MRI characteristics in focal hepatic disease before and after administration of MnDPDP:: discriminant analysis as a diagnostic tool

The aim of this study was to determine if different types of focal hepatic lesions can be differentiated by specific quantitative and qualitative imaging characteristics pre- and post-Mangafodipir trisodium (MnDPDP) administration using a computerized multivariable, discriminant analysis (DA). In a multicenter trial, 151 patients with focal liver disease were studied at 1.5 and 1.0 T using gradient-recalled echo T1 and fast spin-echo T2-weighted images pre and post MnDPDP (0.005 mmol/kg b.w.) i.v. administration. Analysis could be performed in 141 of 151 of the patients. The variables used in both single variable analysis and DA included contrast-to-noise ratios pre and post MnDPDP, presence of rim enhancement, margin, and heterogeneity of a lesion pre and post MnDPDP. The classification of diagnoses using DA was compared with a standard of reference (HCC in 23%, metastases in 25%, cyst in 13%, FNH in 10%, hemangioma in 11%, and other or no lesion in 18% of the patients; histology in 49%, long-term follow-up in 51% of the cases). In the differentiation of the various hepatic lesions, CNR together with the presence of heterogeneity or rim enhancement as variables for DA gave the highest sensitivity, specificity, and accuracy which ranged between 65 and 93, 44 and 83, and 65 and 86%, respectively. The DA models based on post-MnDPDP variables showed better classification results than the models based on pre-MnDPDP variables. An improvement of accuracy was observed when differentiating HCC from FNH lesion groups (48.9-67.4%; pless than or equal to0.05), and when differentiating HCC from metastasis lesion groups (68.3-84.1%; pless than or equal to0.01). In all regards there was no difference for T2-weighted images pre and post MnDPDP. By combining quantitative and qualitative variables, DA proved to be a useful tool in lesion discrimination. Due to considerable heterogeneity within some of the lesion type groups, the definite diagnostic impact of MnDPDP cannot be completely established yet, and further investigation is still necessary.