p = 0.01). CONCLUSION Contrast-enhanced dynamic MR imaging with gadobenate dimeglumine significantly increases sensitivity and accuracy over unenhanced imaging for the characterization of focal hepatic lesions, and delayed MR imaging contributes to the improved detection of lesions.
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Affiliation(s)
- G Pirovano
- Bracco, Medical and Regulatory Affairs, Via Egidio Folli 50, 20134 Milan, Italy
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40
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Affiliation(s)
- G T Sica
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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41
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Marinelli ER, Neubeck R, Song B, Wagler T, Ranganathan RS, Sukumaran K, Wedeking PW, Nunn A, Runge VM, Tweedle MF. Synthesis, characterization, and imaging performance of a new class of macrocyclic hepatobiliary MR contrast agents. Invest Radiol 2000; 35:8-24. [PMID: 10639032 DOI: 10.1097/00004424-200001000-00002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the effect of substituent lipophilicity, substituent position, and overall charge on the hepatobiliary clearance and tolerance of a series of aromatic ring-containing macrocyclic Gd chelates to select a candidate compound for evaluation as a hepatobiliary imaging agent. METHODS Hepatobiliary clearance was studied in rats. Tissue distribution and tolerance were studied in mice. Imaging was performed in cats, rabbits, and Rhesus monkeys using T1-weighted pulse sequences or T1-weighted breath-hold pulse sequences. RESULTS All the compounds were excreted bimodally. Gd-2,5-BPA-DO3A (15d) was found to have the optimal combination of hepatobiliary clearance (47% in rats, 29% in mice) and tolerance (minimum lethal dose 5.0 mmol/kg). Initial imaging studies in cats demonstrated the feasibility of Gd-2,5-BPA-DO3A for hepatic imaging. In rabbits with implanted VX-2 adenocarcinoma as a model for metastatic liver disease, Gd-2,5-BPA-DO3A provided sustained hepatic signal intensity (SI) enhancement and lesion conspicuity over a 120-minute imaging time course. In Rhesus monkeys with normal liver function, Gd-2,5-BPA-DO3A afforded sustained hepatic SI enhancement and a time-dependent increase in gallbladder SI over the entire 90-minute imaging time course. CONCLUSIONS Gd-2,5-BPA-DO3A provides dramatic and sustained SI enhancement of hepatic tissue in cats, rabbits, and Rhesus monkeys that was superior in all respects to the extracellular space MRI agent, Gd-HP-DO3A, that was employed as a control.
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Affiliation(s)
- E R Marinelli
- Bracco Research USA, Princeton, New Jersey 08540, USA
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42
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De Corato DR, Krinsky GA, Rofsky NM, Earls JP, Lebowitz J, Weinreb JC. Contrast-enhanced hepatic MRI: comparison of half-dose and standard-dose gadolinium DTPA administration in lesion characterization with T1-weighted gradient echo sequences. Clin Imaging 1999; 23:302-10. [PMID: 10665348 DOI: 10.1016/s0899-7071(99)00150-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objective of this article was to compare half-dose (0.05 mm/kg) gadolinium-enhanced dynamic hepatic MR imaging to standard doses (0.10 mm/kg). Eighteen patients for follow-up hepatic MR received 0.05 mm/kg of gadolinium DTPA dynamically with gradient-echo imaging. Imaging parameters were identical to a 0.10-mm/kg study; patients were imaged during multiple phases of contrast enhancement. Two readers assessed for enhancement patterns and characterization. Quantitative signal-to-noise ratios (S/N) were obtained for abdominal viscera and contrast-to-noise ratios (C/N) were obtained on up to three lesions. No significant difference for the arterial dominant phase (P > 0.05) was found. Significant differences were found in all categories during the portal venous phase (except pancreas) and equilibrium phase (except liver). Lesion C/N ratios were not significant at any point (P > 0.05). Sixty-two out of 64 lesions (97%) were identically characterized. Therefore, half-dose dynamic gadolinium-enhanced MR may have diagnostic value.
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Affiliation(s)
- D R De Corato
- Department of Radiology, New York University Medical Center, NY 10017, USA
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43
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Tanimoto A, Kuwatsuru R, Kadoya M, Ohtomo K, Hirohashi S, Murakami T, Hiramatsu K, Yoshikawa K, Katayama H. Evaluation of gadobenate dimeglumine in hepatocellular carcinoma: results from phase II and phase III clinical trials in Japan. J Magn Reson Imaging 1999; 10:450-60. [PMID: 10508308 DOI: 10.1002/(sici)1522-2586(199909)10:3<450::aid-jmri29>3.0.co;2-k] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To evaluate the clinical efficacy of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging for hepatocellular carcinoma (HCC), we reviewed the results of clinical phase II and III trials in Japan. Gd-BOPTA was administered at a dose of 0.1 mmol/kg to 139 patients who were suspected to have HCC. Dynamic phase images [breath-hold T1-weighted gradient echo (GRE)], spin-echo (SE) images obtained within 10 minutes of injection, and delayed breath-hold GRE images obtained 40-120 minutes after injection were evaluated. All post-contrast images were compared with T1- and T2-weighted pre-contrast images. The contrast efficacy for the dynamic study was classified as ( ) or (++) in 92.1% (128/139), in 43.1% (59/137) with SE within 10 minutes of injection, and in 43.2% (60/139) with breath-hold GRE at delayed phase. The increase in lesion-liver contrast-to-noise ratio was best at the arterial phase of dynamic breath-hold GRE. Liver signal-to-noise ratio showed a mean 52.3% increase in delayed phase. Additional information at delayed phase compared with images acquired within 10 minutes of injection (including the dynamic study) was classified as ( ) or (++) in 28.1% (39/139). With regard to safety, the overall incidence of adverse reactions was 5.0% (7/141) of the patients who were suspected to have HCC, all of whom recovered within 12 hours without any sequelae. No clinically important changes were observed in the blood and urine laboratory tests. It was concluded that Gd-BOPTA was well tolerated and effective in both dynamic study and delayed static imaging for the diagnosis of HCC.
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Affiliation(s)
- A Tanimoto
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo 160-8582, Japan.
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44
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Spinazzi A, Lorusso V, Pirovano G, Kirchin M. Safety, tolerance, biodistribution, and MR imaging enhancement of the liver with gadobenate dimeglumine: results of clinical pharmacologic and pilot imaging studies in nonpatient and patient volunteers. Acad Radiol 1999; 6:282-91. [PMID: 10228617 DOI: 10.1016/s1076-6332(99)80451-6] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to assess safety, tolerance, biodistribution, and magnetic resonance (MR) imaging enhancement of the liver with gadobenate dimeglumine. MATERIALS AND METHODS Phase I single-blind studies were performed in 53 healthy volunteers, of whom 39 received gadobenate dimeglumine and 14 placebo. Another 106 patients with focal liver disease received gadobenate dimeglumine in parallel-group, open-label, phase II studies. The imaging potential of gadobenate dimeglumine was assessed in all 106 patients plus 11 healthy volunteers, whereas pharmacokinetics were determined for 42 healthy volunteers. Safety was assessed for all subjects enrolled in the study. Imaging protocols for healthy volunteers were similar to those for patients and comprised predose T2-weighted sequences and pre- and postinjection T1-weighted spin-echo and gradient-echo sequences. RESULTS Gadobenate dimeglumine was safe and well tolerated in healthy volunteers and patients, with pharmacokinetics described adequately as a distribution phase and an elimination phase. Most of the injected dose of gadobenate was excreted unchanged in urine within 24 hours, although a fraction corresponding to 0.6%-4.0% of the injected dose was eliminated with the bile and recovered in the feces. The gadobenate dimeglumine-enhanced signal intensity of liver parenchyma was dose-related and constant for 120 minutes. Gadobenate dimeglumine-enhanced MR imaging was superior to nonenhanced MR imaging in more than 50% of patient studies, with more lesions seen in 26%-38% of patients and smaller lesions in 21%-33% of patients. In general, image sets acquired 40-180 minutes after administration of a dose were preferred, whereas images acquired during the dynamic phase after administration were typical of those obtained with extracellular fluid contrast agents. CONCLUSION Gadobenate dimeglumine is a safe and efficacious MR imaging contrast agent suitable for both delayed and dynamic imaging of the liver.
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Affiliation(s)
- A Spinazzi
- Medical and Regulatory Affairs, Bracco SpA, Milan, Italy
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45
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Semelka RC, Balci NC, Op de Beeck B, Reinhold C. Evaluation of a 10-minute comprehensive MR imaging examination of the upper abdomen. Radiology 1999; 211:189-95. [PMID: 10189470 DOI: 10.1148/radiology.211.1.r99ap32189] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether a 10-minute magnetic resonance (MR) imaging examination of the upper abdomen provides sufficiently comprehensive information to replace a longer MR protocol. MATERIALS AND METHODS Images obtained with selected breathing-independent and breath hold MR sequences, with 2 minutes of total acquisition time and an estimated 10 minutes of total study time, in consecutive MR examinations of the upper abdomen in 72 patients (age range, 23-87 years) were retrospectively reviewed in a blinded fashion by two separate interpreters. Determination was made of major and minor findings, and the two separate retrospective interpretations and the prospective clinical interpretation were correlated by using kappa statistics. Surgical and clinical findings were also correlated with imaging findings. RESULTS In 61 patients, all major and minor findings were identical in the original clinical interpretation and the two retrospective readings. In 66 patients, the major findings were identical in these three readings. Close agreement was present between the two separate retrospective readings and the prospective clinical interpretation (kappa = 0.49-1.00). CONCLUSION The findings suggest that the diagnostic information provided by a shortened MR imaging protocol that includes breath-hold and breathing-independent sequences is in close agreement with lengthier MR protocols. The advantages of a shortened protocol include increased patient throughput and decreased study cost.
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Affiliation(s)
- R C Semelka
- Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA
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Pawluk RS, Tummala S, Brown JJ, Borrello JA. A retrospective analysis of the accuracy of T2-weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions. J Magn Reson Imaging 1999; 9:266-73. [PMID: 10077023 DOI: 10.1002/(sici)1522-2586(199902)9:2<266::aid-jmri17>3.0.co;2-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to determine the relative ability of T2-weighted and dynamic gadolinium-enhanced T1-weighted gradient-echo sequences to detect and characterize focal hepatic lesions. We retrospectively studied 37 patients with proven focal hepatic lesions using the following sequences: a T1-weighted spin-echo sequence (T1), a T2-weighted sequence (T2), and a series of breath-hold dynamic gadolinium-enhanced T1-weighted gradient-echo sequences (Gd). Two observers were asked to determine retrospectively the number and type of focal hepatic lesions present using images from three combinations of sequences (T1+T2, T1+Gd, T1+T2+Gd). Proof of the number and diagnosis of focal lesions in each patient was established using a consensus read. Both readers detected more focal lesions when both the T2-weighted sequences and the gadolinium-enhanced sequences were available than on either sequence alone, although this improvement reached statistical significance (P<0.05) only for one of the readers. There was no significant difference (P<0.05) in the ability to characterize lesions between any of the sets of sequences. The combination of dynamic gadolinium-enhanced images and T2-weighted images was shown to assess focal hepatic lesions better than either of these sequences alone.
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Affiliation(s)
- R S Pawluk
- Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri 63110, USA
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Lencioni R, Donati F, Cioni D, Paolicchi A, Cicorelli A, Bartolozzi C. Detection of colorectal liver metastases: prospective comparison of unenhanced and ferumoxides-enhanced magnetic resonance imaging at 1.5 T, dual-phase spiral CT, and spiral CT during arterial portography. MAGMA (NEW YORK, N.Y.) 1998; 7:76-87. [PMID: 9951768 DOI: 10.1007/bf02592232] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to compare the efficacy of unenhanced and ferumoxides-enhanced magnetic resonance imaging with that of dual-phase spiral CT and spiral CT during arterial portography (CTAP) for the detection of colorectal liver metastases. Fourteen patients with liver metastases candidates for partial hepatectomy were examined with dual-phase spiral CT, unenhanced and ferumoxides-enhanced MR imaging at 1.5 T, and spiral CTAP. Imaging tests were read blinded, prospectively, quantitating number of lesions excepting CTAP which used US to exclude cysts. Subsequent intraoperative US and pathologic findings were correlated with preoperative imaging results. At surgery, 36 lesions 0.5-13 cm in diameter (mean+/-standard deviation, 2.9+/-2.1 cm) were identified. Dual-phase spiral CT depicted 21/36 (58%); precontrast MR imaging, 19/36 (53%); ferumoxides-enhanced MR imaging, 30/36 (83%); and spiral CTAP, 34/36 (94%) lesions. Ferumoxides-enhanced MR imaging was significantly more sensitive than spiral CT and unenhanced MR imaging (P < 0.01). The difference in sensitivity between ferumoxides-enhanced MR imaging and spiral CTAP was not statistically significant (P> 0.1). Spiral CTAP, however, depicted nine false-positive lesions (2 hemangiomas, 7 perfusion defects). The positive predictive value was 79% for spiral CTAP and 100% for combined pre- and postcontrast MR imaging. We conclude that ferumoxides-enhanced MR imaging is superior to unenhanced MR imaging and biphasic spiral CT for depiction of colorectal liver metastases. Further investigation is needed to clarify whether MR imaging with use of ferumoxides might replace spiral CTAP for preoperative evaluation of liver resection candidates.
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Affiliation(s)
- R Lencioni
- Department of Oncology, University of Pisa, Italy.
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Clément O, Siauve N, Lewin M, de Kerviler E, Cuénod CA, Frija G. Contrast agents in magnetic resonance imaging of the liver: present and future. Biomed Pharmacother 1998; 52:51-8. [PMID: 9755795 DOI: 10.1016/s0753-3322(98)80003-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
New contrast agents are being developed by drug companies to better image the liver magnetic resonance imaging (MRI). They can be divided into hepatobiliary agents (Gd-EOB-DTPA, Gd-BOPTA, Mangafodipir) and nanoparticulate agents directed to the reticulo-endothelial system (ferumoxides, SHU 555A). After intravenous injection, all these agents concentrate in the liver and induce profound signal changes. Particulate agents induce predominantly a darkening of the liver parenchyma, while hepatobiliary agents induce a brightening. In both cases, liver-lesion conspicuity is enhanced, leading to a better visualization of the lesion. After a description of the principal pharmacokinetic characteristics of the compounds, this review paper summarizes the utility of the agents in the detection and characterization of focal liver diseases.
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Affiliation(s)
- O Clément
- Service de Radiologie, Hôpital Laënnec, Paris, France
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50
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Abstract
MRI of the liver is a powerful imaging modality for detection and characterization of liver pathology. MRI technology continues to evolve with developments in scanner hardware performance and refinements in imaging sequences, particularly in respect to fast imaging techniques, improving the quality of images that can be routinely achieved. Fast imaging techniques allow dynamic contrast-enhanced scanning to assist in lesion detection and characterization. An array of tissue-specific contrast agents are also becoming available; the clinical utility of some of these agents is yet to be fully established. An overview of scanning technique, contrast media, and the role of MRI in liver lesion detection and characterization is presented, with a review of the typical imaging characteristics of common focal and diffuse hepatic diseases. Where possible, emphasis has been placed on features that allow distinction between the various pathologic entities described.
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Affiliation(s)
- A D Laing
- Department of Radiology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia
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