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Bashir MR, Castelli P, Davenport MS, Larson D, Marin D, Hussain HK, Jaffe TA. Respiratory motion artifact affecting hepatic arterial phase MR imaging with gadoxetate disodium is more common in patients with a prior episode of arterial phase motion associated with gadoxetate disodium. Radiology 2014; 274:141-8. [PMID: 25162310 DOI: 10.1148/radiol.14140386] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine, in a dual-center setting, whether patients who experience transient severe motion ( TSM transient severe motion ) in the arterial phase during gadoxetate disodium-enhanced magnetic resonance (MR) imaging are at higher risk for a subsequent episode of TSM transient severe motion than patients who do not have TSM transient severe motion during initial gadoxetate disodium administration. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective, multi-institutional HIPAA-compliant study. The requirement for informed consent was waived. One hundred seventy patients each underwent two MR imaging examinations with bolus injection of gadoxetate disodium at one of two sites. Three radiologists reviewed the examinations at each site for TSM transient severe motion , based on severe arterial phase motion, despite minimal motion in the other dynamic phases. The occurrence rate of TSM transient severe motion in the second examination was compared between patients who had TSM transient severe motion in their first examination and those who did not by using the χ(2) or Fisher exact test, as appropriate. Relative risks and 95% confidence intervals ( CI confidence interval s) were calculated. RESULTS TSM transient severe motion rates in second examinations were significantly higher for patients who had TSM transient severe motion in their first examination: site 1, 67% (six of nine) vs 4% (three of 69) (P < .0001); site 2, 60% (three of five) vs 6% (five of 87) (P < .005); and both sites, 64% (nine of 14) vs 5% (eight of 156) (P < .0001). Relative risks were 15 for site 1 (95% CI confidence interval : 5, 51), 10 for site 2 (95% CI confidence interval : 3, 32), and 13 for both sites (95% CI confidence interval : 6, 27). CONCLUSION Patients who experience TSM transient severe motion during gadoxetate disodium-enhanced MR imaging are at significantly and substantially higher risk for TSM transient severe motion in the next gadoxetate disodium-enhanced examination compared with patients who do not have TSM transient severe motion during their initial gadoxetate disodium administration.
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Affiliation(s)
- Mustafa R Bashir
- From the Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710 (M.R.B., D.L., D.M., T.A.J.); and Department of Radiology, University of Michigan Health System, Ann Arbor, MI (P.C., M.S.D., H.K.H.)
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Palmucci S. Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI. World J Hepatol 2014; 6:477-485. [PMID: 25067999 PMCID: PMC4110539 DOI: 10.4254/wjh.v6.i7.477] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/14/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid (Gd-EOB-DTPA) properties. Following contrast injection, it provides dynamic vascular phases (arterial, portal and equilibrium phases) and hepatobiliary phase, the latter due to its uptake by functional hepatocytes. The main advantages of Gd-EOB-DTPA of focal liver lesion detection and characterization are discussed in this paper. Namely, we focus on the possibility of distinguishing focal nodular hyperplasia (FNH) from hepatic adenoma (HA), the identification of early hepatocellular carcinoma (HCC) and the pre-operative assessment of metastasis in liver parenchyma. Regarding the differentiation between FNH and HA, adenoma typically appears hypointense in hepatobiliary phase, whereas FNH is isointense or hyperintense to the surrounding hepatic parenchyma. As for the identification of early HCCs, many papers recently published in literature have emphasized the contribution of hepatobiliary phase in the characterization of nodules without a typical hallmark of HCC. Atypical nodules (no hypervascularizaton observed on arterial phase and/or no hypovascular appearance on portal phase) with low signal intensity in the hepatobiliary phase, have a high probability of malignancy. Finally, regarding the evaluation of focal hepatic metastases, magnetic resonance pre-operative assessment using gadoxetic acid allows for more accurate diagnosis.
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Haimerl M, Wächtler M, Zeman F, Verloh N, Platzek I, Schreyer AG, Stroszczynski C, Wiggermann P. Quantitative evaluation of enhancement patterns in focal solid liver lesions with Gd-EOB-DTPA-enhanced MRI. PLoS One 2014; 9:e100315. [PMID: 24950259 PMCID: PMC4065046 DOI: 10.1371/journal.pone.0100315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 05/25/2014] [Indexed: 01/26/2023] Open
Abstract
Purpose The objective was to investigate the dynamic enhancement patterns in focal solid liver lesions after the administration of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) by means of dynamic magnetic resonance imaging (MRI) including hepatobiliary phase (HP) images 20 min after Gd-EOB-DTPA administration. Materials and Methods Non-enhanced T1/T2-weighted as well as dynamic magnetic resonance (MR) images during the arterial phase (AP), the portal venous phase (PVP), the late phase (LP), and the HP (20 min) were obtained from 83 patients (54 male, 29 female, mean age 62.01 years) with focal solid liver lesions. MRI was conducted by means of a 1.5-T system for 63 patients with malignant liver lesions (HCCs: n = 34, metastases: n = 29) and for 20 patients with benign liver lesions (FNH lesions: n = 14, hemangiomas: n = 3, adenomas: n = 3). For quantitative analysis, signal-to-noise ratios (SNR), contrast enhancement ratios (CER), lesion-to-liver contrast ratios (LLC), and signal intensity (SI) ratios were measured. Results The SNR of liver parenchyma significantly increased in each dynamic phase after Gd-EOB-DTPA administration compared to the SNR of non-enhanced images (p<0.001). The CER of HCCs and metastases significantly decreased between LP and HP images (p = 0.0011, p<0.0001). However, FNH lesions did not show any significant difference, whereas an increased CER was found in hemangiomas. The mean LLCs of FNH lesions were significantly higher than those of HCCs and metastases. The LLC values of hemangiomas remained negative during the entire time course, whereas the LLC of adenomas indicated hyperintensity from the AP to the LP. Furthermore, adenomas showed hypointensity in HP images. Conclusion Gd-EOB-DTPA-enhanced MRI may help diagnose focal solid liver lesions by evaluating their enhancement patterns.
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Affiliation(s)
- Michael Haimerl
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
- * E-mail:
| | - Max Wächtler
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Medical Center Regensburg, Regensburg, Germany
| | - Niklas Verloh
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Ivan Platzek
- Department of Radiology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | | | - Philipp Wiggermann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Bashir MR, Breault SR, Braun R, Do RK, Nelson RC, Reeder SB. Optimal timing and diagnostic adequacy of hepatocyte phase imaging with gadoxetate-enhanced liver MRI. Acad Radiol 2014; 21:726-32. [PMID: 24717550 DOI: 10.1016/j.acra.2014.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 12/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate clinical and imaging features associated with adequacy of the hepatocyte phase (HP) in gadoxetate disodium-enhanced liver magnetic resonance imaging (MRI) in patients without chronic liver disease (CLD). MATERIALS AND METHODS This was a retrospective institutional review board-approved study of 97 patients who underwent liver MRI examinations with gadoxetate disodium and had no history of CLD. Available late dynamic and HP sequences (3-20 minutes postinjection) were independently analyzed by four radiologists for perceived image adequacy and level of biliary enhancement. Signal intensity ratios (SIRs) of liver/inferior vena cava (IVC), liver/spleen, and liver/muscle were measured. The Spearman ρ and receiver operating characteristic analyses were performed correlating various factors with HP adequacy. A rule for predicting HP adequacy was also derived and tested to determine whether overall examination time could be shortened. RESULTS A visually adequate HP was observed in 12% of subjects by 10 minutes, 80% by 15 minutes, and 93% by 20 minutes. An SIRliver/IVC > 1.8 was the imaging feature that had the strongest correlation with an adequate HP (ρ = 0.813, P < .001), and was more predictive of adequacy of the HP than the time postinjection (ρ = 0.5, P < .001). The time at which an adequate HP was first observed did not correlate with any tested demographic or laboratory values. Stopping imaging when an SIRliver/IVC > 1.8 would have successfully reduced mean postcontrast time to 15:39 ± 4:02 from 20:00 (P < .001), although maintaining HP adequacy. CONCLUSIONS Most patients without CLD undergoing gadoxetate-enhanced liver MRI achieve adequate HP at 20 minutes. However, a shorter postcontrast stopping time can be used in most patients.
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Affiliation(s)
- Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710.
| | - Steven R Breault
- Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710
| | - Ryan Braun
- Department of Radiology, Rush University Medical Center, Chicago, IL 60612
| | - Richard K Do
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Rendon C Nelson
- Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI 53792; Department of Medical Physics, University of Wisconsin, Madison, WI 53792; Department of Biomedical Engineering, University of Wisconsin, Madison, WI 53792; Department of Medicine, University of Wisconsin, Madison, WI 53792
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Pietryga JA, Burke LMB, Marin D, Jaffe TA, Bashir MR. Respiratory motion artifact affecting hepatic arterial phase imaging with gadoxetate disodium: examination recovery with a multiple arterial phase acquisition. Radiology 2014; 271:426-34. [PMID: 24475864 DOI: 10.1148/radiol.13131988] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine whether the use of a multiple arterial phase imaging technique provides adequate image quality in patients experiencing transient severe motion (TSM) in the arterial phase on abdominal magnetic resonance (MR) images obtained with gadoxetate disodium. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and was compliant with HIPAA. The requirement to obtain informed consent was waived. Five hundred forty-nine consecutive MR examinations were evaluated, 345 performed with gadoxetate disodium and 204 performed with gadobenate dimeglumine. All examinations included single-breath-hold triple arterial phase acquisition. Five radiologists blinded to the contrast material rated motion on a scale of 1 (no motion) to 5 (nondiagnostic images) for the precontrast phase, the three arterial phases, the portal venous phase, and the late dynamic phase. Adequacy of late hepatic arterial timing was also rated for the each of the three arterial phases. Mean motion scores were compared by using the Wilcoxon signed rank test. The number of patients with TSM, as well as the number of those with "adequate" arterial phases, was compared with the χ(2) or Fisher exact test, as appropriate. RESULTS Mean motion scores in all three arterial phases in the gadoxetate disodium cohort were significantly worse than those in the gadobenate dimeglumine cohort (P < .005). TSM occurred at a higher rate with gadoxetate disodium than with gadobenate dimeglumine (10.7% [37 of 345 examinations] vs 0.5% [one of 204 examinations], P < .001). However, 30 of 37 examinations affected by TSM had at least one well-timed arterial phase with a mean motion score of 3 or less and were thus considered adequate. CONCLUSION Use of single-breath-hold multiple arterial phase acquisition in abdominal MR imaging with gadoxetate disodium recovers most arterial phases that would otherwise have been compromised by transient motion.
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Affiliation(s)
- Jason A Pietryga
- From the Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710
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Sutherland T, Seale M, Yap K. Part 2: MRI of hypervascular focal liver lesions using liver specific contrast agents. J Med Imaging Radiat Oncol 2013; 58:56-63. [DOI: 10.1111/1754-9485.12129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/26/2013] [Indexed: 01/02/2023]
Affiliation(s)
- Tom Sutherland
- Medical Imaging Department; St. Vincent's Hospital; Fitzroy Victoria Australia
| | - Melanie Seale
- Medical Imaging Department; St. Vincent's Hospital; Fitzroy Victoria Australia
| | - Kelvin Yap
- Medical Imaging Department; St. Vincent's Hospital; Fitzroy Victoria Australia
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Morana G, Cugini C, Scatto G, Zanato R, Fusaro M, Dorigo A. Use of contrast agents in oncological imaging: magnetic resonance imaging. Cancer Imaging 2013; 13:350-9. [PMID: 24060901 PMCID: PMC3781607 DOI: 10.1102/1470-7330.2013.9018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Magnetic resonance plays a leading role in the management of oncology patients, providing superior contrast resolution and greater sensitivity compared with other techniques, which enables more accurate tumor identification, characterization and staging. Contrast agents are widely used in clinical magnetic resonance imaging; approximately 40-50% of clinical scans are contrast enhanced. Most contrast agents are based on the paramagnetic gadolinium ion Gd3+, which is chelated to avoid the toxic effects of free gadolinium. Multiple factors such as molecule structure, molecule concentration, dose, field strength and temperature determine the longitudinal and transverse relaxation rates (R1 and R2, respectively) and thus the T1- and T2-relaxivities of these chelates. These T1- and T2-relaxivities, together with their pharmacokinetic properties (i.e. distribution and concentration in the area of interest), determine the radiologic efficacy of the gadolinium-based contrast agents.
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Affiliation(s)
- Giovanni Morana
- Radiological Department, General Hospital Ca' Foncello, Treviso, Italy
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An HS, Park HS, Kim YJ, Jung SI, Jeon HJ. Focal nodular hyperplasia: characterisation at gadoxetic acid-enhanced MRI and diffusion-weighted MRI. Br J Radiol 2013; 86:20130299. [PMID: 23873903 DOI: 10.1259/bjr.20130299] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this study was to assess the enhancement patterns of hepatic focal nodular hyperplasia (FNH) on gadoxetic acid-enhanced MRI and diffusion-weighted (DW) MRI. METHODS This retrospective study had institutional review board approval. Gadoxetic acid-enhanced and DW MR images were evaluated in 23 patients with 30 FNHs (26 histologically proven and 4 radiologically diagnosed). The lesion enhancement patterns of the hepatobiliary phase images were classified as heterogeneous or homogeneous signal intensity (SI), and as dominantly high/iso or low SI compared with those of adjacent liver parenchyma. Heterogeneous (any) SI lesions and homogeneous low SI lesions were categorised into the fibrosis group, whereas homogeneous high/iso SI lesions were categorised into the non-fibrosis group. Additionally, lesion SI on T2 weighted images, DW images and apparent diffusion coefficient (ADC) values were compared between the two groups. RESULTS The lesions showed heterogeneous high/iso SI (n=16), heterogeneous low SI (n=5), homogeneous high/iso SI (n=7) or homogeneous low SI (n=2) at the hepatobiliary phase MR images. The fibrosis group lesions were more likely to show high SI on DW images and T2 weighted images compared with those in the non-fibrosis group (p<0.05). ADC values tended to be lower in the fibrosis group than those in the non-fibrosis group without significance. CONCLUSION FNH showed variable enhancement patterns on hepatobiliary phase images during gadoxetic acid-enhanced MRI. SI on DW and T2 weighted images differed according to the fibrosis component contained in the lesion. ADVANCES IN KNOWLEDGE FNH shows a wide spectrum of imaging findings on gadoxetic acid-enhanced MRI and DW MRI.
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Affiliation(s)
- H S An
- Department of Radiology, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Republic of Korea
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Grieser C, Steffen IG, Seehofer D, Kramme IB, Uktolseya R, Scheurig-Muenkler C, Hamm B, Denecke T. Histopathologically confirmed focal nodular hyperplasia of the liver: Gadoxetic acid-enhanced MRI characteristics. Magn Reson Imaging 2013; 31:755-60. [DOI: 10.1016/j.mri.2012.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/06/2012] [Indexed: 02/07/2023]
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MOTOSUGI U, ICHIKAWA T, ARAKI T. Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges. Magn Reson Med Sci 2013; 12:161-75. [DOI: 10.2463/mrms.2012-0085] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma. Int J Hepatol 2013; 2013:374170. [PMID: 23606972 PMCID: PMC3623472 DOI: 10.1155/2013/374170] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/24/2013] [Indexed: 12/22/2022] Open
Abstract
HEPATOCELLULAR ADENOMAS (HCAS) ARE CURRENTLY CATEGORIZED INTO DISTINCT GENETIC AND PATHOLOGIC SUBTYPES AS FOLLOWS: inflammatory hepatocellular adenoma, hepatocyte-nuclear-factor-1-alpha (HNF-1 α -mutated) hepatocellular adenoma, and β -catenin-mutated hepatocellular adenomas; the fourth, defined as unclassified subtype, encompasses HCAs without any genetic abnormalities. This classification has accepted management implications due to different risks of haemorrhage and malignant transformation of the four subtypes. Imaging guided biopsy and/or surgical resection very important in obtaining definitive characterization; nevertheless, MRI with intra-extravascular and hepatobiliary (dual phase) agents, is an important tool not only in differential subtypes definition but even in surveillance with early identification of complications and discovery of some signs of HCA malignant degeneration. Inflammation, abnormal rich vascularisation, peliotic areas, and abundant fatty infiltration are pathologic findings differently present in the HCA subtypes and they may be detected by multiparametric MRI approach. Lesion enlargement and heterogeneity of signal intensity and of contrast enhancement are signs to be considered in malignant transformation. The purpose of this paper is to present the state of the art of MRI in the diagnosis of HCA and subtype characterization, with particular regard to morphologic and functional information available with dual phase contrast agents, and to discuss differential diagnosis with the most common benign and malignant lesions mimicking HCAs.
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