Purpose: The sensitivity of computerised tomography (CT) in detecting neuroendocrine liver metastases is variable and three-phase imaging is advocated. However, patients are often young and may require prolonged follow-up, thus a technique that avoids radiation exposure would be desirable. Our purpose was to assess the diagnostic performance of MRI, before and after administration of mangafodipir trisodium (MnDPDP), in the detection of neuroendocrine liver metastases. Methods: Patients who had undergone single-phase or multi-phase contrast-enhanced MD-CT for neuroendocrine liver metastases were invited to have MRI. Two independent observers made quantitative measurements (number and size of lesions). All measurements were made on each available CT phase and all MRI sequences independently, and repeated after an interval to assess reproducibility. The final number of lesions was agreed on by consensus of three observers. A qualitative assessment (contrast and spatial resolution) and preferred modality were agreed on by consensus. Results: 265 lesions were detected by consensus in 11 patients. Non-contrast CT was available in 4/11, arterial phase in 6/11 and portal phase in 10/11 patients. When compared with the consensus number of lesions, MD-CT identified 17% on non-contrast, 44% on arterial and 43% on portal venous imaging. Lesion detection on MRI was 48% on T1W, 52% on T2W and 92% on MnDPDP-MRI. The number of lesions detected on MnDPDP-MRI was closest to the final consensus reading (variance = 0.994, p = 0.0027). The reproducibility of lesion size measurements was best on MnDPDP-MRI (variance = 0.033, p = 0.0021). The preferred modality subjectively was MnDPDP-MRI in 9/11 cases and T2W MRI in 2/11. Conclusion: MRI is a robust technique in the demonstration of neuroendocrine liver metastases. It is highly reproducible in both detecting the number and measuring the size of lesions. We recommend T2W MRI and MnDPDP-MRI in detection and follow-up of neuroendocrine liver metastases.

Keywords:
Mangafodipir trisodium (MnDPDP), MnDPDP-enhanced MRI, Neuroendocrine liver metastases, detection, Neuroendocrine tumours
1.
Kaltsas GA, Besser GM, Grossman AB: The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev 2004;3:458–511.
2.
Woodard PK, Feldman JM, Paine SS, Baker ME: Midgut carcinoid tumors: CT findings and biochemical profiles. J Comput Assist Tomogr 1995;19:400–405.
3.
Rockall AG, Britton KE, Grossman AB, Reznek RH: Neuroendocrine tumours; in Husband JE, Reznek RH (eds): Imaging in Oncology. London, Taylor & Francis, 2004, pp 789–814.
4.
Paulson EK, McDermott VG, Keogan MT, Delong DM, Frederick MG, Nelson RC: Carcinoid metastases to the liver: role of triple-phase helical CT. Radiology 1998;206:143–150.
5.
Rummeny EJ, Marchal G: Liver imaging. Clinical applications and future perspectives. Acta Radiol 1997;38:626–630.
6.
Federle M, Chezmar J, Rubin DL, Weinreb J, Freeny P, Schmiedl UP, et al: Efficacy and safety of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the US Multicenter phase III clinical trials. Efficacy of early imaging. J Magn Reson Imaging 2000;12:689–701.
7.
Heiken JP, Weyman PJ, Lee JK, Balfe DM, Picus D, Brunt EM, et al: Detection of focal hepatic masses: prospective evaluation with CT, delayed CT, CT during arterial portography, and MR imaging. Radiology 1989;171:47–51.
8.
Lim KO, Stark DD, Leese PT, Pfefferbaum A, Rocklage SM, Quay SC: Hepatobiliary MR imaging: first human experience with MnDPDP. Radiology 1991;178:79–82.
9.
Rummeny EJ, Torres CG, Kurdziel JC, Nilsen G, Op DB, Lundby B: MnDPDP for MR imaging of the liver. Results of an independent image evaluation of the European Phase III Studies. Acta Radiol 1997;38:638–642.
10.
Bader TR, Semelka RC, Chiu VC, Armao DM, Woosley JT: MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver. J Magn Reson Imaging 2001;14:261–269.
11.
Torres CG, Lundby B, Sterud AT, McGill S, Gordon PB, Bjerknes HS: MnDPDP for MR imaging of the liver. Results from the European Phase III Studies. Acta Radiol 1997;38:631–637.
12.
Wang C: Mangafodipir trisodium (MnDPDP)-enhanced magnetic resonance imaging of the liver and pancreas. Acta Radiol 1998;415(suppl):1–31.
© 2008 S. Karger AG, Basel
2008
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