Gero Wieners

Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging

ObjectiveTo compare diffusion-weighted imaging (DWI) and Gd-EOB-DTPA-enhanced magnetic resonance (MR) imaging for the detection and characterisation of focal liver lesions (FLLs) in patients with colorectal carcinoma.MethodsSeventy-three patients underwent MR imaging including echoplanar DWI (MR-DWI) and dynamic (MR-Dyn) and hepatobiliary phase (MR-Late) Gd-EOB-DTPA-enhanced images. Two blinded readers independently reviewed 5 different image sets using a 5-point confidence scale. Accuracy was assessed by the area (Az) under the receiver operating characteristic curve, and sensitivity and specificity were calculated.ResultsA total of 332 FLLs were evaluated. Detection rates were significantly higher for MR-Late images (94.4% for benign and 100% for malignant lesions) compared with MR-DWI (78.3% and 97.5%) and MR-Dyn images (81.5% and 89.9%). Accuracy was 0.82, 0.76 and 0.89 for MR-DWI, MR-Dyn and MR-Late images while sensitivity was 0.98, 0.87 and 0.95, respectively. For characterisation of subcentimetre lesions sensitivity was highest for MR-DWI (0.92). Combined reading of unenhanced and contrast-enhanced images had an identical high accuracy of 0.98.ConclusionLate-phase Gd-EOB-DTPA-enhanced images were superior for the detection of FLLs, while DWIs were most valuable for the identification of particularly small metastases. Combined interpretation of unenhanced images resulted in precise characterisation of FLLs.

Computed Tomography–Guided High-Dose-Rate Brachytherapy in Hepatocellular Carcinoma: Safety, Efficacy, and Effect on Survival

PURPOSE To determine the safety and efficacy of computed tomography (CT)-guided brachytherapy in hepatocellular carcinoma (HCC). METHODS AND MATERIALS A total of 83 patients were recruited, presenting with 140 HCC- lesions. Treatment was performed by CT-guided high-dose-rate (HDR) brachytherapy with an iridium-192 source. The primary endpoint was time to progression; secondary endpoints included local tumor control and overall survival (OS). A matched-pair analysis with patients not receiving brachytherapy was performed. Match criteria included the Cancer of the Liver Italian Program (CLIP) score, alpha-fetoprotein, presence, and extent of multifocal disease. For statistical analysis, Kaplan-Meier and Cox regression were performed. RESULTS Mean and median cumulative TTP for all patients (n = 75) were 17.7 and 10.4 months. Five local recurrences were observed. The OS after inclusion reached median times of 19.4 months (all patients), 46.3 months (CLIP score, 0), 20.6 months (CLIP score, 1) 12.7 months, (CLIP score, 2), and 8.3 months (CLIP score, >or=3). The 1- and 3-year OS were 94% and 65% (CLIP score, 0), 69% and 12% (CLIP score, 1), and 48% and 19% (CLIP score, 2), respectively. Nine complications requiring intervention were encountered in 124 interventions. Matched-pair analysis revealed a significantly longer OS for patients undergoing CT-guided brachytherapy. CONCLUSION Based on our results the study treatment could be safely performed. The study treatment had a beneficial effect on OS in patients with advanced HCC, with respect to (and depending on) the CLIP score and compared with OS in a historical control group. A high rate of local control was also observed, regardless of applied dose in a range of 15 to 25 Gy.

CT-Guided Interstitial Brachytherapy of Primary and Secondary Lung Malignancies

Background and Purpose:CT-guided interstitial brachytherapy of primary lung malignancies and pulmonary metastases represents a novel interventional technique, combining conventional high-dose-rate (HDR) iridium-192 (192Ir) brachytherapy with modern CT guidance for applicator positioning and computer-aided 3-D radiation treatment planning. The purpose of this study was to assess safety and efficacy of this technique.Patients and Methods:30 patients with 83 primary or secondary lung malignancies were recruited in a prospective nonrandomized trial (Table 1). After catheter positioning under CT fluoroscopy, a spiral CT was acquired for treatment planning (Figure 1). All but two patients received a defined single dose (coverage > 99%) of at least 20 Gy from a 192Ir source in HDR technique.Results:Adverse effects were nausea (n = 3, 6%), minor (n = 6, 12%) and one major pneumothorax (2%). Post intervention, no changes of vital capacity and forced expiratory volume could be detected. The median follow-up period was 9 months (1–21 months) with a local tumor control of 91% at 12 months (Figure 2).Conclusion:CT-guided interstitial brachytherapy proved to be safe and effective for the treatment of primary and secondary lung malignancies.Hintergrund und Ziel:Die CT-gesteuerte interstitielle Brachytherapie von primären Lungenmalignomen und Lungenmetastasen stellt eine weiterentwickelte interventionelle Technik dar, welche die konventionelle Hochdosisraten-(HDR)-Iridium-192-(192Ir-)Brachytherapie mittels moderner CT-Bildführung zur Applikatorpositionierung und computergestützter 3-D-Bestrahlungsplanung kombiniert. Ziel der Studie war die Analyse von Sicherheit und Effektivität dieses Verfahrens.Patienten und Methodik:30 Patienten mit 83 primären Lungenmalignomen oder pulmonalen Metastasen wurden in einer prospektiven, nicht randomisierten Phase-II-Studie behandelt (Tabelle 1). Nach Katheterpositionierung unter CT-Fluoroskopie erfolgte die Gewinnung eines 3-D-Datensatzes für die Bestrahlungsplanung (Abbildung 1). Alle Patienten bis auf zwei erhielten eine vorgeschriebene Einzeldosis (Abdeckung > 99%) von mindestens 20 Gy über eine 192Ir-Quelle in HDR-Technik.Ergebnisse:Minorkomplikationen waren Übelkeit (n = 3, 6%), diskreter (n = 6, 12%) sowie ein therapiebedürftiger Pneumothorax (2%). Postinterventionell ergaben sich keine Änderungen der Vitalkapazität oder des forcierten exspiratorischen Volumens. Die mediane Nachbeobachtungszeit betrug 9 Monate (1–21 Monate). Die lokale Tumorkontrolle lag nach 12 Monaten bei 91% (Abbildung 2).Schlussfolgerung:Die CT-gesteuerte interstitielle HDR-Brachytherapie stellt ein sicheres und effektives Verfahren zur Behandlung von primären Lungenmalignomen und pulmonalen Metastasen dar.

Treatment of hepatic metastases of breast cancer with CT-guided interstitial brachytherapy - a phase II-study.

PURPOSE The aim of the study was the evaluation of feasibility, safety and effectiveness of interstitial brachytherapy for the treatment of hepatic metastases of breast cancer. MATERIALS AND METHODS Forty-one consecutive patients with 115 unresectable hepatic metastases of breast cancer were included in this phase-II-trial. They were treated in 69 interventions of CT-guided-interstitial-brachytherapy of the liver. Brachytherapy was applied as a single fraction high-dose-irradiation (15-25Gy (Gray)) using a (192)Ir-source of 10Ci. Nineteen patients presented systemically pretreated extrahepatic tumors. Primary endpoints were complications, local tumor control and progression-free survival. RESULTS The median tumor diameter was 4.6 cm (1.5-11 cm). The median irradiation time per intervention was 26.5 min (range: 7-47 min). The applied median minimal dose at the CTV (clinical target volume) margin was 18.5 Gy (12-25 Gy). In 69 interventions and during the postinterventional period, one major complication (symptomatic post-interventional bleeding) (1.5%) and six minor complications occurred (8.7%). The median follow-up time was 18 months (range: 1-56). After 6, 12 and 18 months, local tumor control was 97%, 93.5% and 93.5%, intra- and extrahepatic progression free survival was 53%, 40% and 27%, and overall survival was 97%, 79% and 60%, respectively. CONCLUSION CT-guided-brachytherapy is safe and effective for the treatment of liver metastases of breast cancer.

Radiotherapy of Liver Metastases Comparison of Target Volumes and Dose-Volume Histograms Employing CT- or MRI-Based Treatment Planning

Purpose:To assess differences in delineated target volumes of liver metastases using contrast-enhanced CT and different MRI sequences for radiation treatment planning.Patients and Methods:25 patients with 43 colorectal liver metastases were recruited. Tumor margins were defined by two experienced radiologists. The resulting D90 was assessed and the CT-based 3-D dose distribution merged with the according MRI dataset by employing image fusion. A theoretical D90 as a result of MRI-based treatment planning was assessed for various MRI sequences individually.Results:In venous phase contrast-enhanced CT, the mean tumor volume was 20 ml; T1-weighted (T1w) MRI, 27 ml; contrast-enhanced T1w 42 ml; T2w 65 ml. The difference between the target volumes as assessed by either CT or MRI was 181% for T1w images, 178% for contrast-enhanced T1w, and 246% for T2w sequences. All differences were statistically significant (p < 0.05).The analysis of the dose-volume histograms revealed statistically significant differences (i.e., for the D90) for the different target volumes specified by CT and MRI: mean D90 on CT, 18 Gy; plain T1w, 16 Gy; contrast-enhanced T1w, 15.5 Gy; T2w, 12 Gy. Hence, delineation of a larger target volume in T2w MRI compared to contrast-enhanced CT resulted in a smaller D90.The mean differences of tumor volumes assessed by CT and plain T1w were significantly higher in the group of patients showing local tumor recurrences as compared to patients with long-term local tumor control (p = 0.002).Conclusion:For treatment planning of liver metastases, the use of either plain T1w or T2w sequences is recommended to delineate the clinical target volume as completely as possible and not to miss potential tumor cell congregations in the surroundings as in CT.Ziel:Beurteilung von Unterschieden in der Abgrenzung von Zielvolumina bei kontrastmittelverstärkter CT- und MRT-gestützter Bestrahlungsplanung.Patienten und Methodik:25 Patienten mit 43 Lebermetastasen kolorektalen Ursprungs wurden in dieser Studie untersucht. Zur Definition der Zielvolumina wurden CT- und MRT-Untersuchungen verwendet, die Konturierung der Tumorränder wurde von zwei erfahrenen Radiologen vorgenommen. Die D90 wurde nach Bildfusionierung der CT-basierten dreidimensionalen Dosisverteilungen mit den MRT-Datensätzen beurteilt. Eine theoretische D90 als Resultat der MRT-basierten Bestrahlungsplanung wurde bestimmt.Ergebnisse:In der venösen Phase der kontrastmittelverstärkten CT-Untersuchung betrug das mittlere Tumorvolumen 20 ml; MRT T1-gewichtet (T1w) 27 ml; kontrastmittelverstärkte T1w 42 ml; T2w 65 ml. Die Unterschiede der Zielvolumina im Verhältnis zur CT-gestützten Planung betrugen 181% für T1w-, 178% für kontrastmittelverstärkte T1w- und 246% für T2w-Sequenzen. Alle Unterschiede stellten sich als signifikant heraus (p < 0,05). Im Vergleich zur kontrastmittelverstärkten CT resultierte somit das Bemessen des Tumorvolumens im T2w MRT in einer niedrigeren D90.Die Analyse der Dosis-Volumen-Histogramme zeigte signifikante Unterschiede der verschiedenen Volumina. Die mittlere D90 betrug bei CT 18 Gy, bei nativer T1w 16 Gy, bei kontrastmittelverstärkter T1w 15,5 Gy und bei T2w 12 Gy.Die mittleren Unterschiede des Zielvolumens durch CT- und native T1w-gestützte MRT-Bestrahlungsplanung waren in der Gruppe der Patienten mit lokalen Tumorrezidiven signifikant höher als in der Gruppe mit langfristiger lokaler Kontrolle (p = 0,002).Schlussfolgerung:Für die Bestrahlungsplanung der Therapie von Lebermetastasen wird die Verwendung von nativen T1w- oder T2w-Sequenzen zur Abgrenzung des Zielvolumens empfohlen, um eine möglichst vollständige Erfassung der Metastase einschließlich evtl. vorhandener peripherer Tumorausläufer zu erreichen.

CT-guided brachytherapy (CTGB) versus interstitial laser ablation (ILT) of colorectal liver metastases: an intraindividual matched-pair analysis.

Purpose:To compare local tumor control after percutaneous tumor ablation by interstitial laser therapy (ILT) or CT-guided brachytherapy (CTGB).Patients and Methods:In a matched pair analysis including 18 patients with 36 liver metastases of colorectal primary, both ILT and CTGB were performed in different lesions. The following matching factors were considered: (i) tumor size ≤ 5 cm, and (ii) execution of chemotherapy after tumor ablation. Primary endpoint was local tumor control.Results:Treated lesions were identical in terms of tumor size and all matching criteria were fulfilled in all patients except for the performance of adjuvant chemotherapy. Median follow-up was 14 months (3–24 months) for both groups. Only five of 18 patients (28%) demonstrated local tumor progression after CTGB, whereas in ten of 18 patients (56%) tumor progression was found after ILT. Differences encountered were significant for all patients (p = 0.04), whereas in those who fulfilled all matching criteria (n = 14) the level of statistical significance was not reached (p = 0.23).Conclusion:CTGB demonstrated superior local tumor control compared to ILT in long-term follow-up.Ziel:Intraindividueller Vergleich lokaler Kontrollraten nach perkutaner Tumorablation mit interstitieller Lasertherapie (ILT) oder CT-gestützter Brachytherapie (CTGB) von intrahepatischen Metastasen bei kolorektalem Karzinom.Patienten und Methodik:Eine Matched-Pair-Analyse wurde bei 18 Patienten mit insgesamt 36 Lebermetastasen eines kolorektalen Karzinoms durchgeführt. Je eine Metastase wurde mit perkutaner Tumorablation mit ILT und je eine mit CTGB behandelt. Bei den Patienten mit identischer Tumorhistologie wurden folgende Faktoren betrachtet: 1. Tumorgröße ≤ 5 cm und 2. Durchführung oder Verzicht auf eine adjuvante Chemotherapie. Als primärer Endpunkt wurde die lokale Tumorkontrolle definiert.Ergebnisse:Die Verteilung der Tumorgrößen war gleich, und alle Patienten erreichten volle Übereinstimmung bis auf den Vergleichsfaktor der adjuvanten Chemotherapie. Die mediane Beobachtungszeit betrug 14 Monate (3–24 Monate) für beide Gruppen. Fünf von 18 Patienten (28%) hatten eine lokale Tumorprogression nach CTGB und zehn von 18 Patienten (56%) nach ILT. Die Differenz zwischen den Gruppen war für alle Patienten signifikant (p = 0,04). Bei der Betrachtung der Patienten mit völliger Übereinstimmung wurde die Signifikanzgrenze nicht erreicht (p = 0,23).Schlussfolgerung:Die CTGB zeigt in der Langzeitbeobachtung überlegene lokale Tumorkontrollraten im Vergleich zur ILT.

Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imaging

BackgroundThe aim was to compare the return-to-sports-time (RTST) following stress fractures on the basis of site and severity of injury. This retrospective study was set up at a single institution. Diagnosis was confirmed by an interdisciplinary adjudication panel and images were rated in a blinded-read setting.Methods52 athletes (female, n = 30; male, n = 22; mean age, 22.8 years) with stress fracture (SFX) who had undergone at least one examination, either MRI or bone scintigraphy, were included. Magnetic resonance images (MRI) and/or bone scintigraphy (BS) of SFX were classified as either low- or high-grade SFX, according to existing grading systems. For MRI, high-grade SFX was defined as visibility of a fracture line or bone marrow edema in T1-, T2-weighted and short tau inversion recovery (STIR) sequences, with low-grade SFX showing no fracture line and bone marrow edema only in STIR and/or T2-weighted sequences. In BS images, a mild and poorly defined focal tracer uptake represented a low-grade lesion, whereas an intense and sharply marginated uptake marked a high-grade SFX. In addition, all injuries were categorized by location as high- or low-risk stress fractures. RTST was obtained from the clinical records. All patients were treated according to a non-weight-bearing treatment plan and comprehensive follow-up data was complete until full recovery. Two-sided Wilcoxon’s rank sum test was used for group comparisons.ResultsHigh-risk SFX had a mean RTST of 132 days (d) [IQR 64d – 132d] compared to 119d [IQR 50d – 110d] for low-risk sites (p = 0.19). RTST was significantly longer (p = 0.01) in high-grade lesions [mean, 143d; IQR 66d – 134d] than in low-grade [mean, 95d; IQR 42d – 94d]. Analysis of high-risk SFX showed no difference in RTST (p = 0.45) between high- and low-grade [mean, 131d; IQR 72d – 123d vs. mean, 135d; IQR 63d – 132d]. In contrast, the difference was significant for low-risk SFX (p = 0.005) [low-grade; mean, 61d; IQR 35d – 78d vs. high-grade; mean, 153d; IQR 64d – 164d].ConclusionFor SFX at low-risk sites, the significant difference in RTST between low- and high-grade lesions allows more accurate estimation of RTST by this approach. Both location of the injury and severity determined by imaging should therefore be considered for prediction of RTST.

Radiotherapy of Liver Metastases

Purpose:To assess differences in delineated target volumes of liver metastases using contrast-enhanced CT and different MRI sequences for radiation treatment planning.Patients and Methods:25 patients with 43 colorectal liver metastases were recruited. Tumor margins were defined by two experienced radiologists. The resulting D90 was assessed and the CT-based 3-D dose distribution merged with the according MRI dataset by employing image fusion. A theoretical D90 as a result of MRI-based treatment planning was assessed for various MRI sequences individually.Results:In venous phase contrast-enhanced CT, the mean tumor volume was 20 ml; T1-weighted (T1w) MRI, 27 ml; contrast-enhanced T1w 42 ml; T2w 65 ml. The difference between the target volumes as assessed by either CT or MRI was 181% for T1w images, 178% for contrast-enhanced T1w, and 246% for T2w sequences. All differences were statistically significant (p < 0.05).The analysis of the dose-volume histograms revealed statistically significant differences (i.e., for the D90) for the different target volumes specified by CT and MRI: mean D90 on CT, 18 Gy; plain T1w, 16 Gy; contrast-enhanced T1w, 15.5 Gy; T2w, 12 Gy. Hence, delineation of a larger target volume in T2w MRI compared to contrast-enhanced CT resulted in a smaller D90.The mean differences of tumor volumes assessed by CT and plain T1w were significantly higher in the group of patients showing local tumor recurrences as compared to patients with long-term local tumor control (p = 0.002).Conclusion:For treatment planning of liver metastases, the use of either plain T1w or T2w sequences is recommended to delineate the clinical target volume as completely as possible and not to miss potential tumor cell congregations in the surroundings as in CT.Ziel:Beurteilung von Unterschieden in der Abgrenzung von Zielvolumina bei kontrastmittelverstärkter CT- und MRT-gestützter Bestrahlungsplanung.Patienten und Methodik:25 Patienten mit 43 Lebermetastasen kolorektalen Ursprungs wurden in dieser Studie untersucht. Zur Definition der Zielvolumina wurden CT- und MRT-Untersuchungen verwendet, die Konturierung der Tumorränder wurde von zwei erfahrenen Radiologen vorgenommen. Die D90 wurde nach Bildfusionierung der CT-basierten dreidimensionalen Dosisverteilungen mit den MRT-Datensätzen beurteilt. Eine theoretische D90 als Resultat der MRT-basierten Bestrahlungsplanung wurde bestimmt.Ergebnisse:In der venösen Phase der kontrastmittelverstärkten CT-Untersuchung betrug das mittlere Tumorvolumen 20 ml; MRT T1-gewichtet (T1w) 27 ml; kontrastmittelverstärkte T1w 42 ml; T2w 65 ml. Die Unterschiede der Zielvolumina im Verhältnis zur CT-gestützten Planung betrugen 181% für T1w-, 178% für kontrastmittelverstärkte T1w- und 246% für T2w-Sequenzen. Alle Unterschiede stellten sich als signifikant heraus (p < 0,05). Im Vergleich zur kontrastmittelverstärkten CT resultierte somit das Bemessen des Tumorvolumens im T2w MRT in einer niedrigeren D90.Die Analyse der Dosis-Volumen-Histogramme zeigte signifikante Unterschiede der verschiedenen Volumina. Die mittlere D90 betrug bei CT 18 Gy, bei nativer T1w 16 Gy, bei kontrastmittelverstärkter T1w 15,5 Gy und bei T2w 12 Gy.Die mittleren Unterschiede des Zielvolumens durch CT- und native T1w-gestützte MRT-Bestrahlungsplanung waren in der Gruppe der Patienten mit lokalen Tumorrezidiven signifikant höher als in der Gruppe mit langfristiger lokaler Kontrolle (p = 0,002).Schlussfolgerung:Für die Bestrahlungsplanung der Therapie von Lebermetastasen wird die Verwendung von nativen T1w- oder T2w-Sequenzen zur Abgrenzung des Zielvolumens empfohlen, um eine möglichst vollständige Erfassung der Metastase einschließlich evtl. vorhandener peripherer Tumorausläufer zu erreichen.

CT-Guided Brachytherapy (CTGB) versus Interstitial Laser Ablation (ILT) of Colorectal Liver Metastases

Purpose:To compare local tumor control after percutaneous tumor ablation by interstitial laser therapy (ILT) or CT-guided brachytherapy (CTGB).Patients and Methods:In a matched pair analysis including 18 patients with 36 liver metastases of colorectal primary, both ILT and CTGB were performed in different lesions. The following matching factors were considered: (i) tumor size ≤ 5 cm, and (ii) execution of chemotherapy after tumor ablation. Primary endpoint was local tumor control.Results:Treated lesions were identical in terms of tumor size and all matching criteria were fulfilled in all patients except for the performance of adjuvant chemotherapy. Median follow-up was 14 months (3–24 months) for both groups. Only five of 18 patients (28%) demonstrated local tumor progression after CTGB, whereas in ten of 18 patients (56%) tumor progression was found after ILT. Differences encountered were significant for all patients (p = 0.04), whereas in those who fulfilled all matching criteria (n = 14) the level of statistical significance was not reached (p = 0.23).Conclusion:CTGB demonstrated superior local tumor control compared to ILT in long-term follow-up.Ziel:Intraindividueller Vergleich lokaler Kontrollraten nach perkutaner Tumorablation mit interstitieller Lasertherapie (ILT) oder CT-gestützter Brachytherapie (CTGB) von intrahepatischen Metastasen bei kolorektalem Karzinom.Patienten und Methodik:Eine Matched-Pair-Analyse wurde bei 18 Patienten mit insgesamt 36 Lebermetastasen eines kolorektalen Karzinoms durchgeführt. Je eine Metastase wurde mit perkutaner Tumorablation mit ILT und je eine mit CTGB behandelt. Bei den Patienten mit identischer Tumorhistologie wurden folgende Faktoren betrachtet: 1. Tumorgröße ≤ 5 cm und 2. Durchführung oder Verzicht auf eine adjuvante Chemotherapie. Als primärer Endpunkt wurde die lokale Tumorkontrolle definiert.Ergebnisse:Die Verteilung der Tumorgrößen war gleich, und alle Patienten erreichten volle Übereinstimmung bis auf den Vergleichsfaktor der adjuvanten Chemotherapie. Die mediane Beobachtungszeit betrug 14 Monate (3–24 Monate) für beide Gruppen. Fünf von 18 Patienten (28%) hatten eine lokale Tumorprogression nach CTGB und zehn von 18 Patienten (56%) nach ILT. Die Differenz zwischen den Gruppen war für alle Patienten signifikant (p = 0,04). Bei der Betrachtung der Patienten mit völliger Übereinstimmung wurde die Signifikanzgrenze nicht erreicht (p = 0,23).Schlussfolgerung:Die CTGB zeigt in der Langzeitbeobachtung überlegene lokale Tumorkontrollraten im Vergleich zur ILT.

Local arterial infusion of superparamagnetic iron oxide particles in hepatocellular carcinoma: A feasibility and 3.0 T MRI study.

Objectives:We sought to prove feasibility of selective arterial infusion of superparamagnetic iron oxide (SPIO) particles in patients with hepatocellular carcinoma (HCC). Materials and Methods:We studied 13 patients with HCC who underwent modified transarterial chemoembolization (TACE). Six patients received concurrent infusion of Ferucarbotran (Resovist, Schering, Berlin, Germany) in tumor-feeding arteries, and another 6 received MFL AS (MagForce, Nanotechnologies, Berlin, Germany). The iron content of both dispersions was 3.92 mg. One patient served as a control. All patients underwent magnetic resonance imaging (MRI) as baseline and immediate follow-up investigation. Results:Selective arterial infusion of both SPIO particles resulted in significant intratumoral signal intensity decrease on T1-weighted sequences (P < 0.0001), which was greater after MagForce infusion compared with Resovist (P = 0.002). Only minimal amounts of dispersed particles were found in adjacent normal liver parenchyma. No change in intratumoral signal intensity was noted when ferromagnetic particles were omitted. Conclusions:Modified TACE with selective arterial infusion of SPIO particles can be used for precise tumor targeting in patients with HCC, for which MagForce appeared superior to Resovist.