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Kim H, Park SH, Kim EK, Kim MJ, Park YN, Park HJ, Choi JY. Histogram analysis of gadoxetic acid-enhanced MRI for quantitative hepatic fibrosis measurement. PLoS One 2014; 9:e114224. [PMID: 25460180 PMCID: PMC4252123 DOI: 10.1371/journal.pone.0114224] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/05/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The diagnosis and monitoring of liver fibrosis is an important clinical issue; however, this is usually achieved by invasive methods such as biopsy. We aimed to determine whether histogram analysis of hepatobiliary phase images of gadoxetic acid-enhanced magnetic resonance imaging (MRI) can provide non-invasive quantitative measurement of liver fibrosis. METHODS This retrospective study was approved by the institutional ethics committee, and a waiver of informed consent was obtained. Hepatobiliary phase images of preoperative gadoxetic acid-enhanced MRI studies of 105 patients (69 males, 36 females; age 56.1±12.2) with pathologically documented liver fibrosis grades were analyzed. Fibrosis staging was F0/F1/F2/F3/F4 (METAVIR system) for 11/20/13/15/46 patients, respectively. Four regions-of-interest (ROI, each about 2 cm2) were placed on predetermined locations of representative images. The measured signal intensity of pixels in each ROI was used to calculate corrected coefficient of variation (cCV), skewness, and kurtosis. An average value of each parameter was calculated for comparison. Statistical analysis was performed by ANOVA, receiver operating characteristic (ROC) curve analysis, and linear regression. RESULTS The cCV showed statistically significant differences among pathological fibrosis grades (P<0.001) whereas skewness and kurtosis did not. Univariable linear regression analysis suggested cCV to be a meaningful parameter in predicting the fibrosis grade (P<0.001, β = 0.40 and standard error = 0.06). For discriminating F0-3 from F4, the area under ROC score was 0.857, standard deviation 0.036, 95% confidence interval 0.785-0.928. CONCLUSION Histogram analysis of hepatobiliary phase images of gadoxetic acid-enhanced MRI can provide non-invasive quantitative measurements of hepatic fibrosis.
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Affiliation(s)
- Honsoul Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Kyung Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Jeong Park
- Department of Nuclear Medicine, Radiology and Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014; 272:635-54. [PMID: 25153274 PMCID: PMC4263631 DOI: 10.1148/radiol.14132361] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The first article of this two-part review discusses key concepts of HCC development, growth, and spread, emphasizing those features with imaging correlates and hence most relevant to radiologists; state-of-the-art CT and MR imaging technique with extracellular and hepatobiliary contrast agents; and the imaging appearance of precursor nodules that eventually may transform into overt HCC.
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Affiliation(s)
- Jin-Young Choi
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
| | - Jeong-Min Lee
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
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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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Bastati N, Feier D, Wibmer A, Traussnigg S, Balassy C, Tamandl D, Einspieler H, Wrba F, Trauner M, Herold C, Ba-Ssalamah A. Noninvasive differentiation of simple steatosis and steatohepatitis by using gadoxetic acid-enhanced MR imaging in patients with nonalcoholic fatty liver disease: a proof-of-concept study. Radiology 2014; 271:739-47. [PMID: 24576046 DOI: 10.1148/radiol.14131890] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine whether gadoxetic acid-enhanced magnetic resonance (MR) imaging can be used to distinguish between simple steatosis and nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD), defined according to the steatosis activity and fibrosis (SAF) scoring system, which is based on the semiquantitative scoring of steatosis activity and liver fibrosis. MATERIALS AND METHODS The local institutional review committee approved this study and waived written informed consent. This was a retrospective study of gadoxetic acid-enhanced 3-T MR imaging performed in 81 patients with NAFLD (45 men [56%]; mean age, 56 years; range, 25-78 years). The MR images were analyzed by using the relative enhancement (the ratio of signal intensities of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid). Univariate and multiple regression analyses were applied to identify variables associated with relative enhancement measurements. The ability of relative enhancement to allow differentiation between simple steatosis and NASH was assessed by using area under the receiver operating characteristic (ROC) curve analysis. RESULTS Relative enhancement negatively correlated with the degree of lobular inflammation (r = -0.59, P < .0001), ballooning (r = -0.44, P < .0001), and fibrosis (r = -0.59, P ≤ .0001), but not with steatosis (r = -0.16, P = .15). Patients with NASH had a significantly lower relative liver enhancement (0.82 ± 0.22) than those with simple steatosis (1.39 ± 0.52) (P < .001). Relative enhancement measurements performed well in the differentiation between simple steatosis and NASH, with an area under the ROC curve of 0.85 (95% confidence interval: 0.75, 0.91) (cutoff = 1.24, sensitivity = 97%, specificity = 63%). CONCLUSION Gadoxetic acid relative enhancement was significantly lower in patients with NASH than in patients with simple steatosis, but further prospective studies are warranted.
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Affiliation(s)
- Nina Bastati
- From the Department of Radiology (N.B., D.F., A.W., C.B., D.T., H.E., C.H., A.B.S.), Division of Gastroenterology and Hepatology, Department of Internal Medicine III (S.T., M.T.), and Department of Pathology (F.W.), Medical University Vienna, General Hospital of Vienna, Vienna, Austria
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Verloh N, Haimerl M, Zeman F, Schlabeck M, Barreiros A, Loss M, Schreyer AG, Stroszczynski C, Fellner C, Wiggermann P. Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla. Eur Radiol 2014; 24:1013-9. [PMID: 24531844 DOI: 10.1007/s00330-014-3108-y] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/13/2013] [Accepted: 01/27/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the usefulness of Gd-EOB-DTPA-enhanced 3-T MRI to determine the hepatic functional reserve expressed by the model for end-stage liver disease (MELD) score. METHODS A total of 121 patients with normal liver function (NLF; MELD score ≤ 10) and 29 patients with impaired liver function (ILF; MELD score > 10) underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. T1-weighted volume interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 min after contrast injection. Relative enhancement (RE) between plain signal intensity and contrast-enhanced signal intensity was calculated and was used to determine Gd-EOB-DTPA uptake into the liver parenchyma for patients with different MELD scores. RESULTS RE differed significantly (p ≤ 0.001) between patients with NLF (87.2 ± 29.5 %) and patients with ILF (45.4 ± 26.5 %). The optimal cut-off value for RE to differentiate NLF from ILF was 47.7 % (AUC 0.87). This cut-off value showed a sensitivity of 82.8 % and a specificity of 92.7 % for the differentiation of the analysed groups. CONCLUSION Gd-EOB-DTPA uptake in hepatocytes is strongly affected by liver function. Gd-EOB-DTPA-enhanced MRI and assessment of RE during the hepatobiliary phase (HBP) may serve as a useful image-based test in liver imaging for determining regional and global liver function. KEY POINTS Hepatic uptake of Gd-EOB-DTPA is strongly affected by liver function. Relative enhancement during HBP in GD-EOB-DTPA MRI correlates with the MELD score. Assessment of relative enhancement may help improve treatment in routine clinical practice.
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Affiliation(s)
- N Verloh
- Department of Radiology, University Hospital Regensburg, 93042, Regensburg, Germany,
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Jattujan P, Pinlaor S, Charoensuk L, Arunyanart C, Welbat JU, Chaijaroonkhanarak W. Curcumin prevents bile canalicular alterations in the liver of hamsters infected with Opisthorchis viverrini. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:695-701. [PMID: 24516276 PMCID: PMC3916460 DOI: 10.3347/kjp.2013.51.6.695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/20/2013] [Accepted: 10/11/2013] [Indexed: 11/23/2022]
Abstract
Opisthorchis viverrini infection causes inflammation and liver injury leading to periductal fibrosis. Little is known about the pathological alterations in bile canaliculi in opisthorchiasis. This study aimed to investigate bile canalicular alterations in O. viverrini-infected hamsters and to examine the chemopreventive effects of curcumin on such changes. Hamsters were infected with O. viverrini and one group of animals was fed with 1% dietary curcumin supplement. Animals were examined during the acute infection phase, days 21 and 30 post-infection (PI) and chronic infection phase (day 90 PI). Scanning electron microscopy revealed that in the infected group fed with a normal diet, bile canaliculi became slightly tortuous by 30 day PI and more tortuous at day 90 PI. Transmission electron microscopy showed a reduction in microvilli density of canaliculi starting at day 30 PI, with a marked loss of microvilli at day 90 PI. These ultrastructral changes were slightly seen at day 21 PI, which was similar to that found in infected animals fed with 1% curcumin-supplemented diet. Notably, curcumin treatment prevented the reduction of microvilli density, reduced the dilation of bile canaliculi, and decreased the tortuosity of the bile canaliculi relative to non-infected animals on a normal diet at days 30 and 90 PI. These results suggest that curcumin reduces alteration of bile canaliculi and may be a promising agent to prevent the onset of bile duct abnormalities induced by O. viverrini infection.
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Affiliation(s)
- Prapaporn Jattujan
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Somchai Pinlaor
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. ; Liver Fluke and Cholangiocarcinoma Research Center, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Lakhanawan Charoensuk
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. ; Liver Fluke and Cholangiocarcinoma Research Center, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Channarong Arunyanart
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Jariya Umka Welbat
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Haimerl M, Verloh N, Zeman F, Fellner C, Müller-Wille R, Schreyer AG, Stroszczynski C, Wiggermann P. Assessment of clinical signs of liver cirrhosis using T1 mapping on Gd-EOB-DTPA-enhanced 3T MRI. PLoS One 2013; 8:e85658. [PMID: 24392025 PMCID: PMC3877368 DOI: 10.1371/journal.pone.0085658] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 11/29/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess the differences between normal and cirrhotic livers by means of T1 mapping of liver parenchyma on gadoxetic acid (Gd-EOB-DTPA)-enhanced 3 Tesla (3T) MR imaging (MRI). METHODS 162 patients with normal (n = 96) and cirrhotic livers (n = 66; Child-Pugh class A, n = 30; B, n = 28; C, n = 8) underwent Gd-EOB-DTPA-enhanced 3T MRI. To obtain T1 maps, two TurboFLASH sequences (TI = 400 ms and 1000 ms) before and 20 min after Gd-EOB-DTPA administration were acquired. T1 relaxation times of the liver and the reduction rate between pre- and post-contrast enhancement images were measured. RESULTS The T1 relaxation times for Gd-EOB-DTPA-enhanced MRI showed significant differences between patients with normal liver function and patients with Child-Pugh class A, B, and C (p < 0.001). The T1 relaxation times showed a constant significant increase from Child-Pugh class A up to class C (Child-Pugh class A, 335 ms ± 80 ms; B, 431 ms ± 75 ms; C, 557 ms ± 99 ms; Child-Pugh A to B, p < 0.001; Child-Pugh A to C, p < 0.001; Child-Pugh B to C, p < 0.001) and a constant decrease of the reduction rate of T1 relaxation times (Child-Pugh class A, 57.1% ± 8.8%; B, 44.3% ± 10.2%, C, 29.9% ± 6.9%; Child-Pugh A to B, p < 0.001; Child-Pugh A to C,p < 0.001; Child-Pugh B to C, p < 0.001). CONCLUSION Gd-EOB-DTPA-enhanced T1 mapping of the liver parenchyma may present a useful method for determining severity of liver cirrhosis.
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Affiliation(s)
- Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - Niklas Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas G. Schreyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Sirlin CB, Hussain HK, Jonas E, Kanematsu M, Min Lee J, Merkle EM, Peck-Radosavljevic M, Reeder SB, Ricke J, Sakamoto M. Consensus report from the 6th International forum for liver MRI using gadoxetic acid. J Magn Reson Imaging 2013; 40:516-29. [PMID: 24923695 DOI: 10.1002/jmri.24419] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/21/2013] [Indexed: 02/06/2023] Open
Abstract
As the utility of liver-specific magnetic resonance imaging (MRI) increases, it is pertinent to optimize and expand protocols to improve accuracy and foster evolution of techniques; in turn, positive impacts should be seen in patient management. This article reports on the latest expert thinking and current evidence in the field of liver-specific MRI, as discussed at the 6(th) International Forum for Liver MRI, which was held in Vancouver, Canada in September 2012. Topics discussed at this forum described the use of gadoxetic acid-enhanced MRI for the assessment of liver function at the segmental level; to increase accuracy in the diagnosis of liver metastases; to overcome current challenges in patients with cirrhosis, including management of arterial hypo-/isovascular, hepatobiliary phase hypointense nodules; and the data which would be required in order to recommend the use of this modality in hepatocellular carcinoma management guidelines. Growing evidence suggests that gadoxetic acid-enhanced MRI can help to improve the management of patients with a number of different liver disorders; however, more data are needed in some areas, and there may be a case for developing an interpretation guideline for gadoxetic acid-enhanced MRI findings to aid standardization.
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Affiliation(s)
- Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, California, USA
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Biologic factors affecting HCC conspicuity in hepatobiliary phase imaging with liver-specific contrast agents. AJR Am J Roentgenol 2013; 201:322-31. [PMID: 23883212 DOI: 10.2214/ajr.12.9478] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate factors influencing hepatic enhancement and the conspicuity of hepatocellular carcinoma (HCC) on gadobenate dimeglu-mine- and gadoxetate disodium-enhanced hepatobiliary phase MR images. MATERIALS AND METHODS Patients with chronic liver disease who underwent liver MRI with gadobenate dimeglumine (n = 93) or gadoxetate disodium (n = 92) were included in this study. The degree of hepatic enhancement on 1-hour and 3-hour delayed phase gadobenate dimeglumine-enhanced and 20-minute delayed phase gadoxetate disodium-enhanced hepatobiliary phase images were evaluated with quantitative and visual indexes. The conspicuity of 40 HCCs in the gadobenate dimeglumine group and 38 HCCs in the gadoxetate disodium group were graded on a 5-point scale. Correlation between hepatic enhancement indexes and clinical factors (age, body weight, serum bilirubin concentration, model for end-stage liver disease score, Child-Pugh class, and renal function stage) and association between the conspicuity of HCCs and clinical factors, lesion diameter, and hepatic enhancement indexes were evaluated. RESULTS In the gadobenate dimeglumine group, the visual index of hepatic enhancement independently correlated with Child-Pugh class on both 1- and 3-hour delayed images (p < 0.001) and with renal function stage only on 3-hour delayed images (p ≤ 0.031). In the gadoxetate disodium group, both quantitative and visual indexes of hepatic enhancement independently correlated with Child-Pugh class (p ≤ 0.019). The conspicuity of HCCs independently correlated with Child-Pugh class and lesion diameter on 3-hour delayed gadobenate dimeglumine-enhanced images (p ≤ 0.031) and on gadoxetate disodium-enhanced images (p = 0.033) and significantly correlated with the visual index of hepatic enhancement on both gadobenate dimeglumine- and gadoxetate disodium-enhanced images (p ≤ 0.001). CONCLUSION Liver enhancement and conspicuity of HCC are significantly affected by Child-Pugh class on both gadobenate dimeglumine- and gadoxetate disodium-enhanced hepatobiliary phase MR images.
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Feier D, Balassy C, Bastati N, Stift J, Badea R, Ba-Ssalamah A. Liver fibrosis: histopathologic and biochemical influences on diagnostic efficacy of hepatobiliary contrast-enhanced MR imaging in staging. Radiology 2013. [PMID: 23878281 DOI: 10.1148/radiol.13122482] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the staging of liver fibrosis in patients with diffuse chronic liver diseases (CLDs) and to investigate the factors that may influence the results. MATERIALS AND METHODS With the approval of the Hospital Ethics Committee and waiver of the informed consent requirement, data in 102 patients with histologically proven liver fibrosis (classified according to the METAVIR system) of various underlying causes were retrospectively analyzed. Patients underwent 3.0-T MR imaging with gadoxetic acid. The signal intensity of the liver was defined by using region of interest measurements before contrast material injection and in the hepatobiliary phase (20 minutes after contrast material administration), and relative enhancement was calculated. Univariate and multivariate regression analyses were applied to identify variables associated with relative enhancement measurements, and the performance of relative enhancement measurements in the staging of liver fibrosis was assessed by using area under the receiver operating characteristic curve (AUC) analysis. RESULTS At analysis of the relationship between enhancement measurements and histologic parameters, the relative enhancement values correlated strongly with liver fibrosis stage (r = -0.65, P < .0001) and moderately with necroinflammatory activity grades (r = -0.41, P = .002) and the presence of iron load (r = -0.21, P = .05). In multivariate analysis, only liver fibrosis stage independently influenced relative enhancement values (P < .001). The measurements performed well in the staging of liver fibrosis, with an AUC of 0.81 for stages of F1 or greater, 0.82 for stages of F2 or greater, 0.85 for stages of F3 or greater, and 0.83 for stage F4. Increased aspartate aminotransferase, gammaglutamyl transpeptidase, and alkaline phosphatase levels were independent predictors of false-negative results. CONCLUSION The presence of hepatic fibrosis can be assessed with good discrimination by using gadoxetic acid-enhanced MR imaging, but assessment can be confounded in the setting of abnormal aspartate aminotransferase, gammaglutamyl transpeptidase, and alkaline phosphatase levels.
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Affiliation(s)
- Diana Feier
- Department of Medical Imaging, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Dynamic Contrast-Enhanced MRI of the Liver in Mrp2-Deficient Rats Using the Hepatobiliary Contrast Agent Gd-EOB-DTPA. Invest Radiol 2013; 48:548-53. [DOI: 10.1097/rli.0b013e3182856a06] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakamura Y, Hirokawa Y, Kitamura S, Yamasaki W, Arihiro K, Tatsugami F, Iida M, Kakizawa H, Date S, Awai K. Effect of lapatinib on hepatic parenchymal enhancement on gadoxetate disodium (EOB)-enhanced MRI scans of the rat liver. Jpn J Radiol 2013; 31:386-92. [PMID: 23605127 DOI: 10.1007/s11604-013-0208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/09/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of lapatinib treatment on hepatic parenchymal enhancement on Gd-EOB-MRI scans in rat. MATERIALS AND METHODS Institutional animal review board approval was received prior to the commencement of all studies. Five rats received a single oral dose of 100 mg/kg/day lapatinib for 7 consecutive days. The controls (n = 5) were given 0.5 % (w/v) aqueous hydroxypropyl methyl cellulose containing 0.1 % (v/v) Tween 80 for 7 days. After the acquisition of gadoxetate disodium-enhanced MR images using 0.025 mmol gadolinium/kg, their livers were subjected to pathologic study to determine the expression level of organic anion-transporting polypeptide 1 (oatp1) and multi-drug resistance-associated protein 2 (mrp2). RESULTS Relative enhancement of the liver was similar in both groups. At the hepatobiliary phase, which in rats occurs 3 min after the injection of Gd-EOB, it was 0.90 ± 0.06 in lapatinib-treated rats and 0.84 ± 0.08 in the controls (p = 0.30). There was also no difference in the expression level of oatp1 and mrp2. CONCLUSION In rats, the administration of lapatinib for 7 days had no effect on hepatic parenchymal enhancement on Gd-EOB-MRI scans.
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
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Kim YC, Kim MJ, Park YN, Kim KS, Ahn SH, Jung SE, Kim JK. Relationship between severity of liver dysfunction and the relative ratio of liver to aortic enhancement (RE) on MRI using hepatocyte-specific contrast. J Magn Reson Imaging 2013; 39:24-30. [PMID: 23553935 DOI: 10.1002/jmri.24100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 02/06/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate differences in liver enhancement among patients with low and high morbidity risks and to determine the relationship between severity of liver dysfunction and the relative ratio of liver to aortic enhancement (RE) on MRI using hepatocyte-specific contrast. MATERIALS AND METHODS A total of 126 patients underwent magnetic resonance imaging (MRI) and blood serum testing including serology, bilirubin, international normalized ratio, and creatinine tests. Radiologists analyzed a region of interest in the liver and aorta on precontrast and 10- and 20-minute delayed hepatobiliary phase MR images. Liver enhancement after 10 (LE10min ) and 20 minutes (LE20min ) were compared between the low- and high-risk groups by independent t-test. Regression analysis was used to assess the relationship between the Model for Endstage Liver Disease (MELD) score and RE. RESULTS All 126 patients were classified into either the low-risk group (MELD <8; n = 85) or high-risk group (MELD ≥8; n = 41). The mean LE10min and LE20min were significantly higher in the low-risk group (471.61; 95% confidence interval [CI]: 449.79-493.43 and 510.69; 95% CI: 486.51-534.87, respectively) than in the high-risk group (401.6776; 95% CI: 364.75-438.61 and 413.81; 95% CI: 370.91-456.70). There was a moderate inverse correlation between MELD score and the relative ratio of liver enhancement (RLE) (r = -0.5442; 95% CI: -0.6480 to -0.4207; P<0.01), but a high positive correlation between MELD score and RE (r = 0.7470; 95% CI: 0.6665-0.8102; P < 0.01). CONCLUSION Although liver enhancement was significantly greater in low-risk patients compared to high-risk patients, RE may be a better predictor of liver function than RLE.
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Affiliation(s)
- Young Chul Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Republic of Korea
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Hyperintense lesions on gadoxetate disodium-enhanced hepatobiliary phase imaging. AJR Am J Roentgenol 2013; 199:W575-86. [PMID: 23096201 DOI: 10.2214/ajr.11.8205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to illustrate various focal hepatic lesions that may show hyperintensity on hepatobiliary phase images on gadoxetate disodium-enhanced MRI. CONCLUSION Hyperintense lesions on gadoxetate disodium-enhanced MRI include focal nodular hyperplasia (FNH) or FNH-like nodules, hepatocellular adenoma, dysplastic nodules, and hepatocellular carcinoma. Understanding the contrast enhancement patterns on hepatobiliary phase images and other imaging findings is important to ensure correct diagnosis.
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Disodium gadoxetate uptake in progressive familial intrahepatic cholestasis type I: Enhancing our understanding of the cholestatic disease. Radiol Case Rep 2013; 8:661. [PMID: 27330609 PMCID: PMC4900202 DOI: 10.2484/rcr.v8i1.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatocyte-specific magnetic resonance imaging (MRI) contrast agents are commonly used to depict anatomic hepatobiliary lesions and are also useful in characterizing the kinetics of hepatocyte uptake and excretion. We report a case of a 13-year old female with progressive familial intrahepatic cholestasis (PFIC) type 1 who demonstrated decreased uptake and excretion of gadoxetate disodium contrast material. This case illustrates the challenge of imaging children with cholestasis using hepatobiliary-specific contrast agents; we propose an alternative explanation for the delayed excretion that may be related to the underlying genetic defect of this child.
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Wu Z, Matsui O, Kitao A, Kozaka K, Koda W, Kobayashi S, Ryu Y, Minami T, Sanada J, Gabata T. Usefulness of Gd-EOB-DTPA-enhanced MR imaging in the evaluation of simple steatosis and nonalcoholic steatohepatitis. J Magn Reson Imaging 2012; 37:1137-43. [PMID: 23172731 DOI: 10.1002/jmri.23921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/27/2012] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging (EOB-MRI) in differentiating between simple steatosis and nonalcoholic steatohepatitis (NASH), as compared with MR in-phase/out-of-phase imaging. The correlations between the MR features and histological characteristics were preliminarily investigated. MATERIALS AND METHODS From April 2008 to October 2011, 25 patients (13 simple steatosis and 12 NASH) who underwent both EOB-MRI and in-phase/out-of-phase imaging were analyzed. The hepatobiliary-phase enhancement ratio and signal intensity loss on opposed-phase T1-weighted images (fat fraction) were compared between the simple steatosis and NASH groups. In the simple steatosis and NASH groups, the correlations between enhancement ratio and histological grade/stage were explored. In the NASH group, fat fraction was correlated with the steatosis score. RESULTS The enhancement ratio in NASH was significantly lower than that in simple steatosis (P = 0.03). In the simple steatosis and NASH groups, the enhancement ratio was significantly correlated with the fibrosis stage (r = -0.469, P = 0.018). Fat fraction in NASH was strongly correlated with the steatosis score (r = 0.728, P = 0.007). CONCLUSION In simple steatosis and NASH, the hepatobiliary-phase enhancement ratio of EOB-MRI showed significant association with fibrosis stage, and may be a useful discriminating parameter compared with the fat fraction measured by in-phase/out-of-phase imaging.
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Affiliation(s)
- Zhuo Wu
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
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Magnetic Resonance Elastography as a Predictor of Insufficient Liver Enhancement on Gadoxetic Acid–Enhanced Hepatocyte-Phase Magnetic Resonance Imaging in Patients With Type C Hepatitis and Child-Pugh Class A Disease. Invest Radiol 2012; 47:566-70. [DOI: 10.1097/rli.0b013e318260ac9e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bashir MR, Gupta RT, Davenport MS, Allen BC, Jaffe TA, Ho LM, Boll DT, Merkle EM. Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis? J Magn Reson Imaging 2012; 37:398-406. [PMID: 23011874 DOI: 10.1002/jmri.23818] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 08/14/2012] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd-EOB-DTPA, in a North American population. MATERIALS AND METHODS One hundred MRI examinations performed with the intravenous injection of Gd-EOB-DTPA in patients with cirrhosis were reviewed retrospectively. Nodules were classified as HCC (n = 70), indeterminate (n = 33), or benign (n = 22). Five readers independently reviewed each examination with and without hepatobiliary phase images (HBP). Lesion conspicuity scores were compared between the two readings. Lesion detection, confidence scores, and receiver operating characteristic (ROC) analysis were compared. RESULTS Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged. CONCLUSION Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd-EOB-DTPA.
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Affiliation(s)
- Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Abstract
Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA, Primovist in Europe and Eovist in the USA) is a liver-specific magnetic resonance imaging contrast agent that has up to 50% hepatobiliary excretion in the normal liver. After intravenous injection, Gd-EOB-DTPA distributes into the vascular and extravascular spaces during the arterial, portal venous and late dynamic phases, and progressively into the hepatocytes and bile ducts during the hepatobiliary phase. The hepatocyte uptake of Gd-EOB-DTPA mainly occurs via the organic anion transporter polypeptides OATP1B1 and B3 located at the sinusoidal membrane and biliary excretion via the multidrug resistance-associated proteins MRP2 at the canalicular membrane. Because of these characteristics, Gd-EOB-DTPA behaves similarly to non-specific gadolinium chelates during the dynamic phases, and adds substantial information during the hepatobiliary phase, improving the detection and characterization of focal liver lesions and diffuse liver disease. This information is particularly relevant for the detection of metastases, and for the detection and characterization of nodular lesions in liver cirrhosis, including early hepatocellular carcinomas. Finally, GD-EOB-DTPA-enhanced magnetic resonance imaging may provide quantitative assessment regarding liver perfusion and hepatocyte function in diffuse liver diseases. The full potential of GD-EOB-DTPA-enhanced magnetic resonance imaging has to be established further. It is already clear that GD-EOB-DTPA-enhanced magnetic resonance imaging provides anatomic and functional information in the setting of focal and diffuse liver disease that is unattainable with magnetic resonance imaging enhanced with non-specific contrast agents.
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Hope TA, Doherty A, Fu Y, Aslam R, Qayyum A, Brasch RC. Gadolinium accumulation and fibrosis in the liver after administration of gadoxetate disodium in a rat model of active hepatic fibrosis. Radiology 2012; 264:423-7. [PMID: 22570507 DOI: 10.1148/radiol.12112453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of gadoxetate disodium on fibrosis in a rat model of active hepatic fibrosis. MATERIALS AND METHODS The local committee for animal research approved this study. Hepatic fibrosis was induced during 12 weeks of intraperitoneal injection of carbon tetrachloride (CCl(4)). Gadoxetate disodium was administered at 10 mmol/kg for 5 consecutive days starting after the final dose of CCl(4) (clinical dose of gadoxetate disodium is 0.25 mmol/kg). Three groups of Sprague-Dawley rats were studied. Group 1 consisted of six rats treated only with gadoxetate disodium, group 2 consisted of nine rats treated only with CCl(4), and group 3 consisted of nine rats treated with both gadoxetate disodium and CCl(4). Seven days after the final injection of gadoxetate disodium, the rats were sacrificed, and histologic findings and gadolinium deposition in the liver were examined. Fibrosis stage and gadolinium deposition were compared by using the Mann-Whitney test and Student t test. RESULTS Fibrosis grading in groups 2 and 3 did not differ significantly (mean Batts-Ludwig fibrosis stage in group 2 was 2.67 and in group 3 was 2.78, P = .70; mean Ishak fibrosis stage in group 2 was 3.89 and in group 3 was 4.11, P = .71). Gadolinium deposition in the liver was slightly increased in group 3 in comparison to group 1 (3.2 ppm versus 4.0 ppm, P = .01), although this reversed when corrected as a percentage of total injected dose (0.022% versus 0.017%, P = .003). CONCLUSION The high-dose administration of gadoxetate disodium in the setting of active hepatic fibrosis was not associated with increased fibrosis, suggesting that gadoxetate disodium does not incite a nephrogenic systemic fibrosis-like fibrotic change in the setting of active hepatic inflammation.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA.
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Hepatic parenchymal enhancement at Gd-EOB-DTPA-enhanced MR imaging: correlation with morphological grading of severity in cirrhosis and chronic hepatitis. Magn Reson Imaging 2012; 30:356-60. [DOI: 10.1016/j.mri.2011.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 10/07/2011] [Accepted: 11/06/2011] [Indexed: 02/01/2023]
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Tatsumi M, Yamamoto S, Imaizumi M, Watabe T, Kanai Y, Aoki M, Kato H, Shimosegawa E, Hatazawa J. Simultaneous PET/MR body imaging in rats: initial experiences with an integrated PET/MRI scanner. Ann Nucl Med 2012; 26:444-9. [PMID: 22359223 DOI: 10.1007/s12149-012-0581-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 01/25/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We recently developed an integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) (iPET/MRI) scanner for small animals, which had relatively large field-of-view (FOV) covering up to the size of a rat body. The purpose of this study was to report results of simultaneous PET/MRI of a rat body using this scanner with some radiotracers. METHODS C-11-methionine (MET), F-18-fluorodeoxyglucose (FDG), or F-18-sodium fluoride (NaF) was injected as a radiotracer for PET portion in addition to gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid, a hepatobiliary contrast agent, for MRI portion. Simultaneous PET/MRI was performed in normal rats. PET, MRI, and co-registered fusion images were evaluated regarding image quality and feasibility for rat imaging studies. RESULTS MET uptake was clearly shown in the liver and pancreas, which was confirmed with magnetic resonance (MR) and fused PET/MR images. PET/MR images depicted intense FDG uptake in the brain, Harderian glands, and myocardium. NaF uptake was observed in all bones and joints within FOV, except in ribs, which was well recognized with the help of MR and fused PET/MR images. CONCLUSION This study demonstrated that simultaneous PET/MRI with an integrated dual-modality molecular imaging scanner was a feasible technique for imaging studies targeting on a rat body. However, further developments including attenuation correction methods are required to use this technique routinely in rat imaging studies.
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Affiliation(s)
- Mitsuaki Tatsumi
- Department of Nuclear Medicine, Osaka University Graduate School of Medicine, 2-2-D9 Yamadaoka, Suita, Osaka, 565-0871, Japan,
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MORIYAMA Y, SAITO S, KOBAYASHI S, OGIHARA R, KOTO D, KITAMURA A, MATSUSHITA T, NISHIURA M, MURASE K. Evaluation of Concanavalin A-induced Acute Liver Injury in Rats using an Empirical Mathematical Model and Dynamic Contrast-enhanced MR Imaging with Gd-EOB-DTPA. Magn Reson Med Sci 2012; 11:53-60. [DOI: 10.2463/mrms.11.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
The diagnostic imaging of hepatocellular carcinoma (HCC) has recently undergone marked progress. The advent of the ultrasound (US) contrast agent Sonazoid, approved in January 2007, and magnetic resonance imaging (MRI) with the liver-specific MRI contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-MRI), approved in January 2008, are of particular significance. Sonazoid contrast-enhanced US (Sonazoid-CEUS) is useful not only for the diagnosis of HCC, but also for guiding treatment and assessing treatment response. Sonazoid-CEUS has proven to be particularly effective for screening and staging, which used to be considered impossible with CEUS, through the introduction of the newly developed diagnostic technique of defect reperfusion imaging. It is still not possible if other vascular agents such as SonoVue and Definity are used. In particular, Gd-EOB-DTPA-MRI has been suggested to be much more reliable in the differentiation of early HCC from precancerous dysplastic nodules than any other modalities such as multidetector raw computed tomography, dynamic MRI, and superparamagnetic iron oxide-MRI. A decrease in contrast uptake in the hepatocyte phase observed on EOB-MRI is strongly suggestive of cancer, and the absence of early staining in the arterial phase suggests early HCC. The differential diagnostic capacity of Gd-EOB-DTPA-MRI is considered to far exceed that of what were previously the most useful imaging techniques, computed tomography (CT) during hepatic arteriography or CT during arterial portography, and to be comparable to that of the pathological diagnosis by pathologists specialized in liver.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama, Osaka, Japan.
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Kim KA, Kim MJ, Jeon HM, Kim KS, Choi JS, Ahn SH, Cha SJ, Chung YE. Prediction of microvascular invasion of hepatocellular carcinoma: usefulness of peritumoral hypointensity seen on gadoxetate disodium-enhanced hepatobiliary phase images. J Magn Reson Imaging 2011; 35:629-34. [PMID: 22069244 DOI: 10.1002/jmri.22876] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 10/06/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine whether peritumoral hypointensity seen on hepatobiliary phase images of preoperative gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) is useful for predicting microvascular invasion of hepatocellular carcinoma (HCC). MATERIALS AND METHODS This study was approved by the Institutional Review Board. In all, 104 HCC masses in 104 patients who had undergone EOB-MRI and liver surgery within 1 month after EOB-MRI were evaluated. Two radiologists independently recorded the presence of a peritumoral hypointensity on hepatobiliary phase. Interobserver agreement was assessed and consensus records were used. Tumor size was measured. A chi-square test and independent t-test were used for univariate analysis. Multiple logistic regression was performed to determine factors for predicting microvascular invasion. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of peritumoral hypointensity were calculated. RESULTS Sixty HCCs had microvascular invasion and 44 did not. Interobserver agreement in determining peritumoral hypointensity was excellent (κ = 0.83). By univariate analysis, peritumoral hypointensity and tumor size were significant for predicting microvascular invasion of HCC. On multiple logistic regression analysis, only peritumoral hypointensity was significant in predicting microvascular invasion of HCC (P = 0.013). The sensitivity, specificity, PPV, and NPV of peritumoral hypointensity were 38.3%, 93.2%, 88.5%, and 52.6%, respectively. CONCLUSION Peritumoral hypointensity on the hepatobiliary phase of EOB-MRI is not sensitive but has high specificity for predicting microvascular invasion of HCC.
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Affiliation(s)
- Kyung Ah Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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Chen BB, Hsu CY, Yu CW, Wei SY, Kao JH, Lee HS, Shih TTF. Dynamic contrast-enhanced magnetic resonance imaging with Gd-EOB-DTPA for the evaluation of liver fibrosis in chronic hepatitis patients. Eur Radiol 2011; 22:171-80. [PMID: 21879400 DOI: 10.1007/s00330-011-2249-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 08/02/2011] [Accepted: 08/10/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To develop a non-invasive MRI method for evaluation of liver fibrosis, with histological analysis as the reference standard. METHODS The study protocol was approved by the Institutional Review Board for Human Studies of our hospital, and written informed consent was obtained from all subjects. Seventy-nine subjects who received dynamic contrast-enhanced MRI (DCE-MRI) with Gd-EOB-DTPA were divided into three subgroups according to Metavir score: no fibrosis (n = 30), mild fibrosis (n = 34), and advanced fibrosis (n = 15). The DCE-MRI parameters were measured using two models: (1) dual-input single-compartment model for arterial blood flow (F (a)), portal venous blood flow, total liver blood flow, arterial fraction (ART), distribution volume, and mean transit time; and (2) curve analysis model for Peak, Slope, and AUC. Statistical analysis was performed with Student's t-test and the nonparametric Kruskal-Wallis test. RESULTS Slope and AUC were two best perfusion parameters to predict the severity of liver fibrosis (>F2 vs. ≦F2). Four significantly different variables were found between non-fibrotic versus mild-fibrotic subgroups: F (a), ART, Slope, and AUC; the best predictor for mild fibrosis was F (a) (AUROC:0.701). CONCLUSIONS DCE-MRI with Gd-EOB-DTPA is a noninvasive imaging, by which multiple perfusion parameters can be measured to evaluate the severity of liver fibrosis.
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Affiliation(s)
- Bang-Bin Chen
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Rd, Taipei, Taiwan
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Tsuda N, Matsui O. Signal profile on Gd-EOB-DTPA-enhanced MR imaging in non-alcoholic steatohepatitis and liver cirrhosis induced in rats: correlation with transporter expression. Eur Radiol 2011; 21:2542-50. [PMID: 21830099 DOI: 10.1007/s00330-011-2228-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare the transporter expression and signal profile on Gd-EOB-DTPA-enhanced MRI between non-alcoholic steatohepatitis (NASH) and cirrhotic liver induced in rats, and investigate the correlation of the transporter expression and fibrosis rate in both diseases. METHODS Forty-eight rats were divided into four groups of 12: TAA (cirrhosis), NASH 7- and 10-week, and control groups. Each group was divided into two subgroups: Group 1 for MRI and Group 2 for transporter examinations. RESULTS The relative enhancement of the TAA group was significantly lower than those of other groups (p < 0.01). The T(max) and T(1/2) of the NASH 10-week group was significantly prolonged in comparison with the TAA group (p < 0.01). There was no significant difference in the oatp1 expression, whereas the mrp2 expression of the TAA group was significantly higher than those of other groups (p < 0.01). There was no significant correlation between the fibrosis rate and oatp1 expression, whereas a paradoxical correlation was found between the fibrosis rate and mrp2 expression (NASH: negative correlation, r = 0.91, p < 0.01; TAA: positive correlation, r = 0.85, p < 0.01). CONCLUSIONS Our findings showed that the mrp2 expression in cirrhosis increases in comparison with NASH, and there was a paradoxical correlation between the fibrosis rate and mrp2 expression.
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Affiliation(s)
- Natsuko Tsuda
- Diagnostic Imaging Medical Affairs, Medical Affairs, Bayer Yakuhin, Ltd., 4-9, Umeda 2-chome, Kita-ku, Osaka, Osaka 530-0001, Japan.
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Lee JM, Zech CJ, Bolondi L, Jonas E, Kim MJ, Matsui O, Merkle EM, Sakamoto M, Choi BI. Consensus report of the 4th International Forum for Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid Magnetic Resonance Imaging. Korean J Radiol 2011; 12:403-15. [PMID: 21852900 PMCID: PMC3150667 DOI: 10.3348/kjr.2011.12.4.403] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/27/2011] [Indexed: 12/16/2022] Open
Abstract
This paper reports on issues relating to the optimal use of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA MR imaging) together with the generation of consensus statements from a working group meeting, which was held in Seoul, Korea (2010). Gd-EOB-DTPA has been shown to improve the detection and characterization of liver lesions, and the information provided by the hepatobiliary phase is proving particularly useful in differential diagnoses and in the characterization of small lesions (around 1-1.5 cm). Discussion also focused on advances in the role of organic anion-transporting polypeptide 8 (OATP8) transporters. Gd-EOB-DTPA is also emerging as a promising tool for functional analysis, enabling the calculation of post-surgical liver function in the remaining segments. Updates to current algorithms were also discussed.
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Affiliation(s)
- Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
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Tsuda N, Harada K, Matsui O. Effect of change in transporter expression on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging during hepatocarcinogenesis in rats. J Gastroenterol Hepatol 2011; 26:568-76. [PMID: 21332553 DOI: 10.1111/j.1440-1746.2010.06494.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS To analyze the difference in signal intensity on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) among various hepatocellular nodules during hepatocarcinogenesis as correlated with the expressions of the transporters of Gd-EOB-DTPA. METHODS We received institutional animal review board approval prior to the commencement of all studies. Forty rats were divided into three groups. The rats in the tumor groups received N-nitrosomorpholine solution (n = 16), and rats in the cirrhosis group (thioacetamide [TAA] group) received thioacetamide solution (n = 12). As a control, the remaining 12 rats were fed normal water. Each group was divided into two sub-groups: Group 1 for Gd-EOB-DTPA-enhanced MRI (0.025 mmol Gd/kg, n =7) and Group 2 for reverse transcription-polymerase chain reaction to compare transporter (oatp1 and mrp2) expressions (n = 5 for control and TAA groups, n = 9 for tumor groups). RESULTS Signal enhancement of tumors decreased according to the progress of hepatocarcinogenesis. Although the relative enhancement of each tumor group was significantly lower than that of the control group (P < 0.01), and there was no significant difference between TAA, hyperplastic nodules (HPN), and HCC(well) groups. The relative enhancement of the HCC(mod) group was significantly lower than the other groups (P < 0.01). The oatp1 expression of HPN tended to be higher than those of HCC(well) and HCC(mod). The mrp2 expression of TAA was significantly higher than those of HCC(well), HCC(mod), HPN and control (P < 0.01). The mrp2 expression of HPN tended to be higher than those of HCC(well ) and HCC(mod). CONCLUSION It was suggested that the signal enhancement on Gd-EOB-DTPA-enhanced MRI would correlate with the transporter expression in various hepatocellular nodules during hepatocarcinogenesis.
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Affiliation(s)
- Natsuko Tsuda
- Diagnostic Imaging Medical Affair, Medical Affairs, Bayer Yakuhin, Ltd., Osaka, Japan.
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Chanyaputhipong J, Low SCA, Chow PKH. Gadoxetate Acid-Enhanced MR Imaging for HCC: A Review for Clinicians. Int J Hepatol 2011; 2011:489342. [PMID: 21994860 PMCID: PMC3170825 DOI: 10.4061/2011/489342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 02/28/2011] [Accepted: 03/31/2011] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is increasingly being detected at an earlier stage, owing to the screening programs and regular imaging follow-up in high-risk populations. Small HCCs still pose diagnostic challenges on imaging due to decreased sensitivity and increased frequency of atypical features. Differentiating early HCC from premalignant or benign nodules is important as management differs and has implications on both the quality of life and the overall survival for the patients. Gadoxetate acid (Gd-EOB-DTPA, Primovist(®), Bayer Schering Pharma) is a relatively new, safe and well-tolerated liver-specific contrast agent for magnetic resonance (MR) imaging of the liver that has combined perfusion- and hepatocyte-specific properties, allowing for the acquisition of both dynamic and hepatobiliary phase images. Its high biliary uptake and excretion improves lesion detection and characterization by increasing liver-to-lesion conspicuity in the added hepatobiliary phase imaging. To date, gadoxetate acid-enhanced MRI has been mostly shown to be superior to unenhanced MRI, computed tomography, and other types of contrast agents in the detection and characterization of liver lesions. This review article focuses on the evolving role of gadoxetate acid in the characterization of HCC, differentiating it from other mimickers of HCC.
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Affiliation(s)
| | - Su-Chong Albert Low
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore,*Su-Chong Albert Low:
| | - Pierce K. H. Chow
- Department of General Surgery, Singapore General Hospital, 169608, Singapore ,Duke-NUS Graduate Medical School, 169857, Singapore
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