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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.
