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Colorectal Hepatic Metastases: Detection with SPIO-enhanced Breath-hold MR Imaging—Comparison of Optimized Sequences¹

¹ From the Department of Clinical Radiology (J.W., J.A.G., D.W., P.A., P.J.R.), Hepatobiliary and Transplantation Unit (J.P.L., G.J.T.), and Department of Histopathology (J.I.W.), St James’s University Hospital, Beckett St, Leeds LS9 7TF, England. Received March 28, 2002; revision requested June 10; final revision received December 18; accepted January 23, 2003. Address correspondence to J.W. (e-mail: janice.ward@leedsth.nhs.uk).

View larger version (37K): [in a new window]   Figure 1. Histogram illustrates the area under the ROC curve for each observer (Obs) and the mean of all observers for analysis of all 101 malignant lesions with each MR sequence. The mean difference in accuracy between unenhanced (black bars) and SPIO-enhanced FSE (striped bars) MR sequences was -0.07 (95% CI: -0.69, 0.06; P = .7). The mean difference in accuracy between SPIO-enhanced FSE and MEDIC (white bars) MR imaging was -0.08 (95% CI: -0.17, 0.004; P = .05). The mean difference between MEDIC and GRE with a TE of 11 msec (dark gray bars) sequences was -0.013 (95% CI: -0.05, 0.02; P = .26). The mean difference between GRE imaging with a TE of 11 msec and that with a TE of 15 msec (light gray bars) was -0.01 (95% CI: -0.03, 0.01; P = .2). MEDIC and GRE sequences were significantly more accurate than were unenhanced sequences (P < .05). Unenhanced MR images comprised T1-weighted in-phase and opposed-phase GRE images and T2-weighted FSE images. Postcontrast images were reviewed in combination with unenhanced T2-weighted FSE images.

View larger version (33K): [in a new window]   Figure 2. Histogram illustrates the area under the ROC curve for each observer (Obs) and the mean of all observers for analysis of all 27 lesions smaller than 1 cm with each MR imaging sequence. The mean difference in accuracy between unenhanced (black bars) and SPIO-enhanced FSE (striped bars) MR sequences was -0.02 (95% CI: -0.04, 0.005; P = .07). The mean difference in accuracy between SPIO-enhanced FSE and MEDIC (white bars) sequences was -0.13 (95% CI: -0.28, 0.07; P = .05). The mean difference in accuracy between MEDIC and GRE imaging with a TE of 11 msec (dark gray bars) was -0.03 (95% CI: -0.16, 0.110; P = .49). The mean difference in the accuracy of GRE imaging with a TE of 11 msec and that with a TE of 15 msec (light gray bars) was -0.02 (95% CI: -0.63, 0.023; P = .18).

View larger version (34K): [in a new window]   Figure 3. Histogram illustrates the sensitivity of each observer (Obs) and the mean of all observers for analysis of all 101 malignant lesions with each MR sequence. The mean number of lesions detected by all observers and the number of lesions detected by each observer are indicated above the bars. The mean difference in the sensitivity of unenhanced (black bars) and SPIO-enhanced FSE (striped bars) sequences was -3.8 (95% CI: -11.8, 4.2; P = .18). The mean difference in the sensitivity of SPIO-enhanced FSE and MEDIC (white bars) sequences was -11.4 (95% CI: -15.6, 7.2; P = .007). The mean difference in the sensitivity of MEDIC and GRE imaging with a TE of 11 msec (dark gray bars) was -1.6 (95% CI: -8.2, 5.1; P = .4). The mean difference in the sensitivity of GRE imaging with a TE of 11 msec and that with a TE of 15 msec (light gray bars) was -1.3 (95% CI: -8.2, 5.7; P = .5).

View larger version (29K): [in a new window]   Figure 4. Histogram illustrates the sensitivity of each observer (Obs) and the mean of all observers with each MR sequence for analysis of all 27 lesions smaller than 1 cm. The mean number of lesions detected by all observers and the number of lesions detected by each observer are indicated above the bars. The mean difference in the sensitivity of unenhanced (black bars) and SPIO-enhanced FSE (striped bars) sequences was -14.2 (95% CI: -29.9, 1.5; P = .06). The mean difference in the sensitivity of SPIO-enhanced FSE and MEDIC (white bars) sequences was -16.8 (95% CI: -22.5, 11.0; P = .006). The mean difference in the sensitivity of MEDIC and GRE imaging with a TE of 11 msec (dark gray bars) was -2.4 (95% CI: -18.3, 13.4; P = .6). The mean difference in the sensitivity of GRE imaging with a TE of 11 msec and that with a TE of 15 msec (light gray bars) was -1.97 (95% CI: -17.0, 13.1: P = .6).

View larger version (161K): [in a new window]   Figure 5a. Seven metastases in a 63-year-old woman. Transverse MR images obtained with (a) SPIO-enhanced FSE (2,650/88), (b) MEDIC (188/27, 30° flip angle), (c) GRE with a TE of 11 msec (165/11, 30° flip angle), and (d) GRE with a TE of 15 msec (165/15, 30° flip angle) sequences. Two 1-cm metastases (arrows) clearly seen on b-d are not visible on a. Note the clear depiction of vascular structures and decreased level of artifact on b-d compared with those on a.

View larger version (130K): [in a new window]   Figure 5b. Seven metastases in a 63-year-old woman. Transverse MR images obtained with (a) SPIO-enhanced FSE (2,650/88), (b) MEDIC (188/27, 30° flip angle), (c) GRE with a TE of 11 msec (165/11, 30° flip angle), and (d) GRE with a TE of 15 msec (165/15, 30° flip angle) sequences. Two 1-cm metastases (arrows) clearly seen on b-d are not visible on a. Note the clear depiction of vascular structures and decreased level of artifact on b-d compared with those on a.

View larger version (139K): [in a new window]   Figure 5c. Seven metastases in a 63-year-old woman. Transverse MR images obtained with (a) SPIO-enhanced FSE (2,650/88), (b) MEDIC (188/27, 30° flip angle), (c) GRE with a TE of 11 msec (165/11, 30° flip angle), and (d) GRE with a TE of 15 msec (165/15, 30° flip angle) sequences. Two 1-cm metastases (arrows) clearly seen on b-d are not visible on a. Note the clear depiction of vascular structures and decreased level of artifact on b-d compared with those on a.

View larger version (138K): [in a new window]   Figure 5d. Seven metastases in a 63-year-old woman. Transverse MR images obtained with (a) SPIO-enhanced FSE (2,650/88), (b) MEDIC (188/27, 30° flip angle), (c) GRE with a TE of 11 msec (165/11, 30° flip angle), and (d) GRE with a TE of 15 msec (165/15, 30° flip angle) sequences. Two 1-cm metastases (arrows) clearly seen on b-d are not visible on a. Note the clear depiction of vascular structures and decreased level of artifact on b-d compared with those on a.

View larger version (134K): [in a new window]   Figure 6a. Eight metastases in a 67-year-old man. Transverse MR images obtained with (a) SPIO-enhanced FSE (2,650/88) and (b) GRE with a TE of 11 msec (165/15/300) sequences. The 5-mm metastasis, which is well shown on b (arrow), is not seen on a.

View larger version (134K): [in a new window]   Figure 6b. Eight metastases in a 67-year-old man. Transverse MR images obtained with (a) SPIO-enhanced FSE (2,650/88) and (b) GRE with a TE of 11 msec (165/15/300) sequences. The 5-mm metastasis, which is well shown on b (arrow), is not seen on a.

View larger version (126K): [in a new window]   Figure 7a. Coexistent benign and malignant lesions in a 46-year-old woman. Transverse MR images obtained with (a) unenhanced FSE (2,650/88), (b) SPIO-enhanced FSE (2,650/88), (c) GRE with a TE of 11 msec (165/11/300), and (d) GRE with a TE of 11 msec (165/15/300) sequences. Four simple cysts are well shown on a-d (straight arrows), and a solitary metastasis (curved arrow) not visible on a is demonstrated on b-d. On c and d, the cysts have a relatively reduced SI compared with that on a and b, while the metastasis is more conspicuous on c and d because of the 30° flip angle chosen to maximize the SI of metastases. However, all five lesions have the same SI on c and d. By means of combined review of pre- and postcontrast images, all observers detected and classified the metastasis correctly.

View larger version (129K): [in a new window]   Figure 7b. Coexistent benign and malignant lesions in a 46-year-old woman. Transverse MR images obtained with (a) unenhanced FSE (2,650/88), (b) SPIO-enhanced FSE (2,650/88), (c) GRE with a TE of 11 msec (165/11/300), and (d) GRE with a TE of 11 msec (165/15/300) sequences. Four simple cysts are well shown on a-d (straight arrows), and a solitary metastasis (curved arrow) not visible on a is demonstrated on b-d. On c and d, the cysts have a relatively reduced SI compared with that on a and b, while the metastasis is more conspicuous on c and d because of the 30° flip angle chosen to maximize the SI of metastases. However, all five lesions have the same SI on c and d. By means of combined review of pre- and postcontrast images, all observers detected and classified the metastasis correctly.

View larger version (131K): [in a new window]   Figure 7c. Coexistent benign and malignant lesions in a 46-year-old woman. Transverse MR images obtained with (a) unenhanced FSE (2,650/88), (b) SPIO-enhanced FSE (2,650/88), (c) GRE with a TE of 11 msec (165/11/300), and (d) GRE with a TE of 11 msec (165/15/300) sequences. Four simple cysts are well shown on a-d (straight arrows), and a solitary metastasis (curved arrow) not visible on a is demonstrated on b-d. On c and d, the cysts have a relatively reduced SI compared with that on a and b, while the metastasis is more conspicuous on c and d because of the 30° flip angle chosen to maximize the SI of metastases. However, all five lesions have the same SI on c and d. By means of combined review of pre- and postcontrast images, all observers detected and classified the metastasis correctly.

View larger version (119K): [in a new window]   Figure 7d. Coexistent benign and malignant lesions in a 46-year-old woman. Transverse MR images obtained with (a) unenhanced FSE (2,650/88), (b) SPIO-enhanced FSE (2,650/88), (c) GRE with a TE of 11 msec (165/11/300), and (d) GRE with a TE of 11 msec (165/15/300) sequences. Four simple cysts are well shown on a-d (straight arrows), and a solitary metastasis (curved arrow) not visible on a is demonstrated on b-d. On c and d, the cysts have a relatively reduced SI compared with that on a and b, while the metastasis is more conspicuous on c and d because of the 30° flip angle chosen to maximize the SI of metastases. However, all five lesions have the same SI on c and d. By means of combined review of pre- and postcontrast images, all observers detected and classified the metastasis correctly.