Abstract
Aim: Investigation whether the signal intensity of hepatocellular carcinoma (HCC) on dynamic magnetic resonance imaging (MRI) with hepatocellular contrast medium (CM) correlates with the histologic malignancy grade and cytometric DNA index. Material and Methods: MRI at 1.5 T with hepatocellular CM Gd-DTPA-EOB of 63 patients (52 men, 11 women; 64.0 ± 8.5 years) with HCC in cirrhosis. SI of the tumor and liver tissue in sequences (T1, T1fs, T2fs, T1fs + CM (arterial, venous, late venous phase) were correlated like the asymmetry coefficient of the SI in the arterial and venous phases respective the native and late venous phases of the tumor with the histologic malignancy grade and DNA index indicating the grade of abnormal DNA steam line respective aneuploid DNA. Results: SI did not significantly correlate with the histologic malignancy grade or DNA index for precontrast or postcontrast images. There is a significant correlation for the asymmetry coefficient of the SI in the arterial and venous phases with the DNA-index (p values of 0.00089 (Pearson) and 0.0082 (Spearman). Conclusion: A highly arterialized hepatocellular carcinoma with rapid washout in the venous phase corresponds to a higher malignant potential. These findings suggest that the MR parameters investigated here may predict the malignant potential and prognosis of HCC before surgery.
Highlights
Magnetic resonance imaging (MRI) with contrast medium is currently the best imaging modality for the detection and characterization of hepatocellular carcinoma (HCC) [1,2]
Analysis by degree of HCC differentiation did not reveal any significant correlations for the standardized signal intensities on the unenhanced pulse sequences and the cytometric DNA index for any of the groups
We found no correlation between the MR signal intensities of HCCs on the pulse sequences investigated and the tumor stage or cytometric DNA index for nonenhanced images or the arterial, venous, or late venous phases of the dynamic series; we saw a tendency for increasing DNA indices to be associated with higher standardized signal intensities in the arterial phase and lower intensities in the venous phase
Summary
Magnetic resonance imaging (MRI) with contrast medium is currently the best imaging modality for the detection and characterization of hepatocellular carcinoma (HCC) [1,2]. It is based on the signal enhancement pattern after administration of contrast medium, extracellular or tissue-specific hepatobiliary agents [2]. Gd-EOB-DTPA (Primovist®, Bayer Healthcare, Berlin, Germany) is an MR contrast agent combining the properties of extracellular and hepatocellular agents This means that images can be acquired both in the dynamic phase when the contrast agent is still in the intravascular space and in the hepatobiliary phase when the agent is metabolized by the hepatocytes. Though, the use of morphologic imaging criteria allows adequate characterization of an intrahepatic tumor, and histologic confirmation of the diagnosis of HCC is generally not necessary before surgery
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