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Detection of Liver Metastases: Comparison of Gadobenate Dimeglumine–enhanced and Ferumoxides-enhanced MR Imaging Examinations¹

¹ From the Institute of Radiology, Udine University, Policlinico Universitario a Gestione diretta, via Colugna 50, 33100 Udine, Italy (C.D.F., M.B., C.Z., V.L., G.C., R.Z.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (K.J.M., P.R.R.). From the 2000 RSNA scientific assembly. Received November 20, 2001; revision requested December 19; revision received February 18, 2002; accepted April 16. Address correspondence to C.D.F. (e-mail: iaiacdf@hotmail.com).

View larger version (139K): [in a new window]   Figure 1. Transverse MR images obtained in a 49-year-old man with colorectal carcinoma. (a) Nonenhanced T1-weighted GRE image (200/5, matrix, 80 x 256; number of signals acquired, one; rectangular field of view, 238 x 380 mm; section thickness, 8 mm; intersection gap, 20%) shows a lesion with irregular borders at the dome of the liver. The lesion (arrowhead) is isointense and has a slightly hyperintense rim (arrow). (b, c) T1-weighted GRE images obtained after Gd-BOPTA administration during the (b) arterial and (c) portal venous phases (together constituting the delayed phase) of hepatic enhancement; the lesion is seen better during this dynamic phase. (d) T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase. The depiction of the lesion is not as good as that during the dynamic phase (b and c). The lesion is isointense to the normal liver parenchyma and has a slightly hyperintense rim, as seen during the nonenhanced examination (a). (e) On the nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap), the lesion is hyperintense relative to the normal liver parenchyma. (f) The depiction of the lesion on the T2-weighted TSE STIR image obtained after ferumoxides administration is much better than that on the nonenhanced TSE STIR image (e).

View larger version (146K): [in a new window]   Figure 1. Transverse MR images obtained in a 49-year-old man with colorectal carcinoma. (a) Nonenhanced T1-weighted GRE image (200/5, matrix, 80 x 256; number of signals acquired, one; rectangular field of view, 238 x 380 mm; section thickness, 8 mm; intersection gap, 20%) shows a lesion with irregular borders at the dome of the liver. The lesion (arrowhead) is isointense and has a slightly hyperintense rim (arrow). (b, c) T1-weighted GRE images obtained after Gd-BOPTA administration during the (b) arterial and (c) portal venous phases (together constituting the delayed phase) of hepatic enhancement; the lesion is seen better during this dynamic phase. (d) T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase. The depiction of the lesion is not as good as that during the dynamic phase (b and c). The lesion is isointense to the normal liver parenchyma and has a slightly hyperintense rim, as seen during the nonenhanced examination (a). (e) On the nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap), the lesion is hyperintense relative to the normal liver parenchyma. (f) The depiction of the lesion on the T2-weighted TSE STIR image obtained after ferumoxides administration is much better than that on the nonenhanced TSE STIR image (e).

View larger version (146K): [in a new window]   Figure 1. Transverse MR images obtained in a 49-year-old man with colorectal carcinoma. (a) Nonenhanced T1-weighted GRE image (200/5, matrix, 80 x 256; number of signals acquired, one; rectangular field of view, 238 x 380 mm; section thickness, 8 mm; intersection gap, 20%) shows a lesion with irregular borders at the dome of the liver. The lesion (arrowhead) is isointense and has a slightly hyperintense rim (arrow). (b, c) T1-weighted GRE images obtained after Gd-BOPTA administration during the (b) arterial and (c) portal venous phases (together constituting the delayed phase) of hepatic enhancement; the lesion is seen better during this dynamic phase. (d) T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase. The depiction of the lesion is not as good as that during the dynamic phase (b and c). The lesion is isointense to the normal liver parenchyma and has a slightly hyperintense rim, as seen during the nonenhanced examination (a). (e) On the nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap), the lesion is hyperintense relative to the normal liver parenchyma. (f) The depiction of the lesion on the T2-weighted TSE STIR image obtained after ferumoxides administration is much better than that on the nonenhanced TSE STIR image (e).

View larger version (150K): [in a new window]   Figure 1. Transverse MR images obtained in a 49-year-old man with colorectal carcinoma. (a) Nonenhanced T1-weighted GRE image (200/5, matrix, 80 x 256; number of signals acquired, one; rectangular field of view, 238 x 380 mm; section thickness, 8 mm; intersection gap, 20%) shows a lesion with irregular borders at the dome of the liver. The lesion (arrowhead) is isointense and has a slightly hyperintense rim (arrow). (b, c) T1-weighted GRE images obtained after Gd-BOPTA administration during the (b) arterial and (c) portal venous phases (together constituting the delayed phase) of hepatic enhancement; the lesion is seen better during this dynamic phase. (d) T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase. The depiction of the lesion is not as good as that during the dynamic phase (b and c). The lesion is isointense to the normal liver parenchyma and has a slightly hyperintense rim, as seen during the nonenhanced examination (a). (e) On the nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap), the lesion is hyperintense relative to the normal liver parenchyma. (f) The depiction of the lesion on the T2-weighted TSE STIR image obtained after ferumoxides administration is much better than that on the nonenhanced TSE STIR image (e).

View larger version (147K): [in a new window]   Figure 1. Transverse MR images obtained in a 49-year-old man with colorectal carcinoma. (a) Nonenhanced T1-weighted GRE image (200/5, matrix, 80 x 256; number of signals acquired, one; rectangular field of view, 238 x 380 mm; section thickness, 8 mm; intersection gap, 20%) shows a lesion with irregular borders at the dome of the liver. The lesion (arrowhead) is isointense and has a slightly hyperintense rim (arrow). (b, c) T1-weighted GRE images obtained after Gd-BOPTA administration during the (b) arterial and (c) portal venous phases (together constituting the delayed phase) of hepatic enhancement; the lesion is seen better during this dynamic phase. (d) T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase. The depiction of the lesion is not as good as that during the dynamic phase (b and c). The lesion is isointense to the normal liver parenchyma and has a slightly hyperintense rim, as seen during the nonenhanced examination (a). (e) On the nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap), the lesion is hyperintense relative to the normal liver parenchyma. (f) The depiction of the lesion on the T2-weighted TSE STIR image obtained after ferumoxides administration is much better than that on the nonenhanced TSE STIR image (e).

View larger version (141K): [in a new window]   Figure 1. Transverse MR images obtained in a 49-year-old man with colorectal carcinoma. (a) Nonenhanced T1-weighted GRE image (200/5, matrix, 80 x 256; number of signals acquired, one; rectangular field of view, 238 x 380 mm; section thickness, 8 mm; intersection gap, 20%) shows a lesion with irregular borders at the dome of the liver. The lesion (arrowhead) is isointense and has a slightly hyperintense rim (arrow). (b, c) T1-weighted GRE images obtained after Gd-BOPTA administration during the (b) arterial and (c) portal venous phases (together constituting the delayed phase) of hepatic enhancement; the lesion is seen better during this dynamic phase. (d) T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase. The depiction of the lesion is not as good as that during the dynamic phase (b and c). The lesion is isointense to the normal liver parenchyma and has a slightly hyperintense rim, as seen during the nonenhanced examination (a). (e) On the nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap), the lesion is hyperintense relative to the normal liver parenchyma. (f) The depiction of the lesion on the T2-weighted TSE STIR image obtained after ferumoxides administration is much better than that on the nonenhanced TSE STIR image (e).

View larger version (162K): [in a new window]   Figure 2. Transverse MR images obtained in a 61-year-old man with rectal carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) shows a 5-mm slightly hyperintense lesion (arrow) in the posterior aspect of the seventh hepatic segment. (b) The lesion (arrow) is better seen on this T2-weighted TSE STIR image obtained after ferumoxides administration. (c) On the T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained after Gd-BOPTA administration during the delayed phase, the lesion (arrow) is hypointense relative to the surrounding liver parenchyma. (d) Nonenhanced T2-weighted TSE STIR image obtained at an upper level in the same patient does not show a lesion. (e) T2-weighted TSE STIR image obtained after ferumoxides administration shows an additional 6-mm hyperintense lesion (arrow). (f) On the T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase, the additional lesion (arrow) depicted in e is hypointense relative to the surrounding liver parenchyma.

View larger version (159K): [in a new window]   Figure 2. Transverse MR images obtained in a 61-year-old man with rectal carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) shows a 5-mm slightly hyperintense lesion (arrow) in the posterior aspect of the seventh hepatic segment. (b) The lesion (arrow) is better seen on this T2-weighted TSE STIR image obtained after ferumoxides administration. (c) On the T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained after Gd-BOPTA administration during the delayed phase, the lesion (arrow) is hypointense relative to the surrounding liver parenchyma. (d) Nonenhanced T2-weighted TSE STIR image obtained at an upper level in the same patient does not show a lesion. (e) T2-weighted TSE STIR image obtained after ferumoxides administration shows an additional 6-mm hyperintense lesion (arrow). (f) On the T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase, the additional lesion (arrow) depicted in e is hypointense relative to the surrounding liver parenchyma.

View larger version (162K): [in a new window]   Figure 2. Transverse MR images obtained in a 61-year-old man with rectal carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) shows a 5-mm slightly hyperintense lesion (arrow) in the posterior aspect of the seventh hepatic segment. (b) The lesion (arrow) is better seen on this T2-weighted TSE STIR image obtained after ferumoxides administration. (c) On the T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained after Gd-BOPTA administration during the delayed phase, the lesion (arrow) is hypointense relative to the surrounding liver parenchyma. (d) Nonenhanced T2-weighted TSE STIR image obtained at an upper level in the same patient does not show a lesion. (e) T2-weighted TSE STIR image obtained after ferumoxides administration shows an additional 6-mm hyperintense lesion (arrow). (f) On the T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase, the additional lesion (arrow) depicted in e is hypointense relative to the surrounding liver parenchyma.

View larger version (150K): [in a new window]   Figure 2. Transverse MR images obtained in a 61-year-old man with rectal carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) shows a 5-mm slightly hyperintense lesion (arrow) in the posterior aspect of the seventh hepatic segment. (b) The lesion (arrow) is better seen on this T2-weighted TSE STIR image obtained after ferumoxides administration. (c) On the T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained after Gd-BOPTA administration during the delayed phase, the lesion (arrow) is hypointense relative to the surrounding liver parenchyma. (d) Nonenhanced T2-weighted TSE STIR image obtained at an upper level in the same patient does not show a lesion. (e) T2-weighted TSE STIR image obtained after ferumoxides administration shows an additional 6-mm hyperintense lesion (arrow). (f) On the T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase, the additional lesion (arrow) depicted in e is hypointense relative to the surrounding liver parenchyma.

View larger version (161K): [in a new window]   Figure 2. Transverse MR images obtained in a 61-year-old man with rectal carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) shows a 5-mm slightly hyperintense lesion (arrow) in the posterior aspect of the seventh hepatic segment. (b) The lesion (arrow) is better seen on this T2-weighted TSE STIR image obtained after ferumoxides administration. (c) On the T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained after Gd-BOPTA administration during the delayed phase, the lesion (arrow) is hypointense relative to the surrounding liver parenchyma. (d) Nonenhanced T2-weighted TSE STIR image obtained at an upper level in the same patient does not show a lesion. (e) T2-weighted TSE STIR image obtained after ferumoxides administration shows an additional 6-mm hyperintense lesion (arrow). (f) On the T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase, the additional lesion (arrow) depicted in e is hypointense relative to the surrounding liver parenchyma.

View larger version (154K): [in a new window]   Figure 2. Transverse MR images obtained in a 61-year-old man with rectal carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) shows a 5-mm slightly hyperintense lesion (arrow) in the posterior aspect of the seventh hepatic segment. (b) The lesion (arrow) is better seen on this T2-weighted TSE STIR image obtained after ferumoxides administration. (c) On the T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained after Gd-BOPTA administration during the delayed phase, the lesion (arrow) is hypointense relative to the surrounding liver parenchyma. (d) Nonenhanced T2-weighted TSE STIR image obtained at an upper level in the same patient does not show a lesion. (e) T2-weighted TSE STIR image obtained after ferumoxides administration shows an additional 6-mm hyperintense lesion (arrow). (f) On the T1-weighted GRE image obtained after Gd-BOPTA administration during the delayed phase, the additional lesion (arrow) depicted in e is hypointense relative to the surrounding liver parenchyma.

View larger version (163K): [in a new window]   Figure 3. Transverse MR images obtained in a 70-year-old man with colon carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) does not show lesions. (b) T2-weighted TSE STIR image obtained after ferumoxides administration shows an 8-mm hyperintense lesion (arrow) in the fourth liver segment. (c) T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained at a comparable level after Gd-BOPTA administration during the delayed phase does not depict the lesion detected after ferumoxides administration (b).

View larger version (166K): [in a new window]   Figure 3. Transverse MR images obtained in a 70-year-old man with colon carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) does not show lesions. (b) T2-weighted TSE STIR image obtained after ferumoxides administration shows an 8-mm hyperintense lesion (arrow) in the fourth liver segment. (c) T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained at a comparable level after Gd-BOPTA administration during the delayed phase does not depict the lesion detected after ferumoxides administration (b).

View larger version (155K): [in a new window]   Figure 3. Transverse MR images obtained in a 70-year-old man with colon carcinoma. (a) Nonenhanced T2-weighted TSE STIR image (5,100/90, 120-msec inversion time, 196 x 256 matrix, three signals acquired, 285 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) does not show lesions. (b) T2-weighted TSE STIR image obtained after ferumoxides administration shows an 8-mm hyperintense lesion (arrow) in the fourth liver segment. (c) T1-weighted GRE image (148.4/5.0, 80 x 256 matrix, one signal acquired, 238 x 380-mm rectangular field of view, 8-mm section thickness, 20% intersection gap) obtained at a comparable level after Gd-BOPTA administration during the delayed phase does not depict the lesion detected after ferumoxides administration (b).

View larger version (28K): [in a new window]   Figure 4. Bar graph depicts CNRs (C/N) between the lesion and the liver parenchyma at MR imaging before Gd-BOPTA administration (-4.8) and during the delayed phase after Gd-BOPTA administration (-5.5) and at MR imaging before (3.8) and after (6.8) ferumoxides administration. CNRs at nonenhanced T1-weighted GRE MR imaging (box 1), Gd-BOPTA-enhanced delayed phase T1-weighted GRE MR imaging (box 2), nonenhanced T2-weighted TSE STIR MR imaging (box 3), and ferumoxides-nonenhanced T2-weighted TSE STIR MR imaging (box 4) are illustrated. Vertical bars represent standard errors of the mean.