Korean J Radiol.  2013 Dec;14(6):894-904. 10.3348/kjr.2013.14.6.894.

MR Imaging in Patients with Suspected Liver Metastases: Value of Liver-Specific Contrast Agent Gadoxetic Acid

• Lee KH
• Lee JM
• Park JH
• Kim JH
• Park HS
• Yu MH
• Yoon JH
• Han JK
• Choi BI

• KMID: 1711455
• DOI: http://doi.org/10.3348/kjr.2013.14.6.894

Abstract

OBJECTIVE
To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging with that of triple-phase multidetector-row computed tomography (MDCT) in the detection of liver metastasis.
MATERIALS AND METHODS
Our institutional review board approved this retrospective study and waived informed consent. The study population consisted of 51 patients with hepatic metastases and 62 patients with benign hepatic lesions, who underwent triple-phase MDCT and gadoxetic acid-enhanced MRI within one month. Two radiologists independently and randomly reviewed MDCT and MRI images regarding the presence and probability of liver metastasis. In order to determine additional value of hepatobiliary-phase (HBP), the dynamic-MRI set alone and combined dynamic-and-HBP set were evaluated, respectively. The standard of reference was a combination of pathology diagnosis and follow-up imaging. For each reader, diagnostic accuracy was compared using the jackknife alternative free-response receiver-operating-characteristic (JAFROC).
RESULTS
For both readers, average JAFROC figure-of-merit (FOM) was significantly higher on the MR image sets than on the MDCT images: average FOM was 0.582 on the MDCT, 0.788 on the dynamic-MRI set and 0.847 on the combined HBP set, respectively (p < 0.0001). The differences were more prominent for small (< or = 1 cm) lesions: average FOM values were 0.433 on MDCT, 0.711 on the dynamic-MRI set and 0.828 on the combined HBP set, respectively (p < 0.0001). Sensitivity increased significantly with the addition of HBP in gadoxetic acid-enhanced MR imaging (p < 0.0001).
CONCLUSION
Gadoxetic acid-enhanced MRI shows a better performance than triple-phase MDCT for the detection of hepatic metastasis, especially for small (< or = 1 cm) lesions.

Keyword

Gadoxetic acid; Magnetic resonance imaging; Computed tomography; Hepatic metastasis

MeSH Terms

Adult
Aged
Aged, 80 and over
Contrast Media/diagnostic use
Diagnosis, Differential
Female
Gadolinium DTPA/*diagnostic use
Humans
Liver Neoplasms/*diagnosis/secondary
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Multidetector Computed Tomography/methods
ROC Curve
Retrospective Studies
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 Flow chart of inclusion criteria. Patients with and without liver metastasis were enrolled in evaluation of detectability of liver metastasis. RFA = radiofrequency ablation, FLL = focal liver lesion, F/U = follow-up

• 

  Fig. 2 Surgically proven liver metastasis from ascending colon cancer in 53-year-old woman. A, B. Contrast-enhanced CT scans on arterial (A) and portal phase (B) show no definite liver metastasis. C. Respiratory-triggered, T2-weighted FSE image reveals one metastatic lesion in gallbladder bed (arrow). D, E. Arterial (D) and equilibrium (E) phase images after administration of gadoxetic-acid show lesion as faintly hypo-intense nodule (arrow). F. Gadoxetic-acid HBP MR image shows low-signal-intensity nodule in segment IV of liver (arrow). FSE = fast spin echo, HBP = hepatobiliary-phase

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