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Clark T, Maximin S, Meier J, Pokharel S, Bhargava P. Hepatocellular Carcinoma: Review of Epidemiology, Screening, Imaging Diagnosis, Response Assessment, and Treatment. Curr Probl Diagn Radiol 2015; 44:479-86. [PMID: 25979220 DOI: 10.1067/j.cpradiol.2015.04.004] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/11/2015] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma is a common malignancy for which prevention, screening, diagnosis, treatment, and surveillance demand a multidisciplinary approach. Knowledge of the underlying pathophysiology as well as advances in clinical management should be employed by radiologists to effectively communicate with hepatologists, surgeons, and oncologists. In this review article, we present recent developments in the clinical management of hepatocellular carcinoma.
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Affiliation(s)
- Toshimasa Clark
- Department of Radiology, Abdominal Imaging Section, University of Colorado Denver, Aurora, CO.
| | - Suresh Maximin
- Department of Radiology, University of Washington & VA Puget Sound Health Care System, Seattle, WA
| | - Jeffrey Meier
- Department of Radiology, Abdominal Imaging Section, University of Colorado Denver, Aurora, CO
| | - Sajal Pokharel
- Department of Radiology, Abdominal Imaging Section, University of Colorado Denver, Aurora, CO
| | - Puneet Bhargava
- Department of Radiology, University of Washington & VA Puget Sound Health Care System, Seattle, WA
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Ringe KI, Wacker F. Radiological diagnosis in cholangiocarcinoma: Application of computed tomography, magnetic resonance imaging, and positron emission tomography. Best Pract Res Clin Gastroenterol 2015; 29:253-65. [PMID: 25966426 DOI: 10.1016/j.bpg.2015.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/07/2015] [Indexed: 01/31/2023]
Abstract
The purpose of radiological imaging in patients with suspected or known cholangiocarcinoma (CCA) is tumour detection, lesion characterization and assessment of resectability. Different imaging modalities are implemented complementary in the diagnostic work-up. Non-invasive imaging should be performed prior to invasive biliary procedures in order to avoid false positive results. For assessment of intraparenchymal tumour extension and evaluation of biliary and vascular invasion, MRI including MRCP and CT are the primarily used imaging modalities. The role of PET remains controversial with few studies showing benefit with the detection of unexpected metastatic spread, the differentiation between benign and malignant biliary strictures, and for discriminating post therapeutic changes and recurrent CCA.
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Affiliation(s)
- Kristina I Ringe
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Frank Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Carl-Neuberg Str. 1, 30625 Hannover, Germany
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Joo I, Lee JM, Lee DH, Jeon JH, Han JK, Choi BI. Noninvasive diagnosis of hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout? Eur Radiol 2015; 25:2859-68. [DOI: 10.1007/s00330-015-3686-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/03/2015] [Accepted: 02/19/2015] [Indexed: 02/07/2023]
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Asayama Y, Nishie A, Ishigami K, Ushijima Y, Takayama Y, Fujita N, Kubo Y, Aishima S, Shirabe K, Yoshiura T, Honda H. Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI. Diagn Interv Radiol 2015; 21:96-104. [PMID: 25698097 PMCID: PMC4463313 DOI: 10.5152/dir.2014.13013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/03/2014] [Accepted: 09/24/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to gain further insight in magnetic resonance imaging characteristics of mass-forming intrahepatic cholangiocarcinoma (mICC), its enhancement pattern with gadoxetic acid contrast agent, and distinction from poorly differentiated hepatocellular carcinoma (pHCC). METHODS Fourteen mICC and 22 pHCC nodules were included in this study. Two observers recorded the tumor shape, intratumoral hemorrhage, fat on chemical shift imaging, signal intensity at the center of the tumor on T2-weighted image, fibrous capsule, enhancement pattern on arterial phase of dynamic study, late enhancement three minutes after contrast injection (dynamic late phase), contrast uptake on hepatobiliary phase, apparent diffusion coefficient, vascular invasion, and intrahepatic metastasis. RESULTS Late enhancement was more common in mICC (n=10, 71%) than in pHCC (n=3, 14%) (P < 0.001). A fat component was observed in 11 pHCC cases (50%) versus none of mICC cases (P = 0.002). Fibrous capsule was observed in 13 pHCC cases (59%) versus none of mICC cases (P < 0.001). On T2-weighted images a hypointense area was seen at the center of the tumor in 43% of mICC (6/14) and 9% of pHCC (2/22) cases (P = 0.018). Other parameters were not significantly different between the two types of nodules. CONCLUSION The absence of fat and fibrous capsule, and presence of enhancement at three minutes appear to be most characteristic for mICC and may help its differentiation from pHCC.
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Affiliation(s)
- Yoshiki Asayama
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Akihiro Nishie
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kousei Ishigami
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasuhiro Ushijima
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yukihisa Takayama
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Nobuhiro Fujita
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuichiro Kubo
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Shinichi Aishima
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ken Shirabe
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takashi Yoshiura
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiroshi Honda
- From the Departments of Radiology (Y.A. , A.N., K.I., Y.U., N.F., T.Y., H.H.), Molecular Imaging & Diagnosis (Y.T.), Anatomic Pathology (N.F., Y.K., S.A.), Surgery and Science (K.S.), Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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The impact of hepatocyte phase imaging from infancy to young adulthood in patients with a known or suspected liver lesion. Pediatr Radiol 2015; 45:354-65. [PMID: 25246096 DOI: 10.1007/s00247-014-3160-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/21/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Hepatocyte-specific contrast agents are used to help characterize liver lesions. However, there are no studies evaluating the utility of these agents in detecting or diagnosing pediatric liver lesions. The purpose of this study is to assess the impact of the hepatocyte phase of imaging on lesion detection, tumor staging and diagnostic confidence. MATERIALS AND METHODS All patients undergoing an MRI between September 2010 and August 2012 using gadoxetate disodium as the contrast agent were included in this study. Each exam was duplicated so that one copy contained all sequences, including the hepatocyte phase of imaging, and the other copy contained all sequences except the hepatocyte phase of imaging. One reviewer evaluated all exams in a blinded, random fashion. Data tracked included imaging diagnosis, confidence in diagnosis, number of lesions and PRETEXT grade. The imaging diagnosis was compared to histopathology, when available. Data were analyzed for the study population as well as the subset of patients diagnosed with focal nodular hyperplasia (FNH). RESULTS There were 112 patients (56 male; mean age: 9.25 years) included in this study. A total of 33 patients had a malignant tumor and the remainder had either a benign lesion or no lesion. The addition of the hepatocyte phase of imaging significantly improved the diagnostic confidence for all patients (P < 0.0001) as well as specifically for patients diagnosed with FNH (P = 0.003). In nearly a quarter of patients, the hepatocyte phase of imaging allowed the reviewer to detect additional lesions (P = 0.005). In the patients with a malignant tumor, the addition of the hepatocyte phase of imaging changed the PRETEXT grade in 7/30 patients although the results were not significant (P = 0.161). CONCLUSION The addition of the hepatocyte phase of imaging helps to improve lesion detection and increase the diagnostic confidence for all liver tumors, as well as for FNH in particular.
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Consensus Statements From a Multidisciplinary Expert Panel on the Utilization and Application of a Liver-Specific MRI Contrast Agent (Gadoxetic Acid). AJR Am J Roentgenol 2015; 204:498-509. [PMID: 25714278 DOI: 10.2214/ajr.13.12399] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Endrikat JS, Dohanish S, Balzer T, Breuer JAM. Safety of gadoxetate disodium: Results from the clinical phase II-III development program and postmarketing surveillance. J Magn Reson Imaging 2015; 42:634-43. [PMID: 25643844 DOI: 10.1002/jmri.24838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/13/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To summarize the safety data of gadoxetate disodium, reported in 12 Phase II and III clinical development studies and in the postmarketing surveillance database. MATERIALS AND METHODS Patients with liver lesions received gadoxetate disodium-enhanced liver magnetic resonance imaging (MRI). Adverse events (AEs) were recorded and evaluated with regard to a potential drug relationship. Subgroup analyses were run on patients with special medical history. Worldwide spontaneous AEs and adverse drug reactions (ADRs) from postmarketing safety surveillance were analyzed. RESULTS A total of 1989 patients were included in the clinical development program. A total of 1581/1989 (79.5%) patients received the finally approved dose of 0.025 mmol/kg body weight. 10.1% of patients reported AEs, 4.1% were classified as related AEs. Nausea and headache were the most frequently reported related AEs, with 1.1% each. Age, history of contrast media allergy, liver cirrhosis, or impaired liver or renal function did not significantly impact the frequency and type of AEs. The postmarketing safety surveillance database encompassed more than 2.2 million patients. Nausea was the most frequent ADR, with a reporting rate of 0.00652%; all other symptoms were below 0.004%. CONCLUSION Gadoxetate disodium for liver MRI has an excellent safety profile.
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Affiliation(s)
- Jan S Endrikat
- Bayer HealthCare Pharmaceuticals, Medical Care, Global Medical and Clinical Affairs, Radiology & Interventional, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | - Susan Dohanish
- Bayer HealthCare Pharmaceuticals, Global Pharmacovigilance and Risk Management, Whippany, New Jersey, USA
| | - Thomas Balzer
- Bayer HealthCare Pharmaceuticals, Medical Care, Medical and Clinical Affairs, Radiology & Interventional, Whippany, New Jersey, USA
| | - Josy A M Breuer
- Bayer HealthCare Pharmaceuticals, Medical Care, Global Medical and Clinical Affairs, Radiology & Interventional, Berlin, Germany
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Besa C, Kakite S, Cooper N, Facciuto M, Taouli B. Comparison of gadoxetic acid and gadopentetate dimeglumine-enhanced MRI for HCC detection: prospective crossover study at 3 T. Acta Radiol Open 2015; 4:2047981614561285. [PMID: 25793110 PMCID: PMC4364400 DOI: 10.1177/2047981614561285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/31/2014] [Indexed: 12/29/2022] Open
Abstract
Background Gadoxetic acid and gadopentetate dimeglumine are gadolinium-based contrast agents (GBCAs) with an established role in HCC detection and characterization. Purpose To compare gadopentetate dimeglumine and gadoxetic acid-enhanced magnetic resonance imaging (MRI) for image quality and hepatocellular carcinoma (HCC) detection/conspicuity. Material and Methods In this IRB approved cross-over pilot prospective study, 12 patients (all men; mean age, 56 years) with chronic liver disease at risk of HCC underwent two repeat MRI examinations using gadopentetate dimeglumine and gadoxetic acid (mean interval between studies, 5 days). Two independent observers analyzed images for image quality and HCC detection/conspicuity. Per-lesion sensitivity, positive predictive value, quantitative enhancement, and lesion-to-liver contrast ratio were calculated for both contrast agents. Results There was no significant difference in image quality scores between both GBCAs (P = 0.3). A total of 20 HCCs were identified with reference standard in 12 patients (mean size 2.6 cm, range, 1.0–5.0 cm). Higher sensitivity was seen for observer 1 for gadoxetic acid-set in comparison with gadopentetate dimeglumine-set (sensitivity increased from 85.7% to 92.8%), while no difference was noted for observer 2 (sensitivity of 78.5%). Lesion conspicuity was significantly higher on hepatobiliary phase (HBP) images compared to arterial phase images with both GBCAs for both observers (P < 0.05). Lesion-to-liver contrast ratios were significantly higher for HBP compared to all dynamic phases for both agents (P < 0.05). Conclusion Our initial experience suggests that gadoxetic acid-set was superior to gadopentetate dimeglumine-set in terms of HCC detection for one observer, with improved lesion conspicuity and liver-to-lesion contrast on HBP images.
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Affiliation(s)
- Cecilia Besa
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suguru Kakite
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nancy Cooper
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marcelo Facciuto
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, New York, NY, USA ; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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160
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Geisel D, Lüdemann L, Fröling V, Malinowski M, Stockmann M, Baron A, Gebauer B, Seehofer D, Prasad V, Denecke T. Imaging-based evaluation of liver function: comparison of ⁹⁹mTc-mebrofenin hepatobiliary scintigraphy and Gd-EOB-DTPA-enhanced MRI. Eur Radiol 2014; 25:1384-91. [PMID: 25447973 DOI: 10.1007/s00330-014-3536-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare Gd-EOB-enhanced MRI and (99m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) as imaging-based liver function tests for separate evaluation of right (RLL) and left liver lobe (LLL) function. METHODS Fourteen patients underwent Gd-EOB-enhanced MRI and (99m)Tc-mebrofenin HBS after portal vein embolization within 24 h. Relative enhancement (RE) and hepatic uptake index (HUI) were determined from MRI; and T max, T 1/2 and mebrofenin uptake were determined from HBS, all values separately for RLL and LLL. RESULTS Mebrofenin uptake correlated significantly with HUI and RE for both liver lobes. There was strong correlation of mebrofenin uptake with HUI for RLL (r (2) = 0.802, p = 0.001) and RE for LLL (r (2) = 0.704, p = 0.005) and moderate correlation with HUI for LLL (r (2) = 0.560, p = 0.037) and RE for RLL (r (2) = 0.620, p = 0.018). Correlating the percentage share of RLL function derived from MRI (with HUI) with the percentage of RLL function derived from mebrofenin uptake revealed a strong correlation (r (2) = 0.775, p = 0.002). CONCLUSIONS Both RE and HUI correlate with mebrofenin uptake in HBS. The results suggest that Gd-EOB-enhanced MRI and (99m)Tc-mebrofenin HBS may equally be used to separately determine right and left liver lobe function. KEY POINTS • Information about liver function can be acquired with routine Gd-EOB-MRI. • Gd-EOB-MRI and (99m) Tc-mebrofenin HBS show elevated function of non-embolized lobe. • Gd-EOB-MRI and (99m) Tc-mebrofenin HBS can determine lobar liver function.
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Affiliation(s)
- Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Oh J, Martin DR, Hu X. Partitioned edge-function-scaled region-based active contour (p-ESRAC): automated liver segmentation in multiphase contrast-enhanced MRI. Med Phys 2014; 41:041914. [PMID: 24694145 DOI: 10.1118/1.4867865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In multiphase contrast-enhanced magnetic resonance imaging (CE-MRI), liver segmentation is an important preprocessing step for the computer-aided evaluation of liver disease. However, because of the liver's irregular shape, proximity to surrounding organs, and large intensity variation, and peripheral contrast enhancement in the kidney, liver segmentation has been very challenging. This paper presents a novel hybrid active contour model and overall procedures that are specific to liver segmentation. METHODS The authors introduced an edge-function-scaled (weighted) region-based active contour model (ESRAC) and utilization of registered, multiphase sequences to address leakage-to-kidney and oversegmentation problems. The model incorporated weighted regional information with a compactly supported edge map, computed from a combination of images obtained during arterial and delayed phases, and it was coupled with a geodesic edge term. To cope with signal-inhomogeneity on MRI, all of the axial slices were partitioned into eight sectors with an angular span of 45°, centered on the inferior vena cava, each in the superior and inferior regions and the regional information regarding ESRAC was computed for each partition, henceforth the so-called partitioned ESRAC (p-ESRAC). Initialization of the active contour was performed by thresholding with a range of [200, +∞) and simple morphological operation during the delayed phase. At the end, to fill the holes in the segmented images caused by high gradients around the vasculature, noise, or outstanding texture features, iterative morphological operations were performed until convergence. The authors compared the segmentation accuracy of p-ESRAC to that with geodesic active contour, region-based active contour, geodesic active region, and localized region-based active contour using quantitative and visual assessments. RESULTS In three-dimensional experimental studies conducted on 30 subjects (14 normal or benign cases and 16 malignant cases), compared with other active contours, p-ESRAC achieved the highest dice similarity coefficients of 93.9 ± 1.6% (normal) and 91.6 ± 2.2% (malignant), respectively. In addition, p-ESRAC resulted in the lowest false positive rates of 4.5 ± 3.2% (normal) and 7.9 ± 3.0% (malignant), demonstrating it to be the most effective in reducing oversegmentation. The partition scheme improved segmentation accuracy by 5.4 ± 9.2% (normal) and 22.2 ± 27.6% (malignant) of the true segmentation that was missed by ESRAC. Visual assessment confirmed that p-ESRAC prevented leakage of the segmentation results of the liver into the kidney. CONCLUSIONS A novel active-contour model was developed, allowing for accurate liver segmentation on multiphase CE-MRI, with conditions that include signal inhomogeneity and weak boundary conditions. Such a technique could be useful for applications that involve computer-aided diagnosis of liver disease.
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Affiliation(s)
- Jihun Oh
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332
| | - Diego R Martin
- Department of Medical Imaging, University of Arizona, Tucson, Arizona 85724
| | - Xiaoping Hu
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332
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Primary biliary tract malignancies: MRI spectrum and mimics with histopathological correlation. ACTA ACUST UNITED AC 2014; 40:1520-57. [DOI: 10.1007/s00261-014-0300-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Park VY, Choi JY, Chung YE, Kim H, Park MS, Lim JS, Kim KW, Kim MJ. Dynamic enhancement pattern of HCC smaller than 3 cm in diameter on gadoxetic acid-enhanced MRI: comparison with multiphasic MDCT. Liver Int 2014; 34:1593-602. [PMID: 24673802 DOI: 10.1111/liv.12550] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The dynamic enhancement pattern of HCCs smaller than 3 cm in diameter on gadoxetic acid-enhanced magnetic resonance imaging (MRI) have not been extensively investigated. We aimed to evaluate the dynamic enhancement patterns of small HCCs (≤3 cm) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and compare enhancement patterns with multiphasic multidetector computed tomography (MDCT) based on tumour cellular differentiation and size. METHODS We retrospectively included 55 patients with 67 surgically confirmed small HCCs (≤3 cm) who underwent multiphasic MDCT and gadoxetic acid-enhanced MRI. Dynamic enhancement patterns were analysed according to tumour cellular differentiation and size. Hepatobiliary phase images were also analysed to assess their additional value. RESULTS The proportion of small HCCs demonstrating the typical enhancement pattern differed depending on tumour cellular differentiation on both MRI (P = 0.001) and MDCT (P = 0.001), but differed depending on tumour size only on CT (P = 0.008). Gadoxetic acid-enhanced MRI more sensitively depicted the typical enhancement pattern than CT for all tumours (P = 0.001), for moderately or poorly differentiated HCCs (P = 0.021) and for HCCs ≤2 cm (P = 0.001). 80% of tumours with atypical enhancement could be diagnosed as HCC based on tumour size and hepatobiliary phase images. CONCLUSIONS On both gadoxetic acid-enhanced MRI and multiphasic CT, the dynamic enhancement patterns of small HCCs (≤3 cm) differed according to tumour cellular differentiation. Gadoxetic acid-enhanced MRI more frequently demonstrated the typical HCC enhancement pattern than CT in small HCCs.
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Affiliation(s)
- Vivian Y Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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Usefulness of controlled aliasing in parallel imaging results in higher acceleration in gadoxetic acid-enhanced liver magnetic resonance imaging to clarify the hepatic arterial phase. Invest Radiol 2014; 49:183-8. [PMID: 24276676 DOI: 10.1097/rli.0000000000000011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to determine whether the controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique could improve the image quality of the hepatic arterial phase of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging. MATERIALS AND METHODS A total of 320 patients underwent gadoxetic acid-enhanced liver MR imaging: a conventional protocol (a fixed scan delay and 2-mL/s injection) using a standard 3-T MR system (Trio-Tim; Siemens, commercialized since 2005) (group A), an optimized protocol (bolus tracking and 1-mL/s injection) using a standard 3-T MR (group B), an optimized protocol using a new 3-T MR (Skyra; Siemens, commercialized since 2012) (group C), and an optimized protocol with CAIPIRINHA using a new 3-T MR (group D). The image quality of the hepatic arterial phase was graded using a 4-point rating scale from 1 (no artifacts) to 4 points (non-diagnostic images with severe artifacts). The differences in image quality scores among the 4 groups were evaluated. In addition, the detection rates of hypervascular hepatocellular carcinomas among the 4 groups were evaluated. RESULTS Scores of 4 points were observed in groups A (n = 7), B (n = 5), and C (n = 3) but not in group D. The median image quality score was 2 in groups A and B and 1 in groups C and D. From group A to group D, the median image quality score decreased significantly (P = 0.0001). The median image quality score was significantly lower in group D than in groups A and B (P = 0.0001 and 0.001, respectively), whereas there was no significant difference observed between groups C and D (P = 0.656). The detection rates of hypervascular hepatocellular carcinomas on the hepatic arterial phase were not significantly different among the groups (all P > 0.03), except between groups A and D (P = 0.007). CONCLUSIONS The CAIPIRINHA technique improved the image quality of hepatic arterial phase imaging with gadoxetic acid, reducing the number of non-diagnostic arterial phase studies.
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Inoue Y, Hata H, Nakajima A, Iwadate Y, Ogasawara G, Matsunaga K. Optimal techniques for magnetic resonance imaging of the liver using a respiratory navigator-gated three-dimensional spoiled gradient-recalled echo sequence. Magn Reson Imaging 2014; 32:975-80. [DOI: 10.1016/j.mri.2014.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 02/19/2014] [Accepted: 05/26/2014] [Indexed: 12/22/2022]
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Chavhan GB, Mann E, Kamath BM, Babyn PS. Gadobenate-dimeglumine-enhanced magnetic resonance imaging for hepatic lesions in children. Pediatr Radiol 2014; 44:1266-74. [PMID: 24771094 DOI: 10.1007/s00247-014-2975-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Magnetic resonance imaging enhanced by hepatocyte-specific contrast media has been found useful to characterize liver lesions in adults and children. OBJECTIVE To present our experience with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for evaluation of focal liver lesions in children. MATERIALS AND METHODS We retrospectively reviewed gadobenate-dimeglumine-enhanced MR images obtained for evaluation of suspected hepatic lesions in 30 children. Signal characteristics on various sequences including 45- to 60-min hepatobiliary phase images were noted by two radiologists. Chart review identified relevant clinical details including history of cancer treatment, available pathology and stability of lesion size on follow-up imaging. RESULTS Of the 30 children who had gadobenate-enhanced MRI, 26 showed focal lesions. Diagnoses in 26 children were focal nodular hyperplasia (FNH) in 15, hemangiomas in 3, regenerating nodules in 3, focal fatty infiltration in 2, indeterminate lesions in 3, and one patient each with adenomas, hepatoblastoma and metastasis. Two patients had multiple diagnoses. All FNH lesions (39), all regenerative nodules (19) and an indeterminate lesion were iso- or hyperintense on hepatobiliary-phase images while all other lesions (28) were hypointense to hepatic parenchyma. The average follow-up period was 21.7 months. CONCLUSION Our experience with gadobenate-enhanced MRI indicates potential utility of gadobenate in the evaluation of pediatric hepatic lesions in differentiating FNH and regenerating nodules from other lesions.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, Canada, M5G 1X8,
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Lamba R, Fananazapir G, Corwin MT, Khatri VP. Diagnostic Imaging of Hepatic Lesions in Adults. Surg Oncol Clin N Am 2014; 23:789-820. [DOI: 10.1016/j.soc.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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168
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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: 323] [Impact Index Per Article: 32.3] [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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D'Ippolito G. The role of MRI using liver-specific contrast agent in the assessment of focal liver lesion. Radiol Bras 2014; 47:VII-VIII. [PMID: 25741113 PMCID: PMC4341389 DOI: 10.1590/0100-3984.2014.47.5e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Giuseppe D'Ippolito
- Associate Professor, Department of Imaging Diagnosis - Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), MD, Radiologist, Laboratório Fleury - Hospital São Luiz, São Paulo, SP, Brazil. E-mail:
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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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171
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Presurgical planning for hepatobiliary malignancies: clinical and imaging considerations. Magn Reson Imaging Clin N Am 2014; 22:447-65. [PMID: 25086939 DOI: 10.1016/j.mric.2014.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are many considerations in the evaluation of liver malignancy before planned surgical treatment. This article focuses on interpretation of MR imaging of the liver for surgical treatment planning of hepatocellular carcinoma, colorectal cancer metastases, and hilar cholangiocarcinoma. Clinical status, anatomic variants, future liver remnant, and underlying liver disease are all important factors in the decision to proceed with liver resection. The primary objective of preoperative imaging is to correctly identify patients who are candidates for curative intervention and to accurately stage their disease. Treatment planning for these complex patients is best done with a multidisciplinary team approach.
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172
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Dose-toxicity relationship of gadoxetate disodium and transient severe respiratory motion artifact. AJR Am J Roentgenol 2014; 203:796-802. [PMID: 25055154 DOI: 10.2214/ajr.13.11587] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this article is to determine whether there is a dose-toxicity relationship between gadoxetate disodium and transient severe respiratory motion artifact. MATERIALS AND METHODS Gadoxetate disodium-enhanced MRI studies (559 studies of 559 patients) using a fixed 20-mL (2 mL/s; n = 112) or 10-mL (1-2 mL/s; n = 447) volume at two health systems were included (dose range, 0.05-0.42 mL/kg; mean, 0.15 mL/kg; above-label dosing, 479 [86%]). Each dynamic phase was assigned a respiratory motion score from 1 (none) to 5 (nondiagnostic). Examinations with an unenhanced score of 1-2, arterial score of 4-5, and venous or late-dynamic scores of 1-3 were labeled as transient severe respiratory motion artifact. Stepwise multivariate logistic regression was performed. RESULTS The overall incidence of transient severe respiratory motion artifact was 12% (67/559; site 1, 15% [35/232]; site 2, 9.8% [32/327]). The administered volume of contrast material had a statistically significant effect (20 mL, 20% [22/112] vs 10 mL, 10%, [45/447]; multivariate p = 0.01; odds ratio, 2.1 [20 vs 10 mL]; 95% CI, 1.2-3.7). There was no dose-toxicity relationship for dose-by-weight (p = 0.61 [multivariate]) or above-label dosing (p = 0.88 [univariate]; 13% [10/80] rate for at- or below-label dosing vs 12% [57/479] rate for above-label dosing). Chronic obstructive pulmonary disease was the only non-dose-related predictor in the multivariate model (p < 0.0001; OR, 5.1 [95% CI, 2.5-11.5]; 39% [12/31] vs 10% [55/528]). CONCLUSION Gadoxetate disodium-associated transient severe respiratory motion artifact is significantly more common after 20-mL administration (2 mL/s) and occurs significantly more often in patients with chronic obstructive pulmonary disease. The volume-related effect suggests a nonallergiclike mechanism.
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Inflammatory hepatocellular adenomas can mimic focal nodular hyperplasia on gadoxetic acid-enhanced MRI. AJR Am J Roentgenol 2014; 203:W408-14. [PMID: 25055198 DOI: 10.2214/ajr.13.12251] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Inflammatory hepatocellular adenoma (HCA) is a recently categorized entity of hepatocellular neoplasms. We investigated whether gadoxetic acid-enhanced MRI can distinguish inflammatory HCA from focal nodular hyperplasia (FNH). MATERIALS AND METHODS From January 1, 2009, through January 1, 2013, gadoxetic acid-enhanced MRI examinations from two institutions were reviewed for HCA, with specific histologic features of inflammatory HCA. Biopsy and resection slides were reviewed, and immunohistochemistry for glutamine synthetase was performed in a subset to confirm the initial diagnosis. RESULTS A total of 10 possible cases of inflammatory HCA were identified in the pathology database. On the basis of glutamine synthetase staining performed for this study, three cases were rediagnosed as FNH and thus were excluded from the study. Therefore, a total of seven patients with inflammatory HCA were identified. On gadoxetic acid-enhanced MRI, four of these patients had classic features of FNH (group A, FNH mimics), and three had imaging features suggestive of HCA (group B, typical inflammatory HCA). Imaging features that were considered diagnostic of FNH included isointense or minimal T2 hyperintensity, arterial enhancement, and diffuse hyperintensity on hepatobiliary phase. Three of the four patients with FNH mimics had slides available for pathologic rereview, and the diagnosis of inflammatory HCA was supported by glutamine synthetase immunohistochemistry findings. The pathology reports of the remaining four cases were rereviewed and were also found to have features consistent with inflammatory HCA. CONCLUSION Inflammatory HCA can mimic FNH on MRI, including hepatobiliary phase hyperintensity. Moreover, conventional pathology using histopathology alone may lead to misclassification of inflammatory HCA.
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174
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Hepatobiliary magnetic resonance imaging in patients with liver disease: correlation of liver enhancement with biochemical liver function tests. Eur Radiol 2014; 24:2482-90. [PMID: 25030459 DOI: 10.1007/s00330-014-3291-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate hepatobiliary magnetic resonance imaging (MRI) using Gd-EOB-DTPA in relation to various liver function tests in patients with liver disorders. METHODS Fifty-one patients with liver disease underwent Gd-EOB-DTPA-enhanced liver MRI. Based on region-of-interest (ROI) analysis, liver signal intensity was calculated using the spleen as reference tissue. Liver-spleen contrast ratio (LSCR) and relative liver enhancement (RLE) were calculated. Serum levels of total bilirubin, gamma glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), lactate dehydrogenase (LDH), serum albumin level (AL), prothrombin time (PT), creatinine (CR) as well as international normalised ratio (INR) and model for end-stage liver disease (MELD) score were tested for correlation with LSCR and RLE. RESULTS Pre-contrast LSCR values correlated with total bilirubin (r = -0.39; p = 0.005), GGT (r = -0.37; p = 0.009), AST (r = -0.38; p = 0.013), ALT (r = -0.29; p = 0.046), PT (r = 0.52; p < 0.001), GLDH (r = -0.55; p = 0.044), INR (r = -0.42; p = 0.003), and MELD Score (r = -0.53; p < 0.001). After administration of Gd-EOB-DTPA bilirubin (r = -0.45; p = 0.001), GGT (r = -0.40; p = 0.004), PT (r = 0.54; p < 0.001), AST (r = -0.46; p = 0.002), ALT (r = -0.31; p = 0.030), INR (r = -0.45; p = 0.001) and MELD Score (r = -0.56; p < 0.001) significantly correlated with LSCR. RLE correlated with bilirubin (r = -0.40; p = 0.004), AST (r = -0.38; p = 0.013), PT (r = 0.42; p = 0.003), GGT (r = -0.33; p = 0.020), INR (r = -0.36; p = 0.011) and MELD Score (r = -0.43; p = 0.003). CONCLUSIONS Liver-spleen contrast ratio and relative liver enhancement using Gd-EOB-DTPA correlate with a number of routinely used biochemical liver function tests, suggesting that hepatobiliary MRI may serve as a valuable biomarker for liver function. The strongest correlation with liver enhancement was found for the MELD Score. KEY POINTS • Relative enhancement (RLE) of Gd-EOB-DTPA is related to biochemical liver function tests. • Correlation of RLE with bilirubin, ALT, AST, GGT, INR and MELD Score is reverse. • The correlation of relative liver enhancement with prothrombin time is positive. • AST, ALT, GLDH, prothrombin time, INR and MELD Score correlate with pre-contrast liver-spleen contrast ratio. • Such biomarkers may help to evaluate liver function.
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175
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Schalkx HJ, van Stralen M, Coenegrachts K, van den Bosch MAAJ, van Kessel CS, van Hillegersberg R, van Erpecum KJ, Verkooijen HM, Pluim JPW, Veldhuis WB, van Leeuwen MS. Liver perfusion in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI): comparison of enhancement in Gd-BT-DO3A and Gd-EOB-DTPA in normal liver parenchyma. Eur Radiol 2014; 24:2146-56. [DOI: 10.1007/s00330-014-3275-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/26/2014] [Accepted: 06/03/2014] [Indexed: 01/01/2023]
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Donati OF, Hunziker R, Fischer MA, Raptis DA, Breitenstein S, Patak MA. MRI for characterization of primary tumors in the non-cirrhotic liver: Added value of Gd-EOB-DTPA enhanced hepatospecific phase. Eur J Radiol 2014; 83:1074-1079. [DOI: 10.1016/j.ejrad.2014.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/12/2014] [Accepted: 03/18/2014] [Indexed: 12/23/2022]
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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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Yu MH, Kim JH, Yoon JH, Kim HC, Chung JW, Han JK, Choi BI. Small (≤1-cm) Hepatocellular Carcinoma: Diagnostic Performance and Imaging Features at Gadoxetic Acid–enhanced MR Imaging. Radiology 2014; 271:748-60. [DOI: 10.1148/radiol.14131996] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract- an update. Cancer Imaging 2014; 14:14. [PMID: 25608662 PMCID: PMC4331820 DOI: 10.1186/1470-7330-14-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 12/13/2022] Open
Abstract
Malignancies of the biliary tract include cholangiocarcinoma, gallbladder cancers and carcinoma of the ampulla of Vater. Biliary tract adenocarcinomas are the second most common primary hepatobiliary cancer. Due to their slow growing nature, non-specific and late symptomatology, these malignancies are often diagnosed in advanced stages with poor prognosis. Apart from incidental discovery of gall bladder carcinoma upon cholecystectomy, early stage biliary tract cancers are now detected with computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). Accurate characterization and staging of these indolent cancers will determine outcome as majority of the patients’ are inoperable at the time of presentation. Ultrasound is useful for initial evaluation of the biliary tract and gallbladder masses and in determining the next suitable modality for further evaluation. Multimodality imaging plays an integral role in the management of the biliary tract malignancies. The imaging techniques most useful are MRI with MRCP, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and positron emission tomography (PET). In this review we will discuss epidemiology and the role of imaging in detection, characterization and management of the biliary tract malignancies under the three broad categories of cholangiocarcinomas (intra- and extrahepatic), gallbladder cancers and ampullary carcinomas.
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Abstract
OBJECTIVE Fibrolamellar hepatocellular carcinoma (HCC) is a rare primary liver tumor, which significantly differs from conventional HCC. This article reviews the molecular cytogenetics, pathology, imaging features, and management of this relatively rare tumor. CONCLUSION Fibrolamellar HCC predominantly occurs in young patients without underlying hepatitis or cirrhosis. Serum α-fetoproteins are not elevated in most cases, and hence imaging plays an important role in diagnosis, staging, and surveillance.
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Abstract
Focal liver lesions (FLLs) are commonly encountered on routine imaging studies. Most lesions detected are benign, but many are indeterminate at the time of initial imaging. This article reviews the important role of MR imaging for the detection and characterization of various benign FLLs while illustrating typical imaging appearances and potential pitfalls in interpretation. The utility of diffusion-weighted imaging and hepatocyte-specific contrast agents is also discussed.
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Affiliation(s)
- Jonathan R Cogley
- Section of Body Imaging, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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Guglielmo FF, Mitchell DG, Gupta S. Gadolinium contrast agent selection and optimal use for body MR imaging. Radiol Clin North Am 2014; 52:637-56. [PMID: 24889165 DOI: 10.1016/j.rcl.2014.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Proper selection of a gadolinium-based contrast agent (GBCA) for body magnetic resonance imaging (MRI) cases requires understanding the indication for the MRI exam, the key features of the different GBCAs, and the effect that the GBCA has on the selected imaging protocol. The different categories of GBCAs require timing optimization on postcontrast sequences and adjusting imaging parameters to obtain the highest T1 contrast. Gadoxetate disodium has many advantages when evaluating liver lesions, although there are caveats and limitations that need to be understood. Gadobenate dimeglumine, a high-relaxivity GBCA, can be used for indications when stronger T1 relaxivity is needed.
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Affiliation(s)
- Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA.
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA
| | - Shiva Gupta
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, FCT15.5013, Houston, TX 77030, USA
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Further evaluation of interesting liver lesions on gadoxetic acid-enhanced MRI. EGYPTIAN LIVER JOURNAL 2014. [DOI: 10.1097/01.elx.0000445720.78658.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Davenport MS, Caoili EM, Kaza RK, Hussain HK. Matched within-patient cohort study of transient arterial phase respiratory motion-related artifact in MR imaging of the liver: gadoxetate disodium versus gadobenate dimeglumine. Radiology 2014; 272:123-31. [PMID: 24617733 DOI: 10.1148/radiol.14132269] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare frequency and severity of arterial phase respiratory motion-related artifact following gadoxetate disodium and gadobenate dimeglumine in matched patients administered both contrast media at different times. MATERIALS AND METHODS Institutional review board approval was obtained, with patient consent waived, for this retrospective, HIPAA-compliant study. Ninety patients underwent gadobenate dimeglumine-enhanced abdominal magnetic resonance (MR) followed by gadoxetate disodium-enhanced abdominal MR and were matched to 90 patients who were administered the same contrast media in reverse order (180 patients). Matching was based on length of time between paired examinations. Gadobenate dimeglumine dose was weight based (0.1 mmol per kilogram body weight). Gadoxetate disodium dose was typically fixed (10 or 20 mL [off label]). Three readers blinded to contrast agent assigned a respiratory motion-related artifact score (1 [none] to 5 [nondiagnostic]) for nonenhanced, arterial, venous, and late dynamic phases. Frequency of greater new arterial phase respiratory motion-related artifact in each within-patient pair and aggregate rate of new severe transient arterial phase respiratory motion-related artifact (scores ≤ 2, nonenhanced and venous and/or late dynamic phases; ≥ 4, arterial phase) were compared (McNemar test). RESULTS For groups 1 and 2, respectively, mean dose (gadoxetate disodium, 16.6 mL vs 16.6 mL, P = .99; gadobenate dimeglumine, 18.0 mL vs 17.8 mL, P = .77) and mean time between examinations (191 days vs 191 days, P = .99) were not significantly different between matched populations. Gadoxetate disodium was associated with significantly higher incidence of new arterial phase respiratory motion-related artifact compared with gadobenate dimeglumine (39% vs 10%, P < .0001) and of new severe transient arterial phase respiratory motion-related artifact (18% vs 2%, P < .0001) in patients administered both agents at different times. CONCLUSION Fixed off-label dose (10 or 20 mL) of gadoxetate disodium is associated with arterial phase respiratory motion-related artifact that is sometimes severe and occurs significantly more often than after gadobenate dimeglumine in patients who received both contrast media.
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Affiliation(s)
- Matthew S Davenport
- From the Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109
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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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187
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Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging 2014; 37:1260-76. [PMID: 23712841 DOI: 10.1002/jmri.23947] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2012] [Indexed: 12/11/2022] Open
Abstract
Diffusion-weighted imaging (DWI) plays an emerging role for the assessment of focal and diffuse liver diseases. This growing interest is due to that fact that DWI is a noncontrast technique with inherent high contrast resolution, with promising results for detection and characterization of focal liver lesions. Recent advances in diffusion image quality have also added interest to this technique in the abdomen. The purpose of this review is to describe the current clinical roles of DWI for the detection and characterization of focal liver lesions, and to review pitfalls, limitations, and future directions of DWI for assessment of focal liver disease.
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Affiliation(s)
- Nicola Galea
- Sapienza University of Rome, Department of Radiological Sciences, Rome, Italy
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188
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Molecular imaging of EGFR/HER2 cancer biomarkers by protein MRI contrast agents. J Biol Inorg Chem 2013; 19:259-70. [PMID: 24366655 DOI: 10.1007/s00775-013-1076-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/06/2013] [Indexed: 12/22/2022]
Abstract
Epidermal growth factor receptor (EGFR) and HER2 are major prognosis biomarkers and drug targets overexpressed in various types of cancer cells. There is a pressing need to develop MRI contrast agents capable of enhancing the contrast between normal tissues and tumors with high relaxivity, capable of targeting tumors, and with high intratumoral distribution and minimal toxicity. In this review, we first discuss EGFR signaling and its role in tumor progression as a major drug target. We then report our progress in the development of protein contrast agents with significant improvement of both r1 and r2 relaxivities, pharmacokinetics, in vivo retention time, and in vivo dose efficiency. Finally, we report our effort in the development of EGFR-targeted protein contrast agents with the capability to cross the endothelial boundary and with good tissue distribution across the entire tumor mass. The noninvasive capability of MRI to visualize spatially and temporally the intratumoral distribution as well as quantify the levels of EGFR and HER2 would greatly improve our ability to track changes of the biomarkers during tumor progression, monitor treatment efficacy, aid in patient selection, and further develop novel targeted therapies for clinical application.
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Abstract
Refined stratification of disease is thought to result in better survival from childhood malignant disease while minimizing the adverse effects of anticancer therapies. There is a potential for magnetic resonance imaging (MRI) to contribute to such stratification by improved tissue characterization, anatomical depiction, staging, and assessment of early treatment response. Recent advances in pediatric MRI outside the central nervous system (CNS) are reviewed in this context. The focus is on new applications for conventional MRI and on clinical implementation of tissue-specific and quantitative techniques. This area is largely unexplored, and potential directions for research are indicated.
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Affiliation(s)
- Øystein E Olsen
- Radiology Department, Great Ormond Street Hospital for
Children NHS Foundation Trust, Great Ormond Street, London, UK
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191
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Ringe KI, Hinrichs J, Merkle EM, Weismüller TJ, Wacker F, Meyer BC. Gadoxetate disodium in patients with primary sclerosing cholangitis: an analysis of hepatobiliary contrast excretion. J Magn Reson Imaging 2013; 40:106-12. [PMID: 24923477 DOI: 10.1002/jmri.24381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/18/2013] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess hepatobiliary excretion of gadoxetate disodium in patients with primary sclerosing cholangitis (PSC) over time and to determine a possible correlation with severity of the disease. MATERIALS AND METHODS A total of 111 patients (36 females, 75 males, mean age 41.5 yr) with confirmed diagnosis of PSC who underwent gadoxetate disodium enhanced hepatic MRI were included in this retrospective institutional review board-approved study. Hepatocyte phase images (10-493 min post injection [p.i.]) were evaluated by one radiologist for the presence of contrast agent in the intrahepatic bile ducts (IBD), common bile duct (CBD), gallbladder (GB), and duodenum. In 54 patients, in whom hepatocyte phase scans were acquired within 10-20 min p.i., hepatobiliary excretion was compared with data collected in a previous study from patients without liver disease (controls; Mann-Whitney U-test). Excretion was further correlated with liver function tests (Kruskal-Wallis test). RESULTS Compared with controls, excretion was significantly delayed in patients with PSC: 20 min p.i. gadoxetate disodium could be detected in the IBD in 55.6% (controls:100%), CBD 53.7% (controls:100%), GB 39.6% (controls:87%), duodenum 13% (controls:66%), respectively. Contrast appearance in different bile duct sections increased over time and correlated significantly with serum bilirubin and AP levels (P < 0.05). CONCLUSION Hepatobiliary excretion of gadoxetate disodium in PSC patients is significantly delayed. Excretion correlates with bilirubin levels, and thus indirectly with severity of disease.
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Affiliation(s)
- Kristina I Ringe
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
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192
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Detecting hepatocellular carcinoma in gadoxetic-acid-enhanced hepatobiliary-phase MR imaging at 3T: comparing high and low flip angle. Jpn J Radiol 2013; 31:803-11. [DOI: 10.1007/s11604-013-0255-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/01/2013] [Indexed: 12/22/2022]
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Agrawal MD, Agarwal S, Fuentes-Oreego JM, Hayano K, Sahani DV. New Liver Imaging Techniques. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-013-0028-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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194
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MRI assessment of biliary ductal obstruction: is there added value of T1-weighted gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MR cholangiography? AJR Am J Roentgenol 2013; 201:W49-56. [PMID: 23789696 DOI: 10.2214/ajr.12.9332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The goal of the present study was to determine the added value of gadolium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced magnetic resonance cholangiography (MRC) to standard liver MRI including T2-weighted MRCP in assessment of biliary ductal obstruction. MATERIALS AND METHODS Thirty-eight patients (mean age, 48.1 ± 16.7 years) (40 total examinations) who underwent liver MRI (including T2-weighted MRCP and gadoxetate disodium-enhanced MRC) for suspicion of biliary disease were included in this institutional review board-approved, HIPAA-compliant retrospective study. Three blinded radiologists first evaluated MR images without gadoxetate disodium-enhanced MRC for presence and significance of biliary obstruction, underlying cause for obstruction, and confidence in final diagnosis. After inclusion of gadoxetate disodium-enhanced MRC, readers again determined presence and significance of biliary obstruction and confidence in final diagnosis. Reference standard was established using MRI along with ERCP, percutaneous transhepatic cholangiography, intraoperative cholangiography, or a combination thereof. RESULTS Overall sensitivity across all readers in diagnosing significance of obstruction was 60% without gadoxetate disodium-enhanced MRC and 91% with gadoxetate disodium- enhanced MRC (p < 0.001). Across all readers, assessment of significance of obstruction was changed when adding gadoxetate disodium-enhanced MRC in 40 of 120 cases (33%); significance of obstruction was correctly changed in 35 of 40 cases (87.5%). Biliary obstruction was graded of unknown significance in 27 of 120 cases (22.5%) across all readers when gadoxetate disodium-enhanced MRC was not reviewed. Significance of biliary obstruction was classified correctly after adding gadoxetate disodium-enhanced MRC in 25 of these 27 cases (93%). Confidence in final diagnosis was significantly higher with addition of gadoxetate di-sodium-enhanced MRC for two of three readers (p < 0.003). CONCLUSION Addition of gadoxetate disodium-enhanced MRC to liver MRI significantly improves sensitivity in assessing significance of biliary obstruction and can improve reader confidence in establishing a final diagnosis. This added information could have a substantial impact in the determination of the most appropriate therapeutic options.
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195
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Burke C, Alexander Grant L, Goh V, Griffin N. The role of hepatocyte-specific contrast agents in hepatobiliary magnetic resonance imaging. Semin Ultrasound CT MR 2013; 34:44-53. [PMID: 23395317 DOI: 10.1053/j.sult.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatocyte-specific contrast agents have been made available in the last 15 years for magnetic resonance imaging of the liver. These agents are differentially taken up by functioning hepatocytes and excreted in the biliary system. They can help distinguish focal liver lesions of hepatocellular origin from lesions of nonhepatocellular origin, and can also be used in the evaluation of the biliary tree. The purpose of this review is to summarize the different types of hepatocyte-specific contrast agents presently available, their use in the characterization of focal liver lesions, their role in the evaluation of biliary pathology, and their potential future applications.
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Affiliation(s)
- Chistopher Burke
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
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Imaging Assessment of Hepatocellular Carcinoma Response to Locoregional and Systemic Therapy. AJR Am J Roentgenol 2013; 201:80-96. [DOI: 10.2214/ajr.13.10706] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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197
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Liu PS, Hussain HK. Contemporary and Emerging Technologies in Abdominal Magnetic Resonance Imaging. Semin Roentgenol 2013; 48:203-13. [DOI: 10.1053/j.ro.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Reiner CS, Neville AM, Nazeer HK, Breault S, Dale BM, Merkle EM, Bashir MR. Contrast-enhanced free-breathing 3D T1-weighted gradient-echo sequence for hepatobiliary MRI in patients with breath-holding difficulties. Eur Radiol 2013; 23:3087-93. [PMID: 23732689 DOI: 10.1007/s00330-013-2910-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
Affiliation(s)
- C S Reiner
- Department of Radiology, Duke University Medical Center, Duke North - Room 1417, Erwin Road, Durham, NC, 27710, USA
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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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