Saito Kazuhiro, Ledsam Joseph, Sourbron Steven, Araki Yoichi
Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
Division of Biomedical Imaging, Leeds University, Leeds, UK.
Quant Imaging Med Surg. 2020 Jun;10(6):1298-1306. doi: 10.21037/qims-18-233.
Dynamic susceptibility contrast MR imaging (DSC-MRI) offers direct evaluation of neo-vascularity. Ferucarbotran does not accumulate in the interstitial space, instead remaining in the intravascular space during early phase imaging. We investigate tracer kinetic analysis with DSC-MRI with ferucarbotran and single level CT during hepatic arteriography (SL-CTHA) in assessment of hypervascular hepatocellular lesions and evaluate the usefulness of DSC-MRI with ferucarbotran.
Six patients having hypervascular hepatocellular carcinoma (HCC) and 3 patients having focal nodular hyperplasia (FNH) were included in the study. SL-CTHA was performed with the infusion of 3 mL of contrast media at a rate of 1 mL/s and scanned at a rate of 0.8 second per rotation. DSC-MRI was acquired with the echo-planar method at 1.5T system. A total dose of 1.4 mL (0.5 mol Fe/L) of ferucarbotran was used. Ferucarbotran was injected at a rate of 2 mL/s with 40 mL of physiological saline. Imaging was obtained at a temporal resolution of 1.2 or 0.46 seconds in 5 and 4 patients, respectively. For both CT and MRI modalities, a model-free analysis method was used to derive region of interest-based perfusion parameters. Plasma flow, distribution volume (DV) of contrast agent and estimated mean transit time (EMTT) were estimated.
A strong correlation was obtained with plasma flow (r=0.8231, P=0.0064) between DSC-MRI and SL-CTHA. No significant correlation was obtained for DV and EMTT between DSC-MRI and SL-CTHA. All perfusion parameters showed no significant difference between SL-CTHA and DSC-MRI in FNH. On the other hand, in HCC, DV and EMTT showed significant differences (P=0.046 and 0.046), and plasma flow showed no significant difference between DSC-MRI and SL-CTHA.
This pilot study demonstrates the possibility of quantitative analysis of liver tumor using superparamagnetic iron oxide (SPIO)-based agent and highlights the potential for SPIO-based agent in more precisely assessing the perfusion characteristic of hypervascular liver tumors than by using extracellular contrast media.
动态磁敏感对比磁共振成像（DSC-MRI）可直接评估新生血管情况。 ferucarbotran不会在间质间隙中蓄积，而是在早期成像过程中保留在血管内间隙。我们研究了在肝动脉造影期间使用ferucarbotran的DSC-MRI和单层CT（SL-CTHA）的示踪剂动力学分析，以评估高血供肝细胞病变，并评估使用ferucarbotran的DSC-MRI的实用性。
本研究纳入了6例患有高血供肝细胞癌（HCC）的患者和3例患有局灶性结节性增生（FNH）的患者。SL-CTHA通过以1 mL/s的速率注入3 mL造影剂并以每旋转0.8秒的速率进行扫描。DSC-MRI在1.5T系统上采用回波平面法采集。共使用1.4 mL（0.5 mol Fe/L）的ferucarbotran。ferucarbotran以2 mL/s的速率与40 mL生理盐水一起注射。分别在5例和4例患者中以1.2秒或0.46秒的时间分辨率获得图像。对于CT和MRI两种模式，均使用无模型分析方法得出基于感兴趣区域的灌注参数。估计血浆流量、造影剂分布容积（DV）和估计平均通过时间（EMTT）。
DSC-MRI与SL-CTHA之间的血浆流量具有很强的相关性（r = 0.8231，P = 0.0064）。DSC-MRI与SL-CTHA之间的DV和EMTT无显著相关性。在FNH中，所有灌注参数在SL-CTHA和DSC-MRI之间均无显著差异。另一方面，在HCC中，DV和EMTT存在显著差异（P = 0.046和0.046），DSC-MRI与SL-CTHA之间的血浆流量无显著差异。
这项初步研究证明了使用基于超顺磁性氧化铁（SPIO）的造影剂对肝脏肿瘤进行定量分析的可能性，并突出了基于SPIO的造影剂在比使用细胞外造影剂更精确地评估高血供肝脏肿瘤灌注特征方面的潜力。
