Hepatobiliary Phase MR Images Research Articles

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.

Hepatocellular carcinoma in patients with chronic liver disease: A comparison of gadoxetic acid-enhanced MRI and multiphasic MDCT

To compare the diagnostic performances of gadoxetic acid-enhanced magnetic resonance imaging (MRI) and multiphasic multidetector computed tomography (MDCT) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease. Institutional review board approval was obtained for this study and informed consent was obtained from all patients. Fifty-one patients (43 men, eight women; age range 32-80 years) with 73 HCCs underwent gadoxetic acid-enhanced MRI and multiphasic MDCT. Two readers independently analysed each image in three separate reading sessions. The alternative free-response receiver operating characteristic (AFROC) method was used to analyse the diagnostic accuracy. Positive and negative predictive values and sensitivity were evaluated. A total of 73 HCCs were detected in 51 patients. Although not significant (p>0.05), the areas under the receiver operating characteristic curves were 0.877 and 0.850 for MDCT, 0.918 and 0.911 for dynamic MRI, and 0.905 and 0.918 for combined interpretation of dynamic and hepatobiliary phase MR images. Differences in sensitivity, specificity, and positive and negative predictive values between the readers were not statistically significant (p>0.05). Combined interpretation of dynamic and hepatobiliary phase MRI images was more useful than MDCT in the detection of HCC lesions ≤1cm in diameter for one reader (p=0.043). Gadoxetic acid-enhanced MRI and MDCT show similar diagnostic performances for the detection of HCC in patients with chronic liver disease. However, the combined interpretation of dynamic and hepatobiliary phase MRI images may improve diagnostic accuracy in the detection of HCC lesions ≤1cm in diameter.

Differentiation of Hepatic Hyperintense Lesions Seen on Gadoxetic Acid–Enhanced Hepatobiliary Phase MRI

The purpose of this study was to define imaging features that may help characterize hyperintense lesions seen in the hepatobiliary phase of gadoxetic acid-enhanced hepatic MRI examinations. This retrospective study included 48 hyperintense nodules depicted on gadoxetic acid disodium-enhanced hepatobiliary phase MR images: 16 hepatocellular carcinomas (HCCs), 14 lesions of focal nodular hyperplasia, and 18 benign nodules associated with cirrhosis. Two observers independently reviewed hepatobiliary phase images and recorded the shape, margin, focal defects in contrast uptake, nodule-in-nodule pattern of uptake, central scar, internal septation, and presence of a hypointense rim around the lesion. Interobserver agreement was assessed with kappa statistics, and consensus opinions were reached by conference. For quantitative analysis, one observer measured lesion-to-liver contrast ratio (signal intensity of tumor divided by signal intensity of liver) on hepatobiliary phase images. Logistic regression analysis was used to determine the value of individual clinical and MR findings in prediction of malignancy. Compared with benign lesions, hyperintense HCC more commonly had focal defects in uptake (68.8% vs 3.1%, respectively; p < 0.001), nodule-in-nodule appearance (75.0% vs 0%, p < 0.001), absence of a central scar (100% vs 46.9%, p < 0.001), internal septation (50.0% vs 3.1%, p < 0.001), and a hypointense rim (75.0% vs 15.6%, p < 0.001) on hepatobiliary phase MR images. The mean contrast ratios of HCC (1.31) and benign lesions (1.28) were not significantly different (p = 0.63). Multiple logistic regression analysis showed that a focal defect in contrast uptake (p = 0.025) and a hypointense rim (p = 0.019) were significant predictors of HCC, having odds ratios of 36.8 (95% CI, 1.56-870.0) and 17.5 (1.60-191.4). On gadoxetic acid-enhanced MR images, hyperintense nodules can be differentiated with several imaging characteristics, especially a focal defect in contrast uptake and a hypointense rim, that indicate the diagnosis of hyperintense HCC.

Additional value of gadoxetic acid‐DTPA‐enhanced hepatobiliary phase MR imaging in the diagnosis of early‐stage hepatocellular carcinoma: Comparison with dynamic triple‐phase multidetector CT imaging

To assess the value of hepatobiliary phase gadoxetic acid (EOB)-enhanced magnetic resonance imaging (MRI) for the diagnosis of early stage hepatocellular carcinoma (HCC) (<3 cm) compared to triple-phase dynamic multidetector computed tomography (MDCT). In all, 52 patients with 60 pathologically proven HCCs underwent both EOB-enhanced MRI and triple-phase dynamic MDCT. Two radiologists independently and blindly reviewed three image sets: 1) MDCT, 2) dynamic MRI (unenhanced and EOB-enhanced dynamic MR images), and 3) combined MRI (dynamic MRI + hepatobiliary phase images) using a five-point rating scale on a lesion-by-lesion basis. Receiver operating characteristics (ROC) analysis was performed, and sensitivity and specificity were calculated. The area under the ROC curve (Az) of dynamic MRI was equivalent to that of MDCT for both readers. For both readers, Az and sensitivity of combined MRI for smaller lesions (<1.5 cm) were significantly higher than that of dynamic MRI and MDCT (P < 0.0166). The majority of false-negative nodules on dynamic MRI or MDCT (75% and 62%, respectively) were due to a lack of identified washout findings. Hepatobiliary phase images can increase the value of EOB-enhanced MRI in the diagnosis of early stage HCC. The sensitivity and accuracy were significantly superior to MDCT for the diagnosis of lesions less than 1.5 cm.

Usefulness of Gadobenate Dimeglumine - Enhanced Hepatobiliary Phase MR Imaging on Predicting Histological Grade of Hepatocellular Carcinoma

JKSMRM 15:208-218(2011) Department of Radiology, Research Institute of Radiological Science, Institute of Gastroenterology, Yonsei University College of Medicine Received; October 10, 2011, revised; October 18, 2011, accepted; October 25, 2011 Corresponding author : Myeong-Jin Kim, M.D., Department of Diagnostic Radiology, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemun-gu, Seoul 120-752, Korea. Tel. 82-2-2228-7400 Fax. 82-2-393-3035 E-mail: kimnex@yuhs.ac Usefulness of Gadobenate Dimeglumine Enhanced Hepatobiliary Phase MR Imaging on Predicting Histological Grade of Hepatocellular Carcinoma

Gadoxetic Acid–enhanced Hepatobiliary Phase MR Imaging: Cellular Insight

HomeRadiologyVol. 257, No. 2 PreviousNext CommunicationsLetters to the EditorGadoxetic Acid–enhanced Hepatobiliary Phase MR Imaging: Cellular InsightCatherine M. PastorCatherine M. PastorAuthor AffiliationsLaboratory of Hepatic Pathophysiology and Molecular Imaging, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil, 4, 1205 Geneva, Switzerland e-mail: [email protected]Catherine M. PastorPublished Online:Nov 1 2010https://doi.org/10.1148/radiol.101172MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Tsuboyama T, Onishi H, Kim Tet al.. Hepatocellular carcinoma: hepatocyte-selective enhancement at gadoxetic acid–enhanced MR imaging—correlation with expression of sinusoidal and canalicular transporters and bile accumulation. Radiology 2010;255(3):824–833. Link, Google Scholar2 Narita M, Hatano E, Arizono Set al.. Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol 2009;44(7):793–798. Crossref, Medline, Google Scholar3 Planchamp C, Montet X, Frossard JLet al.. Magnetic resonance imaging with hepatospecific contrast agents in cirrhotic rat livers. Invest Radiol 2005;40(4):187–194. Crossref, Medline, Google Scholar4 Planchamp C, Hadengue A, Stieger Bet al.. Function of both sinusoidal and canalicular transporters controls the concentration of organic anions within hepatocytes. Mol Pharmacol 2007;71(4):1089–1097. Crossref, Medline, Google Scholar5 Pastor CM, Planchamp C, Pochon Set al.. Kinetics of gadobenate dimeglumine in isolated perfused rat liver: MR imaging evaluation. Radiology 2003;229(1):119–125. Link, Google ScholarArticle HistoryPublished online: Nov 2010Published in print: Nov 2010 FiguresReferencesRelatedDetailsCited ByAbdominal Radiology, Vol. 43, No. 7European Radiology, Vol. 28, No. 10Journal of Magnetic Resonance Imaging, Vol. 42, No. 5Magnetic Resonance Imaging Clinics of North America, Vol. 20, No. 4Recommended Articles Imaging Features in the Liver after Stereotactic Body Radiation TherapyRadioGraphics2022Volume: 42Issue: 7pp. 2131-2148Dynamic CT and Gadoxetic Acid-enhanced MRI Characteristics of P53-mutated Hepatocellular CarcinomaRadiology2022Volume: 0Issue: 0Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential PitfallsRadioGraphics2016Volume: 36Issue: 4pp. 1001-1023Benign Hepatocellular Nodules: Hepatobiliary Phase of Gadoxetic Acid–enhanced MR Imaging Based on Molecular BackgroundRadioGraphics2016Volume: 36Issue: 7pp. 2010-2027Using MRI to Assess Microvascular Invasion in Hepatocellular CarcinomaRadiology2020Volume: 297Issue: 3pp. 582-583See More RSNA Education Exhibits Focal Liver Reaction Following Localized Radiation Therapy of Hepatocellular CarcinomaDigital Posters2020Practical Approaches and Updated Topics in Gadoxetate-Enhanced MR Imaging of the Liver: What the Radiologists Should KnowDigital Posters2019All Manner of Things: Hepatocellular Carcinoma Imaging and TherapyDigital Posters2018 RSNA Case Collection Oxaliplatin-induced focal nodular hyperplasiaRSNA Case Collection2021Radioembolization of Liver Metastasis RSNA Case Collection2020Riedel's lobeRSNA Case Collection2021 Vol. 257, No. 2 Metrics Altmetric Score PDF download

Comparison between areas with Gd‐EOB‐DTPA uptake and without in hepatocellular carcinomas on Gd‐EOB‐DTPA‐enhanced hepatobiliary‐phase MR imaging: Pathological correlation

To determine histological and MR imaging differences between areas with Gd-EOB-DTPA (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid) uptake and without in hepatocellular carcinomas (HCCs) as seen on Gd-EOB-DTPA-enhanced hepatobiliary-phase MR images. This study included nine patients with nine histopathologically proven HCCs (mean size, 1.9 cm) that consisted of two portions of a non-hypointense (Gd-EOB-DTPA uptake) and hypointense area (no Gd-EOB-DTPA uptake) in one tumor as depicted on hepatobiliary-phase MR images. Two radiologists and one pathologist compared the histological and MR finding differences between the two portions in consensus. In eight specimens, non-hypointense areas of six specimens showed a green color and two specimens did not show a green color. Microscopically, two of nine showed a higher percentage of bile pigments in the non-hypointense area as compared to the hypointense area and the remaining seven showed no difference. Six were homogeneous Edmondson-Steiner grade II, and one was grade I. In two, non-hypointense areas were grade II and hypointense areas were grade I. No difference between the two portions was found for necrosis, hemorrhage, fibrosis, and a fibrous capsule. Seven on T1/T2-weighted images and eight on arterial and portal phase images showed no different signal intensity between the two portions. Although macroscopically, a non-hypointense area of an HCC seen on GD-EOB-DTPA-enhanced hepatobiliary-phase images may be associated with the area with a green color, no definite microscopic and MR imaging findings that could discriminate a non-hypointense from a hypointense area of an HCC was found.

MDCT and Gd-EOB-DTPA Enhanced MRI Findings of Adrenal Adenoma Arising from an Ectopic Adrenal Gland within the Liver: Radiologic-Pathologic Correlation

We report a case of an adenoma arising from an ectopic adrenal gland mimicking a hepatocellular carcinoma in a heavy alcohol abuser. A MDCT showed a 2.7 low-attenuating nodule in segment VII of the liver through all CT phases. Compared to a precontrast image, however, a subtle enhancement was noted on the arterial phase CT image. On T1 weighted in- and opposed-phase MR images, an abundant fat component within the lesion was seen. Dynamic contrast-enhanced MR images after administration of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) more clearly depicted hypervascularity and wash-out of the lesion on arterial and portal phases, respectively. On delayed hepatobiliary phase MR images, obtained 20 minutes after Gd-EOB-DTPA administration, subtle uptake or retention of the contrast agent by the lesion was suspected. A tumorectomy was performed and adrenal adenoma from an ectopic adrenal gland within the liver was confirmed.