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Published on: April 18, 2015
Detection of Mesenteric Tumor Using Dynamic Contrast Enhanced MRI
Russell N Low1, Robert M Barone2, Bridgette Duggan3
1Department of Radiology, Sharp Memorial Hospital, San Diego, CA, USA. rlow52@yahoo.com.
Purpose:
This study was designed to evaluate the use of a novel imaging technique, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), for detecting mesenteric peritoneal metastases.
Methods:
Thirty-four patients underwent preoperative conventional MRI, including T1, T2, diffusion-weighted (DWI), and delayed gadolinium MRI, as well as DCE MRI. DCE MRI involved imaging the peritoneal cavity every 9 s for 6 min. DCE images were processed to generate parametric maps of tumor vascularity. Two oncologic surgeons and a radiologist reviewed conventional MRI for all tumor and then later reviewed the conventional MRI plus the DCE parametric maps. Images were reviewed for tumor of the parietal peritoneum, porta hepatis, bowel serosa, upper small bowel mesentery, lower small bowel mesentery, and pelvis. Conventional MRI and DCE + MRI findings were compared to operative and histopathologic reports for tumor detection. PCI scores were calculated for surgery, MRI, and DCE.
Results:
Upper mesenteric tumor was present in 21 patients. DCE images showed a sensitivity of 100%, specificity of 92%, and accuracy of 97% compared with conventional MRI sensitivity of 24%, specificity of 93%, and accuracy of 50% (p = 0.006). Lower mesenteric tumor was present in 22 patients. DCE images showed a sensitivity of 100%, specificity of 92%, and accuracy of 97% compared with conventional MRI sensitivity of 45%, specificity of 92%, and accuracy of 62% (p = 0.008). The mean surgical PCI for all 34 patients was 23.4 compared with MRI 20.0 (p = 0.003) and DCE MRI 24.1 (p = 0.26). The addition of the DCE images improved the accuracy of total PCI by > 10% in 16 (0.46) patients. For PCI regions 9-12, the mean surgical PCI was 6.0 compared with MRI 4.8 (p = 0.08) and DCE 6.6 (p = 0.02). The addition of DCE images improved the accuracy of the regional PCI > 10% in 15 (0.43) patients.
Conclusions:
DCE MRI provides a novel contrast tool that improves detection of mesenteric tumor. Depicting small-volume mesenteric tumor is better on DCE MRI compared with conventional MRI.
Insights
Dynamic contrast-enhanced (DCE) MRI significantly improves the detection of mesenteric peritoneal metastases compared to conventional MRI. This novel technique enhances diagnostic accuracy for identifying tumor spread in the mesentery.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Mesenteric peritoneal metastases pose diagnostic challenges.
- Conventional MRI has limitations in detecting small-volume tumors.
Purpose of the Study:
- To evaluate dynamic contrast-enhanced (DCE) MRI for detecting mesenteric peritoneal metastases.
- To compare the efficacy of DCE MRI against conventional MRI in identifying tumor spread.
Main Methods:
- Thirty-four patients underwent preoperative conventional MRI and DCE MRI.
- DCE MRI involved rapid imaging sequences over 6 minutes.
- Parametric maps of tumor vascularity were generated from DCE images.
- Oncologic surgeons and a radiologist reviewed images, comparing conventional MRI with DCE MRI plus parametric maps.
Main Results:
- DCE MRI demonstrated superior sensitivity (100%) and accuracy (97%) for upper and lower mesenteric tumors compared to conventional MRI.
- The addition of DCE MRI improved the accuracy of the Peritoneal Cancer Index (PCI) by over 10% in 46% of patients.
- DCE MRI significantly improved the accuracy of regional PCI calculations in specific areas.
Conclusions:
- DCE MRI is a valuable novel contrast tool for enhancing the detection of mesenteric tumors.
- This technique offers improved visualization of small-volume mesenteric tumors over conventional MRI.
