Superparamagnetic iron oxide-enhanced magnetic resonance images of hepatocellular carcinoma: Correlation with histological grading

Abstract

Superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging has been used for the detection of hepatic tumors. However, little is known about this technique in relation to hepatocellular carcinoma (HCC).The aim of this study was to investigate whether SPIOenhanced MR imaging can be useful in assessing histological grades of HCC. The authors studied histologically proven tumors including 31 HCCs and 6 dysplastic nodules. The ratio of the Kupffer-cell count in the tumorous tissue relative to that in the nontumorous tissue (Kupffer-cell-count ratio) decreased as HCCs became less well differentiated. The ratio of the intensity of the tumorous lesion to that of the nontumorous area on SPIO-enhanced MR images (SPIO intensity ratio) correlated inversely with Kupffer-cell-count ratio in HCCs and dysplastic nodules (r ‫؍‬ ؊.826, P < .001) and increased as the degree of differentiation of HCCs decreased, indicating that the uptake of SPIO in HCCs decreased as the degree of differentiation of HCCs declined. All of the dysplastic nodules and some well-differentiated HCCs showed hypointense or isointense enhancement, relative to the surrounding liver parenchyma, indicating greater or similar uptake of SPIO in the tumor when compared with nontumorous areas. These results suggest that SPIO-enhanced MR imaging reflects Kupffer-cell numbers in HCCs and dysplastic nodules, and is useful for estimation of histological grading in HCCs, although uncertainties persist in differentiating dysplastic nodules from well-differentiated HCCs. (HEPATOLOGY 2000;32:205-212.) Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and a major cause of death in patients with cirrhosis. [1][2][3][4] One of the characteristics of HCC detected by imaging modalities such as computed tomography (CT), magnetic resonance (MR) imaging, and CT angiography, is increased arterial blood flow accompanied by decreased portal blood flow, although some well-differentiated HCCs do not show such blood supply characteristics. [5][6][7][8][9] Another characteristic of HCC, distinct from other metastatic tumors, has recently been clarified by Tanaka et al., 10 namely, that some well-differentiated HCCs have similar numbers of Kupffer cells as do the surrounding nontumorous regions of the liver.Superparamagnetic iron oxide (SPIO) is a tissue-specific MR imaging contrast that is taken up by Kupffer cells in the liver and macrophages in the spleen. 11,12 Because metastatic liver cancers lack Kupffer cells, hepatic metastases do not take up SPIO and thus appear hyperintense relative to the surrounding liver, being useful for the detection of metastatic liver cancers. [11][12][13][14] In an animal model of HCC, Kawamori et al., 15 studied whether SPIO-enhanced MR imaging could allow HCC to be distinguished from hyperplastic nodules. They concluded that SPIO-enhanced MR imaging may be useful in differentiating HCC from hyperplastic nodules, although some HCC nodules were difficult to differentiate from hyperplastic nodules, even after S...

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…More recently, when hypovascular nodules are detected by MDCT and dynamic MRI, the guidelines published by the Japan Society of Hepatology recommend the use of Sonazoid-enhanced US and SPIOenhanced MRI [224]. When uptake by Kupffer cells is reduced in the Kupffer phase of SPIO-enhanced MRI, malignancy should be highly suspected [214,225,226].…”

“…The most sensitive modality capable of objectively depicting the early carcinogenesis process among currently available imaging systems is (1) CTAP, followed by (2) CTHA [239,240], (3) CEUS [241][242][243], and (4) SPIO-enhanced MRI [225,244]. Portal blood flow may be maintained in some cases of DN and early HCC but reduced in other nodules, although the pathology remains because of early HCC, in which arterial blood flow has not yet increased.…”

“…Addition of the postvascular phase (Kupffer phase) allows an assumption of the degree of malignancy based on Kupffer function [189,225,244].…”

Superparamagnetic Iron Oxide Nanoparticles in Biomedicine: Applications and Developments in Diagnostics and Therapy

“…Consequently, the lesion-to-liver contrast increases. This increases the sensitivity for detecting tumorous lesions [65] and can also improve the classification of liver tumors and the grading [66] and delimitation of an HCC with respect to benign liver tumors or hyperplastic nodes [67]. The two SSPIO available in clinical use were ferumoxide (Endorem ® , Guerbet) [68] and ferucarbotran (Resovist ® , Bayer Healthcare Pharmaceuticals) [69].…”

Hepatic Infarction Complicated with Acute Pancreatitis Precisely Diagnosed with Gadoxetate Disodium-enhanced Magnetic Resonance Imaging

“…In addition, the newly introduced gadoxetate disodium is a biphasic hepatobiliary MR contrast agent that permits the visualization of both extracellular fluid and hepatocyte function. Thus, hemodynamic characteristics can be evaluated by dynamic contrastenhanced MR imaging, while hepatocellular function is assessed by hepatobiliary phase imaging using the balance between hepatocelluar uptake of gadoxetate disodium and its excretion through the renal and biliary systems (14,15). We herein present a case of right hepatic infarction complicated with acute pancreatitis displaying simultaneous portal and hepatic vein thromboses.…”