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Detection and characterization of focal hepatic lesions: mangafodipir vs. superparamagnetic iron oxide-enhanced
Myeong-Jin Kim1, Joo Hee Kim, Joon Seok Lim
1Department of Diagnostic Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. kimnex@yumc.yonsei.ac.kr
Purpose:
To compare the mangafodipir-enhanced magnetic resonance (MR) and superparamagnetic iron oxide (SPIO)-enhanced images for their ability to detect and characterize focal hepatic lesions.
Materials And Methods:
Unenhanced, mangafodipir-enhanced, and SPIO-enhanced hepatic MR images obtained from 64 patients were analyzed. A total of 121 hepatic lesions were included: 66 hepatocellular carcinomas (HCCs), 26 metastases, 14 hemangiomas, 5 cysts, 3 cholangiocarcinomas, 4 focal nodular hyperplasias (FNHs), 2 abscesses, and 1 adenoma. Two radiologists independently reviewed the two sets of images in a random order: 1) the unenhanced and mangafodipir-enhanced images (the mangafodipir set) and 2) the unenhanced and SPIO-enhanced images (the SPIO set). This study compared the accuracy of lesion detection, the ability to distinguish between a benign and malignant lesion, and the ability to distinguish between the hepatocellular and nonhepatocellular origins of the lesions using the areas (Az) under the receiver operating characteristic (ROC) curve.
Results:
The overall accuracy for detecting focal lesions was significantly higher (P < 0.05) with the SPIO set (Az = 0.846 and 0.871 for readers 1 and 2, respectively) than with the mangafodipir set (Az = 0.716 and 0.766). Most of the lesions detected only with the SPIO-enhanced MR images by the readers were small HCCs. For lesions larger than 15 mm, the sensitivities of the two contrast enhancement techniques were similar for both readers. The accuracy of the mangafodipir and SPIO sets in distinguishing between benign and malignant lesions was comparable. The accuracy for distinguishing between the hepatocellular and nonhepatocellular origins of the lesions was significantly higher (P < 0.05) using the mangafodipir set (Az = 0.897 and 0.946) than using the SPIO set (Az = 0.741 and 0.833).
Conclusion:
SPIO- and mangafodipir-enhanced images were comparable for detection of focal hepatic lesions other than small HCCs, which were better detected on the SPIO-enhanced images. Mangafodipir-enhanced images are likely better than the SPIO-enhanced images for distinguishing between focal liver lesions with a hepatocellular or nonhepatocellular origin.
Insights
Superparamagnetic iron oxide (SPIO)-enhanced MRI better detects small hepatocellular carcinomas (HCCs) than mangafodipir-enhanced MRI. Mangafodipir contrast is superior for differentiating between hepatocellular and non-hepatocellular liver lesions.
Area of Science:
- Radiology
- Medical Imaging
- Hepatology
Background:
- Focal hepatic lesions require accurate detection and characterization for effective management.
- Magnetic resonance imaging (MRI) is a key modality for evaluating liver lesions.
- Contrast agents like mangafodipir and superparamagnetic iron oxide (SPIO) enhance MRI visualization.
Purpose of the Study:
- To compare the diagnostic performance of mangafodipir-enhanced and SPIO-enhanced MRI in detecting and characterizing focal hepatic lesions.
- To evaluate the ability of each contrast agent to distinguish between benign and malignant lesions.
- To assess the utility of each agent in differentiating hepatocellular from non-hepatocellular liver lesions.
Main Methods:
- Retrospective analysis of unenhanced, mangafodipir-enhanced, and SPIO-enhanced hepatic MRI scans from 64 patients.
- Inclusion of 121 focal hepatic lesions, including hepatocellular carcinomas (HCCs), metastases, and hemangiomas.
- Independent review by two radiologists assessing lesion detection, malignancy differentiation, and origin characterization using ROC curve analysis (Az).
Main Results:
- SPIO-enhanced MRI demonstrated significantly higher overall accuracy for focal lesion detection compared to mangafodipir (Az = 0.846-0.871 vs. 0.716-0.766).
- Small HCCs were more frequently detected with SPIO-enhanced MRI; detection of larger lesions (>15 mm) was similar between agents.
- Accuracy in distinguishing benign from malignant lesions was comparable; mangafodipir showed significantly higher accuracy for differentiating hepatocellular from non-hepatocellular origins (Az = 0.897-0.946 vs. 0.741-0.833).
Conclusions:
- SPIO-enhanced MRI offers superior detection of small HCCs compared to mangafodipir-enhanced MRI.
- Mangafodipir-enhanced MRI is more effective for differentiating the hepatocellular origin of focal liver lesions.
- Both contrast agents have complementary roles in the comprehensive evaluation of hepatic lesions.
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