Lencioni R, Donati F, Cioni D, Paolicchi A, Cicorelli A, Bartolozzi C
Department of Oncology, University of Pisa, Italy.
MAGMA. 1998 Dec;7(2):76-87. doi: 10.1007/BF02592232.
The purpose of this study was to compare the efficacy of unenhanced and ferumoxides-enhanced magnetic resonance imaging with that of dual-phase spiral CT and spiral CT during arterial portography (CTAP) for the detection of colorectal liver metastases. Fourteen patients with liver metastases candidates for partial hepatectomy were examined with dual-phase spiral CT, unenhanced and ferumoxides-enhanced MR imaging at 1.5 T, and spiral CTAP. Imaging tests were read blinded, prospectively, quantitating number of lesions excepting CTAP which used US to exclude cysts. Subsequent intraoperative US and pathologic findings were correlated with preoperative imaging results. At surgery, 36 lesions 0.5-13 cm in diameter (mean+/-standard deviation, 2.9+/-2.1 cm) were identified. Dual-phase spiral CT depicted 21/36 (58%); precontrast MR imaging, 19/36 (53%); ferumoxides-enhanced MR imaging, 30/36 (83%); and spiral CTAP, 34/36 (94%) lesions. Ferumoxides-enhanced MR imaging was significantly more sensitive than spiral CT and unenhanced MR imaging (P < 0.01). The difference in sensitivity between ferumoxides-enhanced MR imaging and spiral CTAP was not statistically significant (P> 0.1). Spiral CTAP, however, depicted nine false-positive lesions (2 hemangiomas, 7 perfusion defects). The positive predictive value was 79% for spiral CTAP and 100% for combined pre- and postcontrast MR imaging. We conclude that ferumoxides-enhanced MR imaging is superior to unenhanced MR imaging and biphasic spiral CT for depiction of colorectal liver metastases. Further investigation is needed to clarify whether MR imaging with use of ferumoxides might replace spiral CTAP for preoperative evaluation of liver resection candidates.
本研究的目的是比较非增强和超顺磁性氧化铁增强磁共振成像与双期螺旋CT及动脉门静脉造影CT（CTAP）对结直肠癌肝转移灶的检测效能。对14例拟行肝部分切除术的肝转移患者进行了双期螺旋CT、1.5T场强下的非增强及超顺磁性氧化铁增强磁共振成像以及螺旋CTAP检查。影像检查由不知情的人员进行前瞻性阅片，除CTAP采用超声排除囊肿外，其他检查均对病灶数量进行定量分析。随后将术中超声及病理结果与术前影像结果进行对比。手术中发现了36个直径为0.5 - 13cm（平均±标准差，2.9±2.1cm）的病灶。双期螺旋CT显示了21/36（58%）个病灶；平扫磁共振成像显示了19/36（53%）个病灶；超顺磁性氧化铁增强磁共振成像显示了30/36（83%）个病灶；螺旋CTAP显示了34/36（94%）个病灶。超顺磁性氧化铁增强磁共振成像的敏感性显著高于螺旋CT及非增强磁共振成像（P < 0.01）。超顺磁性氧化铁增强磁共振成像与螺旋CTAP之间敏感性的差异无统计学意义（P > 0.1）。然而，螺旋CTAP显示了9个假阳性病灶（2个血管瘤，7个灌注缺损）。螺旋CTAP的阳性预测值为79%，而增强前后磁共振成像联合检查的阳性预测值为100%。我们得出结论，超顺磁性氧化铁增强磁共振成像在显示结直肠癌肝转移灶方面优于非增强磁共振成像及双期螺旋CT。需要进一步研究以明确使用超顺磁性氧化铁的磁共振成像是否可替代螺旋CTAP用于肝切除候选者的术前评估。
