Skip to main content
SpringerLink
Log in

Clinical and Cost Effectiveness of a New Hepatocellular MRI Contrast Agent, Mangafodipir Trisodium, in the Preoperative Assessment of Liver Resectability

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Improved preoperative assessment of focal liver disease and tumors could have a potentially significant impact on their treatment. Mangafodipir trisodium (Teslascan; Nycomed Amersham Imaging, Little Chalfont, UK) is a new hepatocellular contrast agent for use with state-of-the-art MR imaging that, in early reports, is accurate in detection and characterization of liver lesions.

Methods: Records and diagnostic images of all patients undergoing enhanced Teslascan MRI (T-MRI) at our institution were reviewed. We assessed the relative sensitivities of contrast-enhanced CT scan (CECT) and T-MRI in detecting lesions, as well as the impact of T-MRI in the decision to operate or not on patients. In those patients taken to surgery, the correlation between T-MRI and intraoperative palpation and intraoperative ultrasound (IOUS) was determined.

Results: Fifty-four patients were noted on CECT to have focal liver lesions and subsequently underwent imaging with T-MRI. The T-MRI correlated with CT findings in 22 patients (41%), upstaged the liver disease in 26, and demonstrated fewer lesions in 6. Only 43 patients were considered operative candidates and T-MRI influenced the operative decision in 32 patients (74%), dissuading operative intervention in 14. In the 25 patients without clear preoperative evidence of unresectability who were taken to the operating room, T-MRI correlated with findings of intraoperative palpation in 19 (76%). In the 20 patients who underwent IOUS, T-MRI correlated with IOUS in 14 patients (70%). IOUS detected an additional nine lesions, all of which were <1 cm. Seventeen patients underwent resection and/or ablation of their liver lesions. Compared with pathology, sensitivities of CECT, T-MRI, and intraoperative evaluation were 61%, 83%, and 93%, respectively. T-MRI failed to predict hepatic-specific unresectability in only one of eight patients, the other seven having extrahepatic disease.

Conclusions: These findings suggest that T-MRI is more sensitive than CECT in the preoperative predicting of the resectability of hepatic lesions. Despite T-MRI accurately correlating with intraoperative surgical findings, IOUS should be performed on all patients prior to a final decision to resect or ablate a focal liver lesion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg 1995; 19: 59–71.

    CAS  PubMed  Google Scholar 

  2. Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997; 15: 938–46.

    CAS  PubMed  Google Scholar 

  3. Bradley AL, Chapman WC, Wright JK, et al. Surgical experience with hepatic colorectal metastasis. Am Surg 1999; 65: 560–6.

    Google Scholar 

  4. Bismuth H, Chiche L, Castaing D. Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: Experience with 68 liver resections. World J Surg 1995; 19: 35–41.

    Google Scholar 

  5. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999; 229: 790–9.

    Article  Google Scholar 

  6. Rose AT, Rose DM, Pinson CW, et al. Hepatocellular carcinoma outcomes based on indicated treatment strategy. Am Surg 1998; 64: 1128–34.

    Google Scholar 

  7. Taylor HM, Ros PR. Hepatic imaging. An overview. Radiol Clin North Am 1998; 36: 237–45.

    Google Scholar 

  8. DeMatteo RP, Fong Y. Imaging of hepatobiliary neoplasms. Surg Oncol Clin N Am 1999; 8: 59–89.

    Google Scholar 

  9. Kemmerer SR, Mortele KJ, Ros PR. CT scan of the liver. Radiol Clin North Am 1998; 36: 247–61.

    Google Scholar 

  10. Wernecke K, Rummeny E, Bongartz G, et al. Detection of hepatic masses in patients with carcinoma: Comparative sensitivities of sonography, CT, and MR imaging. AJR Am J Roentgenol 1991; 157: 731–9.

    Google Scholar 

  11. Kuszyk BS, Bluemke DA, Urban BA, et al. Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: Sensitivity based on comparison with intraoperative and pathologic findings. AJR Am J Roentgenol 1996; 166: 91–5.

    Google Scholar 

  12. Soyer P, Lacheheb D, Levesque M. False-positive CT. portography: Correlation with pathologic findings. AJR Am J Roentgenol 1993; 160: 285–9.

    Google Scholar 

  13. Soyer P, Bluemke DA, Hruban RH, Sitzmann JV, Fishman EK. Primary malignant neoplasms of the liver: Detection with helical CT during arterial portography. Radiology 1994; 192: 389–92.

    Google Scholar 

  14. Soyer P, Bluemke DA, Hruban RH, Sitzmann JV, Fishman EK. Hepatic metastases from colorectal cancer: Detection and false-positive findings with helical CT during arterial portography. Radiology 1994; 193: 71–4.

    Google Scholar 

  15. Kemeny N, Huang Y, Cohen AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 1999; 341: 2039–48.

    Article  CAS  PubMed  Google Scholar 

  16. Siegelman ES, Outwater EK. MR imaging techniques of the liver. Radiol Clin North Am 1998; 36: 263–86.

    CAS  PubMed  Google Scholar 

  17. Hagspiel KD, Neidl KF, Eichenberger AC, Weder W, Marincek B. Detection of liver metastases: Comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US. Radiology 1995; 196: 471–8.

    Google Scholar 

  18. Seneterre E, Taourel P, Bouvier Y, et al. Detection of hepatic metastases: Ferumoxides-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography. Radiology 1996; 200: 785–92.

    CAS  PubMed  Google Scholar 

  19. Hahn PF, Saini S. Liver-specific MR imaging contrast agents. Radiol Clin North Am 1998; 36: 287–97.

    Google Scholar 

  20. Fretz CJ, Stark DD, Metz CE, et al. Detection of hepatic metastases: Comparison of contrast-enhanced CT, unenhanced MR imaging, and iron oxide-enhanced MR imaging. AJR Am J Roentgenol 1990; 155: 763–70.

    Google Scholar 

  21. Ros PR, Freeny PC, Harms SE, et al. Hepatic MR imaging with ferumoxides: A multicenter clinical trial of the safety and efficacy in the detection of focal hepatic lesions. Radiology 1995; 196: 481–8.

    CAS  PubMed  Google Scholar 

  22. Schultz JF, Bell JD, Goldstein RM, Kuhn JA, McCarty TM. Hepatic tumor imaging using iron oxide MRI: Comparison with computed tomography, clinical impact, and cost analysis. Ann Surg Oncol 1999; 6: 691–8.

    CAS  PubMed  Google Scholar 

  23. Rofsky NM, Weinreb JC, Bernardino ME, Young SW, Lee JK, Noz ME. Hepatocellular tumors: Characterization with Mn-DPDP-enhanced MR imaging. Radiology 1993; 188: 53–9.

    Google Scholar 

  24. Murakami T, Baron RL, Federle MP, et al. Cirrhosis of the liver: MR imaging with mangafodipir trisodium (Mn-DPDP). Radiology 1996; 198: 567–72.

    Google Scholar 

  25. Murakami T, Baron RL, Peterson MS, et al. Hepatocellular carcinoma: MR imaging with mangafodipir trisodium (Mn-DPDP). Radiology 1996; 200: 69–77.

    Google Scholar 

  26. Soyer P, Levesque M, Elias D, Zeitoun G, Roche A. Detection of liver metastases from colorectal cancer: Comparison of intraoperative US and CT during arterial portography. Radiology 1992; 183: 541–4.

    CAS  PubMed  Google Scholar 

  27. NiY, Marchal G, YuJ, et al. Experimental liver cancers: Mn-DPDP-enhanced rims in MR- microangiographic-histologic correlation study. Radiology 1993; 188: 45–51.

    Google Scholar 

  28. Schmidt J, Strotzer M, Fraunhofer S, Boedeker H, Zirngibl H. Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: Lesion-by-lesion analysis. World J Surg 2000; 24: 43–7.

    Article  CAS  PubMed  Google Scholar 

  29. Staren ED, Gambla M, Deziel DJ, et al. Intraoperative ultrasound in the management of liver neoplasms. Am Surg 1997; 63: 591–6.

    Google Scholar 

  30. Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D. A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group Protocol 6584. J Clin Oncol 1991; 9: 1105–12.

    Google Scholar 

  31. Low RN, Semelka RC, Worawattanakul S, Alzate GD, Sigeti JS. Extrahepatic abdominal imaging in patients with malignancy: Comparison of MR imaging and helical CT, with subsequent surgical correlation. Radiology 1999; 210: 625–32.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, 91010

    Gary N. Mann MD, Lily L. Lai MD & Lawrence D. Wagman MD

  2. Division of Radiology, City of Hope National Medical Center, Duarte, CA, 91010

    Howard F. Marx MD

  3. Department of Surgery, Section of Surgical Oncology, University of Washington, 1959 NE Pacific Street, P.O. Box 356410, Seattle, WA, 98195

    Gary N. Mann MD

Authors
  1. Gary N. Mann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Howard F. Marx MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lily L. Lai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lawrence D. Wagman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gary N. Mann MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mann, G.N., Marx, H.F., Lai, L.L. et al. Clinical and Cost Effectiveness of a New Hepatocellular MRI Contrast Agent, Mangafodipir Trisodium, in the Preoperative Assessment of Liver Resectability. Ann Surg Oncol 8, 573–579 (2001). https://doi.org/10.1007/s10434-001-0573-8

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-001-0573-8

Key Words:

Search

Navigation