Gadoxetic Acid-enhanced Research Articles

Functional Liver Imaging Score Derived from Gadoxetic Acid-enhanced MRI Predicts Cachexia and Prognosis in Hepatocellular Carcinoma Patients.

Cachexia occurs in approximately half of hepatocellular carcinoma (HCC) patients as the disease progresses and is correlated with a poor prognosis. Therefore, early identification of HCC patients at risk of developing cachexia and their prognosis is crucial. This study investigated the functional liver imaging score (FLIS) derived from gadoxetic acid-enhanced magnetic resonance imaging (MRI) to identify cachexia in HCC patients and their prognosis. Pretreatment clinical and MRI data from 339 HCC patients who underwent gadoxetic acid-enhanced MRI scans were retrospectively collected. Patient weights were recorded for 6 months following the MRI scan to diagnose cachexia. The FLIS was calculated as the sum of the enhancement quality score, the excretion quality score, and the portal vein sign quality score. A Cox proportional hazards model was used to determine the significant factors affecting overall survival (OS). Multivariable logistic regression was then conducted to identify variables predicting cachexia in HCC patients, which were subsequently used to predict OS. Cox regression analysis revealed a significant association between cachexia and worse OS. Both FLIS (0-4 vs. 5-6 points) (OR, 9.20; 95% CI: 4.68-18.10; P<0.001) and α-fetoprotein >100 ng/mL (OR, 4.08; 95% CI: 2.13-7.83; P<0.001) emerged as significant predictors of cachexia in patients with HCC. Furthermore, FLIS (0-4 vs. 5-6 points) (HR, 1.73; 95% CI: 1.19-2.51; P=0.004) was significantly associated with OS. Patients in the FLIS 0-4 points group had shorter OS than those in the FLIS 5-6 points group [20 months (95% CI, 14.7-25.3) vs. 43 months (95% CI, 27.7-58.3); P=0.001]. Cachexia was associated with worse OS. The functional liver imaging score emerged as a significant predictor of cachexia in HCC patients and their prognosis.

Diagnosis of Caroli Disease with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging

Diagnosis of Caroli Disease with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging

Comparison of 68Ga-DOTATATE Positron Emmited Tomography/Computed Tomography and Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for the Detection of Liver Metastases from Well-Differentiated Neuroendocrine Tumors.

This study aimed to compare the detection of neuroendocrine tumor liver metastases (NLMs) in hepatobiliary-specific contrast-enhanced MRI (pMR) versus 68Ga-DOTATATE PET/CT (DT-PET). This retrospective study cohort included 30 patients with well-differentiated neuroendocrine tumors who underwent both DT-PET and pMR. Two readers independently assessed NLMs count, SUVmax on DT-PET, and signal characteristics on pMR. A consensus review by two additional readers resolved discrepancies between the modalities. Results showed concordance between DT-PET and pMR NLM count in 14/30 patients (47%). pMR identified more NLMs in 12/30 patients (40%), of which 4 patients showed multiple deposits on pMR but only 0-1 lesions on DT-PET. DT-PET detected more in 4/30 patients (13%). Overall, pMR detected more metastases than DT-PET (p = 0.01). Excluding the four outliers, there was excellent agreement between the two methods (ICC: 0.945, 95%CI: 0.930, 0.958). Notably, pMR had a higher NLM detection rate than DT-PET, with correlations found between lesion size on pMR and DT-PET detectability, as well as diffusion restriction on pMR and SUVmax on DT-PET. In conclusion, in consecutive patients with well-differentiated NETs, the detection rate of NLM is higher with pMR than with DT-PET. However, when excluding patients whose tumors do not overexpress somatostatin receptors (13% of the cohort), high concordance in the detection of NLM is observed between DT PET and pMR.

A gadoxetic-acid enhancement flux analysis of small liver nodules (≤2 cm) in patients at high risk of hepatocellular carcinoma

PurposeTo discriminate between benignities and hepatocellular carcinomas (HCCs) in patients at high risk of HCC using a novel enhancement flux analysis for gadoxetic-acid enhanced MRI. MethodThis study retrospectively collected 181 liver nodules in 156 patients at high risk of HCC who underwent gadoxetic acid-enhanced MRI examinations with following surgical resection from 1st August 2017 to 31st December 2021 as the training set; another 42 liver nodules in 36 patients were prospectively collected from 1st January 2022 to 1st October 2022 as the test set. The time-intensity curves (TICs) of liver nodules were formed with consecutive time points: 0 s, 20 s, 1 min, 2 min, 5 min, 10 min, 15 min, and 20 min since contrast injection. A novel enhancement flux analysis was applied by using a biexponential function fitting to distinguish benignities and HCC. Besides, previously published models including maximum enhancement ratio (ERmax), percentage signal ratio (PSR), and ERmax+PSR were compared. The areas under the receiver operating characteristic curves (AUCs) were compared among these methods. ResultsThe novel enhancement flux analysis showed the highest AUCs in the training set (0.897, 95%CI: 0.833–0.960) and the test set (0.859, 95%CI: 0.747–0.970) among all models. The AUCs of PSR, ERmax and ERmax+PSR were 0.801 (95%CI: 0.710–0.891), 0.620 (95%CI: 0.510–0.729), and 0.799 (95%CI: 0.709–0.889) in the training set, and were 0.701 (95%CI: 0.539–0.863), 0.529 (95%CI: 0.342–0.717), and 0.708 (95%CI: 0.549–0.867) in the test set. ConclusionsThe biexponential flux analysis for gadoxetic-acid enhanced MRI presents a better potential in accurate diagnosis of small HCC nodules.

Development and External Validation of a Radiomics Model Derived from Preoperative Gadoxetic Acid-Enhanced MRI for Predicting Histopathologic Grade of Hepatocellular Carcinoma.

Histopathologic grade of hepatocellular carcinoma (HCC) is an important predictor of early recurrence and poor prognosis after curative treatments. This study aims to develop a radiomics model based on preoperative gadoxetic acid-enhanced MRI for predicting HCC histopathologic grade and to validate its predictive performance in an independent external cohort. Clinical and imaging data of 403 consecutive HCC patients were retrospectively collected from two hospitals (265 and 138, respectively). Patients were categorized into poorly differentiated HCC and non-poorly differentiated HCC groups. A total of 851 radiomics features were extracted from the segmented tumor at the hepatobiliary phase images. Three classifiers, logistic regression (LR), support vector machine, and Adaboost were adopted for modeling. The areas under the curve of the three models were 0.70, 0.67, and 0.61, respectively, in the external test cohort. Alpha-fetoprotein (AFP) was the only significant clinicopathological variable associated with HCC grading (odds ratio: 2.75). When combining AFP, the LR+AFP model showed the best performance, with an AUC of 0.71 (95%CI: 0.59-0.82) in the external test cohort. A radiomics model based on gadoxetic acid-enhanced MRI was constructed in this study to discriminate HCC with different histopathologic grades. Its good performance indicates a promise in the preoperative prediction of HCC differentiation levels.

Risk Stratification of Patients with Marginal Hepatic Functional Reserve Using the Remnant Hepatocyte Uptake Index in Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for Safe Liver Surgery.

This study aimed to explore the efficacy of gadoxetic acid-enhanced (Gd-EOB) magnetic resonance imaging (MRI) in surgical risk estimation among patients with marginal hepatic function estimated by indocyanine green (ICG) clearance test. This analysis focused on 120 patients with marginal hepatic functional reserve (ICG clearance rate of future liver remnant [ICG-Krem] <0.10). Preoperative Gd-EOB MRI was retrospectively reviewed, and the remnant hepatocyte uptake index (rHUI) was calculated for quantitative measurement of liver function. The predictive power of rHUI for posthepatectomy liver failure was compared with several clinical measures used in current risk estimation before hepatectomy. Receiver operating curve analysis showed that rHUI had the best predictive power for posthepatectomy liver failure among the tested variables (ICG-R15, ICG-Krem, albumin + bilirubin score, and albumin + ICG-R15 score). Cross-validation showed that a threshold of 925 could be the best cut-off value for estimating the postoperative risk of liver failure with sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 0.689, 0.884, 5.94, and 0.352, respectively. rHUI could be a sensitive substitute measure for posthepatectomy liver failure risk estimation among patients with marginal hepatic functional reserve.

The system for assessing liver function according to magnetic resonance imaging with gadoxetic acid

Purpose. To develop a system for assessing liver function in patients with liver cirrhosis according to magnetic resonance imaging (MRI) with gadoxetic acid.Material and Methods. Data from studies of 74 patients who underwent abdominal MRI with intravenous gadoxetic acid (GA) enhancement were analyzed. For statistical analysis of the data, two groups were formed: group 1 (n = 22) comprised patients with unchanged liver parenchyma, normal liver function, and benign tumors; group 2 (n = 52) comprised patients with liver cirrhosis, with the presence of regenerative and/or dysplastic nodes, and hepatocellular carcinoma (HCC). The following quantitative parameters were studied to assess liver function in patients of two groups: relative enhancement (RE), contrast enhancement index (CEI), liver/skeletal muscle (SM) index, liver/spleen index, liver/kidney index, analysis of histograms (AH), and liver function imaging scale (FLIS).Results. The criteria for a functional deficiency of liver function based on calculated data of contrast agent transport and accumulation were a decrease in FLIS total score to 4 and below, RE values below 0.85, and CEI values below 1.38 with sensitivity and specificity of 100 and 75%, the values of liver/SM and liver/kidney indices below 0.350, liver/spleen index below 0.750 with sensitivity and specificity of 100 and 81%, respectively, in patients with cirrhosis.Conclusion. The developed system for assessing liver function using FLIS, intensity matching analysis (IMA), and AH according to MRI with GC in comparison with METAVIR allowed for liver function assessment in patients with cirrhosis with a sensitivity and specificity of 100% and 80%, respectively.

Diagnostic Performance of Simulated Abbreviated MRI for Early-Stage Hepatocellular Carcinoma Screening: A Comparison to Conventional Dynamic Contrast-Enhanced MRI.

PurposeTo compare the per-patient diagnostic performance of simulated abbreviated MRI (AMRI) to that of conventional MRI (CMRI) with full-sequence dynamic gadoxetic acid (GA) enhancement for early-stage hepatocellular carcinoma (HCC) screening in high-risk patients.Materials and MethodsA total of 201 consecutive patients at high-risk for HCC, who underwent 3T liver MRI, were included in this retrospective study. The AMRI protocol comprised T2-weighted imaging, hepatobiliary phase imaging after GA injection, and diffusion-weighted imaging. For each patient, two AMRI and CMRI image sets were independently reviewed by two radiologists. Inter-reader agreement was assessed using Cohen's kappa value. A composite reference standard was used to determine the diagnostic performance of each image set for each reader.ResultsA total of 93 HCCs were detected in 79 patients. The inter-reader agreement was almost perfect for both image sets (κ = 0.839, 0.948). In AMRI, the per-patient sensitivity and negative predictive values (NPV) were 94.9% and 96.4%, respectively. In CMRI, the per-patient sensitivity and NPV were 96.2% and 97.5%, respectively.ConclusionAMRI, using only three sequences, had a comparable diagnostic performance to CMRI in screening early-stage HCC. AMRI could be an alternative HCC screening tool for high-risk HCC patients.

Expression of Organic Anion Transporting Polypeptides in an H-Ras 12V Transgenic Mouse Model of Spontaneous Hepatocellular Carcinoma.

PurposeExpression of organic anion transporting polypeptides (OATPs) 1B1/1B3 in hepatocellular carcinoma (HCC) induces a paradoxical enhancement of gadoxetic acid on liver magnetic resonance imaging (MRI). We examined the expression profile of OATPs with regard to tumor differentiation in a genetically modified H-Ras 12V mouse model of spontaneous HCC that undergoes multistep hepatocarcinogenesis with minimal inter-individual variation.Materials and MethodsTumor nodules were harvested from transgenic H-Ras 12V mice. Hematoxylin and eosin-stained slides were examined for tumor differentiation and high-grade pathological components (tumor necrosis, thickened trabeculae, or vascular invasion). Immunohistochemistry of OATP 1B1/1B3 was performed, and OATP expression was assessed.ResultsWe examined well-differentiated HCCs (n=59) in which high-grade pathological components were absent (n=49) or present (n=10). Among the well-differentiated HCCs without high-grade pathological components (n=49), OATP expression was negative, weak positive, and moderate positive in 23, 17, and nine cases, respectively. Among the well-differentiated HCCs with high-grade pathological components (n=10), OATP expression was negative, weak positive, and moderate positive in one, two, and seven cases, respectively. The ratio of positive OATP 1B1/1B3 expressing tumors was higher in HCCs with high-grade pathological components than in those without high-grade pathological components (p=0.004).ConclusionOur findings support those of previous clinical studies that have reported the frequent appearance of gadoxetic acid-enhanced MRI in moderately differentiated HCC.

Usefulness of noncontrast MRI in differentiation between gallbladder carcinoma and benign conditions manifesting as focal mild wall thickening

BackgroundMagnetic resonance imaging (MRI) is a reliable imaging tool for evaluating gallbladder carcinoma, but it is costly and time-consuming. PurposeTo compare noncontrast MRI with multidetector row CT (MDCT) and gadoxetic acid-enhanced whole MRI in distinguishing gallbladder carcinoma from benign disease. Materials and methods101 patients (36 with gallbladder carcinoma and 65 with benign disease) with mild focal gallbladder wall thickening were included. Two radiologists reviewed the MDCT and MRI to determine the differential features between malignancy and benignity. Then, the diagnostic performance of MDCT and MRI (T1-, T2- and diffusion-weighted images) with and without gadoxetic acid enhancement in the diagnosis of gallbladder carcinoma was evaluated. ResultsThe benign group more often showed T2 necklace sign or T2 hyperintensity within the thickened wall (P < 0.0001) and T1 hyperintensity within the wall or gallbladder lumen (P = 0.0002). Meanwhile, malignancy more frequently showed T2 moderate hyperintensity of the thickened wall, papillary appearance, and diffusion restriction (all P < 0.0001). There were significant differences in sensitivity (79.2% vs 98.6% for observer 1; 84.7% vs 100% for observer 2) and specificity (80.7% vs 96.9%; 79.2% vs 95.4%) between the MDCT and noncontrast MRI (P < 0.05). We found similar diagnostic values between the noncontrast MRI and whole MRI (P = 0.479–1.000) for both observers. ConclusionNoncontrast MRI could be a useful alternative to gadoxetic acid–enhanced MRI in the diagnosis of gallbladder carcinoma that presents as mild gallbladder wall thickening on MDCT.

A New Model for MR Evaluation of Liver Function with Gadoxetic Acid, Including Both Uptake and Excretion.

Most existing models that are in use to model hepatic function through assessment of hepatic gadoxetic acid enhancement kinetics do not consider quantitative measures of gadoxetic excretion. We developed a model that allows a simultaneous quantitation of uptake and excretion of liver specific contrast agents. The aim was to improve the assessment of hepatic synthetic function, and provide quantitative measures of hepatic excretion function. Sixteen patients underwent dynamic T1-weighted turbo gradient echo imaging at 1.5 T prior and after bolus injection of gadoxetic acid at 0.1 ml/kg. DCE-images were obtained for 30 min after injection. A dual-inlet two-compartment model was then used to fit the measured liver signal values. Four tissue parameters (extracellular volume fraction, arterial flow fraction, uptake rate and excretion half-time) were extracted for each liver segment. The proposed model provided a good fit to acquired data. Mean values for arterial flow fraction (0.08+-0.04), extracellular volume (0.20±0.08) and uptake rate (4.02 ±1.32 /100 ml/min) were comparable to those obtained with the conventional model (0.08±0.05, 0.21±0.12, and 4.93±1.74), but exhibited significantly less variation and improved fit quality. The proposed model is more accurate than existing conventional models and provides an additional excretion parameter. • Models of hepatic contrast agent uptake can be extended to include excretion. • Including an additional excretion parameter improves accuracy of the model. • Standard diagnostic sequences can be extended to incorporate the model.

Can contrast-enhanced MRI with gadoxetic acid predict liver failure and other complications after major hepatic resection?

To determine whether a combination of clinical factors, the future liver remnant (FLR) ratio, and hepatic uptake of gadoxetic acid can be used to predict post-hepatectomy liver failure (PHLF) and other major complications (OMC). Sixty-five consecutive patients who underwent pre-hepatectomy gadoxetic acid-enhanced magnetic resonance imaging (MRI) between October 2010 and December 2013 were included. The relative liver enhancement (RLE) of gadoxetic acid was calculated from regions of interest on MRI, and FLR ratios were obtained from computed tomography (CT). PHLF and OMC were defined by the International Study Group of Liver Surgery criteria and Clavien-Dindo grade of ≥3, respectively. Multivariate logistic regression modelling was performed to identify predictors of PHLF and OMC, including RLE, FLR ratio, age, sex, chemotherapy history, intra-operative blood loss, and intra-operative transfusion. Nine patients experienced PHLF and another nine patients experienced OMC. RLE was comparable to the FLR ratio in predicting PHLF (areas under the receiver operating characteristic [AUROC] curves, 0.665 and 0.705), but performed poorly in predicting OMCs (AUROCs, 0.556 and 0.702). Combining all clinical and imaging parameters as predictors yielded the best performing predictive models (AUROCs, 0.875 and 0.742 for PHLF and OMC, respectively). A model based on clinical parameters, the FLR ratio, and RLE of gadoxetic acid may improve pre-hepatectomy risk assessment.

Pre-Hepatectomy Assessment of Bile Transporter Expression by Gadoxetic Acid-Enhanced MRI in a Rat Model of Liver Cirrhosis

ABSTRACTBackground: Gadoxetic acid is a liver-specific intravenous T1 magnetic resonance (MR) contrast agent that is excreted via the hepatobiliary system. We hypothesize that hepatocyte expressions of bile transporters (OATP1 and MRP2) correlate with dynamic profile of Gadoxetic acid enhanced (GE)-MR imaging (MRI). Methods: Two groups of rats, control (n = 6) and cirrhosis (n = 12), received gadoxetic acid enhanced MRI followed by 70% hepatectomy. The change in MR signal intensity from the baseline before the contrast injection (ΔSI) was analyzed every minute for 30 min. Dynamic signal intensity retention ratio (DSR) was defined as the mean ΔSI of the third 10-minmin period divided by the first 10-minmin period. Real-time PCR was utilized to quantify mRNA expressions. Results: Compared to the control, cirrhosis group demonstrated lower mRNA levels of OATP1 (0.038 ± 0.020 vs. 0.232 ± 0.0979; p = 0.004), MRP2 (0.201 ± 0.084 vs. 0.7567 ± 0.254; p = 0.002), and OATP1/MRP2 mRNA ratio (0.193 ± 0.065 vs. 0.342 ± 0.206; p = 0.032). DSR was higher in the cirrhosis group (0.678 ± 0.554 vs −0.125 ± 0.839; p = 0.033). In the cirrhosis group, there was an inverse correlation between the ratios of OATP1/MRP2 mRNA and DSR (R = −0.709, p = 0.01). Conclusion: Bile transporters OATP1/MRP2 mRNA expression ratio in rat liver tissue decreased with DMN-induced liver injury. The expressions of bile transporters correlated with GE-MRI DSR. The GE-MRI DSR has potential utility in qualifying OATP1/MRP2 mRNA expression.

Improved Focal Liver Lesion Detection by Increasing Flip Angle During Gadoxetic Acid-Enhancement in MRI

Improved Focal Liver Lesion Detection by Increasing Flip Angle During Gadoxetic Acid-Enhancement in MRI

O127 STAGING EARLY HEPATOCELLULAR CARCINOMA WITH GADOXETIC ACID-ENHANCED MAGNETIC RESONANCE IMAGING AND IMPROVEMENT IN SURVIVAL

O127 STAGING EARLY HEPATOCELLULAR CARCINOMA WITH GADOXETIC ACID-ENHANCED MAGNETIC RESONANCE IMAGING AND IMPROVEMENT IN SURVIVAL H.-D. Kim, Y.-S. Lim, S. Han, J. An, G.-A. Kim, S.J. Lee, S.Y. Kim, J.H. Byun, H.J. Won. Department of Internal Medicine, Department of Gastroenterology, Liver Center, Department of Biostatistics and Clinical Epidemiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of E-mail: 7mpd5@naver.com

Evaluation of possible drug–drug interaction between gadoxetic acid and erythromycin as an inhibitor of organic anion transporting peptides (OATP)

To evaluate if erythromycin compromises liver-specific enhancement of gadoxetic acid; both compounds competing in organic anion transporting peptides (OATP) -mediated hepatocytic uptake. The study was approved by institutional review board. Twelve healthy subjects (nine men, three woman; mean age, 38.7 years) were examined twice by MR imaging with prior administration of NaCl solution (placebo) or 1000 mg of erythromycin following a randomized sequence. Gadoxetic acid (0.025 mmol/kg body weight) was administered 15 min after the end of infusions. Pre- and 20 min postcontrast two-dimensional gradient-recalled-echo sequences were acquired. Relative enhancements of liver parenchyma and ratio of means were calculated from signal intensity measurements. Plasma levels of gadoxetic acid and erythromycin were determined and given in geometric means and coefficients of variation (CV). Concentration of erythromycin directly after end of infusion was 13.9 mg/L (CV 14.9%). Gadolinium plasma concentrations 5 min after gadoxetic acid administration were 138.7 μmol/L (CV 20.4%) after erythromycin infusion and 129.6 μmol/L (CV 22.8%) after placebo. Mean relative enhancements of liver parenchyma were 88.1 (SD 24.9%) after erythromycin infusion and 92.6 (SD 17.9%) after placebo. Ratio of relative enhancements was 0.951 (95% confidence interval, 0.833; 1.061; statistically not significant). Coadministration of erythromycin has no effect on gadoxetic acid enhanced liver MR imaging.

The effect of gadoxetic acid enhancement on lesion detection and characterisation usingT2weighted imaging and diffusion weighted imaging of the liver

To evaluate the effect of gadoxetic acid enhancement on the detection and characterisation of focal hepatic lesions on T(2) weighted and diffusion weighted (DW) images. A total of 63 consecutive patients underwent T(2) weighted and DW imaging before and after gadoxetic acid enhancement. Two blinded readers independently identified all of the focal lesions using a five-point confidence scale and characterised each lesion using a three-point scale: 1, non-solid; 2, indeterminate; and 3, solid. For both T(2) weighted and DW imaging, the accuracies for detecting focal lesions were compared using the free-response receiver operating characteristic analysis; the accuracies for lesion characterisation were compared using the McNemar test between non-enhanced and gadoxetic acid-enhanced image sets. For hepatic lesions ≥ 1 cm, the lesion-to-liver contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) were compared in the non-enhanced and enhanced image sets using the generalised estimating equations. For both T(2) weighted and DW images, the accuracies for detecting focal lesions (p ≥ 0.52) and those for lesion characterisation (p ≥ 0.63) did not differ significantly between the non-enhanced and enhanced image sets. The lesion-to-liver CNR was significantly higher on enhanced DW images than on non-enhanced DW images (p=0.02), although the difference was not significant for T(2) weighted imaging (p=0.65). The mean ADC values of lesions did not differ significantly on enhanced and non-enhanced DW imaging (p=0.75). The acquisition of T(2) weighted and DW images after administration of gadoxetic acid has no significant effect on the detection or characterisation of focal hepatic lesions, although it improves the lesion-to-liver CNR on DW images.

Hepatocellular Carcinoma: Hepatocyte-selective Enhancement at Gadoxetic Acid–enhanced MR Imaging—Correlation with Expression of Sinusoidal and Canalicular Transporters and Bile Accumulation

To investigate the mechanism of enhancement of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced hepatobiliary phase magnetic resonance (MR) images and to characterize HCC thus enhanced. This retrospective study was approved by the institutional review board, and patient informed consent for research use of the resected specimen was obtained. MR images in 25 patients (20 men, five women; mean age, 68 years; range, 49-82 years) with 27 resected hypervascular HCCs (one well, 13 moderately, 13 poorly differentiated) that demonstrated hepatocyte-selective enhancement on gadoxetic acid-enhanced MR images, were quantitatively studied, and findings were correlated with results of immunohistochemical staining for a sinusoidal transporter, organic anion transporting polypeptide (OATP) 1B1 (OATP1B1) and/or OATP1B3 (OATP1B1 and/or -1B3), and a canalicular transporter, multidrug resistance-associated protein 2 (MRP2), and also with bile accumulation in tumors. Statistical analysis was performed with the Student t test and Scheffé post hoc test. Combined with positive OATP1B1 and/or -1B3 expression (O+), two patterns of MRP2 expression contributed to high enhancement: decreased expression (M-, n = 3) and increased expression at the luminal membrane of pseudoglands (M+[P], n = 3). Nodules without OATP1B1 and/or -1B3 expression (O-, n = 13) and nodules with O+ associated with increased MRP2 expression only at the canaliculi (M+[C], n = 8) induced significantly lower enhancement than those with the two expression patterns described before (O+/M- group vs O- group, P = .002; O+/M- group vs O+/M+[C] group, P = .047; O+/M+[P] group vs O- group, P < .001; O+/M+[P] group vs O+/M+[C] group, P < .001). Nodules with bile pigment (n = 12) showed significantly higher enhancement (P = .004); all five nodules (one well differentiated HCC, four moderately differentiated HCCs), which were enhanced more than adjacent liver parenchyma, contained bile pigment. High hepatocyte-selective enhancement is induced by expression patterns of transporters, which may result in accumulation of gadoxetic acid in cytoplasm of tumor cells or in lumina of pseudoglands. An HCC with gadoxetic acid enhancement is characterized by bile accumulation in tumors.

Ferucarbotran-Enhanced Magnetic Resonance Imaging Versus Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for the Preoperative Detection of Hepatocellular Carcinoma

We compared the diagnostic performance of ferucarbotran-enhanced magnetic resonance imaging (MRI) with that of gadoxetic acid-enhanced MRI for the preoperative detection of hepatocellular carcinoma (HCC) of 27 consecutive patients (male-female, 21:6; 33-76 years) with 38 surgically proven HCCs (mean diameter, 2.8 cm; range, 0.8-10.2 cm) on a 3.0-T unit. 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, sensitivity, positive and negative predictive values was evaluated. For each observer, the values of the area under the receiver operating characteristic curve (Az) were 1.000, 1.000, and 0.974 for ferucarbotran-enhanced MRI and 1.000, 0.987, and 1.000 for gadoxetic acid-enhanced MRI, and the differences were not statistically significant between 2 techniques for each observer (P > 0.05). For each observer, sensitivities were 100%, 100%, and 92.1% for ferucarbotran-enhanced MRI and 100%, 94.7%, and 100% for gadoxetic acid-enhanced MRI with no statistical significance (P > 0.005). The differences of the positive and negative predictive values of 2 techniques for each observer were not statistically significant (P > 0.05). Ferucarbotran-enhanced MRI and gadoxetic acid-enhanced MRI show a similar diagnostic performance for the preoperative detection of HCCs.