Gadobenate Dimeglumine-enhanced Magnetic Resonance Imaging Research Articles

The value of periportal hyperintensity sign from gadobenate dimeglumine-enhanced hepatobiliary phase MRI for predicting clinical outcomes in patients with decompensated cirrhosis

ObjectivesTo determine the value of periportal hyperintensity sign from gadobenate dimeglumine (Gd-BOPTA)-enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI) for predicting clinical outcomes in patients with decompensated cirrhosis.MethodsA total of 199 cirrhotic patients who underwent Gd-BOPTA-enhanced MRI were divided into control group (n = 56) and decompensated cirrhosis group (n = 143). The presence of periportal hyperintensity sign on HBP MRI was recorded. The Cox regression model was used to investigate the association between periportal hyperintensity sign and clinical outcomes.ResultsThere was a significant difference in the frequency of periportal hyperintensity sign on HBP between compensated and decompensated cirrhotic patients (p < 0.05). After a median follow-up of 29.0 months (range, 1.0–90.0 months), nine out of 143 patients (6.2%) with decompensated cirrhosis died. Periportal hyperintensity sign on HBP MRI was a significant risk factor for death (hazard ratio (HR) = 23.677; 95% confidence interval (CI) = 4.759–117.788; p = 0.0001), with an area under the curve (AUC) of 0.844 (95% CI = 0.774–0.899). Thirty patients (20.9%) developed further decompensation. Periportal hyperintensity sign on HBP MRI was also a significant risk factor for further decompensation (HR = 2.594; 95% CI = 1.140–5.903; p = 0.023).ConclusionsPeriportal hyperintensity sign from Gd-BOPTA-enhanced HBP MRI is valuable for predicting clinical outcomes in patients with decompensated cirrhosis.Critical relevance statementPeriportal hyperintensity sign from gadobenate dimeglumine-enhanced hepatobiliary phase magnetic resonance imaging is a new noninvasive method to predict clinical outcomes in patients with decompensated cirrhosis.Key points• There was a significant difference in the frequency of periportal hyperintensity sign on HBP between compensated and decompensated cirrhotic patients.• Periportal hyperintensity sign on the hepatobiliary phase was a significant risk factor for death in patients with decompensated cirrhosis.• Periportal hyperintensity sign on the hepatobiliary phase was a significant risk factor for further decompensation in patients with decompensated cirrhosis.Graphical

Peritumoural MRI radiomics signature of brain metastases can predict epidermal growth factor receptor mutation status in lung adenocarcinoma

To investigate whether magnetic resonance imaging (MRI) radiomics features of brain metastases (BMs) can predict epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma. Between June 2014 and December 2022, 58 histopathologically confirmed lung adenocarcinoma patients (27 with EGFR wild-type, 31 with EGFR mutation) who underwent gadobenate dimeglumine-enhanced brain MRI were recruited retrospectively. A total of 123 metastatic brain lesions were allocated randomly into the training cohort (n=86) and test cohort (n=37) at a ratio of 7:3. Radiomics models based on multi-sequence MRI images in different regions such as volume of interest (VOI)enhancing tumour, VOIwholetumour, VOIperitumour 1mm, VOIperitumour 3mm, and VOIperitumour 5mm were built. The optimal radiomics model was integrated into the clinical or radiological indicators to construct a fusion model through multivariable logistic regression analysis. The optimal radiomics model based on the VOIperitumour 1mm, a combination of nine features selected from the fluid-attenuated inversion recovery (FLAIR) sequence, yielded areas under the curves (AUCs) of >0.75 in the training and test cohorts. The prediction of the fusion model with integration of clinical factors (age) and radiomics score (the optimal radiomics model) was not better than that of the optimal radiomics model alone in the test cohort (AUC: 0.808 and 0.785, respectively, p=0.525). The FLAIR radiomics model based on VOIperitumour 1mm as an effective biomarker helps predict EGFR mutation status in lung adenocarcinoma patients with BMs and then assists clinicians in selecting optimal treatment strategies.

Preoperative radiomics model using gadobenate dimeglumine-enhanced magnetic resonance imaging for predicting β-catenin mutation in patients with hepatocellular carcinoma: A retrospective study.

ObjectiveTo compare and evaluate radiomics models to preoperatively predict β-catenin mutation in patients with hepatocellular carcinoma (HCC).MethodsNinety-eight patients who underwent preoperative gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI were retrospectively included. Volumes of interest were manually delineated on arterial phase, portal venous phase, delay phase, and hepatobiliary phase (HBP) images. Radiomics features extracted from different combinations of imaging phases were analyzed and validated. A linear support vector classifier was applied to develop different models.ResultsAmong all 15 types of radiomics models, the model with the best performance was seen in the RHBP radiomics model. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity of the RHBP radiomics model in the training and validation cohorts were 0.86 (95% confidence interval [CI], 0.75–0.93), 0.75, 1.0, and 0.65 and 0.82 (95% CI, 0.63–0.93), 0.73, 0.67, and 0.76, respectively. The combined model integrated radiomics features in the RHBP radiomics model, and signatures in the clinical model did not improve further compared to the single HBP radiomics model with AUCs of 0.86 and 0.76. Good calibration for the best RHBP radiomics model was displayed in both cohorts; the decision curve showed that the net benefit could achieve 0.15. The most important radiomics features were low and high gray-level zone emphases based on gray-level size zone matrix with the same Shapley additive explanation values of 0.424.ConclusionThe RHBP radiomics model may be used as an effective model indicative of HCCs with β-catenin mutation preoperatively and thus could guide personalized medicine.

Quantitative parameters obtained from gadobenate dimeglumine-enhanced MRI at the hepatobiliary phase can predict post-hepatectomy liver failure and overall survival in patients with hepatocellular carcinoma

PurposeTo determine the value of the quantitative parameters obtained from gadobenate dimeglumine-enhanced magnetic resonance imaging (MRI) at the hepatobiliary phase for predicting post-hepatectomy liver failure and overall survival in patients with hepatocellular carcinoma. MethodThis multicenter retrospective study included 307 patients who underwent gadobenate dimeglumine-enhanced MRI. The quantitative liver-to-portal vein contrast ratio (LPC) and liver-spleen contrast ratio (LSC) at the hepatobiliary phase were measured. Logistic regression analyses were used to evaluate risk factors for post-hepatectomy liver failure. The capacity of the LPC and LSC to predict post-hepatectomy liver failure was evaluated via receiver operating characteristic (ROC) curve. The Cox proportional hazards regression was used to identify prognostic factors for overall survival (OS). ResultsPost-hepatectomy liver failure was observed in 69 patients (22.5%). The LPC and LSC were independent risk factors for the development of post-hepatectomy liver failure, and the areas under the ROC curves of LPC and LSC were 0.882 and 0.782, respectively. The predictive performance of LPC for post-hepatectomy liver failure was superior to LSC. The LPC and LSC were also significant prognostic factors for OS. The cut-off values for the LPC and LSC were 1.07 and 0.89, respectively. The 5-year OS rate was higher in patients with LPC > 1.07 or LSC > 0.89 than in patients with LPC ≤ 1.07 or LSC ≤ 0.89. ConclusionsThe quantitative parameters obtained from gadobenate dimeglumine-enhanced MRI at the hepatobiliary phase were effective imaging biomarkers for predicting both post-hepatectomy liver failure and overall survival in patients with hepatocellular carcinoma.

Differentiating Between an Atypical Hepatic Abscess and Tumor Metastasis Using Magnetic Resonance Imaging and Hepatobiliary Phase Imaging.

ObjectiveTo identify diffusion-weighted imaging (DWI) patterns and conspicuity discrepancies on hepatobiliary phase imaging (HBPI) to distinguish atypical hepatic abscesses from hepatic metastases.Materials and MethodsThis retrospective study recruited 31 patients with 43 atypical hepatic abscesses and 32 patients with 35 hepatic metastases who underwent gadobenate dimeglumine-enhanced magnetic resonance imaging. All lesions were confirmed by pathological or clinical diagnosis. For the qualitative and quantitative analyses, the signal intensity, DWI pattern, apparent diffusion coefficient, degree of perilesional edema, perilesional hyperemia, perilesional signal on HBPI, conspicuity, size discrepancy between sequences, contrast-to-noise ratio, signal-to-noise ratio, and relative enhancement ratio on dynamic phases were independently assessed by two radiologists. Significant findings for differentiating the two groups were identified via univariate and multivariate analyses with a nomogram for predicting atypical hepatic abscesses. The interobserver agreement was also analyzed for each variable.ResultsThe multivariate analysis revealed that the conspicuity discrepancy (odds ratio [OR] 34.78, 95% confidence interval [CI] 2.09–579.47, p = 0.013) and non-peripheral high signal intensity (SI) rim on DWI (OR 67.46, 95% CI 2.64, 1723.20, p = 0.011) were significant independent factors for predicting atypical hepatic abscesses. They were also shown to be high predictor points on the nomogram. When any of the set criteria were satisfied, 97.7% of atypical hepatic abscesses were correctly identified, with a specificity of 65.7%. When both criteria were combined, the specificity was up to 100%, with a sensitivity of 44.9%.ConclusionConspicuity discrepancy and a non-peripheral high SI rim on DWI are reliable and meaningful features that can distinguish atypical hepatic abscesses from hepatic metastases.

Hepatobiliary phase hypointensity on gadobenate dimeglumine-enhanced magnetic resonance imaging may improve the diagnosis of hepatocellular carcinoma.

BackgroundTo determine the clinical value of hepatobiliary phase (HBP) hypointensity for noninvasive diagnosis of hepatocellular carcinoma (HCC).MethodsA total of 246 high-risk patients with 263 selected nodules (126 HCCs, 137 non-HCCs) undergoing gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) were included in the study. Imaging-based diagnoses of small (≤3 cm) and large (>3 cm) HCCs were made using the following 4 criteria: (I) non-rim arterial phase hyper-enhancement (APHE) plus hypointensity on the portal venous phase (PVP); (II) non-rim APHE plus hypointensity on the PVP and/or transitional phase (TP); (III) non-rim APHE plus hypointensity on the PVP and/or TP and/or HBP; (IV) criterion 3 plus non-LR-1/2/M. Based on typical imaging features, LR-1, LR-2, or LR-M (if definitely benign, probably benign, malignant but not HCC specific, respectively) were defined according to the Liver Imaging Reporting and Data System (LI-RADS). Sensitivities and specificities of imaging criteria were calculated and compared using McNemar’s test.ResultsAmong the diagnostic criteria for small HCCs, criterion 3 and 4, which included HBP hypointensity, showed significantly higher sensitivities (96.4% and 94.6%, respectively) than criterion 1 (58.9%, P<0.001 for both). Moreover, criterion 4, which included HBP hypointensity and ancillary features, showed significantly higher specificity (94.7%) than criterion 3 (66.7%, P<0.001) and comparable specificity to criterion 1 (97.4%, P=0.375), achieving the highest accuracies (94.7%). The diagnostic performance of criterion 4 for large HCCs was similar to that for small HCCs.ConclusionsHBP hypointensity acquired from Gd-BOPTA-MRI can improve sensitivity and maintain high specificity in the diagnosis of both small and large HCCs after excluding benignities or non-HCC malignancies according to characteristic imaging features.

MRI in the differential diagnosis between well-differentiated hepatocellular carcinomas and high-grade dysplastic nodules in cirrhotic liver

ObjectiveTo assess the diagnostic efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between well-differentiated hepatocellular carcinomas (WD-HCCs) and high-grade dysplastic nodules (HGDNs) in cirrhotic liver. MethodsFrom January 2012 to April 2018, we retrospectively analyzed 91 cirrhotic nodules (HGDN, n = 31, WD-HCC, n = 60) which were confirmed by surgery or pathology. Each patient underwent gadobenate dimeglumine-enhanced hepatic MRI. The MRI characteristics and enhancement effects were calculated and analyzed. ResultsHyperintensity on diffusion-weighted imaging (DWI), the typical enhancement pattern and hypo-intensity on T1-Weighted imaging (T1WI)were showed with statistically significant difference between WD-HCCs and HGDNs in cirrhotic live (P = 0.002, 0.008, 0.002, respectively). And high signal intensity (SI) on DWI (sensitivity, 66.7%, specificity, 67.7%) was the most specific feature to differentiated WD-HCCs from HGDNs. The combination of DWI and the dynamic enhancement pattern improved the differentiation of WD-HCCs from HGDNs(specificity 83.9%). ConclusionDWI is the most specific technique to differentiate WD-HCCs from HGDNs. The combination of DWI and the typical dynamic enhancement pattern can improve the differentiation of WD-HCCs from HGDNs. Pre-enhanced T1WI, as well as a capsule, provides additional diagnostic values.

Hepatocellular Carcinoma: Retrospective Evaluation of the Correlation Between Gadobenate Dimeglumine-Enhanced Magnetic Resonance Imaging and Pathologic Grade.

The aim of this study was to evaluate the usefulness of gadobenate dimeglumine-enhanced magnetic resonance imaging in characterizing the grade of hepatocellular carcinoma (HCC) using the signal intensity (SI) of the erector spinae as internal reference. Clinical data of 40 patients (a total of 44 lesions) confirmed by pathology for HCC were retrospectively reviewed. Gadobenate dimeglumine-enhanced magnetic resonance imaging was performed in all patients, and SI of lesions (SIles), liver parenchyma around the lesions (SIhep), erector spinae (SImus) and standard deviation of SI of the surrounding noise (SDnoi) on nonenhanced T2WI, nonenhanced T1WI, and contrast-enhanced T1WI (in both arterial and hepatobiliary phase [AP and HBP]) were measured, respectively. Contrast-to-noise ratio (CNR) were separately defined as CNR1 ([SIles - SIhep]/SDnoi) and CNR2 ([SIles - SImus]/SDnoi). Statistical analyses were performed using one-way analysis of variance, least significant difference test, logistic regression analysis, Spearman rank correlation, and receiver operating characteristic curves analysis. Forty-four HCCs, including 3 well-differentiated HCCs, 26 moderately differentiated HCCs, and 15 poorly differentiated (PD) HCCs, were confirmed. On logistic regression analysis, only CNR2 in the HBP was predictor of PD HCCs (P = 0.015, odds ratio = 1.040). The size of lesions, CNR1 in the AP, CNR2 in the AP, and CNR2 in the HBP, showed significant correlations with the degree of differentiation (correlation coefficients = -0.371, 0.435, 0.503, and 0.512, respectively; P = 0.013, 0.003, 0.001, and 0.000, respectively). Contrast-to-noise ratio 2 in the HBP with the cutoff of less than 4.56 could distinguish moderately differentiated HCCs from PD HCC with the sensitivity and specificity of 84.6% and 60.0%, respectively. Relatively low arterial enhancement and low CNR2 value in the HBP are predictive for poor histological grade of HCCs.

Incorporating the hepatobiliary phase of gadobenate dimeglumine-enhanced MRI in the diagnosis of hepatocellular carcinoma: increasing the sensitivity without compromising specificity.

Diagnosis of hepatocellular carcinoma (HCC) is centered on wash-in of contrast during the arterial phase followed by washout during the portal or delayed venous phase. Nodules showing hypointensity on the hepatobiliary phase are also likely to represent HCC, however, the role of this phase is not yet established. To investigate the role of the hepatobiliary phase on Gadobenate dimeglumine (Gd-BOPTA) magnetic resonance imaging (MRI) in characterizing HCCs lacking the typical arterial enhancement and venous washout. Ninety-seven cirrhotic patients (78 men, 19 women; mean age, 58.5 years) who underwent liver transplantation (2004-2012) and Gd-BOPTA enhanced MRI within 3 months of surgery were retrospectively reviewed. A nodule-by-nodule analysis was performed, followed by liver explant correlation. Statistical analysis was then performed by a biostatistician using commercially available software. A total of 193 HCCs were found in 97 liver explants, of which 24.9% (48/193) were not detectable on imaging. The 145 HCCs seen on imaging showed the typical wash-in/washout pattern (Pattern A) in 46.9% (68/145), arterial enhancement without washout (Pattern B) in 37.9% (55/145), and hypovascularity on arterial and venous sequences (Pattern C) in 15.2% (22/145). Pattern A was exclusive to HCC. Twenty-three of the 55 HCCs showing Pattern B were also hypointense on the hepatobiliary phase (Pattern B1). Combining Pattern B1 with Pattern A raises the sensitivity of HCC characterization from 46.9% to 62.8% (P = 0.007), with no significant compromise on specificity. When coupled with Pattern A, Pattern B1 augments sensitivity of HCC characterization with no significant compromise on the specificity.

Effect of increasing the flip angle during the hepatocyte phase of gadobenate dimeglumine‐enhanced 1.5T MRI in cirrhotic patients with hepatocellular carcinoma

To evaluate the effects of increasing the flip angle during the hepatocyte phase of gadobenate dimeglumine-enhanced magnetic resonance imaging (MRI) in cirrhotic patients with hepatocellular carcinoma (HCC). Sixty-three patients with liver cirrhosis underwent gadobenate dimeglumine-enhanced 1.5T MRI with 90-minute delayed hepatocyte phase with flip angles of 10°, 20°, 30°, consecutively. Relative enhancement and signal-to-noise ratio (SNR) of liver parenchyma at hepatocyte phase according to flip angle were calculated. The liver-to-lesion (low signal intensity HCCs, n = 63; ≥1 cm) and contrast-to-noise ratio (CNR) at the hepatocyte phase according to flip angle were calculated. Two radiologists independently assessed the presence of HCCs using a 5-point scale, and detection sensitivity of HCCs was calculated according to flip angle. The relative enhancement of hepatic parenchyma differed significantly according to flip angle (10°, mean relative enhancement = 0.69 ± 0.46; 20°, mean relative enhancement = 0.63 ± 0.47; 30°, mean relative enhancement = 0.49 ± 0.45; P = 0.043). The SNR of hepatic parenchyma was significantly different according to flip angle (10°, mean SNR = 26.2 ± 5.6; 20°, mean SNR = 25.3 ± 5.7; 30°, mean SNR = 22.8 ± 6.1; P = 0.004). The CNR of lesion was not significantly different according to flip angle (10°, mean CNR = 7.5 ± 6.6; 20°, mean CNR = 10.2 ± 6.9; 30°, mean CNR = 10.1 ± 7.1; P = 0.051). The sensitivities with 10° and 20° for HCCs were significantly higher than those with 30° for one reader (P < 0.05). In patients with cirrhosis, hepatocyte phase gadobenate dimeglumine-enhanced 1.5T MRI with 20° flip angle should be recommended rather than 10° and 30° flip angle.

Predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine-enhanced magnetic resonance imaging: diagnostic accuracy and confidence

ObjectiveTo identify predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging. MethodsFifty cirrhotic patients with 120 nodules, including 10 mass-forming intrahepatic cholangiocarcinomas and two combined hepatocellular carcinoma–cholangiocarcinomas, were scanned by Gd-BOPTA-enhanced MR imaging. ResultsT1 hypointensity [odds ratio (OR), 20.12], peripheral hyperintense rim at hepatic arterial phase (OR, 13.5), and iso-hyperintensity at hepatobiliary phase (OR 21.32) were found to be independent predictors of intrahepatic cholangiocarcinoma. ConclusionsT1 hypointensity, peripheral hyperintense rim at hepatic arterial phase, and iso-hyperintensity at hepatobiliary phase are independent predictors of intrahepatic cholangiocarcinoma diagnosis in patients with liver cirrhosis.

Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI.

To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). Thirty-eight patients bearing 67 lesions (40 FNH; 27 HCA) were retrospectively included in this Institutional Review Board-approved study. The same volumetric interpolated breath-hold examination (VIBE) T1 -weighted sequences were performed before and after contrast injection on a 1.5T MRI, with HBP images acquired with a mean delay of 80 minutes (range 60-120 min). After a visual assessment of lesions enhancement (qualitative HBP analysis), the HBP signal intensity ratio (SIR) and the lesion-to-liver contrast enhancement ratio (LLCER) were calculated for each lesion by two observers (Mann-Whitney test). The sensitivities, specificities (receiver operating characteristic [ROC] curve analysis) and interobserver correlation (intraclass coefficient, ICC) of quantitative HBP analysis were determined. All FNH and 44.4% of HCA appeared hyper- or isointense relative to the adjacent liver on qualitative HBP analysis. The mean SIR (P < 0.01) and LLCER (P < 0.0001) of FNH were significantly higher than that of HCA. The area under the ROC curve for the differentiation of FNH from HCA with LLCER was 0.98 for both observers. With a cutoff value of -0.3%-observer 1 with highest experience- LLCER assessment provided respective sensitivity and specificity values of 100% and 96.2% for the differentiation of FNH from HCA. The ICC was 0.7 for SIR measurements and 0.8 for LLCER measurements. Quantitative LLCER assessment allows an accurate differentiation of FNH from HCA, even in hyper- or isointense HCA on HBP images.

Comparison of Portal Venous and Delayed Phases of Gadolinium-Enhanced Magnetic Resonance Imaging Study of Cirrhotic Liver for the Detection of Contrast Washout of Hypervascular Hepatocellular Carcinoma

To retrospectively compare portal venous phase (PVP) and delayed phase (DP) for the detection of tumor washout at gadobenate dimeglumine-enhanced liver magnetic resonance imaging (MRI) in cirrhotic patients with hypervascular hepatocellular carcinoma (HCC). Thirty-three patients with 55 HCCs underwent 1.5-T MRI by means of fat-suppressed T1-weighted sequence obtained before and after gadobenate dimeglumine administration, during early and late arterial phases, PVP (70 seconds), and DP (180 seconds). Detection rates of contrast washout of hypervascular HCCs and tumor-to-liver contrast on PVP and DP were measured and compared. Among 54 hypervascular HCCs, washout was present in 24 (44%) of 54 tumors on PVP and in 44 (82%) of 54 on DP (P < 0.001). In 20 (37%) of 54 tumors, washout was deemed present only on DP. Delayed phase images yielded significantly higher mean tumor-to-liver contrast absolute values compared with PVP images (-24.5 [56.1] vs -9.3 [52.6], P = 0.001). Delayed phase is superior to PVP for the washout detection of hypervascular HCC at gadobenate dimeglumine-enhanced MRI of cirrhotic liver.

Handling a High Relaxivity Contrast Material for Dynamic Breast MR Imaging Using Higher Thresholds for the Initial Enhancement

To increase specificity of gadobenate dimeglumine-enhanced breast magnetic resonance (MR) imaging without losing sensitivity. IRB approval was obtained for this retrospective study and informed consent was waived. Sixty-eight patients with 73 breast lesions underwent dynamic breast 1.5-T MR imaging with 0.1 mmol/kg of gadobenate dimeglumine and 103 or 111-second temporal resolution. A score system based on shape (round/oval/lobular = 0, linear/dendritic/stellate = 1), margins (defined = 0, undefined = 1), pattern (homogeneous = 0, inhomogeneous = 1, rim = 2), kinetics (continuous = 0, plateau = 1, washout = 2), and initial enhancement was used. Initial enhancement was evaluated with standard (<50% = 0, 50%-100% = 1, >100% = 2) or adjusted (<180% = 0, 180%-240% = 1, >240% = 2) thresholds. Scores 0-2, 3, 4 or 5, and from 6 to 8 were considered as equivalent to Breast Imaging Reporting and Data System 2, 3, 4, and 5, respectively. Pathologic examination (core-, vacuum-assisted, or surgical biopsy) served as a reference standard. Nonparametric tests were used. At histopathology, 52 lesions were malignant, 21 were benign. The initial enhancement for benign lesions was 141% +/- 65% (mean +/- SD), whereas for malignant lesions it was 210% +/- 80% (P = 0.001). The median multifactorial score for benign lesions was 4 using the standard thresholds and 3 using the adjusted thresholds (P < 0.001) whereas for malignant lesions it was 7 and 6, respectively (P < 0.001). Specificity increased from 38% with standard thresholds to 71% with adjusted thresholds (gain of 33%; P = 0.016); positive predictive value 80% and 90%, negative predictive value 100% and 100%, and accuracy 82% and 92%, respectively. Sensitivity was 100% for both thresholds. Specificity of gadobenate dimeglumine-enhanced breast MR imaging can be increased without limiting its high sensitivity.

Gadoxetic Acid (Gd-EOB-DTPA)-Enhanced MRI versus Gadobenate Dimeglumine (Gd-BOPTA)-Enhanced MRI for Preoperatively Detecting Hepatocellular Carcinoma: an Initial Experience

ObjectiveThis study was designed to compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine-enhanced MRI for preoperatively detecting hepatocellular carcinoma (HCC).Materials and MethodsEighteen consecutive patients (17 men and one woman, age range: 31-73 years) with 22 HCCs underwent examinations with gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI on a 3.0-Tesla unit. The diagnosis of HCC was established after surgical resection and pathological conformation. Three observers independently reviewed each MR image in a random order on a tumor-by-tumor basis. The diagnostic accuracy of these techniques for the detection of HCC was assessed by performing an alternative free-response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive values were evaluated.ResultsThe average value of the area under the ROC curve (Az) for gadoxetic acid enhanced MRI (0.887) was not significantly different from the Az (0.899) for gadobenate dimeglumine-enhanced MRI (p > 0.05). The overall sensitivities of gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI were 80% and 83%, respectively, with no significant difference (p > 0.05). The differences of the positive predictive values for the two contrast agents for each observer were not statistically significant (p > 0.05).ConclusionThe diagnostic performance of gadoxetic acid-enhanced MRI and gadobenate dimeglumine-enhanced MRI for preoperatively detecting HCC is quite similar.

Small colorectal liver metastases: Detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging

The aim of this prospective study was to compare the diagnostic role of superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) versus gadobenate dimeglumine (GbD)-enhanced MRI and computed tomography (CT) investigations for detection of small (less than 1 cm) colorectal liver metastases (LMs) of colorectal cancer. Seventy-eight LMs in 16 patients were evaluated with dynamic CT imaging, GbD-enhanced dynamic MR imaging and SPIO-enhanced MR imaging. Two radiologists were reviewed the LMs seperately. Agreement between the readers and three algorithms was analyzed. Differences between the lesion detection ratios of the methods were analyzed by two proportion z test. Sensitivity values of each modality were also calculated. Interobserver agreement values with kappa analysis were found to be the best for three modalities and kappa values were 0.866, 0.843, and 1.0 respectively. For all 78 LMs, SPIO-enhanced MRI detected all lesions (100% sensitivity). This sensitivity value was higher than GbD-enhanced MRI, and there was a significant difference ( p < 0.05). GbD-enhanced MRI depicted 71 lesions and this modality could not detected 7 lesions (91% sensitivity). This modality had moderate sensitivity, and this value is greater than CT imaging, so there was a significant difference also ( p < 0.05). Dynamic triphasic CT imaging detected 64 (R1) and 65 (R2) LMs. This modality had the lowest sensitivity (R1: 0.82, R2: 0.83 respectively). Only SPIO-enhanced MRI was able to detect all LMs less than 1 cm. LMs were the best detected with SPIO-enhanced MRI. We recommend SPIO-enhanced MRI to be the primary alternative modality especially for diagnosis of small colorectal LMs.

The value of gadobenate dimeglumine-enhanced hepatobiliary-phase MR imaging for the differentiation of scirrhous hepatocellular carcinoma and cholangiocarcinoma with or without hepatocellular carcinoma

To evaluate the value of the gadobenate dimeglumine-enhanced hepatobiliary-phase magnetic resonance (MR) imaging for the differentiation of scirrhous hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) with or without HCC. We retrospectively evaluated unenhanced and gadobenate dimeglumine-enhanced dynamic and hepatobiliary-phase MR images of five patients with scirrhous HCCs and 29 patients with 57 CCs with or without HCC with statistical analysis using Fisher's exact test. Peripheral hyperintensity compared with the center on T2-weighted images was more frequent for scirrhous HCCs (n = 3, 60%) as compared to CCs with or without HCC (n = 7, 12%) (P = 0.026). There was no significant difference in the gadobenate dimeglumine-enhanced dynamic imaging of both scirrhous HCC and CC with or without HCC (P > 0.05). On hepatobiliary-phase images, scirrhous HCC showed no target appearance as compared with that 50 (87.7%) CCs with or without HCC showed target appearance (P < 0.001). Although both scirrhous HCC and CC with or without HCC show similar imaging findings on unenhanced and gadobenate dimeglumine-enhanced dynamic MR images, gadobenate dimeglumine-enhanced hepatobiliary-phase MR images may be helpful to differentiate scirrhous HCC from CC with or without HCC.

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.

Clinical implication of small (

Objective The purpose of this study is to determine the clinical implication of small (<20 mm) enhancing hepatic nodules observed only at three-dimensional gadobenate dimeglumine-enhanced hepatic arterial-phase magnetic resonance imaging (MRI) of the hepatitis B virus-induced mild cirrhosis. Materials and methods Study population included 75 patients (58 men and 17 women; age range, 45–74 years) who had 100 arterial-only enhancing hepatic nodules occult during portal- and equilibrium-phase MRI. All patients had mild liver cirrhosis (Child class A, n=69; B, n=6) associated with viral hepatitis B. Two reviewers analyzed the MRIs in consensus regarding the size, shape, and signal intensity of nodules on the T1- and T2-weighted images. Results Of these 100 lesions, 78 and 22 proved to be hepatocellular carcinomas (HCCs) (size range, 0.6–1.9 cm; mean, 1.2 cm) and benign lesions (size range, 0.6–1.9 cm; mean, 1.0 cm), respectively. Most of the lesions ( n=98) were oval or round shaped. Thirty-four HCCs were hypointense and/or hyperintense on the T1- and T2-weighted images, respectively. There was a trend toward an increased suspicion of HCC for arterial-only enhancing lesions occult on the portal- and equilibrium-phase and on T1- and T2-weighted MRI ( n=44/66 for HCC vs. n=22/66 for benign lesions). Conclusions Small arterial-only enhancing nodules occult on the portal- and equilibrium-phase images as well as on the T1- and T2-weighted images are more likely to be HCC than nonneoplastic hypervascular benign lesions in patients with hepatitis B-induced mild cirrhosis.

Gadobenate dimeglumine–enhanced magnetic resonance imaging of primary leiomyoma of the liver

We report a case of histologically proven primary leiomyoma of the liver that was evaluated with multiphasic 64-section computed tomography (CT) and gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging. This lesion showed vivid enhancement during the arterial phase with sustained enhancement during the hepatic venous and equilibrium phases. During the liver-specific MR imaging phase (150 minutes after contrast injection), the same lesion demonstrated lack of contrast retention, thus appearing hypointense compared with the background liver. Because of this latter finding, the patient underwent partial resection of the liver. In primary hepatic leiomyoma, the absence of contrast uptake during the liver-specific phase of gadobenate dimeglumine-enhanced MR imaging may be inappropriately interpreted as a sign of malignancy, thus leading to unnecessary, aggressive management of such lesions.