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[Differential diagnosis of focal liver lesions with MRI using the superparamagnetic contrast medium endorem]. 1995

T J Vogl, and R Hammerstingl, and H Keck, and R Felix
Strahlenklinik and Poliklinik, Humboldt Universität Berlin, Klinikum Rudolf Virchow.

OBJECTIVE In a phase III/III-B trial the specific contrast enhancement of benign liver tumors, especially FNH and adenoma, versus malignant liver tumors such as HCC and metastases (colorectal and endocrine tumors) was evaluated using the superparamagnetic iron oxide ENDOREM. METHODS 57 patients were prospectively investigated using T2-(TR/TE=2000/90) and T1-(550/15) weighted spinecho (SE), FLASH-2D-gradientecho (GE), and fat suppressed (FATSAT) sequences before and after administration of ENDOREM (concentration: 0.2 mmol Fe/ml, dose: 15 micromol/kg (b.w.) in transverse slice orientation on a 1.5 Tesla MAGNETOM (Siemens, 63 SP). In 8 patients an in vivo-in vitro correlation 30 minutes after resection was performed. In 12 patients benign primary liver tumors (FNH (n = 10), adenoma (n = 1), and hemangioma (n = 1) were histopathologically proved. Malignant liver tumors (HCC (n = 11, cholangiocarcinoma (n = 1), metastases from colorectal carcinoma (n = 13), and endocrine tumors (n = 4)) were found in 29 patients. 11 patients with liver cirrhosis due to Wilson's disease and 5 with cirrhosis due to other reasons were investigated. RESULTS Contrast-enhanced studies allowed detection of more lesions in 19 of 41 patients with liver tumors. Benign liver tumors showed significant loss of signal intensity of 43.0% +/- 17.9 for FNH, 32.4% for adenoma and 10.2% for hemangioma in proton density-weighted SE images. Malignant tumors showed only minimal signal loss: HCC: 5.3% +/- 17, cholangiocarcinoma: -1.6%, colorectal: -2.0% +/- 11.1, endocrine metastases: 4.2% +/-4.1. Normal liver parenchyma and spleen tissue demonstrated significant signal loss of 59.2% +/- 14.9 and 42.3 +/- 012.5. In ten patients and 13 lesions of FNH, a capsule was seen in 7.7% plain and 23.1% enhanced. Scar tissue was found in 30.8% plain, 84.6% enhanced. In the patient with adenoma, capsule with contrast enhancement was seen, but no scar was detected, whereas in patients with HCC a capsule was seen in three cases enhanced. Statistical analysis (Friedman-test, Wilcoxon-test) showed a statistically significant difference in signal loss between benign and malignant liver lesions (p < 0.05). CONCLUSIONS The use of superparamagnetic iron oxide ENDOREM) allows differentiation of benign and malignant liver tumors on the basis of contrast enhancement, existence and specific enhancement of capsule or scar. In vitro correlation show some limitations of in vivo MRI.

UI MeSH Term Description Entries
D006965 Hyperplasia An increase in the number of cells in a tissue or organ without tumor formation. It differs from HYPERTROPHY, which is an increase in bulk without an increase in the number of cells. Hyperplasias
D007501 Iron A metallic element with atomic symbol Fe, atomic number 26, and atomic weight 55.85. It is an essential constituent of HEMOGLOBINS; CYTOCHROMES; and IRON-BINDING PROTEINS. It plays a role in cellular redox reactions and in the transport of OXYGEN. Iron-56,Iron 56
D008099 Liver A large lobed glandular organ in the abdomen of vertebrates that is responsible for detoxification, metabolism, synthesis and storage of various substances. Livers
D008107 Liver Diseases Pathological processes of the LIVER. Liver Dysfunction,Disease, Liver,Diseases, Liver,Dysfunction, Liver,Dysfunctions, Liver,Liver Disease,Liver Dysfunctions
D008113 Liver Neoplasms Tumors or cancer of the LIVER. Cancer of Liver,Hepatic Cancer,Liver Cancer,Cancer of the Liver,Cancer, Hepatocellular,Hepatic Neoplasms,Hepatocellular Cancer,Neoplasms, Hepatic,Neoplasms, Liver,Cancer, Hepatic,Cancer, Liver,Cancers, Hepatic,Cancers, Hepatocellular,Cancers, Liver,Hepatic Cancers,Hepatic Neoplasm,Hepatocellular Cancers,Liver Cancers,Liver Neoplasm,Neoplasm, Hepatic,Neoplasm, Liver
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D010087 Oxides Binary compounds of oxygen containing the anion O(2-). The anion combines with metals to form alkaline oxides and non-metals to form acidic oxides. Oxide
D011230 Precancerous Conditions Pathological conditions that tend eventually to become malignant. Preneoplastic Conditions,Condition, Preneoplastic,Conditions, Preneoplastic,Preneoplastic Condition,Condition, Precancerous,Conditions, Precancerous,Precancerous Condition
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D003287 Contrast Media Substances used to allow enhanced visualization of tissues. Radiopaque Media,Contrast Agent,Contrast Agents,Contrast Material,Contrast Materials,Radiocontrast Agent,Radiocontrast Agents,Radiocontrast Media,Agent, Contrast,Agent, Radiocontrast,Agents, Contrast,Agents, Radiocontrast,Material, Contrast,Materials, Contrast,Media, Contrast,Media, Radiocontrast,Media, Radiopaque

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