Detection of liver metastasis: is diffusion-weighted imaging needed in Gd-EOB-DTPA-enhanced MR imaging for evaluation of colorectal liver metastases?

Purpose

We compared diagnostic ability for detecting hepatic metastases between gadolinium ethoxy benzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) on a 1.5-T system, and determined whether DWI is necessary in Gd-EOB-DTPA-enhanced MRI for diagnosing colorectal liver metastases.

Materials and methods

We assessed 29 consecutive prospectively enrolled patients with suspected metachronous colorectal liver metastases; all patients underwent surgery and had preoperative Gd-EOB-DTPA-enhanced MRI. Overall detection rate, sensitivity for detecting metastases and benign lesions, positive predictive value, and diagnostic accuracy (Az value) were compared among three image sets [unenhanced MRI (DWI set), Gd-EOB-DTPA-enhanced MRI excluding DWI (EOB set), and combined set].

Results

Gd-EOB-DTPA-enhanced MRI yielded better overall detection rate (77.8?C79.0?%) and sensitivity (87.1?C89.4?%) for detecting metastases than the DWI set (55.9?% and 64.7?%, respectively) for one observer (P?<?0.001). No statistically significant difference was seen between the EOB and combined sets, although several metastases were newly detected on additional DWI.

Conclusions

Gd-EOB-DTPA-enhanced MRI yielded a better overall detection rate and higher sensitivity for detecting metastases compared with unenhanced MRI. Additional DWI may be able to reduce oversight of lesions in Gd-EOB-DTPA-enhanced 1.5-T MRI for detecting colorectal liver metastases.     

Accuracy and confidence of Gd-EOB-DTPA enhanced MRI and diffusion-weighted imaging alone and in combination for the diagnosis of liver metastases

Purpose

To evaluate the accuracy and confidence in diagnosing liver metastases using combined gadolinium-EOB-DTPA (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI)/diffusion-weighted imaging (DWI) in comparison to Gd-EOB-DTPA enhanced MRI and DWI alone.

Materials and methods

Forty-three patients (age, 58 ± 13 years) with 89 liver lesions (28 benign, 61 malignant) underwent liver MRI for suspected liver metastases. Three image sets (DWI, Gd-EOB-DTPA and combined Gd-EOB-DTPA/DWI) in combination with unenhanced T1- and T2-weighted images were reviewed by three readers. Detection rates of focal liver lesions were assessed and diagnostic accuracy was evaluated by calculating the areas under the receiver-operating-characteristics curve (AUC). Confidence in diagnosis was evaluated on a 3-point scale. Histopathology and imaging follow-up served as the standard of reference.

Results

Detection of liver lesions and confidence in final diagnosis for all readers were significantly higher for the combined Gd-EOB-DTPA/DWI dataset than for DWI. The combination of DWI and Gd-EOB-DTPA rendered a significantly higher confidence in final diagnosis (2.44 vs. 2.50) than Gd-EOB-DTPA alone for one reader. For two readers, accuracy in diagnosis of liver metastases was significantly higher for Gd-EOB-DTPA/DWI (AUCs of 0.84 and 0.83) than for DWI datasets (AUCs of 0.73 and 0.72). Adding DWI to Gd-EOB-DTPA did not significantly increase diagnostic accuracy as compared to Gd-EOB-DTPA imaging alone.

Conclusion

Addition of DWI sequences to Gd-EOB-DTPA enhanced MRI did not significantly increase diagnostic accuracy as compared to Gd-EOB-DTPA enhanced MRI alone in the diagnosis of liver metastases. However, the increase in diagnostic confidence might justify acquisition of DWI sequences in a dedicated MRI protocol.     

Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

Objectives

To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy.

Methods

Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis.

Results

Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3–82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6–80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3–72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9–68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4–93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1–95.1). Differences were statistically significant (P?<?0.001). Notably, similar results were obtained analysing only small lesions (<1 cm).

Conclusions

The combination of DWI with Gd-EOB-DTPA-enhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions.

Key Points

? Accurate detection of colorectal liver metastases is essential to determine resectability. ? Almost 80 % of patients are candidates for neoadjuvant chemotherapic treatment at diagnosis. After chemotherapy, metastases usually decrease, and drug-induced liver steatosis may be present. ? The sensitivity of imaging is significantly inferior to that in chemotherapy-naïve patients. ? DWI combined with Gd-EOB-DTPA increases sensitivity in detecting small metastases after chemotherapy.     

Diagnosis of colorectal hepatic metastases: comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI

Purpose:

To compare the diagnostic accuracy of contrast‐enhanced computed tomography (CE‐CT), contrast‐enhanced ultrasonography (CE‐US), superparamagnetic iron oxide‐enhanced magnetic resonance imaging (SPIO‐MRI), and gadoxetic acid‐enhanced MRI (Gd‐EOB‐MRI) in the evaluation of colorectal hepatic metastases.

Materials and Methods:

In all, 111 patients with colorectal cancers were enrolled in this study. Of the 112 metastases identified in 46 patients, 31 in 18 patients were confirmed histologically and the remaining 81 in 28 patients were confirmed by follow‐up imaging. CE‐CT, CE‐US, SPIO‐MRI, and Gd‐EOB‐MRI were evaluated. Mean (of three readers, except for CE‐US) area under the receiver operating characteristic curve (A_z), sensitivities, and positive predictive values (PPV) were calculated. Each value was compared to the others by variance z‐test or chi‐square test with Bonferroni correction.

Results:

For all lesions, mean A_z and sensitivity of Gd‐EOB‐MRI (0.992, 95% [56/59]) were significantly greater than those of CE‐CT (0.847, 63% [71/112]) and CE‐US (0.844, 73% [77/106]). For lesions ≤1 cm, mean A_z and sensitivity of Gd‐EOB‐MRI (0.999, 92% [22/24]) were significantly greater than those of CE‐CT (0.685, 26% [13/50]) and CE‐US (0.7, 41% [18/44]). Mean A_z (95% CI) of SPIO‐MRI for all lesions (0.966 [0.929–0.987]) and lesions ≤ 1 cm (0.961 [0.911–0.988]) were significantly greater than those of CE‐CT and CE‐US. Mean sensitivity of SPIO‐MRI for lesions ≤1 cm (63%, 26/41) was significantly greater than that of CE‐CT.

Conclusion:

Gd‐EOB‐MRI and SPIO‐MRI were more accurate than CE‐CT and CE‐US for evaluation of liver metastasis in patients with colorectal carcinoma. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Detection of colorectal hepatic metastases using MnDPDP MR imaging and diffusion-weighted imaging (DWI) alone and in combination

To compare the diagnostic accuracy of MnDPDP MR imaging and diffusion-weighted imaging (DWI), alone and in combination, for detecting colorectal liver metastases in patients with suspected metastatic disease. Thirty-three consecutive patients with suspected colorectal liver metastases underwent MR imaging. Three image sets (MnDPDP, DWI and combined MnDPDP and DWI) were reviewed independently by two observers. Lesions were scored on a five-point scale for malignancy and the areas (Az) under the receiver operating characteristic curves were calculated for each observer and image set. The sensitivity and specificity for lesion detection were calculated for each image set and compared. There were 83 metastases, 49 cysts and 1 haemangioma. Using the combined set resulted in the highest diagnostic accuracy for both observers (Az = 0.94 and 0.96), with improved averaged sensitivity of lesion detection compared with the DWI set (p = 0.01), and a trend towards improved sensitivity compared with the MnDPDP set (p = 0.06). There was no difference in the averaged specificity using any of the three image sets (p > 0.5). Combination of MnDPDP MR imaging and DWI resulted in the highest diagnostic accuracy and can increase sensitivity without loss in specificity.     

Detection of hepatocellular carcinoma (HCC) using super paramagnetic iron oxide (SPIO)‐enhanced MRI: Added value of diffusion‐weighted imaging (DWI)

Purpose:

To evaluate whether diffusion‐weighted imaging (DWI) improves the detection of hepatocellular carcinoma (HCC) on super paramagnetic iron oxide (SPIO)‐enhanced MRI.

Materials and Methods:

This retrospective study group consisted of 30 patients with 50 HCC nodules who underwent MRI at 1.5 Tesla. Two combined MR sequence sets were compared for detecting HCC: SPIO‐enhanced MRI (axial T2‐weighted fast spin‐echo (FSE) and T1‐/T2*‐weighted fast field echo (FFE) scanned before and after administration of ferucarbotran) and SPIO‐enhanced MRI + DWI (SPIO‐enhanced MRI with axial DWI scanned before and after administration of ferucarbotran). Three blinded readers independently reviewed for the presence of HCC on a segment‐by‐segment basis using a four‐point confidence scale. The performance of the two combined MR sequence sets was evaluated using receiver operating characteristic (ROC) analysis.

Results:

The average area under the ROC curve (Az) of the three readers for the SPIO‐enhanced MRI + DWI set (0.870 ± 0.046) was significantly higher that that for the SPIO‐enhanced MRI set (0.820 ± 0.055) (P = .025). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of HCC were 66.0%, 98.0%, 90.0%, and 91.4%, respectively, for the SPIO‐enhanced MRI set, and 70.0%, 98.6%, 92.9%, and 92.4%, respectively, for the SPIO‐enhanced MRI + DWI set.

Conclusion:

The SPIO‐enhanced MRI + DWI set outperformed the SPIO‐enhanced MRI set for depicting HCC. J. Magn. Reson. Imaging 2010; 31: 373–382. © 2010 Wiley‐Liss, Inc.     

Diagnosis of liver metastases: Can diffusion-weighted imaging (DWI) be used as a stand alone sequence?

Objectives

To evaluate if diffusion-weighted MRI (DWI) can replace gadolinium-enhanced MRI (Gd-MRI) for diagnosing liver metastases. The diagnostic accuracy of both techniques alone and in combination are compared.

Materials and methods

Sixty-eight patients with histologically proven primary extrahepatic tumors were included in this retrospective study. Lesions included 62 metastases and 130 benign lesions. Three image sets (unenhanced T1 and T2/gadolinium enhanced T1 (Gd-MRI), DWI and combination of both) were reviewed independently by 3 observers. The areas under the receiver operating characteristic curves (A_z), sensitivity and specificity for the 3 image sets were compared. The standard of reference was either histopathology or multi-modality and clinical follow-up.

Results

Pooled data showed higher diagnostic accuracy for the combined set (A_z = 0.93) compared to Gd-MRI (p = 0.001) and DWI (p < 0.0001). No difference was found between the performance of Gd-MRI and DWI (p = 0.09). Sensitivity for the combined set was higher than Gd-MRI (p = 0.0003) and DWI (p = 0.0034). Specificity for DWI was lower than Gd-MRI (p < 0.0001) and the combined set (p < 0.0001).

Conclusion

The diagnostic performance of DWI is equal to that of Gd-MRI. DWI alone can be used in patients where gadolinium contrast administration is not allowed. Combination of Gd-MRI and DWI significantly increases diagnostic accuracy.     

T2-weighted and diffusion-weighted MRI for discriminating benign from malignant focal liver lesions: diagnostic abilities of single versus combined interpretations

Purpose:

To compare the diagnostic accuracies of diffusion‐weighted imaging (DWI), T2‐weighted imaging (T2WI), and the combination of both sequences in discriminating benign from malignant focal liver lesions (FLLs).

Materials and Methods:

In all, 166 patients with 269 FLLs (153 benign and 116 malignant) were retrospectively evaluated. Two abdominal readers visually assessed the DWI, T2WI, and the combined (DWI+T2WI) image sets in an independent and blinded manner. The diagnostic abilities of each image set in discriminating the benign from the malignant FLLs set were compared using a binary logistic regression model. Pathologic results, consensus reading, and follow‐up imaging were used as the reference standard.

Results:

The overall characterization accuracy in all lesions of the combined set (80.3%) was significantly higher than those of the T2WI set (68.8%) and DWI set (73.2%) (combined vs. T2WI, P < 0.001; combined vs. DWI, P = 0.001), while there was no significant difference between the T2WI and DWI sets (P = 0.058). All image sets were more accurate in the characterization of malignant FLLs than of benign FLLs (P < 0.001).

Conclusion:

T2WI and DWI are complementary in discriminating benign from malignant FLLs; their combination improves diagnostic confidence. J. Magn. Reson. Imaging 2012;35:1388–1396. © 2012 Wiley Periodicals Inc.     

Comparison of monopolar and bipolar diffusion weighted imaging sequences for detection of small hepatic metastases

Objective

To compare monopolar (MP) and bipolar (BP) diffusion weighted imaging (DWI) in detecting small liver metastases.

Materials and methods

Eighty-eight patients underwent 3-T MRI. The signal-to-noise ratios (SNR) of the liver parenchyma and lesions, the lesion-to-liver contrast-to-noise ratios (CNR), and the detection sensitivities were compared. The lesion distortion was scored (LDS) from 4 (no distortion) to 1 (excessive distortion), dichotomised as no-distortion and distortion, and the association between detected lesions for each reader in the MP or BP DWI group and the dichotomised lesion distortion degree was assessed.

Result

Forty-six hepatic metastases were confirmed. The CNR with BP images showed significantly higher values than with MP (P = 0.017). The detection sensitivities of the three readers were higher in the BP sequence than in MP, and one reader detected significantly more hepatic lesions with BP images (P = 0.04). LDS was significantly improved with BP sequence (P = 0.002). In the no-distortion group, excluding the MP DWI assessments of one reader, detection sensitivities were significantly higher than in the distortion group (P < 0.001 and P = 0.002, respectively).

Conclusion

Reduced lesion distortion improves the detection of small liver metastases, and BP is more sensitive in detecting small liver metastases than MP DWI.     

Added value of breathhold diffusion‐weighted MRI in detection of small hepatocellular carcinoma lesions compared with dynamic contrast‐enhanced MRI alone using receiver operating characteristic curve analysis

Purpose

To evaluate the added value of single‐breathhold diffusion‐weighted MRI (DWI) in detection of small hepatocellular carcinoma (HCC) lesions (≤2 cm) in patients with chronic liver disease, by comparing the detection sensitivity of combined DWI/conventional dynamic contrast‐enhanced (DCE)‐MRI to that of conventional DCE‐MRI alone.

Materials and Methods

A total of 37 patients with chronic liver diseases underwent abdominal MRI at 1.5T, including T1‐weighted imaging (T1WI), T2‐weighted imaging (T2WI), and 2D conventional DCE. For each patient study, axial DWI was performed with a single‐shot echo‐planar imaging (EPI) sequence using a modified sensitivity‐encoding (mSENSE) technique with b‐value of 500 seconds/mm². A total of 20–24 slices were obtained during a 15–17‐second breathhold. Two observers independently interpreted the combined DWI/conventional DCE‐MRI images and the conventional DCE‐MRI images alone in random order. For all small HCC lesions, the diagnostic performance using each imaging set was evaluated by receiver operating characteristic (ROC) curve analysis. Sensitivity and positive predictive values were also calculated and analyzed.

Results

A total of 47 small HCCs were confirmed as final result. The area under the ROC curve (Az) of combined DWI/conventional DCE‐MRI images (observer 1, 0.922; observer 2, 0.918) were statistically higher than those of conventional DCE‐MRI alone (observer 1, 0.809; observer 2, 0.778) for all small HCC lesions (P < 0.01). The lesion detection sensitivities using the combined technique for both observers were significantly higher than those using conventional DCE‐MRI alone (P < 0.01). The sensitivity values for two observers using the combined technique were 97.87% and those using conventional DCE‐MRI alone were 85.11% to 82.98%. The positive predictive values for two observers using the combined imaging technique (97.87%) were slightly higher than those using conventional DCE‐MRI alone (92.86–93.02%), but there was no significant difference between the two imaging sets.

Conclusion

Combined use of breathhold DWI with conventional DCE‐MRI helped to provide higher sensitivities than conventional DCE‐MRI alone in the detection of small HCC lesions in patients with chronic liver disease. J. Magn. Reson. Imaging 2009;29:341–349. © 2009 Wiley‐Liss, Inc.     

Gadoxetic acid disodium-enhanced magnetic resonance imaging for biliary and vascular evaluations in preoperative living liver donors: comparison with gadobenate dimeglumine-enhanced MRI

Purpose

To compare gadoxetic acid disodium (Gd‐EOB‐DTPA)‐enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine (Gd‐BOPTA)‐enhanced MRI in preoperative living liver donors for the evaluation of vascular and biliary variations.

Materials and Methods

Sixty‐two living liver donors who underwent preoperative MRI were included in this study. Thirty‐one patients underwent MRI with Gd‐EOB‐DTPA enhancement, and the other 31 underwent MRI with Gd‐BOPTA enhancement. Two abdominal radiologists retrospectively reviewed dynamic T1‐weighted and T1‐weighted MR cholangiography images and ranked overall image qualities for the depiction of the hepatic artery, portal vein, hepatic vein, and bile duct on a 5‐point scale and determined the presence and types of normal variations in each dynamic phase. Semiquantitative analysis for bile duct visualization was also conducted by calculating bile duct‐to‐liver contrast ratios.

Results

No statistical differences were found between the two contrast media in terms of hepatic artery or bile duct image quality by the two reviewers, or in terms of portal vein image quality by one reviewer (P > 0.05). Gd‐BOPTA provided better image qualities than Gd‐EOB‐DTPA for the depiction of hepatic veins by both reviewers, and for the depiction of portal veins by one reviewer (P < 0.01). The two contrast media‐enhanced images had similar bile duct‐to‐liver contrast ratios (P > 0.05). Regarding diagnostic accuracies with hepatic vascular/biliary branching types, no significant differences were observed between the two contrast media (P > 0.05).

Conclusion

Gd‐EOB‐DTPA could be as useful as Gd‐BOPTA for the preoperative evaluation of living liver donors, and has the advantage of early hepatobiliary phase image acquisition. J. Magn. Reson. Imaging 2011;33:149–159. © 2010 Wiley‐Liss, Inc.     

Evaluation of lymph node metastases: comparison of gadofluorine M-enhanced MRI and diffusion-weighted MRI in a rabbit VX2 rectal cancer model

Purpose:

To compare the diagnostic performance of a diffusion‐weighted imaging (DWI) dataset and a gadofluorine M‐enhanced imaging dataset for identifying lymph node (LN) metastases in a rabbit rectal cancer model.

Materials and Methods:

VX2 carcinomas were injected into the rectum of 26 rabbits. Four weeks later, T2‐weighted imaging (T2WI), pre‐T1WI, DWI, and post‐T1WI were performed. Two radiologists independently reviewed the DWI set (T2WI, pre‐T1WI, DWI) and the gadofluorine M set (T2WI, pre‐ and post‐T1WI) and recorded their confidence scores for LN metastasis on a per‐LN basis. Receiver operating characteristic (ROC) analysis was performed to compare the area under the ROC curve (A_z) of the two imaging sets. Histopathologic results were used as the reference standard.

Results:

The A_z and sensitivity of the gadofluorine M set were comparable to those of the DWI set (A_z, for reader 1, 0.849, 0.829, P = 0.571; for reader 2, 0.923, 0.876, P = 0.212; sensitivity, for reader 1, 97%, 97%; for reader 2, 97%, 92%, P = 0.304). The specificity of the former was greater than that of the latter (for reader 1, 65%, 53%, P = 0.0003; for reader 2, 81%, 68%, P = 0.01).

Conclusion:

Gadofluorine M‐enhanced images provided greater specificity than DWI for identifying LN metastases, whereas the A_z and sensitivity of the former were comparable to those of the latter. J. Magn. Reson. Imaging 2012;35:1179‐1186. © 2012 Wiley Periodicals, Inc.     

Prediction of microvascular invasion of hepatocellular carcinoma: usefulness of peritumoral hypointensity seen on gadoxetate disodium-enhanced hepatobiliary phase images

Purpose:

To determine whether peritumoral hypointensity seen on hepatobiliary phase images of preoperative gadoxetate disodium‐enhanced magnetic resonance imaging (EOB‐MRI) is useful for predicting microvascular invasion of hepatocellular carcinoma (HCC).

Materials and Methods:

This study was approved by the Institutional Review Board. In all, 104 HCC masses in 104 patients who had undergone EOB‐MRI and liver surgery within 1 month after EOB‐MRI were evaluated. Two radiologists independently recorded the presence of a peritumoral hypointensity on hepatobiliary phase. Interobserver agreement was assessed and consensus records were used. Tumor size was measured. A chi‐square test and independent t‐test were used for univariate analysis. Multiple logistic regression was performed to determine factors for predicting microvascular invasion. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of peritumoral hypointensity were calculated.

Results:

Sixty HCCs had microvascular invasion and 44 did not. Interobserver agreement in determining peritumoral hypointensity was excellent (κ = 0.83). By univariate analysis, peritumoral hypointensity and tumor size were significant for predicting microvascular invasion of HCC. On multiple logistic regression analysis, only peritumoral hypointensity was significant in predicting microvascular invasion of HCC (P = 0.013). The sensitivity, specificity, PPV, and NPV of peritumoral hypointensity were 38.3%, 93.2%, 88.5%, and 52.6%, respectively.

Conclusion:

Peritumoral hypointensity on the hepatobiliary phase of EOB‐MRI is not sensitive but has high specificity for predicting microvascular invasion of HCC. J. Magn. Reson. Imaging 2012;35:629‐634. © 2011 Wiley Periodicals, Inc.     

Detection of hepatic hypovascular metastases: 3D gradient echo MRI using a hepatobiliary contrast agent

Purpose:

To assess the diagnostic performance of gadobenate dimeglumine‐enhanced 3D gradient echo (3D‐GRE) magnetic resonance imaging (MRI) for the detection of hepatic hypovascular metastases.

Materials and Methods:

We retrospectively analyzed the initial radiologic reports of MRI of 41 patients with suspected hepatic metastases. Seventy‐nine metastatic lesions were confirmed by histopathology or intraoperative ultrasound (IOUS). The sensitivity and positive predictive values for the diagnosis of hepatic metastasis were determined among each MRI set (hepatobiliary phase, precontrast images, dynamic imaging). The diagnostic performance of dynamic image set and combined dynamic and hepatobiliary image set was also evaluated by two radiologists using alternative free response receiver operating characteristic (ROC) analysis.

Results:

The overall detection rate and positive predictive value of MR were 96.2% (76/79) and 96.2% (76/79), respectively. Images obtained with hepatobiliary phase 3D‐GRE showed a significantly better detection rate compared to those with precontrast sequences or dynamic imaging (P = 0.008 and 0.016, respectively). Regarding lesions 1 cm or smaller, the detection rate was 90.3% (28/31). Each reader showed a higher Az value of the combined hepatobiliary image set than those of the dynamic image set.

Conclusion:

3D‐GRE MRI using a hepatobiliary contrast agent is an accurate tool in the detection of hepatic hypovascular metastases and improves detection rate compared with precontrast and dynamic imaging. J. Magn. Reson. Imaging 2010;31:571–578. © 2010 Wiley‐Liss, Inc.     

Additional value of gadoxetic acid-DTPA-enhanced hepatobiliary phase MR imaging in the diagnosis of early-stage hepatocellular carcinoma: comparison with dynamic triple-phase multidetector CT imaging

Purpose:

To assess the value of hepatobiliary phase gadoxetic acid (EOB)‐enhanced magnetic resonance imaging (MRI) for the diagnosis of early stage hepatocellular carcinoma (HCC) (<3 cm) compared to triple‐phase dynamic multidetector computed tomography (MDCT).

Materials and Methods:

In all, 52 patients with 60 pathologically proven HCCs underwent both EOB‐enhanced MRI and triple‐phase dynamic MDCT. Two radiologists independently and blindly reviewed three image sets: 1) MDCT, 2) dynamic MRI (unenhanced and EOB‐enhanced dynamic MR images), and 3) combined MRI (dynamic MRI + hepatobiliary phase images) using a five‐point rating scale on a lesion‐by‐lesion basis. Receiver operating characteristics (ROC) analysis was performed, and sensitivity and specificity were calculated.

Results:

The area under the ROC curve (Az) of dynamic MRI was equivalent to that of MDCT for both readers. For both readers, Az and sensitivity of combined MRI for smaller lesions (<1.5 cm) were significantly higher than that of dynamic MRI and MDCT (P < 0.0166). The majority of false‐negative nodules on dynamic MRI or MDCT (75% and 62%, respectively) were due to a lack of identified washout findings.

Conclusion:

Hepatobiliary phase images can increase the value of EOB‐enhanced MRI in the diagnosis of early stage HCC. The sensitivity and accuracy were significantly superior to MDCT for the diagnosis of lesions less than 1.5 cm. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Prostate cancer: utility of fusion of T2-weighted and high b-value diffusion-weighted images for peripheral zone tumor detection and localization

Purpose:

To retrospectively assess the utility of fusion of T2‐weighted images (T2WI) and high b‐value diffusion‐weighted images (DWI) for prostate cancer detection and localization.

Materials and Methods:

In this IRB‐approved HIPAA‐compliant study, 42 patients with prostate cancer underwent MRI including multiplanar T2WI and axial DWI before prostatectomy. Two independent radiologists first assessed multiplanar T2WI and axial DWI_b‐1000 images and recorded whether tumor was present in each sextant. Axial T2WI was then fused with axial DWI_b‐1000 images, and the radiologists re‐evaluated each sextant for tumor. Accuracy was compared using generalized estimating equations based on a binary logistic regression model.

Results:

The accuracy, sensitivity, specificity, PPV, and NPV for tumor detection on a sextant‐basis using separate and fused image sets was 65.1%, 50.8%, 78.0%, 67.8%, and 63.6% and 71.0%, 60.8%, 80.3%, 73.7%, and 69.3%, respectively, for reader 1, and 54.0%, 42.5%, 64.4%, 52.0%, and 55.2%, and 61.1%, 56.7%, 65.2%, 59.6%, and 62.3%, respectively, for reader 2. The improvements in accuracy, sensitivity, and NPV using fused images were statistically significant for both readers, as was the improvement in PPV for reader 2 (P ranging from <0.0001 to 0.041). With either separate or fused images, there was greater sensitivity for tumors of higher grade or larger size (P ranging from <0.001 to 0.099).

Conclusion:

Fusion of T2WI and high b‐value DWI resulted in significant improvements in sensitivity and accuracy for tumor detection on a sextant‐basis, with similar specificity. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Detection of liver metastases: Gadoxetic acid-enhanced three-dimensional MR imaging versus ferucarbotran-enhanced MR imaging

Purpose

To compare the diagnostic performance of gadoxetic acid-enhanced MRI with ferucarbotran-enhanced MRI for the detection of liver metastases.

Materials and methods

Thirty-six patients with 80 liver metastases who underwent gadoxetic acid-enhanced MRI using a three-dimensional volumetric interpolated technique and ferucarbotran-enhanced MRI with a mean interval of 7 days (range, 5-10 days) were included in this study. Two observers independently interpreted the two sets of images - the gadoxetic acid set (unenhanced, early dynamic and 20 min delayed phase images) and the ferucarbotran set (unenhanced and ferucarbotran-enhanced T2*-weighted-gradient echo and T2-weighted turbo spin echo images). Diagnostic accuracy was evaluated using the alternative-free response receiver operator characteristic (ROC) method. Sensitivity and positive predictive value were also evaluated.

Results

There was a trend toward increased areas under the ROC curve (Az values) for the gadoxetic acid set (0.950, 0.948) as compared with the ferucarbotran set (0.941 and 0.939) of images, but no significant difference was found for both observers (p < 0.05). Sensitivities of the gadoxetic acid set (93.8% and 92.5%) were also slightly better than those of the ferucarbotran set (88.8% and 87.5%) with no significant difference (p = 0.13). The two image sets showed similar positive predictive values (98.7% and 98.6%, respectively).

Conclusions

Gadoxetic acid-enhanced MRI showed comparable diagnostic performance to ferucarbotran-enhanced MRI for the detection of liver metastases.     

Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation

Objectives

The aim of this prospective study was to compare the diagnostic performance of 64-row MDCT and gadoxetic-acid-enhanced MRI at 3.0 T in patients with colorectal liver metastases in correlation with histopathological findings.

Methods

Lesions detected at MDCT and MRI were interpreted by three blinded readers and compared with histopathological workup as the term of reference. Two subgroups of lesions were additionally evaluated: (1) metastases smaller than 10 mm and (2) lesions in patients with and without steatosis of the liver, assessed histopathologically.

Results

Surgery and histopathological workup revealed 81 colorectal liver metastases in 35 patients and diffuse metastatic involvement in 3 patients. In a lesion-by-lesion analysis, significant sensitivity differences could only be found for reader 1 (P?=?0.035) and reader 3 (P?=?0.003). For segment-based evaluation, MRI was more sensitive only for reader 3 (P?=?0.012). The number of false-positive results ranged from 3 to 12 for MDCT and 8 to 11 for MRI evaluation. In the group of small lesions, the sensitivity differed significantly between both methods (P?=?0.003). In patients with hepatic steatosis, MRI showed a trend toward better performance than MDCT, but without statistical performance.

Conclusions

The 3.0-T MRI with liver-specific contrast agents is the preferred investigation in the preoperative setting, especially for the assessment of small colorectal liver metastases.

Key Points

? Potential surgical treatment requires accurate radiological assessment of colorectal liver metastases ? Magnetic resonance imaging with gadoxetic acid is the preferred imaging investigation. ? MRI is better than multidetector CT for detecting small liver metastases.     

Direct MR arthrography of cadaveric wrists: comparison between MR imaging at 3.0T and 7.0T and gross pathologic inspection

Purpose:

To prospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography for the detection of articular cartilage abnormalities at 3.0T and 7.0T in cadaveric wrists.

Materials and Methods:

MR imaging (MRI) was performed in nine cadaveric wrists (four right wrists, five left; mean age, 81.0 ± 9.8 years) after the intraarticular administration of gadoterate‐meglumine. A 3.0T and 7.0T MR system, mechanically identical custom‐built 8‐channel wrist coil arrays and a similar standard MRI protocol, were used. MR images were evaluated for visibility of articular cartilage surfaces, presence of cartilage lesions, and confidence of diagnosis by two independent radiologists. Open pathologic inspection served as reference standard. Sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV), and accuracy (ACC) were calculated. Wilcoxon signed rank test was used to assess differences in the diagnostic performance.

Results:

Visibility of articular cartilage surfaces was significantly better at 3.0T than at 7.0T (P < 0.001). Mean sensitivity, specificity, NPV, PPV, ACC for both readers were 63%, 90%, 85%, 76%, 82% at 3.0T, respectively, and 52%, 91%, 82%, 75%, 79% at 7.0T. The difference between 3.0T and 7.0T was not significant for reader 1 (P = 0.51), but was significant for reader 2 (P = 0.01). The level of confidence was significantly higher at 3.0T than at 7.0T for both readers (P = 0.004; P = 0.03).

Conclusion:

MR arthrography of the wrist at 7.0T is still limited by the lack of commercially available radiofrequency coils and limited experience in sequence optimization, resulting in a significantly lower visibility of anatomy, lower diagnostic accuracy, and level of confidence in judging cartilage lesions compared to 3.0T. J. Magn. Reson. Imaging 2011;. © 2011 Wiley Periodicals, Inc.     

Comparison of peritoneal tumor imaging using conventional MR imaging and diffusion-weighted MR imaging with different b values

Purpose

The aim of this study was to evaluate the utility of DW MRI with two different b values in identifying peritoneal tumors in oncology patients.

Materials and methods

Nineteen patients with known malignancy underwent abdominal and pelvic MRI before surgery. MRI included free-breathing DWI with b values of 400 and 800 s/mm², T1-weighted fat-suppressed spoiled gradient-echo, T2-weighted fat-saturated turbo spin-echo, and 5-min delayed gadolinium-enhanced imaging. Two observers reviewed images for peritoneal tumors at ten anatomic sites within consensus. The results of laparatomy and histopathological evaluation were compared with MRI results. Sensitivity, specificity, and accuracy of identifying peritoneal metastases were calculated for conventional MRI, combined DWI with a b value of 400 s/mm² and conventional MRI, and combined DWI with a b value of 800 s/mm² and conventional MRI by consensus of two observers.

Results

One-hundred and twenty-five peritoneal metastasis sites were confirmed by surgical and histopathological findings. Conventional MRI alone identified 72 peritoneal metastases (sensitivity, 0.58; specificity, 0.87; accuracy, 0.67). Combined DWI with a b value of 400 s/mm² and conventional MRI revealed 106 peritoneal metastases (sensitivity, 0.85; specificity, 0.88; accuracy, 0.85). Finally, combined DWI with a b value of 800 s/mm² and conventional MRI revealed 103 peritoneal metastases (sensitivity, 0.83; specificity, 0.94; accuracy, 0.86).

Conclusion

DWI with a high b value provides complementary information that can improve the detection of peritoneal tumors when combined with conventional MRI. We recommend combined MRI and DWI with a high b value for increasing the sensitivity and accuracy of the preoperative detection of peritoneal tumors.