Abstract
BackgroundCorrect characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions.MethodsIn this retrospective trial 84 consecutive patients underwent Gd-EOB-DTPA-enhanced MR examinations. MRI was conducted for 64 patients with malignant focal hepatic lesions (34 hepatocellular carcinoma (HCC), 30 metastases) and for 20 patients with benign hepatic lesions (14 focal nodular hyperplasia (FNH), 3 adenoma, 3 hemangioma). Five radiologists independently reviewed three sets of MR images by means of a 5-point confidence scale from score 1 (definitely benign) to score 5 (definitely malignant): set 1: unenhanced images; set 2: unenhanced and Gd-EOB-DTPA-enhanced dynamic images; set 3: hepatobiliary phase images in addition to set 2. Accuracy was assessed by the alternative free-response receiver operating characteristic curve (Az) and the index of diagnostic performance was calculated.ResultsDiagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic images: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images increased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic performance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%).ConclusionsHepatobiliary phase images obtained after Gd-EOB-DTPA-enhanced dynamic MRI improve the differentiation of focal solid hepatic lesions.
Highlights
Correct characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance
Gd-EOB-DTPA is a hydrophilic, paramagnetic, highly water-soluble, and bolus-injectable Gd-DTPA derivate for T1-weighted magnetic resonance imaging (MRI) that allows the evaluation of delayed hepatocyte uptake and biliary excretion [8,9]
50% of the injected dose is taken up by functioning hepatocytes and excreted in bile compared to a hepatocellular uptake rate of 3% to 5% for gadobenate dimeglumine [10]
Summary
Correct characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions. The liver-specific hepatobiliary contrast agent Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA, gadoxetic acid disodium, Primovist, Schering, Berlin, Germany) has been introduced for hepatic MRI examinations. Gd-EOB-DTPA is a hydrophilic, paramagnetic, highly water-soluble, and bolus-injectable Gd-DTPA derivate for T1-weighted MRI that allows the evaluation of delayed hepatocyte uptake and biliary excretion [8,9]. 50% of the injected dose is taken up by functioning hepatocytes and excreted in bile compared to a hepatocellular uptake rate of 3% to 5% for gadobenate dimeglumine [10]
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