Liver transplantationCandidateSuperparamagnectic Iron Oxide-Enhanced Magnetic Resonance for Tumor Surveillance in Cirrhotic Liver Before Liver Transplantation with Explanted Liver Correlation

ObjectiveThe aim of this study was to determine the accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the detection of liver tumors in patients with liver cirrhosis before liver transplantation (LT).Patients and MethodsTwenty-one patients with moderate to severe liver cirrhoses (Child-Pugh score B or C) underwent SPIO-enhanced MRI before LT. SPIO-enhanced MRI was composed of SPIO-enhanced T1-weighted images, T2-weighted turbo spin-echo, and T2*-weighted sequences. The detection of malignant liver tumor was based on hepatic lesions that remain with hyper-signal intensity on SPIO-enhanced delayed T2 and T2*-weighted images. The imaging was compared with findings during histopathologic evaluation of the explanted liver.ResultsForty-two liver nodules were found in 16 of the 21 patients. Thirty-six malignant hepatic neoplasms were detected at histopathologic evaluation. SPIO-enhanced MRI depicted 30 of 36 malignant hepatic neoplasms. Patient-based analysis showed that the sensitivity, specificity, and accuracy of MRI were 93.75%, 100%, and 95.2%, respectively. For lesion-based analysis, the sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve were 90%, 100%, and 0.95, respectively, for lesions >2 cm.ConclusionsSPIO-enhanced MRI can be used as an additional diagnostic tool for the detection and characterization of malignant tumors in cirrhotic livers. This diagnostic evaluation is accurate to triage patients for LT.