Small colorectal liver metastases: Detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging

The aim of this prospective study was to compare the diagnostic role of superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) versus gadobenate dimeglumine (GbD)-enhanced MRI and computed tomography (CT) investigations for detection of small (less than 1 cm) colorectal liver metastases (LMs) of colorectal cancer. Seventy-eight LMs in 16 patients were evaluated with dynamic CT imaging, GbD-enhanced dynamic MR imaging and SPIO-enhanced MR imaging. Two radiologists were reviewed the LMs seperately. Agreement between the readers and three algorithms was analyzed. Differences between the lesion detection ratios of the methods were analyzed by two proportion z test. Sensitivity values of each modality were also calculated. Interobserver agreement values with kappa analysis were found to be the best for three modalities and kappa values were 0.866, 0.843, and 1.0 respectively. For all 78 LMs, SPIO-enhanced MRI detected all lesions (100% sensitivity). This sensitivity value was higher than GbD-enhanced MRI, and there was a significant difference (p < 0.05). GbD-enhanced MRI depicted 71 lesions and this modality could not detected 7 lesions (91% sensitivity). This modality had moderate sensitivity, and this value is greater than CT imaging, so there was a significant difference also (p < 0.05). Dynamic triphasic CT imaging detected 64 (R1) and 65 (R2) LMs. This modality had the lowest sensitivity (R1: 0.82, R2: 0.83 respectively). Only SPIO-enhanced MRI was able to detect all LMs less than 1 cm. LMs were the best detected with SPIO-enhanced MRI. We recommend SPIO-enhanced MRI to be the primary alternative modality especially for diagnosis of small colorectal LMs.