Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Hepatic Angiomyolipoma: Dual-Contrast MRI Findings Using Superparamagnetic Iron Oxide (SPIO) and Gadolinium Agents

간 혈관근육지방종: SPIO 제재와 가돌리늄 제재를 이용한 이중조영증강 자기공명 영상소견

  • Kim, Min-Uk (Department of Radiology, Seoul National University Hospital) ;
  • Kim, Se-Hyung (Department of Radiology, Seoul National University Hospital) ;
  • Kim, Hyo-Cheol (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Jae-Young (Department of Radiology, Seoul National University Hospital) ;
  • Kim, Min-A (Department of Pathology, Seoul National University Hospital) ;
  • Han, Joon-Koo (Department of Radiology, Seoul National University Hospital) ;
  • Choi, Byung-Ihn (Department of Radiology, Seoul National University Hospital)
  • 김민욱 (서울대학교병원 영상의학과) ;
  • 김세형 (서울대학교병원 영상의학과) ;
  • 김효철 (서울대학교병원 영상의학과) ;
  • 이재영 (서울대학교병원 영상의학과) ;
  • 김민아 (서울대학교병원 병리학과) ;
  • 한준구 (서울대학교병원 영상의학과) ;
  • 최병인 (서울대학교병원 영상의학과)
  • Received : 2010.08.01
  • Accepted : 2010.08.20
  • Published : 2010.12.01
⟨ Previous Next ⟩

Abstract

Purpose: To analyze imaging findings of hepatic angiomyolipomas (AMLs) on dualcontrast MRI using superparamagnetic iron oxide (SPIO) and gadolinium (Gd) agents. Materials and Methods: Five histopathologically-proven hepatic AMLs were enrolled in this study. Patients underwent dual-contrast MRI using SPIO and Gd agents on a 3.0T unit and performed a qualitative analysis consisting of measuring the signal intensity (SI) of the lesion, presence of fat, hemorrhage, early draining vein, tortuous tumoral vessels, as well as capsule and enhancement patterns. The signal drop of the lesion on post-SPIO images was also assessed. For the quantitative analysis, relative signal decrease (RSD, %) was calculated. Results: The presence of fat was noted in three lesions. An early draining vein and prominent tortous tumoral vessels were depicted in four lesions. No lesion was found to have a capsule. Four lesions showed early wash-in and early wash-out enhancement patterns, while the remaining lesion depicted strong and persistent enhancement. On post-SPIO images, signal drop was noted in the two lesions with no fat within the lesion. Their RSD was 21.1% and 38.0%, respectively. Conclusion: The presence of an early draining vein and tortuous tumoral vessels are characteristic dynamic enhanced MRI features of hepatic AMLs. In fat-deficient hepatic AMLs, the combination of dynamic enhanced MRI and SPIO-enhanced MRI might findings might increase the accuracy of making a correct diagnosis.

목적: 간 혈관근육지방종의 초자성 산화철 제재(SPIO)와 가돌리늄 제재를 이용한 이중조영증강 자기공명영상 소견을 분석하고자 한다. 대상과 방법: 병리학적으로 확진된 간 혈관근육지방종을 가진 5명의 환자가 분석 대상이 되었다. 모든 환자는 SPIO제재와 가돌리늄 제재를 이용한 이중조영증강 3.0T 자기공명영상 촬영을 시행하였다. 정성적 분석을 위해 병변의 신호강도, 지방, 출혈, 조기 배액 정맥, 구불구불한 종양 내 혈관, 피막, 조영증강 양상 및 SPIO 제재 주입 후 영상에서 병변 내 신호강도의 저하 여부를 판단하였다. 정량적 분석을 위해 SPIO 제재 주입 전과 후의 영상에서 상대적 신호강도 저하의 정도를 계산하였다. 결과: 세 개의 병변에서 지방의 존재가 확인되었다. 조기 배액 정맥 및 구불구불한 종양 내 혈관이 네 개의 병변에서 관찰되었으며, 모든 병변에서 피막은 없었다. 네 개의 병변은 조기 조영증강 및 조기 씻김의 조영증강 패턴을 보였으며 나머지 한 개는 강하고 지속적인 조영증강을 보였다. 지방이 없었던 두 병변은 SPIO 제재 주입 후 영상에서 신호강도의 감소가 관찰되었으며, 상대적 신호강도 저하는 각각 21.1%와 38.0%였다. 결론: 조기 배액 정맥 및 구불구불한 종양 내 혈관은 간 혈관근육지방종의 특징적인 역동적 조영증강 자기공명영상 소견이다. 특히, 지방이 없거나 적은 간 혈관근육지방종의 경우, 역동적 조영증강 자기공명영상과 SPIO 조영증강 자기공명영상 소견을 조합하면 정확한 진단을 내릴 수 있을 것이다.

Keywords

Acknowledgement

Supported by : Seoul National University Hospital

References

  1. Nonomura A, Mizukami Y, Kadoya M. Angiomyolipoma of the liver: a collective review. J Gastroenterol 1994;29:95-105 https://doi.org/10.1007/BF01229084
  2. Tsui WM, Colombari R, Portmann BC, Bonetti F, Thung SN, Ferrell LD, et al. Hepatic angiomyolipoma. A clinicopathological study of 30 cases and delineation of unusual morphological variants. Am J Surg Pathol 1999;23:34-48 https://doi.org/10.1097/00000478-199901000-00004
  3. Yang CY, Ho MC, Jeng YM, Hu RH, Wu YM, Lee PH. Management of hepatic angiomyolipoma. J Gastrointest Surg 2007;11:452-457 https://doi.org/10.1007/s11605-006-0037-3
  4. Zeng JP, Dong JH, Zhang WZ, Wang J, Pang XP. Hepatic Angiomyolipoma: a clinical experience in diagnosis and treatment. Dig Dis Sci Forthcoming 2010
  5. Yan F, Zeng M, Zhou K, Shi W, Zheng W, Da R, et al. Hepatic angiomyolipoma: various appearances on two-phase contrast scanning of spiral CT. Eur J Radiol 2002;41:12-18 https://doi.org/10.1016/S0720-048X(01)00392-8
  6. Zheng RQ, Kudo M. Hepatic angiomyolipoma: identification of an efferent vessel to be hepatic vein by contrast-enhanced harmonic ultrasound. Br J Radiol 2005;78:956-960 https://doi.org/10.1259/bjr/27365821
  7. Takayama Y, Moriura S, Nagata J, Hirano A, Ishiguro S, Tabata T, et al. Hepatic angiomyolipoma: radiologic and histopathologic correlation. Abdom Imaging 2002;27:180-183 https://doi.org/10.1007/s00261-001-0057-0
  8. Sakamoto Y, Inoue K, Ohtomo K, Mori M, Makuuchi M. Magnetic resonance imaging of an angiomyolipoma of the liver. Abdom Imaging 1998;23:158-160 https://doi.org/10.1007/s002619900311
  9. Basaran C, Karcaaltincaba M, Akata D, Karabulut N, Akinci D, Ozmen M, et al. Fat-containing lesions of the liver: cross-sectional imaging findings with emphasis on MRI. AJR Am J Roentgenol 2005;184:1103-1110 https://doi.org/10.2214/ajr.184.4.01841103
  10. Li T, Wang L, Yu HH, Sun HC, Qin LX, Ye QH, et al. Hepatic angiomyolipoma: a retrospective study of 25 cases. Surg Today 2008;38:529-535 https://doi.org/10.1007/s00595-007-3669-3
  11. Namkung S, Zech CJ, Helmberger T, Reiser MF, Schoenberg SO. Superparamagnetic iron oxide (SPIO)-enhanced liver MRI with ferucarbotran: efficacy for characterization of focal liver lesions. J Magn Reson Imaging 2007;25:755-765 https://doi.org/10.1002/jmri.20873
  12. Hamm B, Staks T, Taupitz M. SHU 555A: a new superparamagnetic iron oxide contrast agent for magnetic resonance imaging. Invest Radiol 1994;29 Suppl 2:S87-S89 https://doi.org/10.1097/00004424-199406001-00029
  13. Reimer P, Rummeny EJ, Daldrup HE, Balzer T, Tombach B, Berns T, et al. Clinical results with resovist: a phase 2 clinical trial. Radiology 1995;195:489-496 https://doi.org/10.1148/radiology.195.2.7724772
  14. Jeon TY, Kim SH, Lim HK, Lee WJ. Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver. Eur J Radiol 2010;73:601-606 https://doi.org/10.1016/j.ejrad.2009.01.010
  15. Reimer P, Schneider G, Schima W. Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 2004;14:559-578 https://doi.org/10.1007/s00330-004-2236-1
  16. Prasad SR, Wang H, Rosas H, Menias CO, Narra VR, Middleton WD, et al. Fat-containing lesions of the liver: radiologic-pathologic correlation. Radiographics 2005;25:321-331 https://doi.org/10.1148/rg.252045083
  17. Zhong DR, Ji XL. Hepatic angiomyolipoma-misdiagnosis as hepatocellular carcinoma: a report of 14 cases. World J Gastroenterol 2000;6:608-612
  18. Ren N, Qin LX, Tang ZY, Wu ZQ, Fan J. Diagnosis and treatment of hepatic angiomyolipoma in 26 cases. World J Gastroenterol 2003;9:1856-1858 https://doi.org/10.3748/wjg.v9.i8.1856
  19. Kudo M, Okuno T, Tomita S, Kajiwara T, Shirane H, Usuki N, et al. Hepatic angiomyolipoma pre-operatively diagnosed by imaging. J Gastroenterol Hepatol 1993;8:483-488 https://doi.org/10.1111/j.1440-1746.1993.tb01553.x
  20. Ahmadi T, Itai Y, Takahashi M, Onaya H, Kobayashi T, Tanaka YO, et al. Angiomyolipoma of the liver: significance of CT and MR dynamic study. Abdom Imaging 1998;23:520-526 https://doi.org/10.1007/s002619900391
  21. Clement O, Siauve N, Cuenod CA, Frija G. Liver imaging with ferumoxides (Feridex): fundamentals, controversies, and practical aspects. Topics Magn Reson Imaging 1995;9:167-182
  22. Soyer P, Dufresne AC, Somveille E, Scherrer A. Hepatic cavernous hemangioma: appearance on T2-weighted fast spin-echo MR imaging with and without fat suppression. AJR Am J Roentgenol 1997;168:461-465 https://doi.org/10.2214/ajr.168.2.9016227
  23. Montet X, Lazeyras F, Howarth N, Mentha G, Rubbia-Brandt L, Becker CD, et al. Specificity of SPIO particles for characterization of liver hemangiomas using MRI. Abdom Imaging 2004;29:60-70
  24. Yoshimura H, Murakami T, Kim T, Nakamura H, Hirabuki N, Sakon M, et al. Angiomyolipoma of the liver with least amount of fat component: imaging features of CT, MR, and angiography. Abdom Imaging 2002;27:184-187 https://doi.org/10.1007/s00261-001-0108-6
  25. Weinmann HJ, Schuhmann-Giampieri G, Schmitt-Willich H, Vogler H, Frenzel T, Gries H. A new lipophilic gadolinium chelate as a tissue-specific contrast medium for MRI. Magn Reson Med 1991;22:233-237 https://doi.org/10.1002/mrm.1910220214
  26. Schuhmann-Giampieri G, Schmitt-Willich H, Press WR, Negishi C, Weinmann HJ, Speck U. Preclinical evaluation of Gd-EOB-DTPA as a contrast agent in MR imaging of the hepatobiliary system. Radiology 1992;183:59-64
  27. Hamm B, Staks T, Muhler A, Bollow M, Taupitz M, Frenzel T, et al. Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 1995;195:785-792
  28. van Montfoort JE, Stieger B, Meijer DK, Weinmann HJ, Meier PJ, Fattinger KE. Hepatic uptake of the magnetic resonance imaging contrast agent gadoxetate by the organic anion transporting polypeptide Oatp1. J Pharmacol Exp Ther 1999;290:153-157
  29. Huppertz A, Balzer T, Blakeborough A, Breuer J, Giovagnoni A, Heinz-Peer G, et al. Improved detection of focal liver lesions at MR imaging: a multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 2004;230:266-275 https://doi.org/10.1148/radiol.2301020269
  30. Vogl TJ, Kummel S, Hammerstingl R, Schellenbeck M, Schumacher G, Balzer T, et al. Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 1996;200: 59-67 https://doi.org/10.1148/radiology.200.1.8657946
  31. Reimer P, Rummeny EJ, Daldrup HE, Hesse T, Balzer T, Tombach B, et al. Enhancement characteristics of liver metastases, hepatocellular carcinomas, and hemangiomas with Gd-EOB-DTPA: preliminary results with dynamic MR imaging. Eur Radiol 1997;7:275-280 https://doi.org/10.1007/s003300050150