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Effectiveness of MR Imaging in Characterizing Small Hepatic Lesions: Routine Versus Expert Interpretation

¹ All authors: Department of Radiology/MRI B2B311, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0030.

View larger version (16K): [in a new window]   Fig. 1. —Graph shows receiver operating characteristic curves comparing performance of initial interpreters of MR imaging with performances of two expert interpreters in characterizing all 69 lesions. No statistically significant difference was found between initial interpreters (; area under curve [Az] = 0.94) and either of the expert interpreters (observer 1, •; Az = 0.88; observer 2, ; Az = 0.84) (p > 0.05).

View larger version (129K): [in a new window]   Fig. 2A. —70-year-old man with history of pancreatic carcinoma. Hepatic pseudolesion was visualized on CT and characterized as benign on MR imaging by initial and expert intepreters. Lesion was not visible on unenhanced T1- and T2-weighted MR images (not shown). Patient underwent pancreaticoduodenectomy and intraoperative sonography, and surgical palpation of liver revealed no lesion in area of abnormality seen on CT. Postoperative CT of liver and clinical follow-up did not reveal hepatic metastasis during following 12 months. Patient developed metastatic disease 18 months after surgery and eventually died of pancreatic cancer. Arterial phase CT scan shows 1-cm area of low attenuation (arrowhead) in right hepatic lobe immediately adjacent to gallbladder fossa.

View larger version (119K): [in a new window]   Fig. 2B. —70-year-old man with history of pancreatic carcinoma. Hepatic pseudolesion was visualized on CT and characterized as benign on MR imaging by initial and expert intepreters. Lesion was not visible on unenhanced T1- and T2-weighted MR images (not shown). Patient underwent pancreaticoduodenectomy and intraoperative sonography, and surgical palpation of liver revealed no lesion in area of abnormality seen on CT. Postoperative CT of liver and clinical follow-up did not reveal hepatic metastasis during following 12 months. Patient developed metastatic disease 18 months after surgery and eventually died of pancreatic cancer. Arterial phase T1-weighted spoiled gradient-echo MR image obtained at same level as A shows area (arrowhead) corresponding to that shown in A is slightly accentuated by adjacent vessels but without evidence of mass.

View larger version (113K): [in a new window]   Fig. 2C. —70-year-old man with history of pancreatic carcinoma. Hepatic pseudolesion was visualized on CT and characterized as benign on MR imaging by initial and expert intepreters. Lesion was not visible on unenhanced T1- and T2-weighted MR images (not shown). Patient underwent pancreaticoduodenectomy and intraoperative sonography, and surgical palpation of liver revealed no lesion in area of abnormality seen on CT. Postoperative CT of liver and clinical follow-up did not reveal hepatic metastasis during following 12 months. Patient developed metastatic disease 18 months after surgery and eventually died of pancreatic cancer. In 2-min delayed phase T1-weighted spoiled gradient-echo MR image, area corresponding to that shown in A is slightly accentuated by adjacent vessels (arrowhead) but without evidence of a mass.

View larger version (114K): [in a new window]   Fig. 3A. —Regenerating nodule in 51-year-old man with cirrhosis and history of hepatitis C. CT scan shows 1-cm enhancing lesion (arrowhead) at dome of liver.

View larger version (133K): [in a new window]   Fig. 3B. —Regenerating nodule in 51-year-old man with cirrhosis and history of hepatitis C. Unenhanced T1-weighted spoiled gradient-echo MR image obtained at same level as A shows discrete hyperintense lesion (arrowhead).

View larger version (123K): [in a new window]   Fig. 3C. —Regenerating nodule in 51-year-old man with cirrhosis and history of hepatitis C. Arterial phase T1-weighted spoiled gradient-echo MR image shows heterogeneous enhancement of lesion (arrowhead).

View larger version (112K): [in a new window]   Fig. 3D. —Regenerating nodule in 51-year-old man with cirrhosis and history of hepatitis C. In 2-min delayed phase T1-weighted spoiled gradient-echo MR image, isointensity of lesion with discrete hyperintense rim (arrowhead) is seen. Lesion was not visible on T2-weighted fast spin-echo MR image (not shown). Patient underwent liver transplantation, and histologic results for explanted liver were negative for neoplasm.

View larger version (182K): [in a new window]   Fig. 4A. —78-year-old woman with hepatic metastasis from rectosigmoid carcinoma. Portal venous phase CT scan shows lesion (arrowhead) as tiny hypodensity close to gallbladder.

View larger version (139K): [in a new window]   Fig. 4B. —78-year-old woman with hepatic metastasis from rectosigmoid carcinoma. Arterial phase T1-weighted spoiled gradient-echo MR image obtained at same level as A shows complete rim enhancement of lesion (arrowhead).

View larger version (120K): [in a new window]   Fig. 4C. —78-year-old woman with hepatic metastasis from rectosigmoid carcinoma. Delayed phase T1-weighted spoiled gradient-echo MR image obtained at same level as A shows target configuration of lesion (arrowhead). Diagnosis of metastasis of adenocarcinoma was verified by wedge resection and histology.

View larger version (147K): [in a new window]   Fig. 5A. —Hepatic metastasis in 37-year-old woman with gastrinoma. CT scan shows lobulated low-attenuation lesion (arrowhead) in right lobe of liver.

View larger version (153K): [in a new window]   Fig. 5B. —Hepatic metastasis in 37-year-old woman with gastrinoma. T2-weighted fast spin-echo MR image obtained at same level as A shows hyperintense lesion (arrowhead) with sharp margins.

View larger version (165K): [in a new window]   Fig. 5C. —Hepatic metastasis in 37-year-old woman with gastrinoma. Arterial phase T1-weighted spoiled gradient-echo MR image shows hypointense lesion (arrowhead).

View larger version (156K): [in a new window]   Fig. 5D. —Hepatic metastasis in 37-year-old woman with gastrinoma. Delayed phase T1-weighted spoiled gradient-echo MR image shows progressive accumulation of contrast material in lesion (arrowhead), particularly in periphery.

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