Abstract
ObjectivesTo compare 10-minute (min) delayed hepatocyte phase imaging (HPI) using a 30° flip angle (FA) (10m-FA30) and 20-min delayed HPI using a 10° FA (20m-FA10) or 30° FA (20m-FA30) in Gd-EOB-DTPA-enhanced MRI in patients with chronic hepatitis or cirrhosis, in terms of lesion-to-liver contrast-to-noise ratio (CNR) for hepatocellular carcinoma (HCC) and detection sensitivity for focal hepatic lesions (FHLs).Materials and MethodsOne hundred and four patients with 168 HCCs and 55 benign FHLs who underwent Gd-EOB-DTPA-enhanced MRI with 10m-FA30, 20m-FA10, and 20m-FA30 were enrolled. Patients were divided into two groups according to the Child-Pugh classification: group A with chronic hepatitis or Child-Pugh A cirrhosis and group B with Child-Pugh B or C cirrhosis. Lesion-to-liver CNR for HCCs was compared between 10m-FA30 and 20m-FA10 or 20m-FA30 for each group. The presence of FHLs was evaluated using a four-point scale by two independent reviewers, and the detection sensitivity was analyzed.ResultsIn group A, the CNR for HCCs (n = 86) on 10m-FA30 (165.8 ± 99.7) was significantly higher than that on 20m-FA10 (113.4 ± 71.4) and lower than that of 20m-FA30 (210.2 ± 129.3). However, there was no significant difference in the sensitivity of FHL detection between 10m-FA30 (mean 95.0% for two reviewers) and 20m-FA10 (94.7%) or 20m-FA30 (94.7%). In group B, the CNR (54.0 ± 36.4) for HCCs (n = 57) and the sensitivity (94.2%) of FHL detection for 10m-FA30 were significantly higher than those for 20m-FA10 (41.8 ± 36.4 and 80.8%, respectively) and were not different from those for 20m-FA30 (62.7 ± 44.4 and 93.3%, respectively).ConclusionThe diagnostic performance of 10m-FA30 was similar to or higher than 20m-FA10 or 20m-FA30 in both groups A and B. This finding indicates that 10m-FA30 could replace 20-min delayed HPI regardless of patient liver function and reduce the delay time by 10 minutes.
Highlights
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a liver-specific contrast agent for magnetic resonance imaging (MRI) that provides both dynamic imaging and static hepatocyte-specific imaging
There was no significant difference in the sensitivity of focal hepatic lesions (FHLs) detection between 10m-FA30 and 20m-FA10 (94.7%) or 20m-FA30 (94.7%)
Recent reports show that Gd-EOB-DTPA– enhanced MRI is highly sensitive for the detection of focal hepatic lesions (FHLs) such as hepatocellular carcinomas (HCCs) and metastatic tumors [1,2,3]
Summary
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a liver-specific contrast agent for magnetic resonance imaging (MRI) that provides both dynamic imaging and static hepatocyte-specific imaging. Recent reports show that Gd-EOB-DTPA– enhanced MRI is highly sensitive for the detection of focal hepatic lesions (FHLs) such as hepatocellular carcinomas (HCCs) and metastatic tumors [1,2,3]. Sufficient enhancement of liver parenchyma on hepatocyte phase imaging (HPI) from adequate Gd-EOB-DPTA uptake by hepatocytes is necessary to detect FHLs [4]. HPI is usually obtained 20-minute (min) after intravenous injection of Gd-EOB-DTPA [1, 5,6,7]. Ten-min delayed HPI may be sufficient for detection and characterization of FHLs, but has a significantly lower signal ratio or lesion-to-liver contrast-to-noise ratio (CNR) than 20-min delayed HPI [8, 10]
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