MnDPDP-enhanced MRI vs dual-phase spiral CT in the detection of hepatocellular carcinoma in cirrhosis

The objectives of this study were twofold: (a) to assess safety and tolerab ility of the hepatobiliary MR contrast agent MnDPDP; and (b) to investigate the sensitivity of MnDPDP-enhanced MRI, in comparison with dual-phase spir al CT, in the detection of hepatocellular carcinoma (HCC) in cirrhosis. pat ients with liver cirrhosis and histologically proven HCC were enrolled in a prospective phase-IIIB clinical trial. All patients underwent evaluation d ual-phase spiral CT and pre-contrast and post-contrast MRI at 1.5 T. The MR examination protocol included spin-echo (SE) and gradient-recalled-echo (G RE) T1-weighted images acquired before and 60-120 min after administration of 0.5 mu mol/kg (0.5 ml/kg) MnDPDP (Teslascan, Nycomed Amersham, Oslo, Nor way); and fast T2-weighted SE images obtained solely before contrast inject ion. Gold standard was provided by findings at Lipiodol CT in combination w ith follow-up spiral CT studies, which ere repeated at 4-month intervals ov er a 10- to 27-month (mean +/- SD 20.1 +/- 5.1 months) follow-up period. No serious adverse event occurred. Eighty tumors ranging 0.8-9.1 cm in diamet er (mean +/- SD 3.2 +/- 2.4 cm) were detected by Lipiodol CT or confirmed a s cancerous foci by follow-up CT studies, Pre-contrast MRI detected 38 of 8 0 lesions (48%); MnDPDP-enhanced MRI, 65 of 80 lesions (81%); pre-contrast plus post-contrast MRI, 69 of 80 lesions (86%); and dual-phase spiral CT, 6 4 of 80 lesions (80%). The difference between unenhanced and MnDPDP-enhance d MRI was statistically significant, (p < 0.001). The difference between MR I (pre-contrast plus post-contrast) and dual-phase spiral CT: not statistic ally significant (p = 0.33). The confidence in the final diagnosis, however , was significantly higher for MRI as compared with spiral CT (p < 0.001). MnDPDP is a safe and well-tolerated hepatobiliary MR contrast agent, Magnet ic resonance imaging with use of MnDPDP is significantly more sensitive tha n unenhanced MRI and as good as dual-phase spiral CT for detection of HCC i n cirrhosis.