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MR Imaging of Hepatic Metastases Caused by Neuroendocrine Tumors: Comparing Four Techniques

Clarisse Dromain1, Thierry de Baere1, Eric Baudin2, Joel Galline1, Michel Ducreux3, Valérie Boige3, Pierre Duvillard4, Agnès Laplanche5, Hubert Caillet1, Philippe Lasser6, Martin Schlumberger2 and Robert Sigal1

1 Department of Imaging, Institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805 Villejuif Cedex, France.
2 Department of Nuclear Medicine, Institut Gustave-Roussy, 94805 Villejuif Cedex, France.
3 Department of Medicine, Institut Gustave-Roussy, 94805 Villejuif Cedex, France.
4 Department of Pathology, Institut Gustave-Roussy, 94805 Villejuif Cedex, France.
5 Department of Statistics, Institut Gustave-Roussy, 94805 Villejuif Cedex, France.
6 Department of Surgery, Institut Gustave-Roussy, 94805 Villejuif Cedex, France.



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  		Fig. 1A. —Transverse MR images of multifocal hepatic metastases from neuroendocrine tumor best depicted on hepatic arterial phase in 63-year-old woman. Fat-suppressed T2-weighted respiratory-triggered fast spin-echo image (TR/TE, 6315/100) shows few metastases (arrows).

 


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  		Fig. 1B. —Transverse MR images of multifocal hepatic metastases from neuroendocrine tumor best depicted on hepatic arterial phase in 63-year-old woman. Arterial phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo image (150/4.2) shows metastases depicted on A (arrows) and numerous additional metastases (arrowheads) as multifocal nodular enhancement corresponding to hypervascular metastases.

 


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  		Fig. 1C. —Transverse MR images of multifocal hepatic metastases from neuroendocrine tumor best depicted on hepatic arterial phase in 63-year-old woman. Venous phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo image (150/4.2) does not show any metastases.

 


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  		Fig. 2A. —Characteristic pattern of hypervascular hepatic metastases from neuroendocrine tumor in 54-year-old woman. Transverse fat-suppressed T2-weighted respiratory-triggered fast spin-echo MR image (TR/TE, 7500/100) shows multiple hyperintense metastases with high lesion-to-liver contrast.

 


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  		Fig. 2B. —Characteristic pattern of hypervascular hepatic metastases from neuroendocrine tumor in 54-year-old woman. Transverse unenhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (150/4.2) shows multiple hypointense metastases.

 


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  		Fig. 2C. —Characteristic pattern of hypervascular hepatic metastases from neuroendocrine tumor in 54-year-old woman. Transverse arterial phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (150/4.2) shows early and marked enhancement of metastases.

 


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  		Fig. 2D. —Characteristic pattern of hypervascular hepatic metastases from neuroendocrine tumor in 54-year-old woman. Transverse venous phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (150/4.2) shows decreased enhancement of metastases (washout) and decrease in lesion-to-liver contrast and in number of metastases.

 


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  		Fig. 3A. —Hypovascular metastases from neuroendocrine tumor in 58-year-old man. Transverse breath-hold T2-weighted single-shot fast spin-echo MR image (TR/TE, 48569/92.3) shows no obvious hepatic metastases.

 


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  		Fig. 3B. —Hypovascular metastases from neuroendocrine tumor in 58-year-old man. Transverse arterial phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (150/4.2) shows numerous hypointense metastases (arrows) with no early enhancement.

 


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  		Fig. 3C. —Hypovascular metastases from neuroendocrine tumor in 58-year-old man. Transverse venous phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (150/4.2) shows increase in lesion-to-liver contrast resulting from no enhancement of hepatic metastases.

 


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  		Fig. 4A. —Large hepatic metastasis from neuroendocrine tumor mimicking atypical hemangioma in 68-year-old man. Transverse fat-suppressed T2-weighted respiratory-triggered fast spin-echo MR image (TR/TE, 5454/100) shows extremely hyperintense lesion (arrow) with signal intensity close to that of liquid and similar to expected signal intensity of hemangioma. However, lesion is heterogeneous, with central foci exhibiting moderately high signal intensity.

 


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  		Fig. 4B. —Large hepatic metastasis from neuroendocrine tumor mimicking atypical hemangioma in 68-year-old man. On transverse breath-hold T2-weighted single-shot fast spin-echo MR image (48569/92.3), lesion (arrow) had lower signal intensity than on fast spin-echo T2-weighted image, thus making it different from signal intensity of water.

 


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  		Fig. 4C. —Large hepatic metastasis from neuroendocrine tumor mimicking atypical hemangioma in 68-year-old man. Transverse arterial phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (160/4.2) shows peripheral rim of enhancement (arrow) similar to that of hemangioma but without globular pattern characteristic of benign hemangioma.

 


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  		Fig. 4D. —Large hepatic metastasis from neuroendocrine tumor mimicking atypical hemangioma in 68-year-old man. Transverse venous phase contrast-enhanced breath-hold T1-weighted fast multiplanar spoiled gradient-recalled echo MR image (160/4.2) shows progressive centripetal fill-in enhancement (arrow) similar to that found in hemangioma.

 

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