Analysis of Signal Intensity and Enhancement Patterns of Early Arterial Phase of Small Hepatic Nodular Lesions on MRI_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Yinghua ¹ , SONG Bin ¹ , XU Juan ² , WU Bi ¹

1.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.Department of Radiology, The Fourth People’s Hospital of Sichuan Province, Chengdu 61001６, ChinaCorresponding Author: SONG Bin， E-mail: cjr.songbin@vip.163.com;

Corresponding author：

Keywords：

Magnetic resonance imaging; Small hepatocellular carcinoma; Signal intensity; Enhancement pattern

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　Objective 　To retrospectively assess the importance and imaging appearance of the signal intensity， the signal noise ratio (SNR), the contrast noise ratio (CNR) and enhancement patterns of early arterial phase in diagnosis and differential diagnosis of small hepatic nodular lesions on MRI.
　Methods 　Conventional spin-echo T2W, 2D GRE T1W plain scan and Gd-enhanced 3D-VIBE multi-phasic (early arterial, late arterial and portal venous phase) acquisitions were performed for 68 consecutive patients with 102 lesions on MRI. Native T2W and 2D GRE T1W were acquired first, then 3D-VIBE fast scanning at early arterial, late arterial and portal venous phase respectively. The SNR, CNR, signal intensity and enhanced pattern of the nodular lesions appearances on plain scan and eariy arterial phase were carefully observed.
　Results 　There were hyperintense in 102 (100%) lesions in T2W and hypointense in 95 (93.1%) lesions in T1W in plain scan. There were differences among the SNR, CNR of hepatic cyst, cavernous hemangioma, neoplasm metastasis and small hepatocellular carcinoma in T2W (P＜0.05)，the highest SNR and CNR of lesions were hepatic cyst. The SNR of small hepatocellular carcinoma and the CNR of hepatic cyst were highest in all the type diseases in T1W, there was significantly difference as compared with the other type diseases (P＜0.05). The enhancement rate of small hepatic nodular lesions was 76.5% in early arterial phase. The enhancement rate of small hepatocellular carcinoma and hepatic metastasis were 100% and 87.9% respectively. The non-enhancement rate of hepatic cyst were 100%. The common enhancement patterns of early arterial phase were peripheral enhancement which were 36 lesions (35.3%). The even enhancement and uneven enhancement were 22 lesions (21.6%) and 20 lesions (19.6%) respectively.
　Conclusion 　Qualitative and quantitative evaluation of MR signal intensity combined with the enhancement patterns of early arterial phase will help for qualitation and differential diagnosis of small hepatic nodular lesions on MRI.

Citation： WU Yinghua,SONG Bin,XU Juan,WU Bi. Analysis of Signal Intensity and Enhancement Patterns of Early Arterial Phase of Small Hepatic Nodular Lesions on MRI. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(3): 240-244. doi: Copy

1.	Havelaar IJ, Sugarbaker PH, Vermess M, et al. Rate of growth of intraabdominal metastases from colorectal cancer [Ｊ]. Cancer, 1984; 54(1):163.
2.	Lee VS, Lavelle MT, Rofsky NM, et al. Hepatic MR imaging with a dynamic contrast-enhanced isotropic volumetric interpolated breath-hold examination: feasibility, reproducibility, and technical quality [Ｊ]. Radiology, 2000; 215(2):365.
3.	邬颖华, 宋彬，徐隽，等. VIBE序列在原发性肝癌MRI诊断中的价值 [Ｊ]. 中国普外基础与临床杂志, 2005； 12(2):184.
4.	邬颖华, 宋彬, 徐隽. MRI 3D-VIBE序列动态增强对肝脏局灶性病变的诊断价值 [Ｊ]. 中国普外基础与临床杂志, 2006； 13(2):227.
5.	Negru D, Fotea V, Grigora瘙塂 M, et al. MRI in the differential diagnosis of liver focal lesions [Ｊ]. Rev Med Chir Soc Med Nat Iasi, 2006; 110(3):548.
6.	Coenegrachts K, Delanote J, Ter Beek L, et al. Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques [Ｊ]. Br J Radiol, 2007; 80(955):524.
7.	Hussain SM, Zondervan PE, IJzermans JN, et al. Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation [Ｊ]. Radiographics, 2002; 22(5):1023.
8.	Ni Y, Marchal G, Yu J, et al. Experimental liver cancers: Mn-DPDP-enhanced rims in MR-microangiographic-histologic correlation study [Ｊ]. Radiology, 1993; 188(1):45.
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12.	Kim YH, Saini S, Blake MA, et al. Distinguishing hepatic metastases from hemangiomas: qualitative and quantitative diagnostic performance through dual echo respiratory-triggered fast spin echo magnetic resonance imaging [Ｊ]. J Comput Assist Tomogr, 2005; 29(5):571.
13.	李勇，梁碧玲，张嵘，等. 肝脏血管系统与肝内占位病灶的MR三维重建与融合 [Ｊ]. 癌症， 2006； 25(7):888.
14.	Foley WD, Mallisee TA, Hohenwalter MD, et al. Multiphase hepatic CT with a multirow detector CT scanner [Ｊ]. AJR Am J Roentgenol, 2000; 175(3):679.
15.	Kim T, Murakami T, Hori M, et al. Small hypervascular hepatocellular carcinoma revealed by double arterial phase CT performed with single breath-hold scanning and automatic bolus tracking [Ｊ]. AJR Am J Roentgenol, 2002; 178(4):899.
16.	Murakami T, Kim T, Takamura M, et al. Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT [Ｊ]. Radiology, 2001; 218(3):763.
17.	Namasivayam S, Salman K, Mittal PK, et al. Hypervascular hepatic focal lesions: spectrum of imaging features [Ｊ]. Curr Probl Diagn Radiol, 2007; 36(3):107.
18.	Coenegrachts K, Orlent H, ter Beek L, et al. Improved focal liver lesion detection: comparison of single-shot spin-echo echo-planar and superparamagnetic iron oxide (SPIO)-enhanced MRI [Ｊ]. J Magn Reson Imaging, 2008; 27(1):117.
19.	Burns PN, Wilson SR. Focal liver masses: enhancement patterns on contrast-enhanced images—concordance of US scans with CT scans and MR images [Ｊ]. Radiology, 2007; 242(1):162.
20.	言伟强, 邹立秋, 赵艳, 等. 小肝细胞癌与小肝血管瘤螺旋CT三期扫描的鉴别诊断 [Ｊ]. 中华肿瘤杂志， 2005； 27(11):196.
21.	Jeong YY, Mitchell DG, Kamishima T. Small (＜20 mm) enhancing hepatic nodules seen on arterial phase MR imaging of the cirrhotic liver: clinical implications [Ｊ]. AJR Am J Roentgenol, 2002; 178(6):1327.
22.	Jinzaki M, Tanimoto A, Mukai M, et al. Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis [Ｊ]. J Comput Assist Tomogr, 2000; 24(6):835.
23.	Kan Z, Ivancev K, Lunderquist A, et al. In vivo microscopy of hepatic tumors in animal models: a dynamic investigation of blood supply to hepatic metastases [Ｊ]. Radiology, 1993; 187(3):621.
24.	Lin G, Hgerstrand I, Lunderquist A. Portal blood supply of liver metastases [Ｊ]. AJR Am J Roentgenol, 1984; 143(1):53.
25.	Caseiro-Alves F, Brito J, Araujo AE, et al. Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis [Ｊ]. Eur Radiol, 2007; 17(6):1544.
26.	Yamashita Y, Ogata I, Urata J, et al. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings [Ｊ]. Radiology, 1997; 203(1):121.
27.	Chang SD, Thoeni RF. Effect of T1 shortening on T2-weighted MRI sequences: comparison of hepatic mass conspicuity on images acquired before and after gadolinium enhancement [Ｊ]. AJR Am J Roentgenol, 2008; 190(5):1318.
28.	Heiken JP. Distinguishing benign from malignant liver tumours [Ｊ]. Cancer Imaging, 2007; 7 Spec No A:S1.

1. Havelaar IJ, Sugarbaker PH, Vermess M, et al. Rate of growth of intraabdominal metastases from colorectal cancer [Ｊ]. Cancer, 1984; 54(1):163.
2. Lee VS, Lavelle MT, Rofsky NM, et al. Hepatic MR imaging with a dynamic contrast-enhanced isotropic volumetric interpolated breath-hold examination: feasibility, reproducibility, and technical quality [Ｊ]. Radiology, 2000; 215(2):365.
3. 邬颖华, 宋彬，徐隽，等. VIBE序列在原发性肝癌MRI诊断中的价值 [Ｊ]. 中国普外基础与临床杂志, 2005； 12(2):184.
4. 邬颖华, 宋彬, 徐隽. MRI 3D-VIBE序列动态增强对肝脏局灶性病变的诊断价值 [Ｊ]. 中国普外基础与临床杂志, 2006； 13(2):227.
5. Negru D, Fotea V, Grigora瘙塂 M, et al. MRI in the differential diagnosis of liver focal lesions [Ｊ]. Rev Med Chir Soc Med Nat Iasi, 2006; 110(3):548.
6. Coenegrachts K, Delanote J, Ter Beek L, et al. Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques [Ｊ]. Br J Radiol, 2007; 80(955):524.
7. Hussain SM, Zondervan PE, IJzermans JN, et al. Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation [Ｊ]. Radiographics, 2002; 22(5):1023.
8. Ni Y, Marchal G, Yu J, et al. Experimental liver cancers: Mn-DPDP-enhanced rims in MR-microangiographic-histologic correlation study [Ｊ]. Radiology, 1993; 188(1):45.
9. Yamashita Y, Fan ZM, Yamamoto H, et al. Spin-echo and dynamic gadolinium-enhanced FLASH MR imaging of hepatocellular carcinoma: correlation with histopathologic findings [Ｊ]. J Magn Reson Imaging, 1994; 4(1):83.
10. Winter TC 3rd, Takayasu K, Muramatsu Y, et al. Early advanced hepatocellular carcinoma: evaluation of CT and MR appearance with pathologic correlation [Ｊ]. Radiology, 1994; 192(2):379.
11. Farraher SW, Jara H, Chang KJ, et al. Differentiation of hepatocellular carcinoma and hepatic metastasis from cysts and hemangiomas with calculated T2 relaxation times and the T1/T2 relaxation times ratio [Ｊ]. J Magn Reson Imaging, 2006; 24(6):1333.
12. Kim YH, Saini S, Blake MA, et al. Distinguishing hepatic metastases from hemangiomas: qualitative and quantitative diagnostic performance through dual echo respiratory-triggered fast spin echo magnetic resonance imaging [Ｊ]. J Comput Assist Tomogr, 2005; 29(5):571.
13. 李勇，梁碧玲，张嵘，等. 肝脏血管系统与肝内占位病灶的MR三维重建与融合 [Ｊ]. 癌症， 2006； 25(7):888.
14. Foley WD, Mallisee TA, Hohenwalter MD, et al. Multiphase hepatic CT with a multirow detector CT scanner [Ｊ]. AJR Am J Roentgenol, 2000; 175(3):679.
15. Kim T, Murakami T, Hori M, et al. Small hypervascular hepatocellular carcinoma revealed by double arterial phase CT performed with single breath-hold scanning and automatic bolus tracking [Ｊ]. AJR Am J Roentgenol, 2002; 178(4):899.
16. Murakami T, Kim T, Takamura M, et al. Hypervascular hepatocellular carcinoma: detection with double arterial phase multi-detector row helical CT [Ｊ]. Radiology, 2001; 218(3):763.
17. Namasivayam S, Salman K, Mittal PK, et al. Hypervascular hepatic focal lesions: spectrum of imaging features [Ｊ]. Curr Probl Diagn Radiol, 2007; 36(3):107.
18. Coenegrachts K, Orlent H, ter Beek L, et al. Improved focal liver lesion detection: comparison of single-shot spin-echo echo-planar and superparamagnetic iron oxide (SPIO)-enhanced MRI [Ｊ]. J Magn Reson Imaging, 2008; 27(1):117.
19. Burns PN, Wilson SR. Focal liver masses: enhancement patterns on contrast-enhanced images—concordance of US scans with CT scans and MR images [Ｊ]. Radiology, 2007; 242(1):162.
20. 言伟强, 邹立秋, 赵艳, 等. 小肝细胞癌与小肝血管瘤螺旋CT三期扫描的鉴别诊断 [Ｊ]. 中华肿瘤杂志， 2005； 27(11):196.
21. Jeong YY, Mitchell DG, Kamishima T. Small (＜20 mm) enhancing hepatic nodules seen on arterial phase MR imaging of the cirrhotic liver: clinical implications [Ｊ]. AJR Am J Roentgenol, 2002; 178(6):1327.
22. Jinzaki M, Tanimoto A, Mukai M, et al. Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis [Ｊ]. J Comput Assist Tomogr, 2000; 24(6):835.
23. Kan Z, Ivancev K, Lunderquist A, et al. In vivo microscopy of hepatic tumors in animal models: a dynamic investigation of blood supply to hepatic metastases [Ｊ]. Radiology, 1993; 187(3):621.
24. Lin G, Hgerstrand I, Lunderquist A. Portal blood supply of liver metastases [Ｊ]. AJR Am J Roentgenol, 1984; 143(1):53.
25. Caseiro-Alves F, Brito J, Araujo AE, et al. Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis [Ｊ]. Eur Radiol, 2007; 17(6):1544.
26. Yamashita Y, Ogata I, Urata J, et al. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings [Ｊ]. Radiology, 1997; 203(1):121.
27. Chang SD, Thoeni RF. Effect of T1 shortening on T2-weighted MRI sequences: comparison of hepatic mass conspicuity on images acquired before and after gadolinium enhancement [Ｊ]. AJR Am J Roentgenol, 2008; 190(5):1318.
28. Heiken JP. Distinguishing benign from malignant liver tumours [Ｊ]. Cancer Imaging, 2007; 7 Spec No A:S1.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Signal Intensity and Enhancement Patterns of Early Arterial Phase of Small Hepatic Nodular Lesions on MRI

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