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Siderotic Nodules in the Cirrhotic Liver at MR Imaging with Explant Correlation: No Increased Frequency of Dysplastic Nodules and Hepatocellular Carcinoma¹

¹ From the Departments of Radiology (G.A.K., V.S.L., M.T.N., N.M.R., J.C.W.), Pathology (N.D.T.), and Transplantation (G.R.M., L.W.T.) and the Kaplan Comprehensive Cancer Center (G.A.K., N.D.T.), New York University Medical Center, 530 First Ave, New York, NY 10016. Received March 7, 2000; revision requested April 25; revision received May 25; accepted June 5. G.A.K. supported by an RSNA Seed Grant. Address correspondence to G.A.K. (e-mail: glenn.krinsky@med.nyu.edu).

PURPOSE: To determine the sensitivity of magnetic resonance (MR) imaging for detection of siderotic nodules in patients with cirrhosis and whether the frequency of hepatocellular carcinoma (HCC) and dysplastic nodules is greater if siderotic nodules are present.

MATERIALS AND METHODS: MR imaging (1.5 T) was performed within 0–117 days (mean, 30 days) before liver transplantation in 77 patients. Two readers retrospectively evaluated gradient-echo (GRE) (echo time [TE], 9 and 4–5 msec) and turbo short inversion time inversion-recovery or T2-weighted images for low-signal-intensity nodules. Whole-explant pathologic correlation was available in every case.

RESULTS: At explantation, 28 (36%) of 77 patients had HCC, 25 (32%) had dysplastic nodules, and nine (12%) had both; 35 (45%) patients had siderotic nodules. The sensitivity of GRE imaging with 9-msec or longer TE for the detection of siderotic nodules was 80% (28 of 35) but decreased to 31% (11 of 35) with 4–5-msec TE. Frequency of HCC was not significantly higher (P = .27) in patients with (43% [15 of 35]) than in patients without (31% [13 of 42]) siderotic nodules. Frequency of dysplastic nodules also was not significantly higher (P = .42) in patients with (37% [13 of 35]) than in patients without (29% [12 of 42]) siderotic nodules.

CONCLUSION: Sensitivity of MR imaging for the detection of siderotic nodules was improved with use of GRE pulse sequences with longer TEs of 9 msec or greater (80%) versus 4–5 msec (31%); however, there was no significant increased frequency of HCC or dysplastic nodules in patients with pathologically proved siderotic nodules.

Index terms: Liver, cirrhosis, 761.794 • Liver, MR, 761.121412, 761.121413 • Liver, nodules • Liver, transplantation, 761.45 • Liver neoplasms, 761.32

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