Hepatocellular Carcinoma: Detection with Gadolinium- and Ferumoxides-enhanced MR Imaging of the Liver

December 29, 2001

(Radiology 2002;222:73-80.)

Gastrointestinal Imaging

Hepatocellular Carcinoma: Detection with Gadolinium- and

Ferumoxides-enhanced MR Imaging of the Liver1

Dirk eit, MD, Jochen Textor, MD, Reinald Bachmann, MD, Rudi Conrad, MD,

Sebastian Flacke, MD, Günter Layer, MD, Burkhard Kreft, MD and Hans Schild,

MD

1 From the Department of Radiology, University of Bonn, Germany. Received

September 29, 2000; revision requested November 22; final revision received

July 30, 2001; accepted August 3. Address correspondence to D.P., Department

of Nuclear Medicine, Heinrich-Heine-University Duesseldorf, Research Center

Juelich, 52426 Juelich, Germany (e-mail: pauleit@...).

PURPOSE: To test the hypothesis that the accuracy of gadolinium- and

ferumoxides-enhanced magnetic resonance (MR) imaging is different in small

(1.5-cm) and large (>1.5-cm) hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS: Forty-three consecutive patients with chronic liver

disease were enrolled in this study. The imaging protocol included

unenhanced breath-hold T1-weighted fast field-echo sequences, unenhanced

respiratory-triggered T2-weighted turbo spin-echo (SE) sequences, dynamic

gadolinium-enhanced T1-weighted three-dimensional turbo field-echo

sequences, and ferumoxides-enhanced T2-weighted turbo SE sequences. Images

of each sequence and two sets of sequences (ferumoxides set and gadolinium

set) were reviewed by four observers. The ferumoxides set included

unenhanced T1- and T2-weighted images and ferumoxides-enhanced T2-weighted

turbo SE MR images. The gadolinium set included unenhanced T1- and

T2-weighted images and dynamic gadolinium-enhanced three-dimensional turbo

field-echo MR images. In receiver operating characteristic (ROC) curve

analysis, the sensitivity and accuracy of the sequences were compared in

regard to the detection of all, small, and large HCCs.

RESULTS: Imaging performance was different with gadolinium- and

ferumoxides-enhanced images in the detection of small and large HCCs. For

detection of small HCCs, the sensitivity and accuracy with unenhanced and

gadolinium-enhanced imaging (gadolinium set) were significantly (P = .017)

superior to those with unenhanced and ferumoxides-enhanced imaging

(ferumoxides set). The area under the composite ROC curves, or Az, for the

gadolinium set and the ferumoxides set was 0.97 and 0.81, respectively. For

large HCC, the ferumoxides set was superior compared with the gadolinium

set, but this difference was not statistically significant. Analysis of all

HCCs demonstrated no significant differences for gadolinium- and

ferumoxides-enhanced imaging.

CONCLUSION: For the detection of early HCC, gadolinium-enhanced MR imaging

is preferred to ferumoxides-enhanced MR imaging because the former

demonstrated significantly greater accuracy in the detection of small HCCs.

Index terms: Gadolinium, 761.12143 . Liver neoplasms, MR, 761.121411,

761.121416, 761.12143 . Receiver operating characteristic (ROC) curve

December 29, 2001