Dynamic Phase Imaging Research Articles

Hepatocellular Carcinoma: Imaging Patterns on Gadoxetic Acid–enhanced MR Images and Their Value as an Imaging Biomarker

To investigate the patterns of imaging appearance of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance (MR) images and to assess their potential value as prognostic markers of HCC associated with tumor recurrence after surgery. The institutional review board approved this retrospective study and informed consent was waived. A total of 216 patients with 304 pathologically proved HCCs underwent gadoxetic acid-enhanced MR imaging prior to surgery and were included in the study. Two reviewers, blinded to the clinical data, evaluated in consensus the imaging patterns of HCC according to enhancement patterns on dynamic phase images and signal intensity on hepatobiliary phase (HBP) images. The association of imaging features with clinical-pathologic findings was evaluated by using the Student t test, χ(2) test, Mann-Whitney U test, and linear-by-linear association. The dependence of time to tumor recurrence (TTR) after surgery was evaluated by using the Kaplan-Meier method, log-rank test, and Cox proportional hazard model. HCCs with atypical enhancement pattern (P = .0167, P = .0450, P < .0001, respectively) and iso- to hyperintensity on HBP images (P = .0001, P = .0002, P < .0001, respectively) had smaller tumor size, lower histologic grade, and worse Child-Pugh class. The log-rank test (P = .0064) and Cox proportional hazards model (hazard ratio, 5.676; P = .0158) revealed that HCCs with iso- to hyperintensity on HBP images had significantly longer TTR than HCCs with hypointensity on HBP images. HCCs can be classified into several imaging patterns on gadoxetic acid-enhanced MR images, which are associated with tumor aggressiveness and outcome. In addition, iso- to hyperintensity on HBP images may be a useful imaging biomarker to indicate longer TTR after surgery. .

Dynamics of cellular response to hypotonic stimulation revealed by quantitative phase microscopy and multi-fractal detrended fluctuation analysis

Hypotonic stimulation is known to cause morphological changes in cells and also leads to modulation of cellular physiology. In order to evaluate the dynamics of cellular response to hypotonic stimulation, we utilized digital holographic microscopy for quantitative phase microscopy, achieved by a common-path interferometry geometry based on extraction of reference beam by spatial-filtering. Results from live cell investigations demonstrate the capability of this method for dynamic quantitative phase imaging. Further, wavelet and multi-fractal detrended fluctuation analysis revealed that the dynamic phase changes, in response to hypotonic stimulation, are multifractal in nature.

Dynamic quantitative phase imaging for biological objects using a pixelated phase mask

This paper describes research in developing a dynamic quantitative phase imaging microscope providing instantaneous measurements of dynamic motions within and among live cells without labels or contrast agents. It utilizes a pixelated phase mask enabling simultaneous measurement of multiple interference patterns derived using the polarization properties of light to track dynamic motions and morphological changes. Optical path difference (OPD) and optical thickness (OT) data are obtained from phase images. Two different processing routines are presented to remove background surface shape to enable quantification of changes in cell position and volume over time. Data from a number of different moving biological organisms and cell cultures are presented.

Intrahepatic Mass-forming Cholangiocarcinoma: Enhancement Patterns on Gadoxetic Acid–enhanced MR Images

To evaluate the enhancement patterns of intrahepatic mass-forming cholangiocarcinomas (IMCCs) with emphasis on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) imaging. This retrospective study was institutional review board approved, and the requirement for informed consent was waived. Fifty patients (41 men, nine women; mean age, 62.3 years; range, 44-76 years) with IMCC underwent unenhanced and gadoxetic acid-enhanced T1- and T2-weighted MR imaging including dynamic phase and hepatobiliary phase imaging between May 2008 and December 2010. Signal intensity and enhancement patterns of lesions were compared with those of the liver parenchyma in each phase. Conspicuity and margin sharpness of lesions on dynamic phase and HBP images were rated on a 4- or 5-point scale and compared by using the Wilcoxon signed-rank test. Percentage of relative enhancement was compared among pathologic subgroups by using the unpaired Student t test. On dynamic phase images, 29 of 48 (60%) lesions showed a thin peripheral rim with centripetal or gradual progression. On HBP images, 48 of 50 (96%) IMCCs were hypointense, and two of 50 (4%) were hyperintense. Subjective ratings of conspicuity and margin sharpness were significantly higher on HBP (median scores, 5 and 4, respectively) (P < .001) than on the dynamic phase (median scores, 4 and 3, respectively) images (P < .001). Additional daughter nodules were found in five patients and intrahepatic metastasis was found in one. Percentage of relative enhancement on HBP images was significantly higher in moderately differentiated (66.4% ± 42.1) than in poorly differentiated (36.84% ± 21.5) tumors (P = .039) and in patients without (59.7% ± 28.8) than in those with (24.9% ± 14.7) (P = .036) lymph node metastasis. The most prevalent enhancement pattern on gadoxetic acid-enhanced MR images of IMCCs was a thin peripheral rim with internal heterogeneous enhancement during the dynamic phase. HBP images showed increased lesion conspicuity and better delineation of daughter nodules and intrahepatic metastasis, which may aid in the diagnosis of IMCC.

Hepatocellular Adenoma and Focal Nodular Hyperplasia: Value of Gadoxetic Acid–enhanced MR Imaging in Differential Diagnosis

To retrospectively evaluate the utility of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the differential diagnosis of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH). This study had institutional review board approval; the requirement for informed consent was waived. Eighty-two patients (58 patients with FNH and 24 patients with HCAs) with 111 lesions were included in the study. There were 74 female patients and eight male patients (mean age, 41.9 years±13.2 [standard deviation]; age range, 11-78 years). Two readers reviewed all images in terms of signal intensity (SI) features on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), and SI ratio on dynamic and hepatobiliary phase images were calculated. The CER of FNH in the arterial phase (mean, 94.3%±33.2) was significantly higher than that of HCAs (mean, 59.3%±28.1) (P<.0001). During the hepatobiliary phase, the LLC of FNH showed minimally positive values (mean, 0.05±0.01) and that of HCAs demonstrated strong negative values (mean, -0.67±0.24) (P<.0001). The area under the receiver operating characteristic curve of the hepatobiliary phase SI ratio for differentiation of the two tumors was 0.97, and a sensitivity of 92% and specificity of 91% were found with a cutoff value of 0.87. Among six FNH lesions that showed atypical hypointensity during the hepatobiliary phase, four had a large central scar, one contained a substantial fat component, and one had abundant radiating fibrous septa. Three HCAs were isointense during the hepatobiliary phase owing to severe hepatic steatosis. Gadoxetic acid-enhanced MR imaging facilitates the differentiation of FNH from HCA.

Real-time quantitative phase imaging with a spatial phase-shifting algorithm

This Letter reports on the use of a spatial phase-shifting algorithm in a fast, straightforward method of real-time quantitative phase imaging. The computation time for phase extraction is five times faster than a Fourier transform and twice as fast as a Hilbert transform. The fact that the phase extraction from an interferogram of 512 × 512 pixels takes less than 8.93 ms with a typical desktop computer suggests the proposed method can be readily applied to high-speed dynamic quantitative phase imaging. The proposed method of quantitative phase imaging is effective and sufficiently general for application to the dynamic phenomena of biological samples.

Hypervascular hepatocellular carcinomas: detection with gadoxetate disodium-enhanced MR imaging and multiphasic multidetector CT

To retrospectively compare the accuracy of detection of hypervascular hepatocellular carcinoma (HCC) by multiphasic multidetector CT and by gadoxetate disodium-enhanced MR imaging. After ethical approval, we analysed a total of 73 hypervascular HCC lesions from 31 patients suspected of having HCC, who underwent both gadoxetate disodium-enhanced MR imaging and multiphasic multidetector CT. Five blinded observers independently reviewed CT images, as well as dynamic MR images alone and combined with hepatobiliary phase MR images. Diagnostic accuracy (Az values), sensitivities and positive predictive values were compared by using the Scheffe post hoc test. The mean Az value for dynamic and hepatobiliary phase MR combined (0.81) or dynamic MR images alone (0.78) was significantly higher than that for CT images (0.67, P < 0.001, 0.005, respectively). The mean sensitivity of the combined MR images (0.67) was significantly higher than that of dynamic MR alone (0.52, P < 0.05) or CT images (0.44, P < 0.05). The mean positive predictive values were 0.96, 0.95 and 0.94, for CT, dynamic MR alone and combined MR images, respectively. Compared with multiphasic multidetector CT, gadoxetate disodium-enhanced MR imaging combining dynamic and hepatobiliary phase images results in significantly improved sensitivity and diagnostic accuracy for detection of hypervascular HCC. Gadoxetate disodium is a new liver-specific MR imaging contrast agent. Gadoxetate disodium-enhanced MRI helps the assessment of patients with liver disease. It showed high diagnostic accuracy for the detection of hepatocellular carcinoma.

Optimized high‐resolution contrast‐enhanced hepatobiliary imaging at 3 tesla: A cross‐over comparison of gadobenate dimeglumine and gadoxetic acid

To evaluate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) performance of 0.05 mmol/kg gadoxetic acid and 0.1 mmol/kg gadobenate dimeglumine for dynamic and hepatobiliary phase imaging. In addition, flip angles (FA) that maximize relative contrast-to-noise performance for hepatobiliary phase imaging were determined. A cross-over study in 10 volunteers was performed using each agent. Imaging was performed at 3 Tesla (T) with a 32-channel phased-array coil using breathheld 3D spoiled gradient echo sequences for SNR and CNR analysis, and for FA optimization of hepatobiliary phase imaging. Gadobenate dimeglumine (0.1 mmol/kg) had superior SNR performance during the dynamic phase, statistically significant for portal vein and hepatic vein in the portal venous and venous phase (for all, P < 0.05) despite twice the approved dose of gadoxetic acid (0.05 mmol/kg), while gadoxetic acid had superior SNR performance during the hepatobiliary phase. Optimal FAs for hepatobiliary phase imaging using gadoxetic acid and gadobenate dimeglumine were 25-30° and 20-30° for relative contrast liver versus muscle (surrogate for nonhepatocellular tissues), and 45° and 20° (relative contrast liver versus biliary structures), respectively. Gadobenate dimeglumine may be preferable for applications that require dynamic phase imaging only, while gadoxetic acid may be preferable when the hepatobiliary phase is clinically important. Hepatobiliary phase imaging with both agents benefits from flip angle optimization.

Gadoxetate Acid-Enhanced MR Imaging for HCC: A Review for Clinicians

Hepatocellular carcinoma (HCC) is increasingly being detected at an earlier stage, owing to the screening programs and regular imaging follow-up in high-risk populations. Small HCCs still pose diagnostic challenges on imaging due to decreased sensitivity and increased frequency of atypical features. Differentiating early HCC from premalignant or benign nodules is important as management differs and has implications on both the quality of life and the overall survival for the patients. Gadoxetate acid (Gd-EOB-DTPA, Primovist®, Bayer Schering Pharma) is a relatively new, safe and well-tolerated liver-specific contrast agent for magnetic resonance (MR) imaging of the liver that has combined perfusion- and hepatocyte-specific properties, allowing for the acquisition of both dynamic and hepatobiliary phase images. Its high biliary uptake and excretion improves lesion detection and characterization by increasing liver-to-lesion conspicuity in the added hepatobiliary phase imaging. To date, gadoxetate acid-enhanced MRI has been mostly shown to be superior to unenhanced MRI, computed tomography, and other types of contrast agents in the detection and characterization of liver lesions. This review article focuses on the evolving role of gadoxetate acid in the characterization of HCC, differentiating it from other mimickers of HCC.

Consensus Report of the Third International Forum for Liver Magnetic Resonance Imaging

This consensus report arises from the discussions at the Third International Forum for Liver Magnetic Resonance Imaging, at which attendees evaluated the use of the hepatocyte-specific contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA, Primovist, Bayer Schering Pharma, Berlin, Germany; Eovist, Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ; EOB-Primovist, Bayer Schering Pharma, Osaka, Japan). The impact of Gd-EOB-DTPA uptake by hepatocytes on the enhancement pattern, compared with dynamic imaging with extracellular contrast media, and its value in diagnostic confidence were discussed. Although the dynamic-phase images of typical cavernous hemangiomas are comparable using Gd-EOB-DTPA and gadolinium-based extracellular contrast media, such lesions appear hypointense during the hepatobiliary phase with Gd-EOB-DTPA. The rapid uptake of Gd-EOB-DTPA by hepatocytes results in lesions of hepatocellular origin already appearing hyperintense during the late-dynamic-phase imaging. Focal nodular hyperplasia can be detected with confidence using Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, information on the appearance of the Gd-EOB-DTPA-enhanced images of hepatic adenomas in the hepatobiliary phase is limited. Published data support the use of Gd-EOB-DTPA-enhanced MRI for diagnosis of liver metastases. However, some diagnostic algorithms do not address recent advances in imaging technology and fail to recognize the role of Gd-EOB-DTPA in the detection of hepatocellular carcinoma and its ability to distinguish between benign and malignant lesions. Beyond its approved use for the detection and characterization of liver lesions in adults with known or suspected focal liver disease, Gd-EOB-DTPA has the potential to be used in the assessment of liver function and the examination of the biliary system.

Detection of Small Hepatocellular Carcinoma

To investigate whether gadoxetic acid-enhanced magnetic resonance imaging (MRI) has the diagnostic capability and sensitivity comparable to the combination of gadopentetate dimeglumine-enhanced MRI and superparamagnetic iron oxide-enhanced MRI (double-contrast MRI) in the detection of small hepatocellular carcinomas (HCCs). Forty-one patients with 56 HCCs (size range, 0.5-2.0 cm) who underwent gadoxetic acid-enhanced MRI and double-contrast MRI with a mean interval of 4 days (range, 3-9 days) were included in this study. HCCs were diagnosed by histology (n = 25) and imaging findings (n = 31). Two observers independently reviewed the gadoxetic acid set (unenhanced, early dynamic, and hepatocyte phase images) and the double-contrast MRI set, at an initial reading session, and then reached consensus. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operator characteristic method. Diagnostic accuracy (AZ) and sensitivity were similar for both image sets (0.955, 83.9% for gadoxetic acid set; 0.952, 80.4% for double-contrast MRI set) (P > 0.05). There were 5 and 3 HCCs that were verified only on the gadoxetic acid set and double-contrast MRI set, respectively. All 9 HCCs that were not verified on the gadoxetic acid set were assigned a low confidence rating of 1 or 2. However, 3 of the 11 HCCs, which were not verified on double-contrast MRI, were not seen even upon retrospective review. Gadoxetic acid-enhanced MRI can replace double-contrast MRI for the detection of HCCs. Because all HCCs were delineated on gadoxetic acid-enhanced MRI, even with a low confidence rating, and 3 HCCs were not seen on double-contrast MRI, gadoxetic acid-enhanced MRI could be more advantageous than double-contrast MRI for HCC work-up.

Hepatic Hemangioma and Metastasis: Differentiation With Gadoxetate Disodium–Enhanced 3-T MRI

The purpose of this study was to evaluate the gadoxetate disodium-enhanced MRI findings of hepatic hemangioma and to investigate the diagnostic performance in differentiating hepatic hemangioma and metastasis. Images of 32 hepatic hemangiomas in 25 patients and of 29 hepatic metastatic lesions in 20 patients were retrospectively reviewed. Two independent readers interpreted hepatobiliary phase images alone, dynamic extracellular phase images alone, and combined hepatobiliary and dynamic extracellular phase images. MRI findings and performance with respect to the differential diagnosis of hemangioma and metastasis were assessed. During the hepatic arterial phase, 11 of the 32 hemangiomas (34%) exhibited early total enhancement, and nine (28%) exhibited peripheral nodular enhancement. A bright dot sign or minimal peripheral enhancement during the late dynamic phase was observed for a small number of lesions (6% and 28%, respectively). Twenty-three of the 29 metastatic lesions (79%) exhibited ring enhancement during the hepatic arterial phase. Twenty-nine hemangiomas (91%) and all of the metastatic lesions exhibited homogeneous or heterogeneous hypointensity during the hepatobiliary phase. The sensitivity, specificity, and area under the receiver operating characteristic curve for the detection of hemangioma were 76%, 81%, and 0.87 for the hepatobiliary phase alone; 97%, 88%, and 0.97 for the dynamic extracellular phase alone; and 97%, 88%, and 0.98 for the combination. Five nodules smaller than 1 cm (four hemangiomas, one metastatic lesion) that exhibited no enhancement during the arterial phase and minimal enhancement during the late dynamic phase were not differentiated. Gadoxetate disodium-enhanced MRI was found useful for differentiating hepatic hemangiomas and metastatic lesions, especially during the dynamic extracellular phase. Only a limited number of lesions smaller than 1 cm in diameter, which exhibited minimal enhancement on late dynamic phase images, were difficult to diagnose.

Gadoxetate Disodium–Enhanced MRI of the Liver: Part 1, Protocol Optimization and Lesion Appearance in the Noncirrhotic Liver

The purpose of this article is to review the pharmacokinetic and pharmacodynamic properties of gadoxetate disodium (Gd-EOB-DTPA), to describe a workflow-optimized pulse sequence protocol, and to illustrate the imaging appearance of focal lesions in the noncirrhotic liver. Gd-EOB-DTPA allows a comprehensive evaluation of the liver with the acquisition of both dynamic and hepatocyte phase images. This provides potential additional information, especially for the detection and characterization of small liver lesions. However, protocol optimization is necessary for improved image quality and workflow.

Solid Focal Liver Lesions: Dynamic and Late Enhancement Patterns with the Dual Phase Contrast Agent Gadobenate Dimeglumine

The purpose of this paper is to illustrate contrast enhancement patterns of solid focal liver lesions on dynamic and late phase imaging with gadobenate dimeglumine (Gd-BOPTA). Unenhanced T2- and T1-weighted, dynamic T1-weighted (arterial, portal-venous, and equilibrium) and late phase (1-3 h) Gd-BOPTA-enhanced MR imaging of different focal liver lesions (nodular regenerative hyperplasia, hepatic adenoma, liver adenomatosis, hepatocellular carcinoma, peripheral cholangiocarcinoma, hypervascular metastases, and hypovascular metastases) are shown. Dynamic imaging was performed using GRE T1-w sequences after the bolus injection of 0.1 mmol/kg Gd-BOPTA; late-phase imaging was obtained at 1-3 h after contrast injection. Dynamic imaging with Gd-BOPTA provides the same information as with conventional gadolinium-based extracellular contrast agents, while late-phase imaging gives additional information for lesion identification and characterization.

Detection of Hepatocellular Carcinoma

The aim of this study was to compare the diagnostic accuracy and sensitivity of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with multi-detector row computed tomography (MDCT) for the detection of hepatocellular carcinomas (HCCs). Sixty-two patients (81 HCCs) who underwent MDCT and gadoxetic acid-enhanced MRI using a 3-dimensional volumetric interpolated technique with a mean interval of 7 days (range, 3-11 days) were included in this study. Two observers reached a consensus on 2 sets of images: the gadoxetic acid set (unenhanced, early dynamic, 10-minute, and 20-minute hepatocyte phase images) and the 3-phase MDCT. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operating characteristic method. There was a trend toward increased area under the receiver operating characteristic curve (Az value) for the gadoxetic acid set (0.963) as compared with the MDCT (0.930), but no significant difference was found (P = 0.41). Sensitivity of the gadoxetic acid set (91.4%) was better than that of the MDCT (71.6%; P = 0.0001). There were 12 lesions that showed only arterial hypervascularization on MDCT but showed arterial hypervascularization and delayed hypointensity on the gadoxetic acid set. Gadoxetic acid-enhanced MRI, including hepatocyte phase imaging, is more sensitive than MDCT for the detection of HCCs.

Metastasis Versus Focal Eosinophilic Infiltration of the Liver in Patients With Extrahepatic Abdominal Cancer

To determine the performance of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal eosinophilic infiltration (FEI) from metastasis. Gadobenate dimeglumine-enhanced MRI conducted in 38 patients (lesions of 43 metastases and 33 FEIs) with extrahepatic abdominal carcinoma were reviewed retrospectively. Images were divided into 2 sets. Set 1 was composed of precontrast MRI with dynamic phase images. Set 2 included hepatobiliary phase images in addition to the images of set 1. Two blinded radiologists independently categorized each set of images into 5 grades to differentiate metastases from FEI. The area under the receiver operating characteristic curve (Az) was calculated for each set of images. The observers evaluated the shape, signal intensity (SI), and enhancement pattern of the lesions in consensus. The Az values for set 2 images (reader 1: 0.976, and reader 2: 0.743) were greater than those of set 1 (0.961 and 0.709), without statistical significance (P = 0.470 and 0.223). Target appearance was seen in 27 of 43 (63%) metastases on hepatobiliary phase imaging, but none on the FEI. Twenty-five (76%) of the 33 FEIs showed intermingled hypo-SI and iso-SI on hepatobiliary phase images with changing size and shape compared to the T2-weighted images, whereas none of the metastases did. Gadobenate dimeglumine-enhanced MRI may assist in the differentiation of FEI from metastasis by highlighting the distinctive features between them, even without hepatobiliary phase imaging.

Detection of Hepatocellular Carcinomas on Dynamic Phase Images Using Multi-detector CT: Comparison with Different Slice Thickness and Image Output

Detection of Hepatocellular Carcinomas on Dynamic Phase Images Using Multi-detector CT: Comparison with Different Slice Thickness and Image Output

Accurate Differentiation of Focal Nodular Hyperplasia from Hepatic Adenoma at Gadobenate Dimeglumine–enhanced MR Imaging: Prospective Study

To prospectively determine the accuracy of differentiating benign focal nodular hyperplasia (FNH) from hepatic adenoma (HA) and liver adenomatosis (LA) by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging. The ethics committee at each center approved the study, and all patients provided informed consent. Seventy-three patients with confirmed FNH and 35 patients with confirmed HA (n = 27) or LA (n = 8) underwent MR imaging before (T2-weighted half-Fourier rapid acquisition with relaxation enhancement or T2-weighted fast spin-echo and T1-weighted gradient-echo [GRE] sequences) and at 25-30 seconds (arterial phase), 70-90 seconds (portal venous phase), 3-5 minutes (equilibrium phase), and 1-3 hours (delayed phase) after (T1-weighted GRE sequences only, with or without fat suppression) bolus administration of 0.1 mmol per kilogram of body weight gadobenate dimeglumine. The enhancement of 235 lesions (128 FNH, 32 HA, and 75 LA lesions) relative to the normal liver parenchyma was assessed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for the differentiation of FNH from HA and LA were determined. Hyper- and isointensity on T2-weighted and iso- and hypointensity on T1-weighted GRE images were noted for 177 (88.9%) of 199 lesions visible on unenhanced images. On dynamic phase images after contrast material administration, 231 (98.3%) of 235 lesions showed rapid strong enhancement during the arterial phase and appeared hyper- to isointense during portal venous and equilibrium phases. Accurate differentiation of FNH from HA and LA was not possible on the basis of precontrast or dynamic phase images alone. At 1-3 hours after contrast material enhancement, 124 (96.9%) of 128 FNHs appeared hyper- or isointense, while 107 (100%) HA and LA lesions appeared hypointense. The sensitivity, specificity, PPV, NPV, and overall accuracy for the differentiation of FNH from HA and LA were 96.9%, 100%, 100%, 96.4%, and 98.3%, respectively. Accurate differentiation of FNH from HA and LA is achievable on delayed T1-weighted GRE images after administration of gadobenate dimeglumine.

Evaluation of gadobenate dimeglumine in hepatocellular carcinoma: results from phase II and phase III clinical trials in Japan.

To evaluate the clinical efficacy of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging for hepatocellular carcinoma (HCC), we reviewed the results of clinical phase II and III trials in Japan. Gd-BOPTA was administered at a dose of 0.1 mmol/kg to 139 patients who were suspected to have HCC. Dynamic phase images [breath-hold T1-weighted gradient echo (GRE)], spin-echo (SE) images obtained within 10 minutes of injection, and delayed breath-hold GRE images obtained 40-120 minutes after injection were evaluated. All post-contrast images were compared with T1- and T2-weighted pre-contrast images. The contrast efficacy for the dynamic study was classified as ( ) or (++) in 92.1% (128/139), in 43.1% (59/137) with SE within 10 minutes of injection, and in 43.2% (60/139) with breath-hold GRE at delayed phase. The increase in lesion-liver contrast-to-noise ratio was best at the arterial phase of dynamic breath-hold GRE. Liver signal-to-noise ratio showed a mean 52.3% increase in delayed phase. Additional information at delayed phase compared with images acquired within 10 minutes of injection (including the dynamic study) was classified as ( ) or (++) in 28.1% (39/139). With regard to safety, the overall incidence of adverse reactions was 5.0% (7/141) of the patients who were suspected to have HCC, all of whom recovered within 12 hours without any sequelae. No clinically important changes were observed in the blood and urine laboratory tests. It was concluded that Gd-BOPTA was well tolerated and effective in both dynamic study and delayed static imaging for the diagnosis of HCC.

Evaluation of gadobenate dimeglumine in hepatocellular carcinoma: Results from phase II and phase III clinical trials in Japan

To evaluate the clinical efficacy of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging for hepatocellular carcinoma (HCC), we reviewed the results of clinical phase II and III trials in Japan. Gd-BOPTA was administered at a dose of 0.1 mmol/kg to 139 patients who were suspected to have HCC. Dynamic phase images [breath-hold T1-weighted gradient echo (GRE)], spin-echo (SE) images obtained within 10 minutes of injection, and delayed breath-hold GRE images obtained 40–120 minutes after injection were evaluated. All post-contrast images were compared with T1- and T2-weighted pre-contrast images. The contrast efficacy for the dynamic study was classified as (+++) or (++) in 92.1% (128/139), in 43.1% (59/137) with SE within 10 minutes of injection, and in 43.2% (60/139) with breath-hold GRE at delayed phase. The increase in lesion-liver contrast-to-noise ratio was best at the arterial phase of dynamic breath-hold GRE. Liver signal-to-noise ratio showed a mean 52.3% increase in delayed phase. Additional information at delayed phase compared with images acquired within 10 minutes of injection (including the dynamic study) was classified as (+++) or (++) in 28.1% (39/139). With regard to safety, the overall incidence of adverse reactions was 5.0% (7/141) of the patients who were suspected to have HCC, all of whom recovered within 12 hours without any sequelae. No clinically important changes were observed in the blood and urine laboratory tests. It was concluded that Gd-BOPTA was well tolerated and effective in both dynamic study and delayed static imaging for the diagnosis of HCC. J. Magn. Reson. Imaging 1999;10:450–460. © 1999 Wiley-Liss, Inc.