Enhancement of Focal Liver Lesions at Gadoxetic Acid–enhanced MR Imaging: Correlation with Histopathologic Findings and Spiral CT—Initial Observations

Abstract

To detect hepatocyte-selective enhancement of focal lesions with gadoxetic acid at magnetic resonance (MR) imaging and to correlate enhancement in hepatocyte-selective phases with histopathologic findings and in arterial and portal venous phases with biphasic computed tomographic (CT) findings. Study was supported by local ethics committee; all patients gave written informed consent. In 19 men and 14 women recruited in three clinical studies, histopathologic correlation and CT scans of 41 focal lesions (13 primary malignant lesions, 21 metastases, three adenomas, three cases of focal nodular hyperplasia [FNH], and one cystadenoma) and ultrasonographic confirmation of five cysts were available. MR was performed before and during arterial and portal venous phases and in hepatocyte-selective phases 10 and 20 minutes after injection of gadoxetic acid. Enhancement was evaluated in consensus by two observers. Enhancement pattern and morphologic features during arterial and portal venous phases were correlated between gadoxetic acid-enhanced MR and CT images by means of adjusted chi(2) test. Hepatocyte-selective uptake was observed 10 and 20 minutes after injection in FNH (three of three), adenoma (two of three), cystadenoma (one of one), and highly differentiated hepatocellular carcinoma (HCC [grade G1], two of four). Uptake was not detected in metastases (21 of 21), cholangiocarcinoma (three of three), combined hepatocellular cholangiocarcinoma (one of one), undifferentiated carcinoma (one of one), moderately or poorly differentiated HCC (grade G2-G3) (four of four), HCC (grade G1, two of four), adenoma with atypia (one of three), or cysts (five of five). During arterial and portal venous phases, there was high overall agreement rate of 0.963 between gadoxetic acid-enhanced MR and CT (simultaneous 95% confidence interval: 0.945, 0.981). Liver-specific enhancement of focal lesions is hepatocyte selective and correlates with various histopathologic diagnoses regarding presence of certain hepatocytic functions. Arterial and portal venous MR images obtained with gadoxetic acid are comparable to those of CT.