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Perilesional Enhancement of Hepatic Metastases: Correlation between MR Imaging and Histopathologic Findings-Initial Observations¹

¹ From the Departments of Radiology (R.C.S., S.M.H., H.B.M.) and Pathology (J.T.W.), University of North Carolina Hospitals and School of Medicine, CB #7510, Chapel Hill, NC 27599-7510; and the Department of Radiology, Leiden University Medical Center, the Netherlands (S.M.H.). Received April 19, 1999; revision requested June 14; revision received June 24; accepted August 12. S.M.H. supported in part by the Dutch Cancer Society. Address reprint requests to R.C.S.

View larger version (96K): [in a new window]   Figure 1a. Patient 2. Prominent perilesional enhancement. (a) Transverse, immediately postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image shows intense perilesional enhancement (arrow). (b) Photomicrograph of the histologic specimen demonstrates prominent peritumoral desmoplastic reaction, prominent peritumoral inflammatory cell infiltration (short arrow), mild vascular proliferation (long arrow), mildly compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the hepatic parenchyma (L) by a 0.5-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (127K): [in a new window]   Figure 1b. Patient 2. Prominent perilesional enhancement. (a) Transverse, immediately postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image shows intense perilesional enhancement (arrow). (b) Photomicrograph of the histologic specimen demonstrates prominent peritumoral desmoplastic reaction, prominent peritumoral inflammatory cell infiltration (short arrow), mild vascular proliferation (long arrow), mildly compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the hepatic parenchyma (L) by a 0.5-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (95K): [in a new window]   Figure 2a. Patient 5. No perilesional enhancement. (a) Transverse, precontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image demonstrates a large metastasis in the right lobe of the liver. (b) Transverse, immediately postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image shows no perilesional enhancement and a sharp, external border to the metastasis (arrow). The lesion diameter is identical to that in a. (c) Photomicrograph of the histologic specimen demonstrates no peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration, minimal vascular proliferation, minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the surrounding hepatic parenchyma (L) by a 0.1-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (97K): [in a new window]   Figure 2b. Patient 5. No perilesional enhancement. (a) Transverse, precontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image demonstrates a large metastasis in the right lobe of the liver. (b) Transverse, immediately postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image shows no perilesional enhancement and a sharp, external border to the metastasis (arrow). The lesion diameter is identical to that in a. (c) Photomicrograph of the histologic specimen demonstrates no peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration, minimal vascular proliferation, minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the surrounding hepatic parenchyma (L) by a 0.1-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (135K): [in a new window]   Figure 2c. Patient 5. No perilesional enhancement. (a) Transverse, precontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image demonstrates a large metastasis in the right lobe of the liver. (b) Transverse, immediately postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR image shows no perilesional enhancement and a sharp, external border to the metastasis (arrow). The lesion diameter is identical to that in a. (c) Photomicrograph of the histologic specimen demonstrates no peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration, minimal vascular proliferation, minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the surrounding hepatic parenchyma (L) by a 0.1-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (94K): [in a new window]   Figure 3a. Patient 3. Serial changes in perilesional enhancement after systemic chemotherapy. (a, b) Prechemotherapy, transverse, (a) precontrast and (b) early postcontrast and (c) postchemotherapy, early postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR images. Intense perilesional enhancement (arrow in b) is appreciated in b and results in a considerable increase in lesion diameter from a to b. In c, after the initiation of chemotherapy, a mild decrease in intense perilesional enhancement is appreciated. (d) Photomicrograph of the postchemotherapy histologic specimen demonstrates moderate peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration (short arrow), minimal vascular proliferation (long arrow), minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the hepatic parenchyma (L) by a 0.5-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (100K): [in a new window]   Figure 3b. Patient 3. Serial changes in perilesional enhancement after systemic chemotherapy. (a, b) Prechemotherapy, transverse, (a) precontrast and (b) early postcontrast and (c) postchemotherapy, early postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR images. Intense perilesional enhancement (arrow in b) is appreciated in b and results in a considerable increase in lesion diameter from a to b. In c, after the initiation of chemotherapy, a mild decrease in intense perilesional enhancement is appreciated. (d) Photomicrograph of the postchemotherapy histologic specimen demonstrates moderate peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration (short arrow), minimal vascular proliferation (long arrow), minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the hepatic parenchyma (L) by a 0.5-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (94K): [in a new window]   Figure 3c. Patient 3. Serial changes in perilesional enhancement after systemic chemotherapy. (a, b) Prechemotherapy, transverse, (a) precontrast and (b) early postcontrast and (c) postchemotherapy, early postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR images. Intense perilesional enhancement (arrow in b) is appreciated in b and results in a considerable increase in lesion diameter from a to b. In c, after the initiation of chemotherapy, a mild decrease in intense perilesional enhancement is appreciated. (d) Photomicrograph of the postchemotherapy histologic specimen demonstrates moderate peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration (short arrow), minimal vascular proliferation (long arrow), minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the hepatic parenchyma (L) by a 0.5-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (134K): [in a new window]   Figure 3d. Patient 3. Serial changes in perilesional enhancement after systemic chemotherapy. (a, b) Prechemotherapy, transverse, (a) precontrast and (b) early postcontrast and (c) postchemotherapy, early postcontrast, spoiled gradient-echo (150/4.1, 80° flip angle) MR images. Intense perilesional enhancement (arrow in b) is appreciated in b and results in a considerable increase in lesion diameter from a to b. In c, after the initiation of chemotherapy, a mild decrease in intense perilesional enhancement is appreciated. (d) Photomicrograph of the postchemotherapy histologic specimen demonstrates moderate peritumoral desmoplastic reaction, mild peritumoral inflammatory cell infiltration (short arrow), minimal vascular proliferation (long arrow), minimally compressed hepatic parenchyma, and minimal atrophy of the hepatic cords. The nodule of metastatic, moderately differentiated adenocarcinoma (T) is separated from the hepatic parenchyma (L) by a 0.5-mm-thick zone (dashed line) of fibrocellular stroma (S). (Hematoxylin-eosin stain; original magnification, x100.)