Korean J Radiol.  2009 Apr;10(2):112-120. 10.3348/kjr.2009.10.2.112.

SPIO-Enhanced MRI Findings of Well-Differentiated Hepatocellular Carcinomas: Correlation with MDCT Findings

• Kim SH
• Lee WJ
• Lim HK
• Park CK

• KMID: 1088721
• DOI: http://doi.org/10.3348/kjr.2009.10.2.112

Abstract

OBJECTIVE
This study was designed to assess superparamagnetic iron oxide (SPIO)-enhanced MRI findings of well-differentiated hepatocellular carcinomas (HCCs) correlated with their multidetector-row CT (MDCT) findings.
MATERIALS AND METHODS
Seventy-two patients with 84 pathologically proven well-differentiated HCCs underwent triple-phase MDCT and SPIO-enhanced MRI at a magnetic field strength of 1.5 Tesla (n = 49) and 3.0 Tesla (n = 23). Two radiologists in consensus retrospectively reviewed the CT and MR images for attenuation value and the signal intensity of each tumor. The proportion of hyperintense HCCs as depicted on SPIO-enhanced T2- or T2*-weighted images were compared in terms of tumor size (< 1 cm and > 1 cm), five CT attenuation patterns based on arterial and equilibrium phases and magnetic field strength, by the use of univariate and multivariate analyses.
RESULTS
Seventy-eight (93%) and 71 (85%) HCCs were identified by CT and on SPIO-enhanced T2- and T2*-weighted images, respectively. For the CT attenuation pattern, one (14%) of seven isodense-isodense, four (67%) of six hypodense-hypodense, four (80%) of five isodense-hypodense, 14 (88%) of 16 hyperdense-isodense and 48 (96%) of 50 hyperdense-hypodense HCCs were hyperintense (Cochran-Armitage test for trend, p < 0.001). Based on the use of multivariate analysis, the CT attenuation pattern was the only factor that affected the proportion of hyperintense HCCs as depicted on SPIO-enhanced T2- or T2*-weighted images (p < 0.001). Tumor size or magnetic field strength was not a factor that affected the proportion of hyperintense HCCs based on the use of univariate and multivariate analysis (p > 0.05).
CONCLUSION
Most well-differentiated HCCs show hyperintensity on SPIO-enhanced MRI, although the lesions show various CT attenuation patterns. The CT attenuation pattern is the main factor that affects the proportion of hyperintense well-differentiated HCCs as depicted on SPIO-enhanced MRI.

Keyword

Well-differentiated hepatocellular carcinoma; Superparamagnetic iron oxide-enhanced MRI, MDCT

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*pathology
Contrast Media
Female
Humans
Image Enhancement/methods
Image Processing, Computer-Assisted
Iron/*diagnostic use
Liver Neoplasms/*pathology
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Oxides/*diagnostic use
Retrospective Studies
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 61-year-old woman with 0.5-cm well-differentiated hepatocellular carcinoma in segment VII. A, B. Contrast-enhanced CT scans obtained at arterial (A) and equilibrium (B) phases show small nodule with hypodense-hypodense pattern (arrows), which mimics nonmalignant nodule such as regenerative or dysplastic nodule. Small hypodense lesion (arrowhead in B) in left liver is part of cyst. C. Ferucarbotran-enhanced T2*-weighted fast field-echo (TR/TE, 129/9.2 msec; flip angle, 20°) axial image obtained at 3.0 T shows small hyperintense nodule (arrow). Small hyperintense lesion (arrowhead) in left liver is part of cyst.

• 

  Fig. 2 57-year-old man with 1.9-cm well-differentiated hepatocellular carcinoma in segment V. A, B. Contrast-enhanced CT scans obtained at arterial (A) and equilibrium (B) phases show small nodule with isodense-hypodense pattern (arrows). C. Ferucarbotran-enhanced T2*-weighted fast field-echo (TR/TE, 129/9.2 msec; flip angle, 20°) axial image obtained at 3.0 T shows discrete hyperintense nodule (arrow).

• 

  Fig. 3 48-year-old man with 2.3-cm well-differentiated hepatocellular carcinoma in segment VI. A, B. Contrast-enhanced CT scans obtained at arterial (A) and equilibrium (B) phases show nodule with hyperdense-isodense pattern (arrows). C. As seen on ferucarbotran-enhanced T2*-weighted fast multiplanar gradient-recalled echo axial image (TR/TE range, 130/8.4 msec; flip angle, 30°) obtained at 1.5 T, nodule as seen on CT image does not appear to be hyperintense.

• 

  Fig. 4 64-year-old man with 1.6-cm well-differentiated hepatocellular carcinoma in segment VI. A, B. Contrast-enhanced CT scans obtained at arterial (A) and equilibrium (B) phases show small nodule with hyperdense-hypodense pattern (arrows). C. As seen on ferucarbotran-enhanced T2*-weighted fast multiplanar gradient-recalled echo axial image (TR/TE range, 130/8.4 msec; flip angle, 30°) obtained at 1.5 T, nodule as seen on CT image does not appear to be hyperintense.

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