Vogl T J, Hammerstingl R, Keck H, Felix R
Strahlenklinik and Poliklinik, Humboldt Universität Berlin, Klinikum Rudolf Virchow.
Radiologe. 1995 Nov;35(11 Suppl 2):S258-66.
In a phase III/III-B trial the specific contrast enhancement of benign liver tumors, especially FNH and adenoma, versus malignant liver tumors such as HCC and metastases (colorectal and endocrine tumors) was evaluated using the superparamagnetic iron oxide ENDOREM.
57 patients were prospectively investigated using T2-(TR/TE=2000/90) and T1-(550/15) weighted spinecho (SE), FLASH-2D-gradientecho (GE), and fat suppressed (FATSAT) sequences before and after administration of ENDOREM (concentration: 0.2 mmol Fe/ml, dose: 15 micromol/kg (b.w.) in transverse slice orientation on a 1.5 Tesla MAGNETOM (Siemens, 63 SP). In 8 patients an in vivo-in vitro correlation 30 minutes after resection was performed. In 12 patients benign primary liver tumors (FNH (n = 10), adenoma (n = 1), and hemangioma (n = 1) were histopathologically proved. Malignant liver tumors (HCC (n = 11, cholangiocarcinoma (n = 1), metastases from colorectal carcinoma (n = 13), and endocrine tumors (n = 4)) were found in 29 patients. 11 patients with liver cirrhosis due to Wilson's disease and 5 with cirrhosis due to other reasons were investigated.
Contrast-enhanced studies allowed detection of more lesions in 19 of 41 patients with liver tumors. Benign liver tumors showed significant loss of signal intensity of 43.0% +/- 17.9 for FNH, 32.4% for adenoma and 10.2% for hemangioma in proton density-weighted SE images. Malignant tumors showed only minimal signal loss: HCC: 5.3% +/- 17, cholangiocarcinoma: -1.6%, colorectal: -2.0% +/- 11.1, endocrine metastases: 4.2% +/-4.1. Normal liver parenchyma and spleen tissue demonstrated significant signal loss of 59.2% +/- 14.9 and 42.3 +/- 012.5. In ten patients and 13 lesions of FNH, a capsule was seen in 7.7% plain and 23.1% enhanced. Scar tissue was found in 30.8% plain, 84.6% enhanced. In the patient with adenoma, capsule with contrast enhancement was seen, but no scar was detected, whereas in patients with HCC a capsule was seen in three cases enhanced. Statistical analysis (Friedman-test, Wilcoxon-test) showed a statistically significant difference in signal loss between benign and malignant liver lesions (p < 0.05).
The use of superparamagnetic iron oxide ENDOREM) allows differentiation of benign and malignant liver tumors on the basis of contrast enhancement, existence and specific enhancement of capsule or scar. In vitro correlation show some limitations of in vivo MRI.
在一项III期/III - B期试验中，使用超顺磁性氧化铁恩多雷姆（ENDOREM）评估良性肝肿瘤，尤其是局灶性结节性增生（FNH）和腺瘤，与恶性肝肿瘤如肝细胞癌（HCC）和转移瘤（结直肠癌和内分泌肿瘤转移）的特异性对比增强情况。
对57例患者进行前瞻性研究，在注射ENDOREM（浓度：0.2 mmol Fe/ml，剂量：15 μmol/kg（体重））前后，使用T2加权（TR/TE = 2000/90）和T1加权（550/15）自旋回波（SE）、快速低角度激发二维梯度回波（FLASH - 2D - GE）以及脂肪抑制（FATSAT）序列，在1.5特斯拉的MAGNETOM（西门子，63 SP）上进行横断面扫描。8例患者在切除肿瘤30分钟后进行了体内 - 体外相关性研究。12例患者的良性原发性肝肿瘤（FNH（n = 1）、腺瘤（n = 1）和血管瘤（n = 1））经组织病理学证实。29例患者发现有恶性肝肿瘤（HCC（n = 11）、胆管癌（n = 1）、结直肠癌转移（n = 13）和内分泌肿瘤转移（n = 4））。对11例因威尔逊病导致肝硬化的患者和5例因其他原因导致肝硬化的患者进行了研究。
对比增强研究使41例肝肿瘤患者中的19例检测到更多病变。在质子密度加权SE图像中，良性肝肿瘤显示出明显的信号强度降低：FNH为43.0%±17.9%，腺瘤为32.4%，血管瘤为10.2%。恶性肿瘤仅显示出最小程度的信号降低：HCC为5.3%±17%，胆管癌为 - 1.6%，结直肠癌转移为 - 2.0%±11.1%，内分泌肿瘤转移为4.2%±4.1%。正常肝实质和脾组织显示出明显的信号降低，分别为59.2%±14.9%和42.3±012.5%。在10例患者和13个FNH病变中，平扫时7.7%可见包膜，增强扫描时23.1%可见包膜。平扫时30.8%可见瘢痕组织，增强扫描时84.6%可见瘢痕组织。在腺瘤患者中，可见包膜增强，但未检测到瘢痕，而在HCC患者中，3例增强扫描时可见包膜。统计分析（弗里德曼检验、威尔科克森检验）显示良性和恶性肝病变之间的信号降低存在统计学显著差异（p < 0.05）。
使用超顺磁性氧化铁恩多雷姆可根据对比增强、包膜或瘢痕的存在及特异性增强来区分良性和恶性肝肿瘤。体外相关性研究显示了体内磁共振成像（MRI）的一些局限性。
