Clinical Management of Hepatic Malignancies: Ferucarbotran-Enhanced Magnetic Resonance Imaging Versus Contrast-Enhanced Spiral Computed Tomography
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This study compares ferucarbotran-enhanced magnetic resonance (MR) imaging with spiral computed tomography (CT) in the clinical management of patients with suspected hepatic malignancy. One hundred fifty-nine patients with suspected liver malignancy were included in a prospective, multicenter, phase IIIB clinical trial. Patients were examined with baseline plus contrast-enhanced spiral CT and with baseline plus ferucarbotran-enhanced MR imaging. For each patient, four maps of liver lesions were constructed by a trusted blind party on the basis of (a) baseline plus contrast-enhanced spiral CT, (b) baseline MR imaging, (c) baseline plus ferucarbotran-enhanced MR imaging, and (d) final diagnosis. Three blinded experts evaluated the treatment options for each map. The concordance of the treatment choice based on imaging with the treatment choice based on final diagnosis was verified. The final therapeutic decision was radical therapy for 85 patients, palliative therapy for 49 patients, and no treatment for 25 patients who had a final diagnosis of benign lesion. Proper treatment allocation was achieved in 121 (76%) of 159 patients when the evaluation was based on liver maps obtained from spiral CT, in 97 (61%) of 159 patients when the evaluation was based on liver maps obtained from baseline MR imaging, and in 136 (85%) of 159 patients when the evaluation was based on liver maps obtained from baseline plus ferucarbotran-enhanced MR imaging. MR imaging with ferucabotran was significantly superior to spiral CT for correct treatment allocation (P = 0.0167). Ferucarbotran-enhanced MR imaging is superior to spiral CT in clinical management of patients with suspected hepatic malignancy.
Keywords:hepatocellular carcinoma liver metastases magnetic resonance imaging.
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- 1.Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, EASL Panel of Experts on HCC: Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430, 2001Google Scholar
- 2.Lencioni R, Cioni D, Crocetti L, Della Pina C, Bartolozzi C: Magnetic resonance imaging of liver tumors. J Hepatol 40:162–171, 2004Google Scholar
- 3.Ward J, Naik KS, Guthrie JA, Wilson D, Robinson PJ: Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis. Radiology 210:459–466, 1999PubMedGoogle Scholar
- 4.Mori K, Scheidler J, Helmberger T, et al.: Detection of malignant hepatic lesions before orthotopic liver transplantation: accuracy of ferumoxides-enhanced MR imaging. AJR Am J Roentgenol 179:1045–1051, 2002Google Scholar
- 11.Bruix J, Castells A, Bosch J, et al.: Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111:1018–1022, 1996Google Scholar
- 13.Majno PE, Azoulay D, Bismuth H: General surgical aspects and the risks of liver surgery in patients with hepatic disease. In Oxford Textbook of Hepatology. Bircher J, Rizzetto M, Rhodes J, Benhamou JP (eds). Oxford, Oxford University Press, 1999, pp 1997–2008Google Scholar
- 18.Majno PE, Azoulay D, Bismuth H: Malignant biliary obstruction. In Oxford Textbook of Hepatology. Bircher J, Rizzetto M, Rhodes J, Benhamou JP (eds). Oxford, Oxford University Press, 1999, pp 1530–1545Google Scholar
- 20.Selzner M, Morse MA, Vredenburgh JJ, Meyers WC, Clavien PA: Liver metastases from breast cancer: long-term survival after curative resection. Surgery 127:383–389, 2000Google Scholar