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Ferumoxides-enhanced Double-Echo T2-weighted MR Imaging in Differentiating Metastases from Nonsolid Benign Lesions of the Liver¹

¹ From the Department of Radiology, Yamanashi Medical University, Yamanashi, Japan. From the 2001 RSNA scientific assembly. Received June 21, 2001; revision requested August 15; final revision received April 1, 2002; accepted April 10. Address correspondence to A.S.A., LDRR/CC, National Institute of Health, Bldg 10, Rm B1N256, Bethesda, MD 20892 (e-mail: saali@cc.nih.gov).

PURPOSE: To investigate whether ferumoxides-enhanced double-echo T2-weighted magnetic resonance (MR) imaging alone can allow differentiation of metastases from benign lesions in the noncirrhotic liver.

MATERIALS AND METHODS: At retrospective review of files and images, 60 lesions (22 metastases, 20 hemangiomas, and 18 cysts) were identified in 42 patients. All fast spin-echo T2-weighted MR images obtained before and after administration of ferumoxides with short (80–90 msec) and long (180–250 msec) echo times (TEs) were acquired with a 1.5-T system. Differences in lesion-to-liver signal intensity ratio between images obtained with long and short TEs were calculated. Data from all 60 lesions were entered into a receiver operating characteristic analysis. Three independent readers scored their observations of each lesion with a confidence level of 1–5. The diagnostic accuracy of each analysis method was determined by calculating the area under each reader-specific receiver operating characteristic curve. Interobserver agreement was calculated with the use of chance-corrected statistics. Relative sensitivity, specificity, and accuracy of characterizing benign lesions with each method were calculated.

RESULTS: Markedly low signal intensity and lesion-to-liver ratio on ferumoxides-enhanced images were observed with hemangioma. The difference of lesion-to-liver ratio between long and short TEs on ferumoxides-enhanced images was significantly different from that of unenhanced images and that of metastases or cysts. Interobserver agreement was good to excellent. Ferumoxides-enhanced images (with short and long TEs) showed significantly higher diagnostic accuracy than that of unenhanced images (with short or short and long TEs). Ferumoxides-enhanced images showed similar sensitivity, specificity, and accuracy when all images were reviewed together.

CONCLUSION: Ferumoxides-enhanced T2-weighted MR images appear useful in differentiating metastases from benign (nonsolid) lesions in the liver.

© RSNA, 2002

Index terms: Liver, cysts, 761.3121 • Liver, hemangioma, 761.3194 • Liver neoplasms, metastases, 761.33 • Magnetic resonance (MR), contrast enhancement, 761.12143

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