Chondroitin Sulfate Iron Colloid-Enhanced MR Imaging in Patients with Small Hepatocellular Carcinomas: Correlations with Hemodynamic and Pathologic Examinations

To determine the usefulness of chondroitin sulfate iron colloid (CSIC)-enhanced magnetic resonance imaging (MRI) in evaluation of the histologic grade of hepatocellular carcinoma (HCC), we performed a comparative study with computed tomography during arterial portography (CTAP) and CT arteriography. Twenty-one surgically resected HCCs 3 cm or less in diameter were examined. There were five well- differentiated, six well- to moderately-differentiated and ten moderately- or poorly-differentiated HCCs. T2-weighted spin echo images (repetition time: 2,000 ms, echo time: 90 ms) were taken before and after intravenous injection of 23.6 ?mol Fe/kg of CSIC. The differences between precontrast and postcontrast contrast-to-noise ratios (enhancement index) was correlated with the findings of CTAP, CT arteriography and histological examination. The enhancement index increased with statistical significance as the intranodular arterial perfusion increased (P < 0.01), and as the intranodular portal perfusion decreased (P < 0.01). Though the enhancement index tended to increase as the grade of malignancy increased, no statistical significance was found. CSIC-enhanced MRI allowed a noninvasive evaluation of the intranodular reticuloendothelial function. We consider this procedure as a supplementary method for evaluation of the histologic grade of HCC prior to performing invasive procedures such as angiography and biopsy.