Detection of Malignant Hepatic Tumors

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Abstract
OBJECTIVE. The purpose of our study was to compare how well gadolinium-enhanced and ferumoxide-enhanced MR imaging reveal malignant hepatic tumors. SUBJECTS AND METHODS. Both gadolinium-enhanced and ferumoxide-enhanced MR imaging were separately performed in 53 patients with a total of 87 malignant hepatic tumors (57 hepatocellular carcinomas, 28 metastases, two cholangiocarcinomas). Thirty-one of the 53 patients had hepatic cirrhosis. Images were reviewed by three independent off-site observers. Observer performance was evaluated by means of sensitivity, specificity, and receiver operating characteristic curve analyses. RESULTS. Gadolinium-enhanced MR imaging outperformed ferumoxide-enhanced MR imaging in sensitivity (81% versus 62%, p < 0.01) for malignant-tumor detection. Specificity was comparable (94%) between the two types of MR imaging. Area under receiver operating characteristic curve (Az) value was significantly higher with gadolinium-enhanced MR imaging than with ferumoxide-enhanced MR imaging in patients overall (Az = 0.896 versus 0.805, p < 0.001), in patients with cirrhosis (Az = 0.907 versus 0.807, p < 0.001), and in patients without cirrhosis (Az = 0.899 versus 0.834, p < 0.01). The superiority was enhanced in the subset of patients with cirrhosis. CONCLUSION. Gadolinium-enhanced MR imaging outperforms ferumoxide-enhanced MR imaging in revealing malignant hepatic tumors. Gadolinium-enhanced MR imaging is recommended, particularly for patients with cirrhosis.