Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online before print February 16, 2006, 10.1148/radiol.2383041825
This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Onishi, H.
Right arrow Articles by Nakamura, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Onishi, H.
Right arrow Articles by Nakamura, H.

Hepatic Metastases: Detection with Multi–Detector Row CT, SPIO-enhanced MR Imaging, and Both Techniques Combined1

Hiromitsu Onishi, MD, Takamichi Murakami, MD, PhD, Tonsok Kim, MD, Masatoshi Hori, MD, PhD, Riccardo Iannaccone, MD, Masatomo Kuwabara, MD, Hisashi Abe, MD, Saki Nakata, MD, Keigo Osuga, MD, Kaname Tomoda, MD, PhD, Roberto Passariello, MD and Hironobu Nakamura, MD, PhD

1 From the Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (H.O., T.M., T.K., M.H., M.K., H.A., S.N., K.O., K.T., H.N.); and Department of Radiological Sciences, University of Rome-La Sapienza, Rome, Italy (R.I., R.P.). Received October 25, 2004; revision requested December 29; revision received February 24, 2005; accepted March 15; final version accepted, May 5. Address correspondence to T.M., Department of Diagnostic and Interventional Radiology, Kinki University School of Medicine, 377-2, Ohno-higashi, Osakasayama, Osaka 589-8511, Japan (e-mail: murakami{at}med.kindai.ac.jp).


Figure 1
View larger version (133K):

[in a new window]
  		Figure 1a: Surgically proved liver metastasis from rectal cancer in 71-year-old man. (a) Transverse contrast-enhanced CT scan shows a small and slightly hypoattenuating nodule (arrow). (b) On transverse SPIO-enhanced respiratory-triggered T2-weighted fast spin-echo MR image (4615/64 [effective]; echo train length, eight), the lesion is seen as a high-signal-intensity nodule (arrow). Although on (c) a transverse SPIO-enhanced fast SPGR MR image (150/10; flip angle, 60°), the lesion is seen as a high-signal-intensity nodule (arrow) and on (d) a transverse SPIO-enhanced T1-weighted fast SPGR MR image (150/1.3; flip angle, 90°), the lesion is seen as a low-signal-intensity nodule (arrow), it is difficult to distinguish the true lesion from vessels owing to the small size of the lesion. With CT images alone, two readers assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining reader assigned a score of 2. With MR images alone, three readers assigned this lesion a confidence score of 0 and the remaining reader assigned a score of 1. With both CT and MR images, one reader assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining two readers assigned a score of 3. The combination of contrast-enhanced CT and SPIO-enhanced MR imaging increased the confidence level for this lesion.

 

Figure 1
View larger version (114K):

[in a new window]
  		Figure 1b: Surgically proved liver metastasis from rectal cancer in 71-year-old man. (a) Transverse contrast-enhanced CT scan shows a small and slightly hypoattenuating nodule (arrow). (b) On transverse SPIO-enhanced respiratory-triggered T2-weighted fast spin-echo MR image (4615/64 [effective]; echo train length, eight), the lesion is seen as a high-signal-intensity nodule (arrow). Although on (c) a transverse SPIO-enhanced fast SPGR MR image (150/10; flip angle, 60°), the lesion is seen as a high-signal-intensity nodule (arrow) and on (d) a transverse SPIO-enhanced T1-weighted fast SPGR MR image (150/1.3; flip angle, 90°), the lesion is seen as a low-signal-intensity nodule (arrow), it is difficult to distinguish the true lesion from vessels owing to the small size of the lesion. With CT images alone, two readers assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining reader assigned a score of 2. With MR images alone, three readers assigned this lesion a confidence score of 0 and the remaining reader assigned a score of 1. With both CT and MR images, one reader assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining two readers assigned a score of 3. The combination of contrast-enhanced CT and SPIO-enhanced MR imaging increased the confidence level for this lesion.

 

Figure 1
View larger version (126K):

[in a new window]
  		Figure 1c: Surgically proved liver metastasis from rectal cancer in 71-year-old man. (a) Transverse contrast-enhanced CT scan shows a small and slightly hypoattenuating nodule (arrow). (b) On transverse SPIO-enhanced respiratory-triggered T2-weighted fast spin-echo MR image (4615/64 [effective]; echo train length, eight), the lesion is seen as a high-signal-intensity nodule (arrow). Although on (c) a transverse SPIO-enhanced fast SPGR MR image (150/10; flip angle, 60°), the lesion is seen as a high-signal-intensity nodule (arrow) and on (d) a transverse SPIO-enhanced T1-weighted fast SPGR MR image (150/1.3; flip angle, 90°), the lesion is seen as a low-signal-intensity nodule (arrow), it is difficult to distinguish the true lesion from vessels owing to the small size of the lesion. With CT images alone, two readers assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining reader assigned a score of 2. With MR images alone, three readers assigned this lesion a confidence score of 0 and the remaining reader assigned a score of 1. With both CT and MR images, one reader assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining two readers assigned a score of 3. The combination of contrast-enhanced CT and SPIO-enhanced MR imaging increased the confidence level for this lesion.

 

Figure 1
View larger version (140K):

[in a new window]
  		Figure 1d: Surgically proved liver metastasis from rectal cancer in 71-year-old man. (a) Transverse contrast-enhanced CT scan shows a small and slightly hypoattenuating nodule (arrow). (b) On transverse SPIO-enhanced respiratory-triggered T2-weighted fast spin-echo MR image (4615/64 [effective]; echo train length, eight), the lesion is seen as a high-signal-intensity nodule (arrow). Although on (c) a transverse SPIO-enhanced fast SPGR MR image (150/10; flip angle, 60°), the lesion is seen as a high-signal-intensity nodule (arrow) and on (d) a transverse SPIO-enhanced T1-weighted fast SPGR MR image (150/1.3; flip angle, 90°), the lesion is seen as a low-signal-intensity nodule (arrow), it is difficult to distinguish the true lesion from vessels owing to the small size of the lesion. With CT images alone, two readers assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining reader assigned a score of 2. With MR images alone, three readers assigned this lesion a confidence score of 0 and the remaining reader assigned a score of 1. With both CT and MR images, one reader assigned this lesion a confidence score of 0, another reader assigned a score of 1, and the remaining two readers assigned a score of 3. The combination of contrast-enhanced CT and SPIO-enhanced MR imaging increased the confidence level for this lesion.

 

Figure 2
View larger version (87K):

[in a new window]
  		Figure 2a: Surgically proved liver metastasis from cecal cancer in 61-year-old woman. (a) Transverse contrast-enhanced CT scan shows the lesion as a faint hypoattenuating area (arrow). (b) Transverse SPIO-enhanced fast low-angle shot MR image (150/10; flip angle, 60°) shows the lesion as a hyperintense nodule (arrow). With CT images alone, all four readers assigned a confidence score of 0 to this lesion. With MR images alone, one reader assigned a confidence score of 2, two readers assigned a score of 3, and the remaining reader assigned a score of 4. With both CT and MR images, one reader assigned a score of 0, another reader assigned a score of 2, and the remaining two readers assigned a score of 3.

 

Figure 2
View larger version (116K):

[in a new window]
  		Figure 2b: Surgically proved liver metastasis from cecal cancer in 61-year-old woman. (a) Transverse contrast-enhanced CT scan shows the lesion as a faint hypoattenuating area (arrow). (b) Transverse SPIO-enhanced fast low-angle shot MR image (150/10; flip angle, 60°) shows the lesion as a hyperintense nodule (arrow). With CT images alone, all four readers assigned a confidence score of 0 to this lesion. With MR images alone, one reader assigned a confidence score of 2, two readers assigned a score of 3, and the remaining reader assigned a score of 4. With both CT and MR images, one reader assigned a score of 0, another reader assigned a score of 2, and the remaining two readers assigned a score of 3.

 

Figure 3
View larger version (125K):

[in a new window]
  		Figure 3a: Liver metastasis from rectal cancer in 59-year-old man. At follow-up CT 1 month later, the lesion showed growth and the tumor marker increased during the observation period. Hence, the lesion was considered to be a true metastatic tumor. (a) Transverse contrast-enhanced CT scan shows the lesion as a small hypoattenuating area (arrow). (b) Transverse SPIO-enhanced fast low-angle shot MR image (150/10; flip angle, 60°) shows the lesion as a triangular hyperintense nodule (arrow). With CT images alone, three readers assigned a confidence score of 2 to this lesion and the remaining reader assigned a score of 3. With MR images alone, three readers assigned a score of 0 and the remaining reader assigned a score of 1. With both CT and MR images, one reader assigned a score of 1, two readers assigned a score of 2, and the remaining reader assigned a score of 3. On MR images alone, it was difficult to distinguish the true lesion from vessels because the lesion appeared as a triangular rather than a round shape and mimicked the obliquely sectioned vessel.

 

Figure 3
View larger version (111K):

[in a new window]
  		Figure 3b: Liver metastasis from rectal cancer in 59-year-old man. At follow-up CT 1 month later, the lesion showed growth and the tumor marker increased during the observation period. Hence, the lesion was considered to be a true metastatic tumor. (a) Transverse contrast-enhanced CT scan shows the lesion as a small hypoattenuating area (arrow). (b) Transverse SPIO-enhanced fast low-angle shot MR image (150/10; flip angle, 60°) shows the lesion as a triangular hyperintense nodule (arrow). With CT images alone, three readers assigned a confidence score of 2 to this lesion and the remaining reader assigned a score of 3. With MR images alone, three readers assigned a score of 0 and the remaining reader assigned a score of 1. With both CT and MR images, one reader assigned a score of 1, two readers assigned a score of 2, and the remaining reader assigned a score of 3. On MR images alone, it was difficult to distinguish the true lesion from vessels because the lesion appeared as a triangular rather than a round shape and mimicked the obliquely sectioned vessel.

 




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE
Copyright © 2006 by the Radiological Society of North America.