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Hepatocellular Carcinoma: Detection with Gadolinium- and Ferumoxides-enhanced MR Imaging of the Liver¹

¹ From the Department of Radiology, University of Bonn, Germany. Received September 29, 2000; revision requested November 22; final revision received July 30, 2001; accepted August 3. Address correspondence to D.P., Department of Nuclear Medicine, Heinrich-Heine-University Duesseldorf, Research Center Juelich, 52426 Juelich, Germany (e-mail: pauleit@web.de).

PURPOSE: To test the hypothesis that the accuracy of gadolinium- and ferumoxides-enhanced magnetic resonance (MR) imaging is different in small (1.5-cm) and large (>1.5-cm) hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS: Forty-three consecutive patients with chronic liver disease were enrolled in this study. The imaging protocol included unenhanced breath-hold T1-weighted fast field-echo sequences, unenhanced respiratory-triggered T2-weighted turbo spin-echo (SE) sequences, dynamic gadolinium-enhanced T1-weighted three-dimensional turbo field-echo sequences, and ferumoxides-enhanced T2-weighted turbo SE sequences. Images of each sequence and two sets of sequences (ferumoxides set and gadolinium set) were reviewed by four observers. The ferumoxides set included unenhanced T1- and T2-weighted images and ferumoxides-enhanced T2-weighted turbo SE MR images. The gadolinium set included unenhanced T1- and T2-weighted images and dynamic gadolinium-enhanced three-dimensional turbo field-echo MR images. In receiver operating characteristic (ROC) curve analysis, the sensitivity and accuracy of the sequences were compared in regard to the detection of all, small, and large HCCs.

RESULTS: Imaging performance was different with gadolinium- and ferumoxides-enhanced images in the detection of small and large HCCs. For detection of small HCCs, the sensitivity and accuracy with unenhanced and gadolinium-enhanced imaging (gadolinium set) were significantly (P = .017) superior to those with unenhanced and ferumoxides-enhanced imaging (ferumoxides set). The area under the composite ROC curves, or A_z, for the gadolinium set and the ferumoxides set was 0.97 and 0.81, respectively. For large HCC, the ferumoxides set was superior compared with the gadolinium set, but this difference was not statistically significant. Analysis of all HCCs demonstrated no significant differences for gadolinium- and ferumoxides-enhanced imaging.

CONCLUSION: For the detection of early HCC, gadolinium-enhanced MR imaging is preferred to ferumoxides-enhanced MR imaging because the former demonstrated significantly greater accuracy in the detection of small HCCs.

Index terms: Gadolinium, 761.12143 • Liver neoplasms, MR, 761.121411, 761.121416, 761.12143 • Receiver operating characteristic (ROC) curve

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