Abstract 312: Preoperative Detection of Hepatic Tumors: Comparison of Combined Unenhanced T1- and T2-weighted, Gadolinium-enhanced Triphasic, and Ferumoxides-enhanced MR vs Combined CTAP and Biphasic CTHA.
AUTHORS:
H. Kondo, MD, M. Kanematsu, MD, H. Hoshi, MD, T. Murakami, MD, PhD, T. Kim, MD, M. Hori, MD.
ABSTRACT:
PURPOSE: To compare the diagnostic performance of dedicated MR imaging combined with unenhanced T1- and T2-weighted, gadolinium-enhanced triphasic dynamic, and ferumoxides-enhanced MR imaging versus angiographically-assisted helical CT (AACT) combined with CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the preoperative detection of solid, malignant hepatic tumors.
METHOD AND MATERIALS: MR and AACT images obtained in 33 surgical candidates (HCC [n = 21], metastasis [n = 8], cirrhosis [n = 1], healthy liver [n = 3]) were retrospectively analyzed. Image review was conducted on a liver segment-by-segment basis; a total of 261 liver segments including 56 segments with 39 HCC (6-53 mm, mean 17.5 mm) and 21 metastatic (5-58 mm, mean 18.8 mm) lesions were reviewed for solid, malignant tumors using a five-point confidence scale by three independent radiologists. For MR image review, unenhanced T1-weighted SE, T2-weighted fast SE, and gadolinium-enhanced triphasic dynamic GRE images were reviewed together first, then ferumoxides-enhanced proton-density-weighted SE, T2-weighted fast SE, and T2*-weighted GRE images were added for an integrated review of combination MR images. For AACT image review, CTAP and biphasic CTHA images were reviewed together. Sensitivity and specificity for liver segments with and without tumor burden were evaluated, respectively. Diagnostic accuracy was evaluated by means of ROC curve analysis.
RESULTS: Sensitivity for 56 segments with tumor burden was comparable between AACT (87%) and combination MR images (86%). Specificity for 205 segments without tumor burden was significantly higher with combination MR images (95%, P
CONCLUSIONS: Diagnostic accuracy for solid, malignant hepatic tumors is increased by adding ferumoxides-enhanced MR images to unenhanced T1- and T2-weighted and gadolinium-enhanced triphasic dynamic MR images. Such a dedicated combination of MR images may obviate the need for more invasive angiographically-assisted helical CT in the preoperative detection of solid, malignant hepatic tumors.
