Abstract
PurposeThe objective was to investigate the dynamic enhancement patterns in focal solid liver lesions after the administration of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) by means of dynamic magnetic resonance imaging (MRI) including hepatobiliary phase (HP) images 20 min after Gd-EOB-DTPA administration.Materials and MethodsNon-enhanced T1/T2-weighted as well as dynamic magnetic resonance (MR) images during the arterial phase (AP), the portal venous phase (PVP), the late phase (LP), and the HP (20 min) were obtained from 83 patients (54 male, 29 female, mean age 62.01 years) with focal solid liver lesions. MRI was conducted by means of a 1.5-T system for 63 patients with malignant liver lesions (HCCs: n = 34, metastases: n = 29) and for 20 patients with benign liver lesions (FNH lesions: n = 14, hemangiomas: n = 3, adenomas: n = 3). For quantitative analysis, signal-to-noise ratios (SNR), contrast enhancement ratios (CER), lesion-to-liver contrast ratios (LLC), and signal intensity (SI) ratios were measured.ResultsThe SNR of liver parenchyma significantly increased in each dynamic phase after Gd-EOB-DTPA administration compared to the SNR of non-enhanced images (p<0.001). The CER of HCCs and metastases significantly decreased between LP and HP images (p = 0.0011, p<0.0001). However, FNH lesions did not show any significant difference, whereas an increased CER was found in hemangiomas. The mean LLCs of FNH lesions were significantly higher than those of HCCs and metastases. The LLC values of hemangiomas remained negative during the entire time course, whereas the LLC of adenomas indicated hyperintensity from the AP to the LP. Furthermore, adenomas showed hypointensity in HP images.ConclusionGd-EOB-DTPA-enhanced MRI may help diagnose focal solid liver lesions by evaluating their enhancement patterns.
Highlights
The detection and correct differentiation of focal solid liver lesions still represents a challenge in daily clinical routine
The contrast enhancement ratios (CER) of hepatocellular carcinomas (HCC) and metastases significantly decreased between late phase (LP) and hepatobiliary phase (HP) images (p = 0.0011, p,0.0001)
The lesion-to-liver contrast ratios (LLC) values of hemangiomas remained negative during the entire time course, whereas the LLC of adenomas indicated hyperintensity from the arterial phase (AP) to the LP
Summary
The detection and correct differentiation of focal solid liver lesions still represents a challenge in daily clinical routine. Hepatocellular lesions with functioning bile ducts, such as focal nodular hyperplasia (FNH), exhibit iso- or hyperintensity during the hepatobiliary phase, whereas hepatocellular lesions without any bile ducts, such as adenomas (HCA) and most hepatocellular carcinomas (HCC), lack enhancement in the hepatobiliary phase [9,10,11]. These trials evaluated the qualitative appearance of focal solid liver lesions during Gd-EOBDTPA-enhanced MRI. Only very limited data exist both on the quantification of enhancement patterns of solid focal liver lesions after the injection of Gd-EOB-DTPA as well as on the potential to distinguish different lesions
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