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Ferumoxides-enhanced Double-Echo T2-weighted MR Imaging in Differentiating Metastases from Nonsolid Benign Lesions of the Liver¹

¹ From the Department of Radiology, Yamanashi Medical University, Yamanashi, Japan. From the 2001 RSNA scientific assembly. Received June 21, 2001; revision requested August 15; final revision received April 1, 2002; accepted April 10. Address correspondence to A.S.A., LDRR/CC, National Institute of Health, Bldg 10, Rm B1N256, Bethesda, MD 20892 (e-mail: saali@cc.nih.gov).

View larger version (154K): [in a new window]   Figure 1. Representative case of hemangioma. A, Precontrast short TE MR image shows typical homogeneously high SI in the hemangioma, with slightly decreased SI on B, the precontrast long TE MR image. C, Postcontrast short TE MR image shows comparatively more decreased SI than that of the surrounding liver. D, Postcontrast long TE MR image shows marked decrease in SI, although surrounding liver becomes almost black.

View larger version (163K): [in a new window]   Figure 2. Representative cases of metastasis and cysts in one patient. A, Precontrast short TE, B, precontrast long TE, C, postcontrast short TE, and D, postcontrast long TE MR images. The metastasis (thick arrow) shows inhomogeneously high SI, with slightly decreased SI on long TE images for both pre- and postcontrast long TE sequences. The cyst (thin arrow) shows no definite change of homogeneous SI on pre- and postcontrast short or long TE images.

View larger version (25K): [in a new window]   Figure 3. Graph shows the differences (mean ± standard error of the mean) of lesion-to-liver SI ratios between short and long TE images for pre- and postcontrast sequences. Note the significant reversal of lesion-to-liver SI ratio differences in hemangioma. # = Significant differences (P < .001) between pre- and postcontrast sequences. * = significant differences (P < .001) among hemangiomas, cysts, and metastases.

View larger version (30K): [in a new window]   Figure 4. Graph shows composite ROC curves in the detection of benign lesions of the liver. Az values are presented in Table 2. Both precontrast short TE images and pre- and postcontrast short TE images show significant differences with other images. TPF = true-positive fraction, FPF = false-positive fraction, Pre-S = precontrast short TE images, Pre-S+L = precontrast short and long TE images, Pre+Post-S = pre and postcontrast short TE images, Post-S+L = postcontrast short and long TE images, Pre+Post-S+L = pre- and postcontrast short and long TE images.

View larger version (49K): [in a new window]   Figure 5. Graph shows the relative sensitivity, specificity, and accuracy in characterizing benign lesions (hemangiomas and cysts) of the liver. The values of the proportions are transformed to normality by means of arcsin transformation (see statistical commentary). The data are expressed as mean ± 95% CI. Pre-s = precontrast T2-weighted images with short TEs, Pre-SL = precontrast T2-weighted images with short and long TEs, Post-SL = postcontrast T2-weighted images with short and long TEs, Pre-post-S = pre- and postcontrast T2-weighted images with short TEs, Pre-Post-SL = pre- and postcontrast T2-weighted images with short and long TEs, a = significant differences compared with pre- and postcontrast T2-weighted images with short and long TEs, b = significant differences compared with postcontrast T2-weighted images with short and long TEs.