Focal liver lesion detection and characterization: Comparison of non-contrast enhanced and SPIO-enhanced diffusion-weighted single-shot spin echo echo planar and turbo spin echo T2-weighted imaging

Purpose: To compare lesion conspicuity and image quality between single-shot spin echo echo planar imaging (SS SE-EPI) before, immediately and 5 min after intravenous (IV) injection of superparamagnetic iron oxide (SPIO) for detecting and characterizing focal liver lesions (FLLs). Materials and methods: Twenty-five patients suspected for colorectal liver metastases were prospectively included. Lesion detection and characterization were compared between all SS SE-EPI and T2-weighted turbo spin echo (T2w TSE) sets (two-sided Fisher's exact test). Image quality and lesion conspicuity were compared for SS SE-EPI sets using rank order statistic (RIDIT). Reference standard comprised of surgery, biopsy and/or follow-up. Results: Reference standard demonstrated 18 benign and 43 malignant FLLs. Best lesion detection (p < 0.05) was achieved with non-contrast-enhanced SS SE-EPI. Lesion characterization was best using all T2w TSE sequences. Best image quality and lesion conspicuity (p < 0.05) was achieved with non-contrast-enhanced SS SE-EPI. Conclusion: Non-contrast-enhanced SS SE-EPI was best for lesion detection. SS SE-EPI sequences were not useful for lesion characterization (differentiation between benign and malignant lesions). Unenhanced SS SE-EPI did not allow differentiation especially as many benign FLLs were hyperintense on the highest b-value images. Combining unenhanced and SPIO-enhanced SS SE-EPI performed better but still was not clinically useful due to variable degree of uptake and vascular pooling of SPIO for (especially) benign FLLs. T2w TSE with SPIO-enhancement was needed for characterization. (C) 2008 Elsevier Ireland Ltd. All rights reserved.