Castoldi MC, Fauda V, Scaramuzza D, Vergnaghi D. Hepatic and hepatocarcinoma magnetic resonance: comparison of the results obtained with paramagnetic (gadolinium) and superparamagnetic (iron oxide particles) Radiol Med (Torino) 2000 Sep;100(3):160-7
PURPOSE: To compare prospectively
dynamic gadolinium (Gd)-enhanced with superparamagnetic iron oxide
(SPIO)-enhanced MRI for the detection of hepatocellular carcinoma
(HCC). MATERIAL AND METHODS: Twenty-five patients with histologically
proven HCC and liver cirrhosis (28% of them in B or C Child class)
underwent dynamic Gd-enhanced MRI and, a few days later, (mean
interval: three days) SPIO-enhanced MRI. Only patients with availability
of clinical and imaging follow-up for at least seven months were
enrolled in this prospective study. Axial dynamic Gd-enhanced
imaging was performed with T1 gradient-recalled echo (GRE) sequences.
Both axial and sagittal SPIO-enhanced imaging were performed with
respiratory triggered T2-weighted turbo spin-echo (TSE) and T1-T2*-weighted
GRE sequences. MR images were reviewed by two independent radiologists.
The readers scored each lesion for the presence of HCC and assigned
confidence levels based on a five-grade scale: 1, definitely or
almost definitely absent; 2, possibly present; 3, probably present;
4, definitely present; 5, definitely present with optimal liver/lesion
contrast or good liver/lesion contrast and morphological signs
(intact capsule, intranodular septa, extra-capsular infiltration),
useful for locoregional treatment planning. A positive diagnostic
value was assessed for scores of 3 or higher. RESULTS: Gd-enhanced
and SPIO-enhanced MRI found 44 lesions. The combined use of TSE
and GRE SPIO-enhanced sequences detected 11 more lesions (25%
improvement in sensitivity) than Gd-enhanced MRI. One lesion (2.27%)
was detected only with Gd-enhanced MRI. Eight of twelve lesions
visible with a single contrast agent measured less than 1 cm in
diameter. HCC detectability was 75% with Gd-enhanced MRI and 97.7%
with SPIO-enhanced MRI. SPIO-enhanced T2-weighted TSE images showed
significantly higher diagnostic value than SPIO-enhanced T1-T2*GRE
images only in three cases, while nodule morphological characteristics
(capsule, septa, different cell differentiation components) were
better depicted by TSE images. DISCUSSION AND CONCLUSIONS: In
our study the combined use of SPIO-enhanced T2-weighted TSE and
T1-T2*-weighted GRE sequences showed higher sensitivity than gadolinium-enhanced
GRE dynamic imaging (97.7% versus 75%). These results are at least
partly related to our study conditions, that is: 1) MRI was performed
with a 1T system, 2) both axial and sagittal SPIO-enhanced imaging
were performed with respiratory triggered T2-weighted TSE and
T1-T2*-weighted GRE, 3) there was a low freaquency of severe cirrhosis.
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