Focal liver lesions: Comparison of dual‐phase CT and multisequence multiplanar MR imaging including dynamic gadolinium enhancement

Abstract

The purpose of this study was to compare dual-phase spiral computed tomography (CT) and magnetic resonance imaging (MRI) using dynamic gadolinium enhancement for liver lesion detection and characterization. Twenty-two consecutive patients underwent dual-phase spiral CT and MRI for the evaluation of focal liver disease within a 1-month period. Spiral CT and MR images were interpreted prospectively, in a blinded fashion by separate, individual, experienced investigators, to determine lesion detection and characterization. Liver lesions were confirmed by surgery and pathology in 6 patients, and by clinical and imaging follow-up in the other 16 patients. Pathological correlation of a primary extrahepatic malignancy was available in 5 of the 16 patients who had metastatic liver disease. Spiral CT and MRI detected 53 and 63 lesions, and characterized 39 and 62 true positive lesions, respectively. A kappa statistic test was applied to assess agreement between MR and CT results. MR versus CT for lesion detection resulted in a kappa statistic of 0.54 (95% confidence interval), indicating moderate agreement, and 0.32 (95% confidence interval) for lesion characterization, indicating only slight agreement. More lesions were detected on MR images than CT images in 6 (27%) patients, with lesions detected only on MR images in 4 (18%) patients. More lesions were characterized on MR images in 9 (41%) patients. In 9 patients with a discrepancy between MR and CT findings, the MR images added information considered significant to patient management in all 9 cases. MRI was moderately superior to dual-phase spiral CT for lesion detection, and was markedly superior for lesion characterization, with these differences having clinical significance. J. Index terms: liver; MR; CT; contrast agents; focal liver lesion DUAL-PHASE SPIRAL CT (1,2) and MRI, using dynamic gadolinium administration (3-10), are used to evaluate focal liver disease. Despite the common occurrence of focal liver lesions, and the importance of determining the most accurate method to evaluate focal liver disease, few studies have compared dual-phase spiral CT and MRI, using various contrast agents, for the detection and characterization of liver lesions (11-13). Previous studies from our center compared MRI to dynamic contrast-enhanced CT or single phase spiral CT for liver lesion detection and characterization (5,6). The purpose of the current study was to compare dual-phase spiral CT and MRI, using dynamic gadolinium administration, for the detection and characterization of focal liver lesions. MATERIALS AND METHODS PatientsTwenty-two consecutive patients (11 males, ages 28 -77 years; 11 females, ages 44 -86 years) with suspected liver lesions, who underwent both spiral CT and MRI within a period of less than 1 month, were included in this study. No patients were excluded from the study due to technical, patient, or other factors. No other specific selection criteria were used, and all paired studies were performed at the request of referring physicians. Dual-phase sp...

Liver specific magnetic resonance imaging contrast medium for evaluation of focal liver lesions – Initial experience at a service hospital

“…Focal liver lesions can therefore potentially be differentiated on the basis of their selective source of blood supply reflected in the timeintensity contrast enhancement curves on dynamic postgadolinium T1W imaging. 10,11 Liver specific MR contrast media take advantage of affinity of certain compounds to concentrate in hepatocytes or Kupffer cells. Gadobenate dimeglumine (Gd-BOPTA) is an intravenously administered liver specific MRI contrast medium, which has proven selective uptake by hepatocytes and subsequent biliary excretion.…”

“…2,10,13,15 The liver specificity of the contrast medium was amplified in 5 (10%) patients in the delayed imaging subset, in whom the findings of retained lesional contrast contributed to the definitive diagnosis of HCC, regenerating nodule and chronic abscess (Fig. 4).…”

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI

“…The majority of benign, malignant, and inflammatory diseases of the spleen, adrenals, kidneys, pancreas, and organs of the male and female pelvis are well depicted by MRI, and in the hands of experienced practitioners are better elucidated than they would be on CT (72)(73)(74)(75)(76). The superiority of MRI over CT for detecting and characterizing focal liver lesions and liver disease is well established (77)(78)(79)(80). In patients with malignancy, MRI demonstrates an advantage over CT in detecting extrahepatic abdominal disease in many sites (81).…”

“…A logical first step to a transition in imaging ordering patterns would be to utilize MRI as the primary imaging tool to investigate diseases of the liver. The rationale for this is fourfold: 1) the intrinsic safety of the modality, contrast agents, and intravenous injection process; 2) the established greater accuracy of MRI over CT for liver investigations (78) (Fig. 1); 3) the ease of performing MRI; and 4) the ease of interpreting MRI studies, even without extensive MR training.…”

Multivariable Analysis of Clinical Influence Factors on Liver Enhancement of Gd-EOB-DTPA-Enhanced 3T MRI

“…HRE: high relative enhancement, MRE: medium relative enhancement, LRE: low relative enhancement. Studies have already shown that MRI examination is superior to other examinations as a result of the soft tissue contrast enhancement [16,17]. The method of choice in the diagnosis and classification of liver lesions is currently dynamic contrast-enhanced MRI [18 -20].…”