Yonsei Med J.  2012 Jul;53(4):825-833. 10.3349/ymj.2012.53.4.825.

Diffusion-Weighted MR Imaging before and after Contrast Enhancement with Superparamagnetic Iron Oxide for Assessment of Hepatic Metastasis

• Kim H
• Yu JS
• Kim DJ
• Chung JJ
• Kim JH
• Kim KW

• KMID: 1716885
• DOI: http://doi.org/10.3349/ymj.2012.53.4.825

Abstract

PURPOSE
The purpose of our study was to validate diffusion-weighted MRI (DWI) before and after superparamagnetic iron oxide (SPIO) injection for assessment of hepatic metastases.
MATERIALS AND METHODS
Eighty-six hepatic metastases (size range, 0.3-4.7 cm; mean, 1.5 cm) verified pathologically or by follow-up imaging studies in 22 consecutive patients (17 men and 5 women; 44-83 years; mean age, 60 years) during a 13-month period were enrolled. Hepatic MRI, including DWI (b-factors=50, 400, 800 s/mm2) with breath-holding technique of single-shot spin-echo echo-planar imaging (TR/TE=1000/69 ms, average=2) before and after SPIO administration, were retrospectively reviewed by two independent radiologists with a 5-point scale confidence score for each hepatic lesion on pre-contrast DWI (pre-DWI), SPIO-enhanced DWI (SPIO-DWI), and SPIO-enhanced T2*-weighted imaging (SPIO-T2*wI).
RESULTS
For all lesions, SPIO-T2*wI showed significantly higher confidence score in the diagnosis of hepatic metastases than pre-contrast or SPIO-DWI regardless of the size of b-factors (p<0.05) with only one exception; using b-factor=50 s/mm2, the score of SPIO-T2*wI was still higher than SPIO-DWI but there was no statistical significance given by observer 1 (p=0.730). For the subcentimeter lesions (n=37), SPIO-T2*wI showed the highest score, and using b-factor=50 or 400 s/mm2 SPIO-DWI showed similar confidence scores to SPIO-T2*wI by both observers (p>0.05). Pre-DWI using b-factor=50 sec/mm2 was also comparable with SPIO-T2*wI by observer 1 (p=0.060).
CONCLUSION
Pre-DWI has a limited value for the assessment of hepatic metastases, however, the repetition of DWI after SPIO injection using small b-factors could complement SPIO-T2*wI, especially for subcentimeter lesions.

Keyword

Liver; metastasis; diffusion magnetic resonance imaging; superparamagnetic iron oxide (SPIO)

MeSH Terms

Adult
Aged
Aged, 80 and over
Contrast Media/chemistry/*diagnostic use
Diffusion Magnetic Resonance Imaging/*methods
Female
Ferric Compounds/chemistry/*diagnostic use
Humans
Liver Neoplasms/*diagnosis
Male
Neoplasm Metastasis/*diagnosis

Figure

• 

  Fig. 1 Mean confidence scores with standard deviations of each MRI sequence for overall lesions. SPIO-T2*wI, SPIO-enhanced T2*wI; Pre-DWI_50, pre-contrast DWI with a b-factor of 50 s/mm2; pre-DWI_400, pre-contrast DWI with a b-factor of 400 s/mm2; pre-DWI_800, pre-contrast DWI with a b-factor of 800 s/mm2; SPIO-DWI_50, SPIO-enhanced DWI with a b-factor of 50 s/mm2; SPIO-DWI_400, SPIO-enhanced DWI with a b-factor of 400 s/mm2; SPIO-DWI_800, SPIO-enhanced DWI with a b-factor of 800 s/mm2. SPIO, superparamagnetic iron oxide; DWI, diffusion-weighted MRI; MRI, magnetic resonance imaging; T2*wI, T2* weighted imaging.

• 

  Fig. 2 A 48-year-old man with sigmoid colon cancer. SPIO-enhanced T2*-weighted image (A) shows a metastatic lesion (arrow) in the lateral segment. On the pre-contrast DWIs using b-factor (s/mm2) of 50 (B), 400 (C) and 800 (D), relative signal intensities of the lesions are gradually decreased with the increase of b-factors. On the SPIO-enhanced DWIs using b-factor (s/mm2) of 50 (E), 400 (F) and 800 (G), the lesions are more conspicuously seen, especially on the images using smaller b-factors. With an increase of b-factors, marginal blurring of the lesion looks more severe. SPIO, superparamagnetic iron oxide; DWI, diffusion-weighted MRI.

• 

  Fig. 3 Mean confidence scores with standard deviations of each MRI sequence for 1 cm or larger lesions. SPIO-T2*wI, SPIO-enhanced T2*wI; Pre-DWI_50, pre-contrast DWI with a b-factor of 50 s/mm2; pre-DWI_400, pre-contrast DWI with a b-factor of 400 s/mm2; pre-DWI_800, pre-contrast DWI with a b-factor of 800 s/mm2; SPIO-DWI_50, SPIO-enhanced DWI with a b-factor of 50 s/mm2; SPIO-DWI_400, SPIO-enhanced DWI with a b-factor of 400 s/mm2; SPIO-DWI_800, SPIO-enhanced DWI with a b-factor of 800 s/mm2. SPIO, superparamagnetic iron oxide; DWI, diffusion-weighted MRI; MRI, magnetic resonance imaging; T2*wI, T2* weighted imaging.

• 

  Fig. 4 Mean confidence scores with standard deviations of each MRI sequence for lesions smaller than 1 cm. SPIO-T2*wI, SPIO-enhanced T2*wI; Pre-DWI_50, pre-contrast DWI with a b-factor of 50 s/mm2; pre-DWI_400, pre-contrast DWI with a b-factor of 400 s/mm2; pre-DWI_800, pre-contrast DWI with a b-factor of 800 s/mm2; SPIO-DWI_50, SPIO-enhanced DWI with a b-factor of 50 s/mm2; SPIO-DWI_400, SPIO-enhanced DWI with a b-factor of 400 s/mm2; SPIO-DWI_800, SPIO-enhanced DWI with a b-factor of 800 s/mm2. SPIO, superparamagnetic iron oxide; DWI, diffusion-weighted MRI; MRI, magnetic resonance imaging; T*wI, T2* weighted imaging.

• 

  Fig. 5 A 69-year-old man with colon cancer and numerous metastases throughout the liver including the largest one in the left hemiliver. On the SPIO-enhanced T2*-weighted image (A), metastatic lesions are not well distinguished from the background liver due to small lesion size and masking effect of the intrahepatic vasculature with high signal intensity. On the pre-contrast DWIs using b-factor (s/mm2) of 50 (B), at least 5 metastases (arrowheads) in a single level of right hemiliver are well delineated from the background liver due to 'black-blood' effect. The confidence is worsened on the images using higher b-factors of 400 (C) or 800 (D) with low signal intensity and marginal blurring of the lesions. On the SPIO-enhanced DWIs using b-factor (s/mm2) of 50 (E) or 400 (F), all five lesions are conspicuously seen, compared with poor marginal definition on the image using the b-factor of 800 (G). Compared with pre-contrast DWI, SPIO-enhanced DWI using corresponding b-factors shows consistently higher lesion-to-liver contrasts. SPIO, superparamagnetic iron oxide; DWI, diffusion-weighted MRI.

• 

  Fig. 6 A 69-year-old man with multiple hepatic metastases in the left hemiliver. A small metastatatic lesion (arrowhead) on SPIO-enhanced T2*-weighted image (A) is not well distinguished from the background liver due to small size and the masking effect of the intrahepatic vasculature. On the pre-contrast DWIs using b-factor (s/mm2) of 50 (B), 400 (C) and 800 (D), there is severe motion artifact and no focal lesion is defined. On the SPIO-enhanced DWIs using b-factor (s/mm2) of 50 (E), 400 (F) and 800 (G), the lesion (arrowhead) is well delineated due to the increased lesion-to-liver contrast in spite of the motion artifact. SPIO, superparamagnetic iron oxide; DWI, diffusion-weighted MRI.

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