MR staging of primary colorectal carcinoma: comparison with surgical and histopathologic findings.

BACKGROUND: We retrospectively evaluated the accuracy of magnetic resonance (MR) imaging in staging colorectal cancer and assessing local tumor extent, nodal involvement, and distant abdominal and pelvic metastases. METHODS: Forty-eight patients with primary colorectal carcinoma were referred for presurgical abdominal and pelvic MR imaging. MR imaging included T1-weighted, fat-suppressed T2-weighted, and fat-suppressed gadolinium-enhanced spin gradient-echo imaging. The prospective interpretations of the MR examinations were reviewed. MR depiction of local tumor extent, nodal involvement, and distant metastases at 18 anatomic locations was noted and compared with subsequent surgical and histopathologic findings. RESULTS: Overall TNM MR staging agreed with surgical and pathologic staging in 41 (85%) of 48 patients, including 21 (78%) of 27 colon cancers and 20 (95%) of 21 rectal cancers. For depth of tumor penetration, which was evaluable in 44 patients, MR imaging agreed with pathologic results in 38 (86%) of 44 patients, including 22 (88%) of 25 colon cancers and 16 (84%) of 19 rectal cancers. In 42 (95%) of 44 patients, MR images correctly distinguished tumor confined to the bowel wall (T0, T1, and T2) from tumor with transmural tumor extension (T3 and T4). Regional nodal metastases were depicted in 15 of 22 patients (sensitivity, 68%; accuracy, 83%). Nodal metastases were better depicted for rectal cancer in eight of nine patients, compared with colon cancer in seven of 13 patients. Distant metastases were correctly depicted on MR imaging in 13 of 14 patients (sensitivity, 93%; accuracy, 98%). In the site-by-site analysis, MR imaging prospectively depicted 66 of 77 sites of surgically confirmed metastatic tumor in the abdomen and pelvis (sensitivity, 86%; specificity, 99%; accuracy, 98%). CONCLUSION: MR imaging using currently available techniques can effectively image local tumor extent and distant metastases in patients with colorectal carcinoma. Especially for colon cancer, incomplete depiction of nodal metastases in normal-size lymph nodes remains a limitation of cross-sectional imaging studies.

MR imaging of the liver using gadolinium chelates.

The use of gadolinium chelates has become an essential element in the comprehensive MR examination of the liver. The versatility of the gadolinium chelates, their well-established record of safety, and the wealth of clinical experience with these agents are unmatched. The gadolinium chelates uniquely provide important information about tumor perfusion, which is key in assessment of liver masses. These paramagnetic contrast agents assist with liver lesion detection, characterization, and in establishing the volume of viable perfused tumor.

Gadolinium-enhanced MR imaging of liver capsule and peritoneum.

The ability to accurately depict tumor involving the peritoneum is critical to diagnosis and management in the oncology patient. Unfortunately, the small size of the peritoneal and liver capsular liver implants renders them difficult to image on helical CT scanning or nonenhanced MR imaging. Gadolinium-enhanced, fat-suppressed spoiled gradient-echo (SGE) MR imaging is exquisitely sensitive for the depiction of peritoneal tumors. Compared with helical CT scanning, the superior contrast resolution of fat-suppressed, gadolinium-enhanced SGE MR imaging makes MR imaging superior for depiction of neoplastic and inflammatory diseases involving these hepatic and perihepatic structures.

A clinical comparison of the safety and efficacy of MultiHance (gadobenate dimeglumine) and Omniscan (Gadodiamide) in magnetic resonance imaging in patients with central nervous system pathology.

RATIONALE AND OBJECTIVES: The safety and diagnostic efficacy of MultiHance (gadobenate dimeglumine) in the central nervous system (CNS) were evaluated in a double-blind, multicenter, phase III clinical trial. METHODS: Two hundred five patients highly suspected of having a CNS lesion (by previous imaging exam) were enrolled at 16 sites in the United States. Patients were randomized to one of three incremental dosing regimens. Magnetic resonance imaging with Omniscan (gadodiamide) at doses of 0.1 and 0.3 mmol/kg was compared with MultiHance (gadobenate dimeglumine) at doses of 0.05 and 0.15 mmol/kg and at 0.1 and 0.2 mmol/kg. RESULTS: Compared with predose images alone, efficacy was demonstrated in each of the gadobenate dimeglumine and gadodiamide groups (single and cumulative doses) as indicated by the level of diagnostic information, number of lesions detected, and contrast-to-noise ratio measurements. The level of diagnostic information from gadobenate dimeglumine at 0.1 mmol/kg was equivalent to that with gadodiamide at the same dose. One of the two blinded reviewers found equivalence between the gadobenate dimeglumine 0.05 mmol/kg dose and gadodiamide at 0.1 mmol/kg. Both reviewers found the level of diagnostic information to be equivalent after the second dose of contrast for all three dosing regimens. The cumulative doses of gadobenate dimeglumine were well tolerated and as safe as gadodiamide. CONCLUSIONS: Gadobenate dimeglumine is comparable to gadodiamide in terms of safety and efficacy for imaging of CNS lesions, with a possible advantage in imaging applications owing to enhanced T1 relaxivity.

Extrahepatic abdominal imaging in patients with malignancy: comparison of MR imaging and helical CT in 164 patients.

The purpose of this study was to compare the performance of magnetic resonance (MR) imaging using currently available techniques with contrast-enhanced single-phase helical computed tomography (CT) in depicting extrahepatic disease in patients with malignancy. At two institutions, 164 patients with known or suspected malignancy underwent abdominal imaging with contrast-enhanced helical CT and MR imaging. The prospective interpretations of the CT scans and MR examinations were used to assess the sensitivity of each imaging test in detecting benign and malignant extrahepatic disease at 17 anatomic sites. Imaging findings were compared with results of surgery in 57 patients and with the combined results of image-guided biopsy, follow-up cross-sectional imaging studies, other concurrent imaging tests, and clinical follow-up. For the 164 patients, helical CT scans depicted 221 of 316 (70%) sites of proven extrahepatic tumor compared with 288 sites (91%) (P < 0.0001) for MR imaging. For the 57 patients who underwent exploratory laparotomy, helical CT scans depicted 101 of 154 (66%) findings of surgically confirmed extrahepatic tumor compared with MR imaging, which depicted 139 sites (90%) (P < 0.0001). Anatomic sites at which MR imaging showed a significantly greater detection of extrahepatic tumor included the peritoneum, bowel, and vascular and osseous structures. For depiction of benign extrahepatic disease, there was no significant difference between helical CT and MR imaging. MR imaging, using currently available T1-weighted, RARE T2-weighted, and gadolinium-enhanced imaging, is effective in depicting extrahepatic disease in patients with malignancy. Compared with single-phase helical CT scanning, MR imaging shows an advantage in depicting tumor involving the peritoneum, omentum, bowel, and osseous and vascular structures.

Magnetic resonance imaging of the abdomen: applications in the oncology patient.

Cross-sectional imaging of the abdomen in oncology patients presents unique challenges and opportunities. A close working relationship between the oncologist and radiologist is essential for the exchange of the clinical and imaging information necessary for optimizing patient diagnosis and management. Compared to helical computed tomography (CT), magnetic resonance imaging (MRI) of the abdomen and pelvis offers important advantages, including superior soft-tissue contrast. The multiplanar capabilities of MRI allow for direct coronal or sagittal imaging, providing a truer anatomic presentation of abdominal and pelvic masses. Recent advances in MRI, including the use of intravenous (i.v.) and oral contrast agents, the development of high-performance imagers, and improved surface coil designs, facilitate more rapid abdominal imaging with superior image quality. All of these features combine to produce a versatile imaging examination with exquisite sensitivity for depicting abdominal and pelvic tumors. In this article, we will review the clinical applications for hepatic and extrahepatic abdominal MRI in the oncology patient. The MRI techniques and protocols described can be applied to most commercially available high-field magnetic resonance imagers.

Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning.

The purpose of this study was to evaluate the use of gadolinium and barium-enhanced magnetic resonance (MR) imaging in detecting intestinal and extraintestinal Crohn's disease and compare MRI with contrast-enhanced helical computed tomography (CT). Twenty-six patients with Crohn's disease underwent imaging examinations, including gadolinium-enhanced, fat suppressed fast multiplanar spoiled gradient-recalled (FMPSPGR) MR imaging with oral 2% barium sulfate and rectal water and with helical CT using i.v. and positive (13) or negative (13) intestinal contrast material. MR images and CT scans were reviewed separately by two radiologists for bowel wall thickness and enhancement, presence of abscess, phlegmon, and fistula. MR images and CT scans were then compared side by side. Surgical, endoscopic, and histopathologic findings and results of barium studies were reviewed to determine the location and severity of involvement of intestinal Crohn's disease. Depiction of mural thickening and/or enhancement was superior on the MR images, which showed 55 (85%) and 52 (80%) of 65 abnormal bowel segments for the two observers, compared with helical CT, which showed 39 (60%) and 42 (65%; P < 0.001, P < 0.05) of bowel segments affected by Crohn's disease. Segments of bowel with moderate or marked mural thickening were depicted equally on MR imaging and helical CT. In mildly diseased segments of bowel, with only slight thickening and enhancement, MR imaging depicted 22 (79%) and 19 (68%) of 28 segments, compared with helical CT, which depicted 9 (32%; P < 0.01), and 13 (46%; P > 0.05) of 28 segments. In the side-by side comparison, MR imaging was preferred over helical CT for depicting normal bowel wall (MR 71%, CT 4%, equal 25%; P < 0.001), mural thickening (MR 41%, CT 11% equal 48%; P < 0.01), mural enhancement (MR 89%, equal 11%; P < 0.001), and overall GI tract evaluation (MR 52%, CT 10%, equal 38%; P < 0.001). Gadolinium-enhanced MR imaging with oral dilute barium sulfate and rectal water depicts intestinal and extraintestinal changes of Crohn's disease and shows promise as a clinically useful tool.

Treated ovarian cancer: comparison of MR imaging with serum CA-125 level and physical examination--a longitudinal study.

PURPOSE: To evaluate whether gadolinium-enhanced magnetic resonance (MR) imaging can demonstrate clinically occult tumors in women with treated ovarian cancer and to compare the diagnostic accuracy of MR imaging, serum CA-125 (ovarian cancer antigen) level, and physical examination. MATERIALS AND METHODS: From 1992 to 1997, a longitudinal study comparing MR imaging findings, CA-125 values, and physical examination results with eventual clinical outcome in 69 women with treated ovarian cancer was performed. Tumor presence was determined with surgery, by an elevated CA-125 value, or with follow-up of patients longitudinally to assess for tumor recurrence. Absence of tumor was accepted with a disease-free interval of at least 2 years. RESULTS: Twenty-three of 39 patients in clinical remission with a normal CA-125 level and physical examination result had subclinical tumor proved at laparotomy or clinical follow-up. Gadolinium-enhanced MR imaging correctly demonstrated residual tumor in 20 of 23 patients. In all 69 patients, MR images had a 91% sensitivity, 87% specificity, 90% accuracy, and 72% negative predictive value and were superior to serum CA-125 level (53%, 94%, 63%, and 38%, respectively) (P < .001) and physical examination (26%, 94%, 43%, and 29%, respectively) (P < .001) in the depiction of residual tumor. CONCLUSION: Gadolinium-enhanced MR imaging is a valuable clinical tool in patients with ovarian cancer. An abnormal MR examination with a normal CA-125 value is a strong indication of residual or recurrent tumor.

Extrahepatic abdominal imaging in patients with malignancy: comparison of MR imaging and helical CT, with subsequent surgical correlation.

PURPOSE: To compare state-of-the-art magnetic resonance (MR) imaging with single-phase helical computed tomography (CT) in abdominal screening for extrahepatic disease in patients with proved malignancy. MATERIALS AND METHODS: Fifty-seven patients with known malignancy underwent abdominal contrast material-enhanced helical CT and MR imaging from 1994 through 1997. Prospective interpretations of CT scans and MR images were used to assess each modality's sensitivity in depicting malignant extrahepatic tumor at 17 anatomic sites. Imaging findings were compared with surgical results in all patients. RESULTS: Helical CT depicted 101 (66%) of 154 surgically confirmed extrahepatic tumor sites; MR imaging depicted 139 (90%) (P < .001). MR imaging depicted tumor in more patients at 11 of the 17 anatomic sites; at six sites, MR imaging and helical CT were equivalent. MR imaging showed significantly greater depiction of extrahepatic tumor for the peritoneum (P < .05), bowel (P < .01), and mesentery (P < .05). False-negative interpretations would have altered patient care had the extrahepatic tumor remained undetected in 13 patients for helical CT and in six patients for MR imaging. CONCLUSION: State-of-the-art MR imaging can be used for effective abdominal screening for extrahepatic tumor in patients with malignancy. Compared with single-phase helical CT, MR imaging depicted more sites of extrahepatic tumor and was particularly advantageous for the peritoneum, mesentery, and bowel.

Current uses of gadolinium chelates for clinical magnetic resonance imaging examination of the liver.

The use of gadolinium chelates has become an integral part of magnetic resonance imaging (MRI) of the liver and extrahepatic abdomen. Although liver specific contrast agents are now available, gadolinium chelates continue to offer significant advantages for abdominal MRI. The gadolinium chelates uniquely provide important information about tumor perfusion that is key in our assessment of liver masses. These paramagnetic contrast agents assist with liver lesion detection, characterization, and in establishing the volume of viable perfused tumor. Gadolinium chelates are equally important for MRI of the extrahepatic abdomen. The interstitial accumulation of these agents within peritoneal, omental, and gastrointestinal tumor produces marked enhancement and is key in accurate tumor staging. Depiction of lesions within solid visceral organs such as the pancreas, kidneys, and spleen is also improved following gadolinium injection. The versatility of this workhorse contrast agent assures that gadolinium chelates will continue to occupy a central role in any busy abdominal MRI practice.

Potential renal transplant donors: evaluation with gadolinium-enhanced MR angiography and MR urography.

PURPOSE: To determine prospectively the feasibility and accuracy of combined gadolinium-enhanced magnetic resonance (MR) angiography, MR urography, and MR nephrography in the presurgical evaluation of potential renal transplant donors. MATERIALS AND METHODS: Twenty-two potential donors for renal transplantation were evaluated with 1.5-T MR imaging. MR angiograms were evaluated for the number of renal arteries, presence of early arterial branches, and renal artery stenoses. The renal collecting system and ureters were evaluated on the MR urograms. Renal parenchyma was assessed on the MR nephrogram. Prospective interpretation of MR images was compared with that of conventional angiograms and excretory urograms and with surgical findings. RESULTS: Gadolinium-enhanced MR angiography enabled correct identification of the arterial supply to all 44 native kidneys (44 single or dominant renal arteries and nine accessory renal arteries), four of five early arterial branches arising in the proximal 2 cm of the renal artery, a mild truncal stenosis in one renal artery, and two anomalies of the draining renal veins. The MR urogram accurately depicted a duplicated collecting system and mild unilateral pelvicalicectasis. The MR nephrogram showed renal size and a solitary cyst in one kidney, confirmed with sonography. CONCLUSION: Combined gadolinium-enhanced MR angiography, MR urography, and MR nephrography can accurately depict the arterial supply, collecting system, and renal parenchyma of donor kidneys.

MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT.

OBJECTIVE: To determine an optimal MR imaging technique and pulse sequence for evaluating mural and serosal disease of the gastrointestinal tract, we administered 2% oral barium sulfate and obtained fat-suppressed gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled (FMPSPGR) MR images. We then compared these images with spin-echo T1-weighted and T2-weighted fast spin-echo MR images and with CT images. SUBJECTS AND METHODS: Thirty-one patients with suspected diseases of the gastrointestinal tract were imaged with spin-echo T1-weighted, fast spin-echo T2-weighted, and fat-saturated gadolinium-enhanced FMPSPGR MR imaging. Before undergoing MR imaging, all patients received 1350 ml of 2% barium sulfate oral contrast media. For CT scans, patients received 120 ml of iodinated i.v. contrast material and 2% barium sulfate oral contrast material. CT and MR images were retrospectively and independently reviewed by two radiologists for ability to see normal bowel wall, for the presence of abnormal gastrointestinal tract mural thickening or enhancement, and for overall gastrointestinal tract visualization. Findings were correlated with surgical findings, endoscopy, and barium studies. RESULTS: Ten patients had benign disease, 16 had malignant gastrointestinal tract disease, and five had no gastrointestinal tract abnormalities. In 94% of patients, the gadolinium- and barium-enhanced FMPSPGR MR images were superior to CT and spin-echo MR sequences for depicting the wall of the normal bowel (p < .001). For the two observers, the FMPSPGR MR images with i.v. and oral contrast material were seen as revealing 94% and 95% of bowel segments with malignant or inflammatory mural thickening or serosal tumor. In comparison, CT revealed 64% and 72% (p < .01 and p < .0001, respectively), fast spin-echo T2-weighted MR images revealed 21% and 28% (p < .0001), and T1-weighted MR images revealed 17% and 18% (p < .0001). The gadolinium- and barium-enhanced MR images were preferred for overall gastrointestinal tract visualization in 65% of patients compared with 1% for CT scans (p < .001). In 32% of patients, the enhanced MR images were equivalent to CT images. CONCLUSION: MR evaluation of the gastrointestinal tract requires bowel distention with oral contrast material as well as motion reduction techniques, including glucagon and rapid gradient-echo pulses that allow breath-hold imaging. Fat-suppressed gadolinium-enhanced FMPSPGR MR imaging with diluted barium oral contrast media is effective for imaging benign and malignant mural and serosal abnormalities of the gastrointestinal tract.

Peritoneal tumor: MR imaging with dilute oral barium and intravenous gadolinium-containing contrast agents compared with unenhanced MR imaging and CT.

PURPOSE: To compare fat-suppressed, gadolinium-enhanced, breath-hold magnetic resonance (MR) imaging after administration of dilute oral barium solution with unenhanced MR imaging and computed tomography (CT) in the detection of peritoneal tumors. MATERIALS AND METHODS: In 24 patients in whom peritoneal tumor was known or suspected, double-contrast MR imaging and CT were performed prospectively. MR imaging included T1-weighted, fast spin-echo T2-weighted, and immediate and delayed gadolinium-enhanced, breath-hold, fast multiplanar sequences with fat saturation. Helical and conventional dynamic CT were performed with intravenously and orally administered contrast media. MR images and CT scans were reviewed independently and prospectively by different pairs of radiologists for presence of peritoneal tumor in 17 anatomic sites. Imaging findings were compared with surgical and histopathologic results. RESULTS: Of the 24 patients, 18 had peritoneal tumor confirmed at surgery. Detection of tumor sites was superior with double-contrast MR images (mean sensitivity, specificity, and accuracy, 84%, 87%, and 86%, respectively) compared with CT scans (mean sensitivity, specificity, and accuracy, 54%, 91%, and 74%, respectively). Double-contrast MR imaging enabled better detection of carcinomatosis and tumors less than 1 cm in diameter (75%-80%) than CT (22%-33%; P < .0001). CONCLUSION: Double-contrast MR imaging demonstrated more peritoneal tumors than CT or unenhanced spin-echo MR imaging.

Ovarian vein thrombosis during cesarean section. A report of two cases.

BACKGROUND: Puerperal ovarian vein thrombosis occurs in 0.2-0.5% of deliveries. It is usually thought to result from infection, but it has been hypothesized that thrombosis may occur as a primary event, and radiologic studies raise the possibility that ovarian vein thrombosis may occur quite frequently. CASES: Case 1 had right ovarian vein thrombosis diagnosed at the time of nonemergency cesarean section for placenta previa. This was treated with ligation of the infundibulopelvic ligament above the level of the clot. Subsequent magnetic resonance imaging showed contralateral ovarian vein thrombosis, and therefore anticoagulant therapy was begun. The patient was asymptomatic. Case 2 had right ovarian vein thrombosis extending to the inferior vena cava diagnosed at elective repeat cesarean section. She was heparinized in the recovery room; subsequent ventilation/perfusion scan showed a probable pulmonary embolism. Both patients recovered uneventfully. CONCLUSION: These two cases demonstrate that ovarian vein thrombosis may occur as a primary event, in the absence of infection, and result in pulmonary embolism. Individualized management based on operative findings is recommended.

Contrast agents for MR imaging of the liver.

The evolution of contrast agents for MR imaging of the liver has proceeded along several different paths with the common goal of improving liver-lesion contrast. These contrast agents are used to accentuate the inherent differences in liver-lesion signal intensity through differential enhancement of proton relaxation within adjacent tissues. Contrast agents used for hepatic MR imaging can be broadly categorized into those that target the extracellular space, the hepatobiliary system, and the reticuloendothelial system. Although only a small number of liver contrast agents are currently available, others are rapidly proceeding through clinical trials and may soon be added to our clinical armamentarium. This article will briefly review the current clinical experience with these agents, discussing their mechanism of contrast enhancement, pharmacokinetics, and efficacy in the evaluation of focal liver lesions.

Motion suppression in MR imaging of the liver: comparison of respiratory-triggered and nontriggered fast spin-echo sequences.

OBJECTIVE: Our purpose was to compare the effectiveness of a respiratory-triggered fast spin-echo (RTFSE) pulse sequence and a nontriggered fast spin-echo pulse sequence for imaging liver masses. MATERIALS AND METHODS: Forty-one patients with suspected liver masses were imaged at 1.5 T with a fast spin-echo sequence and an RTFSE sequence designed to trigger data acquisition at end expiration. All other imaging parameters were identical. MR images were compared qualitatively for lesion detection and conspicuity, anatomic sharpness, vascular definition, phase artifacts, and overall image quality. Quantitative analysis was performed to obtain lesion-liver contrast and contrast-to-noise ratio (CNR) measurements of all liver masses. RESULTS: Thirty-three patients had liver masses. The RTFSE images showed superior anatomic sharpness in 83% of examinations and superior overall image quality in 85% of examinations. Lesion detection and conspicuity were superior for the RTFSE images in 53% of examinations and were similar for the two techniques in 38%. In 10 patients we detected more lesions on RTFSE images, and in one patient we detected more lesions on fast spin-echo images. In the remaining patients the number of lesions detected on RTFSE images was identical to the number detected on fast spin-echo images. Respiratory artifacts were less noticeable on the RTFSE images in 66% of examinations and on the fast spin-echo images in 14%. Quantitative analysis showed a 29% increase in mean relative lesion-liver contrast and a 34% increase in mean relative CNR for the RTFSE images. Mean lesion-liver contrast and CNR for the RTFSE images (152.6 +/- 100.9, 14.2 +/- 9.3) were superior to corresponding values for the fast spin-echo images (123.4 +/- 88.0, 10.9 +/- 7.4) (p < .0001). CONCLUSION: Compared with nontriggered fast spin-echo MR images, the RTFSE MR images were superior for our evaluation of liver masses. By acquiring data during a period of reduced respiratory motion, the RTFSE sequence produced images with sharper anatomic detail, equal or less phase ghosting, and measurable improvement in the lesion-liver contrast and CNR.

Dynamic contrast-enhanced breath-hold MR imaging of thoracic malignancy using cardiac compensation.

The purpose of this paper was to evaluate the use of dynamic gadopentetate dimeglumine-enhanced, breath-hold spoiled gradient-recalled (SPGR) MR imaging with cardiac compensation (CMON) compared to spin-echo MR imaging in patients with thoracic malignancy. We retrospectively reviewed MR images from 29 patients with thoracic tumors. MR imaging included axial electrocardiogram (ECG)-gated T1-weighted, fast spin echo (FSE) T2-weighted, and contrast-enhanced breath-hold fast multiplanar SPGR imaging with CMON, which selects the phase-encoding gradient based on the phase within the cardiac cycle. Images were reviewed for lung masses, mediastinal or hilar tumor, disease of the pleura, chest wall, and bones and vascular compression or occlusion. Contrast-enhanced fast multiplanar SPGR imaging with CMON produces images of the chest that are free of respiratory artifact and have diminished vascular pulsation artifact. ECG-gated T1-weighted images were preferred for depicting mediastinal and hilar tumor. The gadopentetate dimeglumine-enhanced fast multiplanar SPGR images were useful for depicting chest wall tumor, vascular compression or thrombosis, osseous metastases, and in distinguishing a central tumor mass from peripheral lung consolidation. Pleural tumor was depicted best on the FSE T2-weighted images and the contrast-enhanced SPGR images. As an adjunct to spin echo T1-weighted and T2-weighted imaging, contrast-enhanced fast multiplanar SPGR imaging with CMON is useful in the evaluation of thoracic malignancy.

Ovarian cancer: comparison of findings with perfluorocarbon-enhanced MR imaging, In-111-CYT-103 immunoscintigraphy, and CT.

PURPOSE: To determine the accuracy of breath-hold gadolinium- and perflubron-enhanced magnetic resonance (MR) imaging, immunoscintigraphy with indium-111-CYT-103 (planar and single photon emission computed tomography [CT]), and contrast material-enhanced CT for the detection of ovarian cancer prior to laparotomy. MATERIALS AND METHODS: Sixteen patients with primary (n = 3) or treated (n = 13) ovarian cancer underwent imaging of the abdomen and pelvis with each modality. All images were reviewed prospectively for tumor location, and results were compared with findings at surgery. RESULTS: With CT or MR imaging, tumor was detected in 11 of 13 (85%) patients compared with 11 of 12 patients (92%) with immunoscintigraphy. Per patient accuracy for CT was 81% compared with 75% for MR imaging and 86% for immunoscintigraphy. For detection of individual sites of tumor, the sensitivity of MR imaging was highest (81%) compared with CT (51%, P < .001) and immunoscintigraphy (50%, P < .01). The combination of MR imaging and immunoscintigraphy depicted 89% of sites of tumor involvement confirmed at laparotomy. CONCLUSION: MR imaging and immunoscintigraphy show promise for the evaluation of patients with ovarian cancer.

MR imaging of peritoneal disease: comparison of contrast-enhanced fast multiplanar spoiled gradient-recalled and spin-echo imaging.

OBJECTIVE: We performed this study to compare contrast-enhanced fast multiplanar spoiled gradient-recalled (SPGR) MR imaging with unenhanced spin-echo imaging for the detection of benign and malignant peritoneal abnormalities. MATERIALS AND METHODS: We retrospectively reviewed abdominal MR images of 34 patients with proved peritoneal abnormalities, including 21 patients with malignant and 13 patients with benign peritoneal disease. Six additional patients had false-positive interpretations of their MR examinations because of diaphragmatic thickening and enhancement. Unenhanced T1-weighted images, fast spin-echo T2-weighted images, and breath-hold fast multiplanar SPGR images obtained immediately and 10-15 min after IV injection of gadopentetate dimeglumine were available. Images were reviewed for evidence of peritoneal disease by two observers who had no knowledge of the clinical findings. The four types of images were separately evaluated for peritoneal thickening, masses, and abnormal enhancement. The anatomic location, thickness, and pattern of thickening of the peritoneum were noted. Results were correlated with surgical findings or results of percutaneous biopsy. RESULTS: Immediate and delayed contrast-enhanced fast multiplanar SPGR images showed malignant peritoneal tumor in all 21 cases, compared with T1-weighted images, which showed tumor in 11 cases (p < .01), and fast spin-echo T2-weighted images, which showed tumor in 13 cases (p < .01). Enhancement of the peritoneal tumor increased the tumor's conspicuity, particularly on delayed fast multiplanar SPGR images, which were selected as the best sequence for detection of peritoneal tumor in 18 of the 21 cases. The MR findings varied widely from moderately and regularly thickened, enhancing peritoneum to very thick (> 1 cm) and lobular or masslike peritoneal thickening with enhancement. Delayed fast multiplanar SPGR images showed evidence of benign peritoneal disease in all 13 cases compared with immediate fast multiplanar SPGR images, which showed disease in 12 cases (p > .05); T1-weighted images, which showed disease in four cases (p < .05); and fast spin-echo T2-weighted images, which showed disease in only one case (p < .01). In the benign forms of peritoneal disease, the peritoneum was often regular in contour and tended to be thinner than in the cases of malignant peritoneal tumor, in which the peritoneum was generally thicker and more lobular or masslike. However, significant overlap was seen between the MR findings in benign and malignant forms of peritoneal disease. CONCLUSION: Detection of peritoneal abnormalities with MR imaging can be improved by using contrast-enhanced fast multiplanar SPGR imaging. The findings of peritoneal thickening and enhancement are best depicted on delayed images.