Superparamagnetic iron oxide (SPIO)-enhanced liver MR imaging with ferucarbotran [Elektronische Ressource] : efficacy for characterization of focal liver lesions with T2-weighted FSE and T2*-weighted GRE and early dynamic T1-weighted GRE sequences / vorgelegt von Sook Namkung

Sook Namkung

Description

Aus de m Ins titut für K linische Ra diologiederL udwig-M aximillians-Universität M ünchenDirektor : Prof. D r. m ed. Dr. h.c. M. ReiserSuperparamagnetic Iron O xide (SPIO)-enhanced Li ver M R Imaging w ith Ferucarbotran: Effi cacy for Characterization of F ocal Li ver Le sions with T2-*weighted FSE an d T2 -w eighted G RE an d Ear ly Dynamic T1-w eighted G RE sequences Dissertation zum Erwerb de s Doktorgrades de r M edizinan de r M edizinischen F akultät de rL udwig-M aximillians-Universität zu M ünchenvorgelegt vonSook N amkungausChunc heon, S üd-K orea2006M it Genehmigung de r M edizinischen F akultätder Universität M ünchenBe richterstatter : PD Dr. m ed. S. SchönbergM itberichterstatter : Priv. D oz. Dr. R. TillingProf. D r. A. G erbesM itbetreuung durc h de nPromovierten M itarbeiter : Dr. m ed. C. ZechDekan : Prof. D r. m ed. D. ReinhardtTag de r m ündlichen P rüfung : 19.10.2006Index of ContentsInde x of Abbreviations……………………………………………………..……...…….41. INTRODUCTION…………………………………………………………..…...…..71.1Cl assification of S PIO Agents………………………………………………..…...…91.1.1 S SPIO Agents for L iver M R Im aging…………………………………….......1 11.2Re view of Gadolinium Che lates-e nhanced L iver M R Im aging………………...….121.2.1 E xtracellular Cont rast Agents……………………………………………...….131.2.2 Cha racteristic Findings of F ocal Liver L esions in U nenhanced- a nd G adolinium Che lates-e nhanced M R Im aging…………...141.2.2.

Sujets

• Gesundheit

Informations

• Publié par: ludwig-maximilians-universitat_munchen
• Publié le: 01 janvier 2006
• Nombre de lectures: 19
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Aus dem Institut für Klinische Radiologie
rdeLudwig-Maximillians-Universität München
Direktor : Prof. Dr. med. Dr. h.c. M. Reiser

Superparamagnetic Iron Oxide (SPIO)-enhanced Liver MR Imaging with
Ferucarbotran: Efficacy for Characterization of Focal Liver Lesions with T2-
weighted FSE and T2*-weighted GRE and Early Dynamic T1-weighted GRE
sequences

Dissertation

zum Erwerb des Doktorgrades der Medizin

an der Medizinischen Fakultät der

Ludwig-Maximillians-Universität zu München

vorgelegt von

kungmaook NSusaChuncheon, Süd-Korea
2006

Berichterstatter :

Mitberichterstatter :

Mit Genehmigung der Medizinischen Fakultät
der Universität München

Mitbetreuung durch den

Promovierten Mitarbeiter :

kaeDn :

Tag der mündlichen Prüfung :

PD Dr. med. S. Schönberg

Priv. Doz. Dr. R. Tilling

Prof. Dr. A. Gerbes

Dr. med. C. Zech

Prof. Dr. med. D. Reinhardt

19.10.2006

Index of Contents

Index of Abbreviations……………………………………………………..……...…….4

1. INTRODUCTION…………………………………………………………..…...…..7

1.1Classification of SPIO Agents………………………………………………..…...…9
1.1.1 SSPIO Agents for Liver MR Imaging…………………………………….......11
1.2Review of Gadolinium Chelates-enhanced Liver MR Imaging………………...….12
1.2.1 Extracellular Contrast Agents……………………………………………...….13
1.2.2 Characteristic Findings of Focal Liver Lesions
in Unenhanced- and Gadolinium Chelates-enhanced MR Imaging…………...14
1.2.2.1 Benign Liver Tumors………………………………………………......14
1.2.2.2 Malignant Liver Tumors………………………………………….…....16

2. PATIENTS, MATERIALS AND METHODS………………..…………..……....20

2.1 Patients………………………… ……………………………………..……......…20
2.1.1 Study I (T2-weighted FSE and T2*-weighted GRE sequences)…………........21
2.1.2 Study II (T1-weighted early dynamic GRE sequences)……………….…...…21
2.2 Contrast Agent……………………… …………………………………….............24
2.3 MR Imaging Method…………………………………………………………….....24
2.3.1 Study I (T2-weighted FSE and T2*-weighted GRE sequences)…………....…25
2.3.2 Study II (T1-weighted early dynamic GRE sequences)………………....……25
2.4 Quantitative Image Analysis……………………………………………….….........26
2.4.1 Study I (T2-weighted FSE and T2*-weighted GRE sequences)……….….......26
2.4.2 Study II (T1-weighted early dynamic GRE sequences)………………....……26
2.5 Qualitative Analysis……………………………………………………….…......…29
2.5.1 Study I (T2-weighted FSE and T2*-weighted GRE sequences)…………....…29
2.5.2 Study II (T1-weighted early dynamic GRE sequences)…………………....…30

3. RESULTS………………….……………………………………..……………....…31

3.1 Study I (T2-weighted FSE and T2*-weighted GRE sequences)………………..…..31
3.1.1 Quantitative Analysis..……………………………………………….……......31

3.1.2 Qualitative Analysis……………………………………………………….......35
3.2 Study II (T1-weighted early dynamic GRE sequences)………………………...….40
3.2.1 Quantitative Analysis…………………………………………………….....…41
3.2.1.1 T1-weighted 2D-GRE Dynamic MR Image…………………….…......41
3.2.1.2 T1-weighted 3D-GRE Dynamic MR Image………………………...…43
3.2.2 Visual Evaluation……………………………………………………..…..…..46
3.2.2.1 T1-weighted 2D-GRE Dynamic MR Image…………………….….…47
3.2.2.2 T1-weighted 3D-GRE Dynamic MR Image…………………….….…47

4. FIGURES……..………………………………………………………………....….49

4.1 Overview………………………………………………………………………...…49
Figure 1: Artifacts due to motion in a case of hepatocellular carcinoma .………...51
Figure 2: Ghosting artifacts in a case of hemangioma ………………..……..…....52
Figure 3: Hepatic adenoma in a patient with cardiomyopathy ..…………..……...53
Figure 4: Focal nodular hyperplasia .…………………………………………..….54
Figure 5: Hepatocellular carcinoma
with mosaic pattern and peripheral capsule………………………….……55
Figure 6: Metastasis from a colorectal carcinoma
with hyperintense rim outside the tumor …………………….…….….….56
Figure 7: Hepatocellular carcinoma
on dynamic T1-weighted 2D-GRE images..……………………….….…57
Figure 8: Metastasis on dynamic T1-weighted 2D-GRE images .……..…….…....58
Figure 9: Adenoma on dynamic T1-weighted 3D-GRE images………………..…59
Figure 10: Focal Nodular hyperplasia
on dynamic T1-weighted 3D-GRE VIBE images……………………...…60
Figure 11: Hemangioma
on dynamic T1-weighted 3D-GRE VIBE images…………………….......61
Figure 12: Hepatocellular carcinoma
on dynamic T1-weighted 3D-GRE VIBE images……………………...…62

5. DISCUSSION…………………..……….……….………………………………….63

5.1 Ferucarbotran-enhanced T2-/T2*- weighted Imaging Sequences………………….63
5.1.1 Characterization of Focal Liver Lesions……………………………………...64
5.1.2 Comparison of the Diagnostic Efficacy between T2-weighted FSE

and T2*-w GRE Sequences in Ferucarbotran-enhanced Liver MRI……...……68

5.2 Ferucarbotran-enhanced T1-weighted Dynamic MR Imaging………………...…...70

5.2.1 Evaluation of Enhancement Pattern in Liver and Vascular Structures……......71

5.2.2 Evaluation of Enhancement Pattern in Focal Liver Lesions………………….72

5.2.3 Advantages of 3D-GRE VIBE sequences over 2D-GRE

in ferucarbotran-enhanced dynamic T1-w liver MR Imging…………… …...75

5.3 Study limitations…………………………………………………………………....76

on………………………………………………………………………….76iusl5.4 Conc

6. SUMMARY……….…………………….…………………………………….....….78

Zusammenfassung……………………………….………………………………..…..82

References……………………………………………………………………….…..…86

List of Publications……………………………………………………………….…....93

Index of Tables…………………………………………………………………………94

Index of Graphs………………………………………………………………….…..…95

Index of Figures…………………………………………………………………..……96

Acknowledgement…………………………………………………………………..…98

Curriculum Vitae…………………………………………………………………….....99

Index of Abbreviations
CCCCholangioCellular Carcinoma
CEContrast-Enhanced
CNRContrast-to-Noise Ratio
CTComputed Tomography
CTAPComputed Tomography during Arterial Portography
FNHFocal Nodular Hyperplasia
FSEFast-Spin Echo
GIGastroIntestinal
GREGRadient Echo
HCCHepatoCellular Carcinoma
i.e.id est (that is)
IVCInferior Vena Cava
MIONMonocrystalline Iron Oxide Nanoparticle
MRMagnetic Resonance
MRAMagnetic Resonance Angiography
MRIMagnetic Resonance Imaging
Nnot identified
NAnot applicable
NCENon-Contrast-Enhanced
NSnot significant
n.s.not significant
1.5-T1.5-Tesla
PACSPicture Archiving and Communicating System
p.o.lr orapePSILPercentage of Signal Intensity Loss
RESReticuloEndothelial System
ROIRegion-Of-Interest
SESpin Echo
SISignal Intensity
SNRSignal-to-Noise Ratio
SPIOSuperParamagnetic Iron Oxide
SSPIOStandard SuperParamagnetic Iron Oxide
3D-GRE VIBE3-Dimentional Volumetric Interpolated Breath-hold
2D-GREExamination

T1-w /T2-w/T2*

CEAT

TACE

TE

RT

IOPSU

-w

2-Dimentional Gradient Echo

T1-weighted/T2-weighted/T2*-weighted

Transcatheter Arterial ChemoEmbolization

Echo Time

Repetition Time

Ultrasmall SuperParamagnetic Iron Oxide

1. INTRODUCTION

An early and accurate diagnosis and differentiation from potentially benign focal liver

lesions is important for the appropriate and successful treatment of patients with

malignant liver tumors, because it influences the decisions on the therapeutic options

such as surgical resection, liver transplantation, transcatheter arterial

chemoembolization (TACE), percutaneous ethanol or radiofrequency ablation (8,52,57).

In selected patients with hepatocellular carcinoma (HCC) or liver metastases, improved

survival can be achieved with surgical resection, and preoperative evaluation of the

number, size, and segmental location of lesions is very important (22,45). Computed

tomography during arterial portography (CTAP) is considered the most sensitive

preoperative imaging modality for the detection of liver lesions, with reported

sensitivities of 81%-93% (21,26,29,50). However, it has potential disadvantages such as

invasiveness of the procedure and the high rate of false-positive findings due to the

difficulties to differentiate benign liver lesions (such as adenoma, hemangioma or focal

nodular hyperplasia), non-tumorous portal vein perfusion defects and small cysts from

malignant lesions (7,38).

Magnetic resonance imaging (MRI) after bolus injection of extracellular paramagnetic

gadolinium chelates is a useful and non-invasive technique for the characterization of

focal liver lesions to study tumor enhancement pattern at dynamic T1-weighted (w)

MRI. However, although characterization of focal liver lesions is possible in

gadolinium-enhanced MRI with sensitivities between 75.3 to 100%, CTAP is considered

to be superior for tumor detection (15,18, 20,37,47,59).

Liver-specific contrast agents, such as superparamagnetic iron oxide (SPIO) particles,

have been developed to increase the potential of MR imaging for the detection and

characterization of focal liver lesions (2,3). SPIO particles are taken up by the reticulo-

endothelial system (RES) cells, so called Kupffer cells, of normal liver parenchyma as
well as by macrophages of the spleen and lymph nodes and shorten T2 and T2*
relaxation time by disturbing the local magnetic field in the liver parenchyma, thereby
resulting in a signal intensity (SI) loss of normal liver parenchyma (16,25,40,54).

Malignant liver tumors do not have a substantial number of RES cells and appear as
hyperinte