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Small malignant hepatic tumor detection in gadolinium- and ferucarbotran-enhanced magnetic resonance imaging: does combining ferucarbotran-enhanced T2*-weighted gradient echo and T2-weighted turbo spin echo images have additive efficacy?

Kim YK, Lee YH, Kwak HS, Kim CS, Han YM - Korean J Radiol (2008 Nov-Dec)

Bottom Line: The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method.The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]).Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Chonbuk, Korea. jmyr@dreamwiz.com

ABSTRACT

Objective: To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients.

Materials and methods: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method.

Results: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01).

Conclusion: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.

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57-year-old man with surgically confirmed 0.4-cm liver metastasis from rectal cancer.A. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows irregular high signal intensity lesion (arrow) at medial margin of right hepatic lobe, which was missed by one observer and was assigned confidence level of 2 by other observer during image interpretation.B. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) clearly shows small round hyperintense mass (arrow) at same location as in A. This was assigned score of 4 by both observers.
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Figure 3: 57-year-old man with surgically confirmed 0.4-cm liver metastasis from rectal cancer.A. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows irregular high signal intensity lesion (arrow) at medial margin of right hepatic lobe, which was missed by one observer and was assigned confidence level of 2 by other observer during image interpretation.B. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) clearly shows small round hyperintense mass (arrow) at same location as in A. This was assigned score of 4 by both observers.

Mentions: For the detection of liver metastases, the Az values of the combined set and the T2W-TSE set were better than those of the T2*W-GRE set for both observers, although the difference was not statistically significant (p = 0.134 for observer 1; p = 0.162, 0.772 for observer 2). The sensitivity of the combined set was the same as that of the T2W-TSE set (98.0%; 95% CI: 92.8%, 99.7%, for observer 1; 96.9%; 95% CI: 91.3%, 99.3%, for observer 2; mean 97.5%), which was significantly better than that of the T2*W-GRE set for both observers (84.7%; 95% CI: 76.0%, 91.2%, for observer 1; 85.7%; 95% CI: 77.2%, 92.0%, for observer 2; mean 85.2%) (p = 0.0001) (Fig. 3). There were 11 metastases (0.4-0.8 cm) that were not detected by either observer on the T2*W-GRE set, but which were clearly revealed on the T2W-TSE set (Fig. 4). However, there was no lesion detected on the T2*W-GRE set that could not be verified on the T2W-TSE set.


Small malignant hepatic tumor detection in gadolinium- and ferucarbotran-enhanced magnetic resonance imaging: does combining ferucarbotran-enhanced T2*-weighted gradient echo and T2-weighted turbo spin echo images have additive efficacy?

Kim YK, Lee YH, Kwak HS, Kim CS, Han YM - Korean J Radiol (2008 Nov-Dec)

57-year-old man with surgically confirmed 0.4-cm liver metastasis from rectal cancer.A. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows irregular high signal intensity lesion (arrow) at medial margin of right hepatic lobe, which was missed by one observer and was assigned confidence level of 2 by other observer during image interpretation.B. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) clearly shows small round hyperintense mass (arrow) at same location as in A. This was assigned score of 4 by both observers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627240&req=5

Figure 3: 57-year-old man with surgically confirmed 0.4-cm liver metastasis from rectal cancer.A. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows irregular high signal intensity lesion (arrow) at medial margin of right hepatic lobe, which was missed by one observer and was assigned confidence level of 2 by other observer during image interpretation.B. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) clearly shows small round hyperintense mass (arrow) at same location as in A. This was assigned score of 4 by both observers.
Mentions: For the detection of liver metastases, the Az values of the combined set and the T2W-TSE set were better than those of the T2*W-GRE set for both observers, although the difference was not statistically significant (p = 0.134 for observer 1; p = 0.162, 0.772 for observer 2). The sensitivity of the combined set was the same as that of the T2W-TSE set (98.0%; 95% CI: 92.8%, 99.7%, for observer 1; 96.9%; 95% CI: 91.3%, 99.3%, for observer 2; mean 97.5%), which was significantly better than that of the T2*W-GRE set for both observers (84.7%; 95% CI: 76.0%, 91.2%, for observer 1; 85.7%; 95% CI: 77.2%, 92.0%, for observer 2; mean 85.2%) (p = 0.0001) (Fig. 3). There were 11 metastases (0.4-0.8 cm) that were not detected by either observer on the T2*W-GRE set, but which were clearly revealed on the T2W-TSE set (Fig. 4). However, there was no lesion detected on the T2*W-GRE set that could not be verified on the T2W-TSE set.

Bottom Line: The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method.The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]).Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01).

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Chonbuk, Korea. jmyr@dreamwiz.com

ABSTRACT

Objective: To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients.

Materials and methods: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method.

Results: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01).

Conclusion: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.

Show MeSH
Related in: MedlinePlus