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Preoperative Depiction of Hepatocellular Carcinoma: Ferumoxides-enhanced MR Imaging versus Triple-Phase Helical CT¹

¹ From the Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. Received November 14, 2001; revision requested January 24, 2002; revision received March 5; accepted April 16. Address correspondence to J.H.L. (e-mail: jhlim@smc.samsung.co.kr).

View larger version (30K): [in a new window]   Figure 1. Graph shows composite ROC curves for the data pooled from all three observers. The mean Az (an indicator of diagnostic accuracy) for detection of HCC on ferumoxides-enhanced MR images obtained with all six sequences was 0.982 ± 0.006; that for triple-phase helical CT was 0.952 ± 0.010. The difference in mean Az between the two modalities was statistically significant (P < .001).

View larger version (120K): [in a new window]   Figure 2a. Images of a 1.7-cm HCC nodule in segment VI of the liver of a 39-year-old man with macronodular liver cirrhosis. (a) Arterial phase, (b) portal venous phase, and (c) delayed phase hepatic CT scans show no definite mass. Only one observer assigned a score of 3 on the basis of these images. (d) Ferumoxides-enhanced, fat-suppressed, respiratory-triggered fast spin-echo MR image (5,000/18) and (e) image from a T2*-weighted fast multiplanar GRE acquisition in the steady state (130/8.4, 30° flip angle) demonstrate a hyperintense mass (arrow) in segment VI.

View larger version (118K): [in a new window]   Figure 2b. Images of a 1.7-cm HCC nodule in segment VI of the liver of a 39-year-old man with macronodular liver cirrhosis. (a) Arterial phase, (b) portal venous phase, and (c) delayed phase hepatic CT scans show no definite mass. Only one observer assigned a score of 3 on the basis of these images. (d) Ferumoxides-enhanced, fat-suppressed, respiratory-triggered fast spin-echo MR image (5,000/18) and (e) image from a T2*-weighted fast multiplanar GRE acquisition in the steady state (130/8.4, 30° flip angle) demonstrate a hyperintense mass (arrow) in segment VI.

View larger version (121K): [in a new window]   Figure 2c. Images of a 1.7-cm HCC nodule in segment VI of the liver of a 39-year-old man with macronodular liver cirrhosis. (a) Arterial phase, (b) portal venous phase, and (c) delayed phase hepatic CT scans show no definite mass. Only one observer assigned a score of 3 on the basis of these images. (d) Ferumoxides-enhanced, fat-suppressed, respiratory-triggered fast spin-echo MR image (5,000/18) and (e) image from a T2*-weighted fast multiplanar GRE acquisition in the steady state (130/8.4, 30° flip angle) demonstrate a hyperintense mass (arrow) in segment VI.

View larger version (130K): [in a new window]   Figure 2d. Images of a 1.7-cm HCC nodule in segment VI of the liver of a 39-year-old man with macronodular liver cirrhosis. (a) Arterial phase, (b) portal venous phase, and (c) delayed phase hepatic CT scans show no definite mass. Only one observer assigned a score of 3 on the basis of these images. (d) Ferumoxides-enhanced, fat-suppressed, respiratory-triggered fast spin-echo MR image (5,000/18) and (e) image from a T2*-weighted fast multiplanar GRE acquisition in the steady state (130/8.4, 30° flip angle) demonstrate a hyperintense mass (arrow) in segment VI.

View larger version (124K): [in a new window]   Figure 2e. Images of a 1.7-cm HCC nodule in segment VI of the liver of a 39-year-old man with macronodular liver cirrhosis. (a) Arterial phase, (b) portal venous phase, and (c) delayed phase hepatic CT scans show no definite mass. Only one observer assigned a score of 3 on the basis of these images. (d) Ferumoxides-enhanced, fat-suppressed, respiratory-triggered fast spin-echo MR image (5,000/18) and (e) image from a T2*-weighted fast multiplanar GRE acquisition in the steady state (130/8.4, 30° flip angle) demonstrate a hyperintense mass (arrow) in segment VI.

View larger version (114K): [in a new window]   Figure 3a. Images of a 1.5-cm HCC nodule in segment VII of the liver of a 60-year-old man. (a) Arterial phase hepatic CT scan shows a small, ill-defined, enhancing mass (arrow). Portal venous and delayed phase images (not shown) revealed no mass; the mass was isoattenuating. (b) MR image from T2*-weighted fast multiplanar spoiled GRE acquisition in the steady state (130/8.4, 30° flip angle) shows a mass (arrow). MR images obtained with other sequences (not shown) revealed no mass. The mass was not interpreted as HCC by any of the three observers, probably because of its inhomogeneity and the noise caused by cirrhotic regenerative nodules.

View larger version (135K): [in a new window]   Figure 3b. Images of a 1.5-cm HCC nodule in segment VII of the liver of a 60-year-old man. (a) Arterial phase hepatic CT scan shows a small, ill-defined, enhancing mass (arrow). Portal venous and delayed phase images (not shown) revealed no mass; the mass was isoattenuating. (b) MR image from T2*-weighted fast multiplanar spoiled GRE acquisition in the steady state (130/8.4, 30° flip angle) shows a mass (arrow). MR images obtained with other sequences (not shown) revealed no mass. The mass was not interpreted as HCC by any of the three observers, probably because of its inhomogeneity and the noise caused by cirrhotic regenerative nodules.

View larger version (163K): [in a new window]   Figure 4a. Images of a 1.7-cm, well-differentiated HCC nodule in segment VII of the liver of a 55-year-old man. (a) Arterial phase and (b) portal venous phase hepatic CT scans do not depict a mass. (c) Delayed phase hepatic CT scan shows a well-defined hypoattenuating mass (arrow). This segment was given a confidence-scale score of 1, 3, and 3 by the three observers on the basis of CT findings. (d) MR image from T2*-weighted fast multiplanar spoiled GRE acquisition in the steady state (130/8.4, 30° flip angle) shows a barely visible, ill-defined, slightly hyperintense mass (arrow). The lesion was not depicted on MR images obtained with other sequences (not shown). This segment was given a confidence-scale score of 1 by each of the three observers on the basis of MR findings.

View larger version (169K): [in a new window]   Figure 4b. Images of a 1.7-cm, well-differentiated HCC nodule in segment VII of the liver of a 55-year-old man. (a) Arterial phase and (b) portal venous phase hepatic CT scans do not depict a mass. (c) Delayed phase hepatic CT scan shows a well-defined hypoattenuating mass (arrow). This segment was given a confidence-scale score of 1, 3, and 3 by the three observers on the basis of CT findings. (d) MR image from T2*-weighted fast multiplanar spoiled GRE acquisition in the steady state (130/8.4, 30° flip angle) shows a barely visible, ill-defined, slightly hyperintense mass (arrow). The lesion was not depicted on MR images obtained with other sequences (not shown). This segment was given a confidence-scale score of 1 by each of the three observers on the basis of MR findings.

View larger version (152K): [in a new window]   Figure 4c. Images of a 1.7-cm, well-differentiated HCC nodule in segment VII of the liver of a 55-year-old man. (a) Arterial phase and (b) portal venous phase hepatic CT scans do not depict a mass. (c) Delayed phase hepatic CT scan shows a well-defined hypoattenuating mass (arrow). This segment was given a confidence-scale score of 1, 3, and 3 by the three observers on the basis of CT findings. (d) MR image from T2*-weighted fast multiplanar spoiled GRE acquisition in the steady state (130/8.4, 30° flip angle) shows a barely visible, ill-defined, slightly hyperintense mass (arrow). The lesion was not depicted on MR images obtained with other sequences (not shown). This segment was given a confidence-scale score of 1 by each of the three observers on the basis of MR findings.

View larger version (148K): [in a new window]   Figure 4d. Images of a 1.7-cm, well-differentiated HCC nodule in segment VII of the liver of a 55-year-old man. (a) Arterial phase and (b) portal venous phase hepatic CT scans do not depict a mass. (c) Delayed phase hepatic CT scan shows a well-defined hypoattenuating mass (arrow). This segment was given a confidence-scale score of 1, 3, and 3 by the three observers on the basis of CT findings. (d) MR image from T2*-weighted fast multiplanar spoiled GRE acquisition in the steady state (130/8.4, 30° flip angle) shows a barely visible, ill-defined, slightly hyperintense mass (arrow). The lesion was not depicted on MR images obtained with other sequences (not shown). This segment was given a confidence-scale score of 1 by each of the three observers on the basis of MR findings.