PURPOSE: To compare lesion conspicuity and image quality between single-shot spin echo echo planar imaging (SS SE-EPI) before, immediately and 5min after intravenous (IV) injection of superparamagnetic iron oxide (SPIO) for detecting and characterizing focal liver lesions (FLLs). MATERIALS AND METHODS: Twenty-five patients suspected for colorectal liver metastases were prospectively included. Lesion detection and characterization were compared between all SS SE-EPI and T2-weighted turbo spin echo (T2w TSE) sets (two-sided Fisher's exact test). Image quality and lesion conspicuity were compared for SS SE-EPI sets using rank order statistic (RIDIT). Reference standard comprised of surgery, biopsy and/or follow-up. RESULTS: Reference standard demonstrated 18 benign and 43 malignant FLLs. Best lesion detection (p<0.05) was achieved with non-contrast-enhanced SS SE-EPI. Lesion characterization was best using all T2w TSE sequences. Best image quality and lesion conspicuity (p<0.05) was achieved with non-contrast-enhanced SS SE-EPI. CONCLUSION: Non-contrast-enhanced SS SE-EPI was best for lesion detection. SS SE-EPI sequences were not useful for lesion characterization (differentiation between benign and malignant lesions). Unenhanced SS SE-EPI did not allow differentiation especially as many benign FLLs were hyperintense on the highest b-value images. Combining unenhanced and SPIO-enhanced SS SE-EPI performed better but still was not clinically useful due to variable degree of uptake and vascular pooling of SPIO for (especially) benign FLLs. T2w TSE with SPIO-enhancement was needed for characterization.
PURPOSE: To compare lesion conspicuity and image quality between single-shot spin echo echo planar imaging (SS SE-EPI) before, immediately and 5min after intravenous (IV) injection of superparamagnetic iron oxide (SPIO) for detecting and characterizing focal liver lesions (FLLs). MATERIALS AND METHODS: Twenty-five patients suspected for colorectal liver metastases were prospectively included. Lesion detection and characterization were compared between all SS SE-EPI and T2-weighted turbo spin echo (T2w TSE) sets (two-sided Fisher's exact test). Image quality and lesion conspicuity were compared for SS SE-EPI sets using rank order statistic (RIDIT). Reference standard comprised of surgery, biopsy and/or follow-up. RESULTS: Reference standard demonstrated 18 benign and 43 malignant FLLs. Best lesion detection (p<0.05) was achieved with non-contrast-enhanced SS SE-EPI. Lesion characterization was best using all T2w TSE sequences. Best image quality and lesion conspicuity (p<0.05) was achieved with non-contrast-enhanced SS SE-EPI. CONCLUSION: Non-contrast-enhanced SS SE-EPI was best for lesion detection. SS SE-EPI sequences were not useful for lesion characterization (differentiation between benign and malignant lesions). Unenhanced SS SE-EPI did not allow differentiation especially as many benign FLLs were hyperintense on the highest b-value images. Combining unenhanced and SPIO-enhanced SS SE-EPI performed better but still was not clinically useful due to variable degree of uptake and vascular pooling of SPIO for (especially) benign FLLs. T2w TSE with SPIO-enhancement was needed for characterization.
Authors: Marius E Mayerhoefer; Ahmed Ba-Ssalamah; Michael Weber; Markus Mitterhauser; Harald Eidherr; Wolfgang Wadsak; Markus Raderer; Siegfried Trattnig; Andreas Herneth; Georgios Karanikas Journal: Eur Radiol Date: 2013-03-08 Impact factor: 5.315