Preoperative detection of malignant hepatic tumors: Comparison of combinedmethods of MR imaging with combined methods of CT

OBJECTIVE, We compared radiologists' performance on combined unenhanced, ga dolinium-enhanced, and ferumoxides-enhanced MR imaging with their performan ce on helical CT during arterial portography (CTAP) and biphasic CT during hepatic arteriography (CTHA) for the preoperative detection of malignant he patic rumors. SUBJECTS AND METHODS. MR images and CT scans obtained in 33 patients were r etrospectively analyzed. Images of the liver were reviewed on a segment-by- segment basis; a total of 261 segments with 39 hepatocellular carcinomas an d 21 metastases were independently reviewed by three radiologists who were invited from outside institutions. Unenhanced and gadolinium-enhanced MR im ages were reviewed first, then ferumoxides-enhanced MR images were added fo r combined review. CTAP images and biphasic CTHA images were reviewed toget her. RESULTS. Sensitivity for the detection of hepatic tumors was analogous for combined unenhanced gadolinium-enhanced, and ferumoxides-enhanced MR images (86%) and for combined CTAP images and biphasic CTHA images (87%). Specifi city was higher with MR images (95%, p < 0.01) than with CT images (91%). R adiologists' performances were improved (A(z) = 0.962, p = 0.0502) by combi ning ferumoxides-enhanced MR images with unenhanced and gadolinium-enhanced MR images (A(z) = 0.950), and were analogous for combined unenhanced, gado linium-enhanced, and ferumoxides-enhanced MR images and for combined CTAP i mages and biphasic CTHA images (A(z) = 0.959). CONCLUSION. Radiologists' performances on combined unenhanced, gadolinium-e nhanced, and ferumoxides-enhanced MR imaging compared with their performanc es on combined helical CTAP and biphasic CTHA are analogous for the preoper ative detection of malignant hepatic tumors. Such a dedicated combination o f MR imaging may obviate the need for more invasive angiographically assist ed helical CT for the preoperative detection of malignant hepatic tumors.