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Focal Hepatic Lesions: Detection and Characterization with Combination Gadolinium- and Superparamagnetic Iron Oxide–enhanced MR Imaging¹

¹ From the Department of Diagnostic Radiology, Research Institute of Radiological Science, Severance Hospital (M.J.K., J.H.K., J.J.C., J.S.L., Y.T.O.), Brain Korea 21 Project for Medical Science (M.J.K.), and Department of Diagnostic Radiology, Yong Dong Severance Hospital (M.S.P.), Yonsei University College of Medicine, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Republic of Korea; and Department of Diagnostic Radiology, NHIC Ilsan Hospital, Gyonggi-do, Korea (J.J.C.). Received June 18, 2002; revision requested August 20; final revision received December 29; accepted January 20, 2003. Address correspondence to M.J.K. (e-mail: kimnex@yumc.yonsei.ac.kr).

View larger version (191K): [in a new window]   Figure 1. Transverse MR images in a 58-year-old woman with a hepatic metastasis from colorectal carcinoma who underwent SPIO-enhanced MR imaging followed immediately by gadolinium-enhanced dynamic MR imaging. Gadolinium-enhanced T1-weighted spoiled GRE MR images (190/1.5, 90° flip angle) obtained in, A, hepatic arterial and, B, portal venous phases show no focal lesions except for tiny cysts (arrows in A) in the posterior aspect of the right lobe of the liver. C, Unenhanced T2-weighted FSE MR image (7,500/104) also shows two cysts, but a metastasis (arrow) was not appreciated by either reader. D, SPIO-enhanced T2-weighted FSE MR image (9,230/104) obtained before the gadolinium-enhanced images clearly shows the metastasis (arrow), as well as two small cysts. Ascitic fluid is seen in the anterior portion of the liver.

View larger version (193K): [in a new window]   Figure 2. Transverse MR images in a 66-year-old man with an HCC who underwent SPIO-enhanced MR imaging 1 day after gadolinium-enhanced MR imaging. A, Unenhanced (6,666/105) and, B, SPIO-enhanced (7,500/104) T2-weighted FSE MR images show hypointense regenerative nodules throughout the liver. Only a moderate decrease in hepatic signal intensity is observed in B compared with A; this suggests poor hepatic uptake of SPIO because of low Kupffer cell activity. The area of high signal intensity seen in the anterior portion of the liver represents ascitic fluid. C, Gadolinium-enhanced T1-weighted spoiled GRE MR image (200/2, 90° flip angle) obtained in the hepatic arterial phase shows a small nodular lesion (arrow) with increased arterial enhancement. D, Delayed phase gadolinium-enhanced T1-weighted spoiled GRE MR image (200/2, 90° flip angle) shows a washout of contrast enhancement from the lesion and a thin fibrotic rim (arrowhead) around the lesion.

View larger version (199K): [in a new window]   Figure 3. Transverse MR images in a 61-year-old man with HCC who underwent SPIO-enhanced MR imaging 1 day after gadolinium-enhanced MR imaging. A, Unenhanced T2-weighted FSE MR image (8,000/105) shows a hyperintense lesion (arrow) at the posterior margin of the right lobe of the liver. B, SPIO-enhanced T2*-weighted GRE MR image (120/10, 30° flip angle) also clearly shows the lesion, but reader confidence in classifying the lesion as benign or malignant was low with this image. C, Gadolinium-enhanced T1-weighted spoiled GRE MR image (200/2, 90° flip angle) obtained in the hepatic arterial phase shows an area of increased arterial enhancement (arrow). D, Gadolinium-enhanced T1-weighted spoiled GRE MR image (200/2, 90° flip angle) obtained in the portal venous phase shows an early washout of contrast enhancement in the central area with an internal mosaic pattern and thick peripheral rim enhancement; these are characteristic findings of HCC.

View larger version (184K): [in a new window]   Figure 4. Transverse MR images of an HCC lesion in a 58-year-old man with cirrhosis who underwent SPIO-enhanced MR imaging 1 day after gadolinium-enhanced MR imaging. A, Unenhanced T1-weighted spoiled GRE MR image (220/4, 90° flip angle) shows a bulging mass (arrow) at the anterior aspect of the right lobe of the liver. B, Gadolinium-enhanced T1-weighted spoiled GRE MR image (220/1.5, 90° flip angle) obtained in the hepatic arterial phase shows the same lesion, but its arterial enhancement is not evident. C, Unenhanced T2-weighted FSE MR image (7,500/98) depicts the same lesion as having signal intensity similar to that of the surrounding liver. D, SPIO-enhanced T2-weighted FSE MR image (7,826/98) shows a hyperintense area (arrowhead) in the nodule that suggests focal malignant degeneration.