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Liver Lesions: Manganese-enhanced MR and Dual-Phase Helical CT for Preoperative Detection and Characterization—Comparison with Receiver Operating Characteristic Analysis¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Sciences (H.J.V.B., D.A.B.) and Department of Surgery and Oncology (M.A.C.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287; Department of Radiology-MRI, New York University Medical Center, New York City (V.S.L.); Department of Radiology, Duke University Medical Center, Durham, NC (E.K.P.); and Department of Radiology, University of Pennsylvania Medical Center, Philadelphia (E.S.S.). Received May 10, 2001; revision requested June 25; revision received August 17; accepted October 8. Supported by an unrestricted grant from Nycomed-Amersham. Address correspondence to D.A.B. (e-mail: dbluemke@jhmi.edu).

PURPOSE: The purpose of this study was to compare, by means of receiver operating characteristic (ROC) analysis, dual-phase helical computed tomography (CT) and manganese-enhanced magnetic resonance (MR) imaging in the detection and characterization of hepatic lesions in patients prior to surgery.

MATERIALS AND METHODS: Twenty-five patients known to have or suspected of having hepatic lesions who were eligible for surgery underwent dual-phase (ie, arterial and portal phase) helical CT and phased-array MR imaging (ie, unenhanced fast spin-echo T2-weighted imaging and gradient-echo T1-weighted imaging performed before and after administration of mangafodipir trisodium). All images were reviewed independently by three off-site blinded reviewers who separately reviewed the CT scans and MR images. The standard of reference was findings at surgery, intraoperative ultrasonography (US), and histopathologic examination. ROC curves were established to analyze the results for each reader and modality.

RESULTS: Ninety-four lesions (77 malignant and 17 benign) were revealed at surgery, intraoperative US, and/or histopathologic examination. The overall rate of lesion detection for the three readers at CT was 81.9% ± 7.8, 90.4% ± 5.9, and 76.6% ± 8.6. At MR imaging, the detection rates were 72.3% ± 9.0, 71.3% ± 9.1, and 69.1% ± 9.3 (P = .001 for the difference between MR and CT). The average rate of false-positive diagnoses in patients was 14.1% at CT and 6.4% at MR imaging (P = .06 for the difference between MR and CT). The mean areas under the alternative-free-response ROC curves were 0.74 for MR and 0.72 for CT (P = .751, not significant).

CONCLUSION: In detection and characterization of liver lesions, manganese-enhanced MR imaging and dual-phase helical CT were not statistically different.

© RSNA, 2002

Index terms: Liver neoplasms, CT, 761.12114 • Liver neoplasms, MR, 761.12143 • Magnetic resonance (MR), contrast media • Manganese

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