Characterization of hyperintense nodules on T1-weighted liver magnetic resonance imaging: comparison of Ferucarbotran-enhanced MRI with accumulation-phase FS-T1WI and gadolinium-enhanced MRI.

BACKGROUND T1-weighted (T1W) hyperintense nodules against a background of cirrhosis are diagnostically challenging in daily practice. All regenerative nodules, dysplastic nodules and hepatocellular carcinoma (HCC) might present hyperintense on T1W imaging (T1WI), so T1W hyperintense nodules cannot be definitively characterized as dysplastic nodules or HCC before biopsy, resection or transplantation. The purpose of our study was to evaluate Ferucarbotran-enhanced Magnetic Resonance Imaging (MRI) with accumulation-phase fat suppression T1-weighted imaging (FS-T1WI) in comparison with gadolinium-enhanced MRI for characterization of hyperintense nodules on unenhanced T1WI within cirrhotic liver. METHODS Two separate groups of patients with histologically-proven T1W hyperintense nodule on MRI were retrospectively identified. The Ferucarbotran group consisted of 17 T1W hyperintense nodules in 12 patients. The gadolinium group consisted of 22 T1W hyperintense nodules in 21 patients. All of the patients had liver cirrhosis. Finally, 11 HCC nodules, and six benign nodules were included in the Ferucarbotran group; 15 HCC nodules and seven benign nodules were included in the gadolinium group. RESULTS With the conventional criteria, in the gadolinium-enhanced group, the sensitivity, specificity, and accuracy were 53%, 100%, and 73%, respectively. Using the conventional criteria in the Ferucarbotran group, the sensitivity, specificity, and accuracy were 73%, 100%, 82%, respectively. Using the conventional criteria plus hyperintense on the accumulation-phase FS-T1WI in the Ferucarbotran group for characterization of the T1W hyperintense nodules, the sensitivity, specificity, and accuracy were 100%, 83%, 94%, respectively. The sensitivity of Ferucarbotran-enhanced MR with accumulation-phase FS-T1WI was better than that of gadolinium-enhanced MRI (p=0.01). CONCLUSION Ferucarbotran-enhanced MR imaging with accumulation-phase FS-T1WI is superior to gadolinium-enhanced MRI in characterization of T1W hyperintense nodules within cirrhotic liver. T1W hyperintense nodule within cirrhotic liver depicting hyperintense on Ferucarbotran-enhanced accumulation-phase FS-T1WI should be investigated aggressively.