Study of diagnostic efficacy in detecting liver metastases using T1-weighted contrast-enhanced studies with magnetization transfer contrast effect

Objective: To evaluate the diagnostic capabilities of detecting metastatic lesions on post-contrast images using magnetization transfer contrast with a short fat-suppressed presaturation pulse.

Materials and methods. The study material consisted of dynamic contrast-enhanced MR images of abdominal organs with metastatic liver involvement. Parameters of the pre-saturation pulse: Δf = -210 Hz, FA = 600°. Contrast ratio (CR) was calculated for each focus using a formula: CR = ((I_FOCUS – I_LIVER) / I_LIVER) • 100%. Vascularization was assessed on a scale of 3 categories: hypovascular, isovascular, and hypervascular. Threshold values for each category were calculated using cluster analysis. To assess the sensitivity of focus detection, they were divided into groups by size: Group 1 − from 5 mm to 10 mm; Group 2 − from 10 mm to 20 mm. Statistical analysis of the results was performed using the Mann-Whitney, Wilcoxon, Cochran, and McNemar criteria.

Results. In the course of the clinical study, heterogeneous groups of patients were obtained in terms of gender and age depending on the nature of vascularization of liver foci during analysis of the arterial phase of DCE: hypervascular (n = 14) and hypovascular (n = 38), with a total of 52 studies conducted, as one patient had dynamic control. The threshold value for the group of hypervascular metastases was identified as CR > 49.6%. In Group 1 (5 mm to 10 mm), the sensitivity of detecting foci on post-contrast images T-TSE-MTC was 47.7%. In Group 2, there were no statistically significant differences between the diagnosis of foci sized 10 mm or larger on post-contrast images T1-TSE-MTC and all phases of DCE (p < 0.0001), with a sensitivity of 100%.

Conclusions. 1. According to cluster analysis, T1-weighted study based on fast spin echo with magnetization transfer contrast (T1-TSE-MTC) allows differentiation of hypervascular metastases from transitional and hypovascular (p < 0.05).

2. The contrast of hypervascular metastases in the post-contrast phase on T1-TSE-MTC images does not significantly differ from the arterial phase of dynamic contrast enhancement (DCE) (p > 0.05).
3. A high sensitivity to enhancement by paramagnetics at low concentrations on T1-TSE-MTC images was revealed, which reduces the contrast of hypovascular metastatic foci sized 5 to 10 mm with a significant decrease in their detection compared to DCE (p < 0.05), while for sizes 10 to 20 mm, no significant differences with DCE were found (p > 0.05).

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