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Bailey RE, Pugliesi RA, Borja-Cacho D, Borhani AA. Imaging Evaluation of the Living Liver Donor: A Systems-Based Approach. Radiol Clin North Am 2023; 61:771-784. [PMID: 37495286 DOI: 10.1016/j.rcl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Liver transplant is the definitive treatment of end-stage liver disease and early hepatocellular carcinoma. The number of liver transplant surgeries done is highly affected by the number and availability of deceased donor organs. Living donor liver transplantation has emerged as an alternative source of donors, increasing the availability of organs for transplant. Many factors must be considered when choosing living donor candidates to maintain a high level of donor safety and organ survival. To that end, potential donors undergo a rigorous pre-donation workup.
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Affiliation(s)
- Ryan E Bailey
- Department of Radiology, Section of Body Imaging, Northwestern University, Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA
| | - Rosa Alba Pugliesi
- Department of Radiology, Section of Body Imaging, Northwestern University, Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA
| | - Daniel Borja-Cacho
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Street Clair Street, Ste 800, Chicago, IL 60611, USA.
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Froehlich JM, Moussa L, Guirguis N, Gutzeit A, Wu D, Sartoretti-Schefer S, Koh DM, Kolokythas O, Matoori S. Comparison of gadolinium-based contrast agents for MR cholangiography in saline, blood and bile: a phantom study. Eur Radiol Exp 2023; 7:21. [PMID: 37093398 PMCID: PMC10126166 DOI: 10.1186/s41747-023-00331-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND We compared T1- and T2-weighted signal intensities of liver-specific (gadoxetate, gadobenate) and non-specific (gadoterate) gadolinium contrast agents (CAs) in a bile phantom. METHODS In a phantom study, gadoxetate, gadobenate, and gadoterate were diluted in saline, blood, and bile at different concentrations (0, 0.25, 0.5. 1, 2.5, 5, 10, and 25 mM) and imaged in a 3-T magnetic resonance imaging (MRI) system using T1- and T2-weighted sequences. The maximum signal intensities of CAs were compared for each sequence separately and across all T1-weighted sequences using one-way ANOVA. RESULTS Using T1-weighted sequences, CA concentration-dependent signal intensity increase was followed by decrease due to T2* effects. Comparing CAs for each sequence in bile yielded higher maximum signal intensities with gadobenate than gadoxetate and gadoterate using T1-weighted spin-echo (p < 0.010), multiecho gradient- and spin-echo (p < 0.001), and T1-weighted high-resolution isotropic volume excitation (eTHRIVE) sequences (p < 0.010). Comparing across all T1-weighted sequences in the bile phantom, gadobenate imaged using T1-weighted turbo field-echo (TFE) sequence showed the highest signal intensity, significantly higher than that using other CAs agents or sequences (p < 0.004) except for gadobenate and gadoxetate evaluated with three-dimensional multiecho fast field-echo (3D-mFFE) and gadoxetate with T1-weighted TFE sequence (p > 0.141). Signal reduction with CA concentration-dependent decrease was observed on T2-weighted images. CONCLUSION In this bile phantom study of gadolinium-based CA, gadobenate and gadoxetate showed high signal intensity with T1-weighted TFE and 3D-mFFE sequences, which supports their potential utility for contrast-enhanced hepatobiliary MRI. KEY POINTS • Contrast-enhanced magnetic resonance (MR) cholangiography depends on contrast agent type, kinetics, and concentration in bile, • We compared signal intensities of three contrast agents in a bile phantom study. • Gadobenate, gadoxetate, and gadoterate demonstrated different signal intensities at identical concentrations. • Gadoxetate and gadobenate showed high signal intensities on T1-weighted MR sequences.
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Affiliation(s)
| | - Leen Moussa
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Natalie Guirguis
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- Department of Health Sciences and Medicine, Universität Luzern, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - David Wu
- Laboratory for Cell and Tissue Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA
| | | | - Dow-Mu Koh
- Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK
| | - Orpheus Kolokythas
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
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Rendell VR, Winslow ER, Colgan TJ, Kovacs SK, Mühler MR, Knobloch G, Loeffler AG, Agni RM, Reeder SB. Radiologic-pathologic correlation of lesions in resected liver specimens with an ex vivo MRI-compatible localization device. Eur Radiol 2023; 33:535-544. [PMID: 35864349 PMCID: PMC10876158 DOI: 10.1007/s00330-022-08990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Liver lesion characterization is limited by the lack of an established gold standard for precise correlation of radiologic characteristics with their histologic features. The objective of this study was to demonstrate the feasibility of using an ex vivo MRI-compatible sectioning device for radiologic-pathologic co-localization of lesions in resected liver specimens. METHODS In this prospective feasibility study, adults undergoing curative partial hepatectomy from February 2018 to January 2019 were enrolled. Gadoxetic acid was administered intraoperatively prior to hepatic vascular inflow ligation. Liver specimens were stabilized in an MRI-compatible acrylic lesion localization device (27 × 14 × 14 cm3) featuring slicing channels and a silicone gel 3D matrix. High-resolution 3D T1-weighted fast spoiled gradient echo and 3D T2-weighted fast-spin-echo images were acquired using a single channel quadrature head coil. Radiologic lesion coordinates guided pathologic sectioning. A final histopathologic diagnosis was prepared for all lesions. The proportion of successfully co-localized lesions was determined. RESULTS A total of 57 lesions were identified radiologically and sectioned in liver specimens from 10 participants with liver metastases (n = 8), primary biliary mucinous cystic neoplasm (n = 1), and hepatic adenomatosis (n = 1). Of these, 38 lesions (67%) were < 1 cm. Overall, 52/57 (91%) of radiologically identified lesions were identified pathologically using the device. Of these, 5 lesions (10%) were not initially identified on gross examination but were confirmed histologically using MRI-guided localization. One lesion was identified grossly but not on MRI. CONCLUSIONS We successfully demonstrated the feasibility of a clinical method for image-guided co-localization and histological characterization of liver lesions using an ex vivo MRI-compatible sectioning device. KEY POINTS • The ex vivo MRI-compatible sectioning device provides a reliable method for radiologic-pathologic correlation of small (< 1 cm) liver lesions in human liver specimens. • The sectioning method can be feasibly implemented within a clinical practice setting and used in future efforts to study liver lesion characterization. • Intraoperative administration of gadoxetic acid results in enhancement in ex vivo MRI images of liver specimens hours later with excellent image quality.
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Affiliation(s)
- Victoria R Rendell
- Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Emily R Winslow
- Department of Surgery, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
- MedStar Georgetown Transplant Institute, 3800 Reservoir Road Northwest, Pasquerilla Healthcare Center 2nd Fl, Washington, DC, 20007, USA
| | - Timothy J Colgan
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - S Krisztian Kovacs
- Department of Pathology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Matthias R Mühler
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Gesine Knobloch
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Agnes G Loeffler
- Department of Pathology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
- MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA
| | - Rashmi M Agni
- Department of Pathology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA.
- Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA.
- Department of Biomedical Engineering, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA.
- Department of Medicine, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA.
- Department of Emergency Medicine, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA.
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Vernuccio F, Cannella R, Gozzo C, Greco V, Midiri M, Furlan A, Tang A, Brancatelli G. Hepatic enhancement in cirrhosis in the portal venous phase: what are the differences between gadoxetate disodium and gadobenate dimeglumine? Abdom Radiol (NY) 2020; 45:2409-2417. [PMID: 32435849 DOI: 10.1007/s00261-020-02578-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the level of parenchymal and portal venous enhancement in the portal venous phase (PVP) in cirrhotic patients undergoing gadoxetate disodium- and gadobenate dimeglumine-enhanced MRI. METHODS In this retrospective study, 84 cirrhotic patients (mean age ± SD: 66 ± 13 years) who underwent contrast-enhanced MRI with both gadoxetate disodium and gadobenate dimeglumine between 2012 and 2018 were included. Two readers measured signal intensities of hepatic parenchyma, portal vein and psoas muscle on precontrast and PVP. Relative enhancement (RE), image contrast, and portal vein-to-liver contrast difference were calculated. Intraindividual differences were compared with the Wilcoxon signed rank-sum test and inter-reader differences with the intraclass correlation coefficient (ICC). RESULTS In PVP, gadoxetate disodium provided lower RE than gadobenate dimeglumine (Reader 1: 42.4 ± 44.6 vs. 56.1 ± 58.8, p = 0.044; Reader 2: 42.4 ± 42.9 vs. 57.7 ± 60.5, p = 0.027;), lower image contrast (Reader 1: 0.27 ± 0.11 vs. 0.35 ± 0.11, respectively; p < 0.001; Reader 2: 0.29 ± 0.10 vs. 0.37 ± 0.07, respectively; p < 0.001), and lower portal vein-to-liver contrast difference (Reader 1: 0.89 ± 0.39 vs. 1.42 ± 0.90, p < 0.001; Reader 2: 0.95 ± 0.40 vs. 1.28 ± 0.37, p < 0.001). ICC was 0.94, 0.79, and 0.69 for RE, image contrast, and portal vein-to-liver contrast difference, respectively. CONCLUSION In cirrhotic patients, gadoxetate disodium yielded lower enhancement of the hepatic parenchyma and lower contrast of the portal vein than gadobenate dimeglumine in PVP.
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Guimaraes L, Babaei Jandaghi A, Menezes R, Grant D, Cattral M, Jhaveri KS. Assessment of biliary anatomy in potential living liver donors: Added value of gadoxetic acid-enhanced T1 MR Cholangiography (MRC) including utilization of controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique in comparison to T2W-MRC. Magn Reson Imaging 2020; 70:64-72. [PMID: 32320722 DOI: 10.1016/j.mri.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the added value of gadoxetic-acid-enhanced T1-weighted magnetic resonance Cholangiography (T1W-MRC) including controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)-Volumetric Interpolated Breathhold (VIBE) technique compared to T2-weighted MR Cholangiography (T2W-MRC) in depicting biliary anatomy in potential living liver donors. METHODS Eighty-five potential donors including 34 men with a mean age of 35.6 years (range, 18-55 years) and 51 women with a mean age of 36.7 years (range, 23-57 years), were enrolled in this ethics-approved retrospective study. Image quality for depiction of bile ducts was evaluated by two readers in consensus in 3 separate reading sessions: 1) T2W-MRC alone, 2) T1W-MRC alone (including CAIPI-VIBE and generalized autocalibrating partially parallel acquisitions (GRAPPA)-VIBE techniques, and 3) combined T1W/T2W-MRC. Accuracy of T2W-MRC, T1W-MRC, and combined T1W/T2W-MRC for the identification/classification of the biliary variants was calculated using intraoperative cholangiogram (IOC) as the reference standard. Image quality and reader diagnostic confidence provided by CAIPI-VIBE technique was compared with GRAPPA-VIBE technique. Datasets were compared using the Wilcoxon signed-rank test. RESULTS Image quality for depiction of the bile ducts was significantly superior in the combined T1W/T2W-MRC group, when compared to each of T2W-MRC and T1W-MRC groups independently (P value = 0.001-0.034). The combination of CAIPI-VIBE and GRAPPA-VIBE was superior compared to each of the sequences individually. The accuracy of T2W-MRC and T1W-MRC was 93% and 91%, respectively. T1W-MRC depicted four biliary variants better than T2W-MRC. Two variants not well seen in T2W-MRC were clearly shown on T1W-MRC. CONCLUSION Gadoxetic-acid-enhanced T1W-MRC and conventional T2W-MRC techniques are complementary for depiction of biliary variants in potential liver donors and the combination of the two improves the results. The combination of CAIPI-VIBE and GRAPPA-VIBE techniques appear to be complementary for optimal diagnostic yield of T1W-MRC.
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Affiliation(s)
- Luis Guimaraes
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Ali Babaei Jandaghi
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada
| | - Ravi Menezes
- Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
| | - David Grant
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Mark Cattral
- Division of General Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
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Cahalane AM, Mojtahed A, Sahani DV, Elias N, Kambadakone AR. Pre-hepatic and pre-pancreatic transplant donor evaluation. Cardiovasc Diagn Ther 2019; 9:S97-S115. [PMID: 31559157 DOI: 10.21037/cdt.2018.09.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.
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Affiliation(s)
- Alexis M Cahalane
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amirkasra Mojtahed
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dushyant V Sahani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nahel Elias
- Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Avinash R Kambadakone
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Choi SH, Kim KW, Kwon HJ, Kim SY, Kwon JH, Song GW, Lee SG. Clinical usefulness of gadoxetic acid–enhanced MRI for evaluating biliary anatomy in living donor liver transplantation. Eur Radiol 2019; 29:6508-6518. [DOI: 10.1007/s00330-019-06292-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/24/2019] [Accepted: 05/29/2019] [Indexed: 12/25/2022]
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Kim B, Kim SY, Kim KW, Jang HY, Jang JK, Song GW, Lee SG. MRI in donor candidates for living donor liver transplant: Technical and practical considerations. J Magn Reson Imaging 2018; 48:1453-1467. [DOI: 10.1002/jmri.26257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Bohyun Kim
- Department of Radiology; Ajou University Medical Center, Ajou University School of Medicine; Suwon South Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Kyoung Won Kim
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Hye Young Jang
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Jong Keon Jang
- Department of Radiology and the Research Institute of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul South Korea
| | - Gi Won Song
- Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
| | - Sung Gyu Lee
- Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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Jhaveri K, Guo L, Guimarães L, Menezes R, McGilvray I, Cattral M, Grant D. Mapping of hepatic vasculature in potential living liver donors: comparison of gadoxetic acid-enhanced MR imaging using CAIPIRINHA technique with CT angiography. Abdom Radiol (NY) 2018; 43:1682-1692. [PMID: 29128992 DOI: 10.1007/s00261-017-1379-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To retrospectively evaluate gadoxetic acid-enhanced magnetic resonance angiography (MRA) using controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique for mapping hepatic vascular anatomy in potential living liver donors, with CT angiography (CTA) as reference standard. METHODS 82 potential living liver donors who underwent MRA and CTA were enrolled in this HIPAA-compliant IRB-approved study. MRA and CTA images were evaluated by two reviewers in consensus with respect to (1) image quality scores for depiction of the hepatic vessels and (2) accuracy of MRA for determining the hepatic vascular variants with CTA as reference standard. The image quality scores were compared using Fisher's exact test between MRA and CTA. RESULTS The accuracy for determining the hepatic arterial, portal, and hepatic venous variants and segment IV arterial origin was 73, 90, 79, and 55%, respectively, compared to CTA. However, subjective image quality for depiction of hepatic arteries in MRA was significantly lower than CTA (p < 0.001). The portal and hepatic venous image quality was almost equal in both modalities (p = 0.059) except left hepatic vein being depicted better on CT images (p = 0.023). CONCLUSION Gadoxetic acid-enhanced MRA using CAIPIRINHA technique is feasible for mapping hepatic vasculature in potential living liver donors, with moderate accuracy for arterial variants and good to excellent results for hepatic and portal vein variants, compared with CTA. However, the specific delineation of segment IV arterial origin was possible in just over half of the liver donors with MRA.
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Affiliation(s)
- Kartik Jhaveri
- Joint Department of Medical Imaging, Mount Sinai Hospital & Women's College Hospital, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada.
| | - Lijun Guo
- Joint Department of Medical Imaging, Mount Sinai Hospital & Women's College Hospital, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada
| | - Luís Guimarães
- Joint Department of Medical Imaging, Mount Sinai Hospital & Women's College Hospital, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada
| | - Ravi Menezes
- Joint Department of Medical Imaging, Mount Sinai Hospital & Women's College Hospital, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada
| | - Ian McGilvray
- Department of Surgery, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada
| | - Mark Cattral
- Department of Surgery, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada
| | - David Grant
- Department of Surgery, University Health Network, University of Toronto, 610 University Ave, 3-957, Toronto, ON M5G, Canada
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Lee JH, Kim B, Kim HJ, Kim BW, Wang HJ, Kim JK. High spatial resolution navigated 3D T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA for evaluation of biliary anatomy in living liver donors. Abdom Radiol (NY) 2018; 43:1703-1712. [PMID: 29450611 DOI: 10.1007/s00261-018-1474-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To determine the feasibility of high-resolution navigated three-dimensional (3D) T1-weighted hepatobiliary MR cholangiography (Nav T1 MRC) using Gd-EOB-DTPA for biliary visualization in living liver donors and to assess added value of 3D T1-weighted hepatobiliary MRCs in improving the confidence and diagnostic accuracy of biliary anatomy in complementary to T2-weighted MRCs. METHODS Twenty-nine right liver donors underwent 3D T2 MRC, 2D T2 MRC, breath-hold T1-weighted hepatobiliary MRC (BH T1 MRC), and Nav T1 MRC. Two readers independently reviewed and compared 3D/2D MRC set, added BH T1 MRC set, and added Nav T1 MRC set for biliary diagnostic accuracy and confidence. For each MRC, biliary segments visualization and image quality were scored. RESULTS Both BH T1 MRC and Nav T1 MRC improved accuracy and specificity in biliary diagnosis when added to 3D/2D T2 MRC-alone set, though without statistical significance (R1, 82.8% to 93.1%; R2, 82.8% to 89.7%). The added Nav T1 MRC set showed the highest diagnostic confidence with both readers. Both readers scored Nav T1 MRC with the highest visualization scores for branching ducts and overall ducts. CONCLUSION Combining T1-weighted hepatobiliary MRCs to 3D/2D T2 MRC set improved accuracy for biliary anatomy diagnosis; time-efficient BH T1 MRC in axial and coronal planes should be considered as a key MRC sequence complementary to T2 MRCs. Given excellent biliary visualization and superior diagnostic confidence, Nav T1 MRC in selected subjects with breath-hold difficulties and inconclusive or complex biliary variations may assist in reaching a correct biliary diagnosis.
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Affiliation(s)
- Jei Hee Lee
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, 164, World-cup Ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Bohyun Kim
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, 164, World-cup Ro, Yeongtong-gu, Suwon, 16499, South Korea.
| | - Hye Jin Kim
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, 164, World-cup Ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Bong-Wan Kim
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, 164, World-cup Ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Hee-Jung Wang
- Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, 164, World-cup Ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jai Keun Kim
- Department of Radiology, Ajou University School of Medicine and Graduate School of Medicine, Ajou University Hospital, 164, World-cup Ro, Yeongtong-gu, Suwon, 16499, South Korea
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11
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Current State-of-the-Art MRI for Comprehensive Evaluation of Potential Living Liver Donors. AJR Am J Roentgenol 2017; 209:55-66. [DOI: 10.2214/ajr.16.17741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kinner S, Schubert TB, Said A, Mezrich JD, Reeder SB. Added value of gadoxetic acid-enhanced T1-weighted magnetic resonance cholangiography for the diagnosis of post-transplant biliary complications. Eur Radiol 2017; 27:4415-4425. [PMID: 28409358 DOI: 10.1007/s00330-017-4797-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/18/2017] [Accepted: 03/07/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Biliary complications after liver transplantation (LT) are common. This study aimed to ascertain the value of gadoxetic acid-enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) to evaluate anastomotic strictures (AS), non-anastomotic strictures (NAS) and biliary casts (BC). METHODS Sixty liver-transplanted patients with suspicion of biliary complications and T2w-MRCP and T1w-MRC followed by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) were analysed. Two readers reviewed the MRCs and rated image quality (IQ) and likelihood for AS/NAS/BC on Likert scales. Sensitivity, specificity and predictive values were calculated, ROC curve analysis performed, and inter-reader variability assessed. The subjective added value of T1w-MRC was rated. RESULTS IQ was high for all sequences without significant differences (2.83-2.88). In 39 patients ERCP/PTC detected a complication. Sensitivity and specificity for AS were 64-96 using T2w-MRCP, increasing to 79-100 using all sequences. Use of all sequences increased the sensitivity of detecting NAS/BC from 72-92% to 88-100% and 67-89% to 72-94%, respectively. Kappa values were substantial (0.45-0.62). T1w-MRC was found to be helpful in 75-83.3%. CONCLUSIONS Combining T1w-MRC and T2w-MRCP increased sensitivity and specificity and diagnostic confidence in patients after LT with suspected biliary complications. T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. KEY POINTS • T1w-MRC is a valuable tool for evaluating post-transplant biliary complications. • Adding T1w-MRC to T2w-MRC increases diagnostic confidence for detection of biliary complications. • A combination of T1w-MRC and T2w-MRCP leads to the best results.
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Affiliation(s)
- Sonja Kinner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA. .,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Tilman B Schubert
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.,Clinic of Radiology and Nuclear Medicine, Basel University Hospital, Basel, Switzerland
| | - Adnan Said
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Joshua D Mezrich
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
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13
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Cai L, Yeh BM, Westphalen AC, Roberts J, Wang ZJ. 3D T2-weighted and Gd-EOB-DTPA-enhanced 3D T1-weighted MR cholangiography for evaluation of biliary anatomy in living liver donors. Abdom Radiol (NY) 2017; 42:842-850. [PMID: 27714420 DOI: 10.1007/s00261-016-0936-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To investigate whether the addition of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced 3D T1-weighted MR cholangiography (T1w-MRC) to 3D T2-weighted MRC (T2w-MRC) improves the confidence and diagnostic accuracy of biliary anatomy in living liver donors. METHODS Two abdominal radiologists retrospectively and independently reviewed pre-operative MR studies in 58 consecutive living liver donors. The second-order bile duct visualization on T1w- and T2w-MRC images was rated on a 4-point scale. The readers also independently recorded the biliary anatomy and their diagnostic confidence using (1) combined T1w- and T2w-MRC, and (2) T2w-MRC. In the 23 right lobe donors, the biliary anatomy at imaging and the imaging-predicted number of duct orifices at surgery were compared to intra-operative findings. RESULTS T1w-MRC had a higher proportion of excellent visualization than T2w-MRC, 66% vs. 45% for reader 1 and 60% vs. 31% for reader 2. The median confidence score for biliary anatomy diagnosis was significantly higher with combined T1w- and T2w-MRC than T2w-MRC alone for both readers (Reader 1: 3 vs. 2, p < 0.001; Reader 2: 3 vs. 1, p < 0.001). Compared to intra-operative findings, the accuracy of imaging-predicted number of duct orifices using combined T1w-and T2w-MRC was significantly higher than that using T2w-MRC alone (p = 0.034 for reader 1, p = 0.0082 for reader 2). CONCLUSION The addition of Gd-EOB-DTPA-enhanced 3D T1w-MRC to 3D T2w-MRC improves second-order bile duct visualization and increases the confidence in biliary anatomy diagnosis and the accuracy in the imaging-predicted number of duct orifices acquired during right lobe harvesting.
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14
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Lewis S, Vasudevan P, Chatterji M, Besa C, Jajamovich G, Facciuto M, Taouli B. Comparison of gadoxetic acid to gadobenate dimeglumine for assessment of biliary anatomy of potential liver donors. Abdom Radiol (NY) 2016; 41:1300-9. [PMID: 26960727 DOI: 10.1007/s00261-016-0693-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare MRI using gadobenate dimeglumine (Gd-BOPTA) vs. gadoxetic acid disodium (Gd-EOB-DTPA) for the assessment of biliary anatomy of potential liver donors. METHODS 76 potential liver donors (39 M/37 F, mean 38 years) who underwent 1.5T MRI using Gd-BOPTA (n = 37) or Gd-EOB-DTPA (n = 39) were retrospectively evaluated. T2 cholangiogram (T2 MRC) and delayed hepatobiliary phase (HBP) T1 cholangiogram (T1 MRC) (performed during HBP 20 min after injection of Gd-EOB-DTPA and 1-2 h after Gd-BOPTA injection) were obtained in addition to MR angiogram/venogram. Two independent observers evaluated image quality (IQ) and conspicuity scores (CS) of the biliary system. Biliary anatomy was assessed in 3 reading sessions (T2 MRC, T1 MRC, and combined T2/T1 MRC). Reference standard consisted of consensus reading of two separate observers of all image sets, clinical/surgical information and intraoperative cholangiogram when available. Datasets were compared using the Mann-Whitney U test or Chi-squared test. RESULTS There was no difference in IQ for T1 MRC using either contrast agent or T2 MRC vs. T1 MRC for both observers (all p values >0.07). There was superior CS for T2 MRC vs. Gd-BOPTA T1 MRC for both observers and T2 MRC vs. Gd-EOB for one observer (p < 0.001). No difference was found for biliary variant detection for T1 MRC (with either contrast agent) vs. T2 MRC. Combined T2/T1 MRC demonstrated improved sensitivity for biliary variant detection using Gd-BOPTA for both observers (p < 0.004) and Gd-EOB-DTPA for one observer (p < 0.001). CONCLUSION Equivalent image quality was found for T1 MRC obtained with Gd-BOPTA or Gd-EOB-DTPA and T2 MRC. T1 MRC is equivalent to T2 MRC for detection of variant biliary anatomy, and the combination of sequences may have added value.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA.
| | - Prasanna Vasudevan
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Manjil Chatterji
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Cecilia Besa
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Guido Jajamovich
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Marcelo Facciuto
- Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
| | - Bachir Taouli
- Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY, 10029, USA
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15
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Lohrke J, Frenzel T, Endrikat J, Alves FC, Grist TM, Law M, Lee JM, Leiner T, Li KC, Nikolaou K, Prince MR, Schild HH, Weinreb JC, Yoshikawa K, Pietsch H. 25 Years of Contrast-Enhanced MRI: Developments, Current Challenges and Future Perspectives. Adv Ther 2016; 33:1-28. [PMID: 26809251 PMCID: PMC4735235 DOI: 10.1007/s12325-015-0275-4] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED In 1988, the first contrast agent specifically designed for magnetic resonance imaging (MRI), gadopentetate dimeglumine (Magnevist(®)), became available for clinical use. Since then, a plethora of studies have investigated the potential of MRI contrast agents for diagnostic imaging across the body, including the central nervous system, heart and circulation, breast, lungs, the gastrointestinal, genitourinary, musculoskeletal and lymphatic systems, and even the skin. Today, after 25 years of contrast-enhanced (CE-) MRI in clinical practice, the utility of this diagnostic imaging modality has expanded beyond initial expectations to become an essential tool for disease diagnosis and management worldwide. CE-MRI continues to evolve, with new techniques, advanced technologies, and novel contrast agents bringing exciting opportunities for more sensitive, targeted imaging and improved patient management, along with associated clinical challenges. This review aims to provide an overview on the history of MRI and contrast media development, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives. FUNDING Bayer HealthCare.
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Affiliation(s)
- Jessica Lohrke
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany
| | - Thomas Frenzel
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany
| | - Jan Endrikat
- Global Medical Affairs Radiology, Bayer HealthCare, Berlin, Germany
- Saarland University Hospital, Homburg, Germany
| | | | - Thomas M Grist
- Radiology, Medical Physics and Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Meng Law
- Radiology and Neurological Surgery, University of South California, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA
| | - Jeong Min Lee
- College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Tim Leiner
- Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Kun-Cheng Li
- Radiology, Xuan Wu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Konstantin Nikolaou
- Radiology, Ludwig-Maximilians University, University Hospitals, Munich, Germany
| | - Martin R Prince
- Radiology, Weill Cornell Medical College, New York, NY, USA
- Columbia College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Kohki Yoshikawa
- Graduate Division of Medical Health Sciences, Graduate School of Komazawa University, Tokyo, Japan
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany.
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16
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Xie S, Liu C, Yu Z, Ren T, Hou J, Chen L, Huang L, Cheng Y, Ji Q, Yin J, Zhang L, Shen W. One-stop-shop preoperative evaluation for living liver donors with gadoxetic acid disodium-enhanced magnetic resonance imaging: efficiency and additional benefit. Clin Transplant 2015; 29:1164-72. [PMID: 26448564 DOI: 10.1111/ctr.12646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To explore the efficiency, cost, and time for examination of one-stop-shop gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in preoperative evaluation for parent donors by comparing with multidetector computer tomography combined with conventional MR cholangiopancreatography (MDCT-MRCP). MATERIALS AND METHODS Forty parent donors were evaluated with MDCT-MRCP, and the other 40 sex-, age-, and weight-matched donors with Gd-EOB-DTPA-enhanced MRI. Anatomical variations and graft volume determined by pre- and intra-operative findings, costs and time for imaging were recorded. Image quality was ranked on a 4-point scale and compared between both groups. RESULTS Gd-EOB-DTPA-enhanced MRI provided better image quality than MDCT-MRCP for the depiction of portal veins and bile ducts by both reviewers (p < 0.05), hepatic veins by one reviewer (p < 0.05), rather hepatic arteries by both reviewers (p < 0.01). Sixty-nine living donors proceeded to liver donation with all anatomical findings accurately confirmed by intra-operative findings. The "in-room" time of Gd-EOB-DTPA-enhanced MRI was 12 min longer than MDCT-MRCP. Gd-EOB-DTPA-enhanced MRI was cheaper than MDCT-MRCP (US$519.72 vs. US$631.85). CONCLUSION One-stop-shop Gd-EOB-DTPA-enhanced MRI has similar diagnostic accuracy as MDCT-MRCP and can provide additional benefit in terms of costs and convenience in preoperative evaluation for parent donors.
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Affiliation(s)
- Shuangshuang Xie
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Chenhao Liu
- Tianjin Third Center Hospital, Tianjin, China
| | - Zichuan Yu
- Department of Radiology, Tianjin First Center Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tao Ren
- Department of Radiology, Tianjin First Center Hospital, Tianjin Medical University, Tianjin, China
| | - Jiancun Hou
- Department of Hepatobiliary Surgery, Tianjin First Center Hospital, Tianjin, China
| | - Lihua Chen
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Lixiang Huang
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Yue Cheng
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Qian Ji
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Jianzhong Yin
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Jiangsu, China
| | - Wen Shen
- Department of Radiology, Tianjin First Center Hospital, Tianjin, China
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17
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Motosugi U, Bannas P, Bookwalter CA, Sano K, Reeder SB. An Investigation of Transient Severe Motion Related to Gadoxetic Acid-enhanced MR Imaging. Radiology 2015; 279:93-102. [PMID: 26473642 DOI: 10.1148/radiol.2015150642] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate the cause of imaging artifacts observed during gadoxetic acid-enhanced arterial phase imaging of the liver. MATERIALS AND METHODS This HIPAA-compliant study was approved by the institutional review board. Data were collected prospectively at two sites (site A, United States; site B, Japan) from patients undergoing contrast material-enhanced MR imaging with gadoxetic acid (site A, n = 154, dose = 0.05 mmol/kg; site B, n = 130, 0.025 mmol/kg) or gadobenate dimeglumine (only site A, n = 1666) from January 2014 to September 2014 at site A and from November 2014 to January 2015 at site B. Detailed comparisons between the two agents were made in the patients with dynamic liver acquisitions (n = 372) and age-, sex-, and baseline oxygen saturation (Spo2)-matched pairs (n = 130) at site A. Acquired data included self-reported dyspnea after contrast agent injection, Spo2, and breath-hold fidelity monitored with respiratory bellows. RESULTS Self-reported dyspnea was more frequent with gadoxetic acid than with gadobenate dimeglumine (site A, 6.5% [10 of 154] vs 0.1% [two of 1666], P < .001; site B, 1.5% [two of 130]). In the matched-pair comparison, gadoxetic acid, as compared with gadobenate dimeglumine, had higher breath-hold failure rates (site A, 34.6% [45 of 130] vs 11.7% [15 of 130], P < .0001; site B, 16.2% [21 of 130]) and more severe artifacts during arterial phase imaging (site A, 7.7% [10 of 130] vs 0% [none of 130], P < .001; site B, 2.3% [three of 130]). Severe imaging artifacts in patients who received gadoxetic acid were significantly associated with male sex (P = .023), body mass index (P = .021), and breath-hold failure (P < .001) but not with dyspnea or Spo2 decrease. CONCLUSION Severe motion-related artifacts in the arterial phase of gadoxetic acid-enhanced liver MR imaging are associated with breath-hold failure but not with subjective feelings of dyspnea or a substantial decrease in blood Spo2. Subjective feelings of dyspnea are not necessarily associated with imaging artifacts. The phenomenon, albeit at a lower rate, was confirmed at a second site in Japan.
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Affiliation(s)
- Utaroh Motosugi
- From the Departments of Radiology (U.M., P.B., C.A.B., S.B.R.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, University of Yamanashi, Yamanashi, Japan (U.M., K.S.); and Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.)
| | - Peter Bannas
- From the Departments of Radiology (U.M., P.B., C.A.B., S.B.R.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, University of Yamanashi, Yamanashi, Japan (U.M., K.S.); and Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.)
| | - Candice A Bookwalter
- From the Departments of Radiology (U.M., P.B., C.A.B., S.B.R.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, University of Yamanashi, Yamanashi, Japan (U.M., K.S.); and Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.)
| | - Katsuhiro Sano
- From the Departments of Radiology (U.M., P.B., C.A.B., S.B.R.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, University of Yamanashi, Yamanashi, Japan (U.M., K.S.); and Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.)
| | - Scott B Reeder
- From the Departments of Radiology (U.M., P.B., C.A.B., S.B.R.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology, University of Yamanashi, Yamanashi, Japan (U.M., K.S.); and Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.)
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18
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Kupczyk PA, Willinek WA, Hadizadeh DR, Traeber F, Gieseke J, Meyer C, Schild HH, Kukuk GM. Abdominal vasculature in dynamic contrast-enhanced liver MRI at 3.0T: an intraindividual comparative study using gadoxetate disodium and gadofosveset trisodium. Magn Reson Imaging 2015; 33:1258-1266. [PMID: 26271178 DOI: 10.1016/j.mri.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To intraindividually compare gadoxetate disodium and gadofosveset trisodium regarding vessel contrast, image quality and vessel delineation in dynamic contrast-enhanced liver MRI at 3.0T. METHODS Twelve patients underwent 3.0T MRI twice (24 examinations) with a single dose of gadoxetate disodium and gadofosveset trisodium, respectively. Signal intensity in abdominal vessels and tissue was determined. Vessel-to-background ratio (VBR) was calculated for each vessel and dynamic phase. All images were evaluated by two radiologists regarding image quality, vessel delineation and anatomic variants or pathologies with digital subtraction angiography as the standard of reference. RESULTS Gadofosveset trisodium demonstrated a significantly higher VBR compared to gadoxetate disodium (arterial phase: 0.57±0.12 [SD] vs. 0.46±0.19; portal venous phase: 0.51±0.11 vs. 0.37±0.14; equilibrium phase: 0.48±0.10 vs. 0.31±0.13; p≤0.01). Image quality and vessel delineation were rated equal or better for gadofosveset trisodium in all cases. These differences were not significant for most vessel segments. All anatomic variants were correctly identified by both readers for both contrast agents. CONCLUSIONS Although gadofosveset trisodium provides a significantly higher vessel contrast at 3.0T, gadoxetate disodium is equivalent by qualitative measurements. Thus, gadoxetate-enhanced liver MRI at 3.0T enables reliable assessment of the upper abdominal vasculature with the additional benefit of hepatobiliary imaging.
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Affiliation(s)
- Patrick A Kupczyk
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Winfried A Willinek
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Dariusch R Hadizadeh
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Frank Traeber
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Juergen Gieseke
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Carsten Meyer
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Hans H Schild
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Guido M Kukuk
- Department of Radiology - University of Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
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19
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Lee Y, Kim SY, Kim KW, Lee SS, Park SH, Byun JH, Lee MG. Contrast-enhanced MR cholangiography with Gd-EOB-DTPA for preoperative biliary mapping: correlation with intraoperative cholangiography. Acta Radiol 2015; 56:773-81. [PMID: 25080516 DOI: 10.1177/0284185114542298] [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: 02/04/2014] [Accepted: 06/11/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gd-EOB-DTPA-enhanced magnetic resonance (MR) could be used for preoperative evaluation of bile duct anatomy in addition to conventional information of focal hepatic lesions. PURPOSE To evaluate accuracy of contrast-enhanced MR cholangiography (CE MRC) reconstructed from Gd-EOB-DTPA-enhanced MR images for depicting biliary anatomy with intraoperative cholangiography. MATERIAL AND METHODS We retrospectively identified 71 patients who underwent both preoperative Gd-EOB-DTPA-enhanced MR imaging (MRI) and intraoperative cholangiography for hepatic resections. Two readers independently analyzed biliary anatomy using CE MRC reconstructed from transverse and coronal images separately in 4 weeks. The accuracy and diagnostic confidence were evaluated in correlation with intraoperative cholangiography. The accuracy and confidence score (3-point scale) were compared on CE MRCs from transverse versus coronal images. RESULTS CE MRCs correctly depicted biliary anatomy in 91.5% and 88.7% with coronal images and in 81.7% and 73.2% with transverse images for readers 1 and 2, respectively. CE MRCs from coronal images tended to show greater accuracy (P = 0.12 and 0.01, for readers 1 and 2) and higher confidence score (P = 0.11 and P = 0.04, for readers 1 and 2) than those from transverse images. CONCLUSION Accurate preoperative biliary mapping can be achieved on CE MRC reconstructed from Gd-EOB-DTPA-enhanced MR images. The diagnostic performance was better on CE MRC reconstructed from coronal than those from transverse images.
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Affiliation(s)
- Yedaun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 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
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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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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Accumulation of Bile in the Gallbladder: Evaluation by means of Serial Dynamic Contrast-Enhanced Magnetic Resonance Cholangiography with Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid. Gastroenterol Res Pract 2015; 2014:479067. [PMID: 25580112 PMCID: PMC4280652 DOI: 10.1155/2014/479067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/30/2014] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to evaluate the process of biliary excretion of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) into the biliary tract and to assess the accumulation patterns in the gallbladder using MR cholangiography obtained with Gd-EOB-DTPA which is a liver-specific hepatobiliary contrast agent. Seventy-five patients underwent Gd-EOB-DTPA enhanced MR imaging. Serial multiphasic hepatobiliary phase imaging was qualitatively reviewed to evaluate the process of the biliary excretion of contrast agent into the bile duct and the gallbladder. The accumulation pattern of contrast agent into gallbladder was classified into two groups (group 1 = orthodromic type and group 2 = delayed type). Furthermore, the results in differences of the presence of T1 hyperintense bile or sludge of gallbladder, gall stones, wall thickening of gallbladder, chronic liver disease, and liver cirrhosis between two groups were compared. Forty-eight of 75 patients (64%) were included in group 1, and remaining 27 (36%) were in group 2. The frequency of the presence of T1 hyperintense bile or sludge of gallbladder was significantly higher in patients with group 2 than that in patients with group 1 (P = 0.041). MR cholangiography obtained with Gd-EOB-DTPA showed that there may be an association between the biliary accumulation pattern in the gallbladder and the pathological condition.
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Kinner S, Steinweg V, Maderwald S, Radtke A, Sotiropoulos G, Forsting M, Schroeder T. Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences. PLoS One 2014; 9:e113882. [PMID: 25426932 PMCID: PMC4245231 DOI: 10.1371/journal.pone.0113882] [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: 05/15/2014] [Accepted: 10/30/2014] [Indexed: 12/19/2022] Open
Abstract
Objectives Preoperative evaluation of potential living liver donors (PLLDs) includes the assessment of the biliary anatomy to avoid postoperative complications. Aim of this study was to compare T2-weighted (T2w) and Gd-EOB-DTPA enhanced T1-weighted (T1w) magnetic resonance cholangiography (MRC) techniques in the evaluation of PLLDs. Materials and Methods 30 PLLDs underwent MRC on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany) using (A) 2D T2w HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) fat saturated (fs) in axial plane, (B) 2D T2w HASTE fs thick slices in coronal plane, (C) free breathing 3D T2w TSE (turbo spin echo) RESTORE (high-resolution navigator corrected) plus (D) maximum intensity projections (MIPs), (E) T2w SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions) plus (F) MIPs and (G) T2w TSE BLADE as well as Gd-EOB-DTPA T1w images without (G) and with (H) inversion recovery. Contrast enhanced CT cholangiography served as reference imaging modality. Two independent reviewers evaluated the biliary tract anatomy on a 5-point scale subjectively and objectively. Data sets were compared using a Mann-Whitney-U-test. Kappa values were also calculated. Results Source images and maximum intensity projections of 3D T2w TSE sequences (RESTORE and SPACE) proved to be best for subjective and objective evaluation directly followed by 2D HASTE sequences. Interobserver variabilities were good to excellent (k = 0.622–0.804). Conclusions 3D T2w sequences are essential for preoperative biliary tract evaluation in potential living liver donors. Furthermore, our results underline the value of different MRCP sequence types for the evaluation of the biliary anatomy in PLLDs including Gd-EOB-DTPA enhanced T1w MRC.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- * E-mail:
| | - Verena Steinweg
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Stefan Maderwald
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg Essen, Essen Germany
| | - Arnold Radtke
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Georgios Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Tobias Schroeder
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Hernando D, Wells SA, Vigen KK, Reeder SB. Effect of hepatocyte-specific gadolinium-based contrast agents on hepatic fat-fraction and R2(⁎). Magn Reson Imaging 2014; 33:43-50. [PMID: 25305414 DOI: 10.1016/j.mri.2014.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 10/04/2014] [Indexed: 12/13/2022]
Abstract
The purpose of this work was to investigate the effect of a hepatocyte-specific gadolinium based contrast agent (GBCA) on quantitative hepatic fat-fraction (FF) and R2* measurements. Fifty patients were imaged at 1.5T, using chemical-shift encoded water-fat MRI with low (5°) and high (15°) flip angles (FA), both before and after administration of a hepatocyte-specific GBCA (gadoxetic acid). Low and high FA, pre- and post-contrast FF and R2* values were measured for each subject. Available serum laboratory studies related to liver disease were also recorded. Linear regression and Bland-Altman analysis were performed to compare measurements. Hepatic FF was unaffected by GBCA at low FA (slope=1.02±0.02, p=0.32). FF was overestimated at high FA pre-contrast (slope=1.33±0.03, p<10(-10)), but underestimated post-contrast (slope=0.81±0.02, p<10(-10)). Hepatic R2* was unaffected by FA (mean difference±95% CI pre-contrast:2.2±4.9s(-1), post-contrast:2.8±3.6s(-1)), but increased post-contrast in patients with total bilirubin <2.5mg/dL (ΔR2*=13.4±12.7s(-1)). Regression analysis of serum values demonstrated a correlation of post-contrast change in R2* with total bilirubin (p<0.01) and model for end-stage liver disease (MELD) score (p≈0.01). In conclusion, GBCA has no effect on hepatic FF at low FA due to a lack of T1-weighting, potentially allowing flexibility for FF imaging with hepatobiliary imaging protocols. Hepatic R2* increased significantly after GBCA administration, particularly in the biliary tree. Therefore, R2* maps should be obtained prior to contrast administration.
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Affiliation(s)
- Diego Hernando
- Department of Radiology, University of Wisconsin - Madison, Madison, WI, United States.
| | - Shane A Wells
- Department of Radiology, University of Wisconsin - Madison, Madison, WI, United States; Department of Radiology, University of Virginia, Charlottesville, VA
| | - Karl K Vigen
- Department of Radiology, University of Wisconsin - Madison, Madison, WI, United States
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin - Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, United States; Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, United States; Department of Medicine, University of Wisconsin - Madison, Madison, WI, United States
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Girometti R, Cereser L, Bazzocchi M, Zuiani C. Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT. World J Radiol 2014; 6:424-436. [PMID: 25071883 PMCID: PMC4109094 DOI: 10.4329/wjr.v6.i7.424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/05/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Despite advances in patient and graft management, biliary complications (BC) still represent a challenge both in the early and delayed period after orthotopic liver transplantation (OLT). Because of unspecific clinical presentation, imaging is often mandatory in order to diagnose BC. Among imaging modalities, magnetic resonance cholangiography (MRC) has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively, using both the conventional technique (based on heavily T2-weighted sequences) and contrast-enhanced MRC (based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents). On this basis, MRC is generally indicated to: (1) avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications; and (2) provide a road map for interventional procedures or surgery. As illustrated in the review, MRC is accurate in the diagnosis of different types of biliary complications, including anastomotic strictures, non-anastomotic strictures, leakage and stones.
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Combination of increased flip angle, radial k-space trajectory, and free breathing acquisition for improved detection of a biliary variant at living donor liver transplant evaluation using gadoxetic acid-enhanced MRCP. J Comput Assist Tomogr 2014; 38:277-80. [PMID: 24625601 DOI: 10.1097/rct.0000000000000071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gadoxetic acid-enhanced magnetic resonance cholangiopancreatography (MRCP) was performed for evaluation of living donor liver transplantation. T2-weighted MRCP and hepatobiliary-phase postcontrast MRCP showed an aberrant right posterior bile duct, although the precise variant was uncertain. Optimized hepatobiliary-phase MRCP was obtained using 3 sequence modifications: increased flip angle to improve contrast between the biliary tree and surrounding tissues; radial k-space sampling to minimize motion artifact; and free-breathing acquisition to improve signal-to-noise ratio and, in turn, spatial resolution (resolution of 1.28 × 1.28 × 1.5 mm). The optimized sequence demonstrated that the right posterior bile duct drained into the cystic duct, consistent with type 3C biliary variant, thus modifying surgical planning.
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Half-dose gadobenate dimeglumine versus standard-dose gadodiamide in dynamic magnetic resonance imaging of non-cirrhotic livers: a retrospective intra-individual crossover comparison. ACTA ACUST UNITED AC 2014; 39:955-62. [DOI: 10.1007/s00261-014-0123-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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27
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Okada M, Wakayama T, Yada N, Hyodo T, Numata K, Kagawa Y, Nishiyama D, Miyakoshi K, Murakami T. Optimal flip angle of Gd-EOB-DTPA-enhanced MRI in patients with hepatocellular carcinoma and liver metastasis. ACTA ACUST UNITED AC 2014; 39:694-701. [DOI: 10.1007/s00261-014-0096-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Ogul H, Kantarci M, Pirimoglu B, Karaca L, Aydinli B, Okur A, Ozturk G, Kizrak Y. The efficiency of Gd-EOB-DTPA-enhanced magnetic resonance cholangiography in living donor liver transplantation: a preliminary study. Clin Transplant 2014; 28:354-60. [PMID: 24506817 DOI: 10.1111/ctr.12320] [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] [Accepted: 01/06/2014] [Indexed: 01/13/2023]
Abstract
The aim of this study was to evaluate utility of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) for the detection of biliary complications after living donor liver transplantation (LDLT). A total of 18 patients with suspected biliary complications underwent MRC. T2-weighted MRC and contrast-enhanced MRC (CE-MRC) were used to identify the biliary complications. MRC included routine breath-hold T2-weighted MRC using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences and Gd-EOB-DTPA-enhanced MRC T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences. Before confirming the biliary complications, one observer reviewed the MRC images and the CE-MRC images separately. The verification procedures and MRC findings were compared, and the sensitivity, specificity, and accuracy of both techniques were calculated for the identification of biliary complications. The observer found six of seven biliary complications using CE-MRC. The sensitivity was 85.7% and the accuracy was 94.4%. Using MRC alone, sensitivity was 57.1% and accuracy was 55.5%. The accuracy of Gd-EOB-DTPA-enhanced MRC was superior to MRC in locating biliary leaks (p < 0.05). The usage of Gd-EOB-DTPA-enhanced MRC yields information that complements the MRC findings that improve the identification of biliary complications. We recommend the use of MRC in addition to Gd-EOB-DTPA-enhanced MRC to increase the preoperative accuracy when assessing the biliary complications after LDLT.
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Affiliation(s)
- Hayri Ogul
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
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Kühn JP, Holmes JH, Brau AC, Iwadate Y, Hernando D, Reeder SB. Navigator flip angle optimization for free-breathing T1-weighted hepatobiliary phase imaging with gadoxetic acid. J Magn Reson Imaging 2013; 40:1129-36. [DOI: 10.1002/jmri.24480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/17/2013] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jens-P. Kühn
- Department of Radiology and Neuroradiology; Ernst Moritz Arndt University Greifswald; Greifswald Germany
- Department of Radiology; University of Wisconsin; Madison Wisconsin USA
| | - James H. Holmes
- Global Applied Science Laboratory GE Healthcare; Madison Wisconsin USA
| | - Anja C.S. Brau
- MR Applications and Workflow GE Healthcare; Munich Germany
| | - Yuji Iwadate
- Global Applied Science Laboratory GE Healthcare; Hino Japan
| | - Diego Hernando
- Department of Radiology and Neuroradiology; Ernst Moritz Arndt University Greifswald; Greifswald Germany
- Department of Radiology; University of Wisconsin; Madison Wisconsin USA
| | - Scott B. Reeder
- Global Applied Science Laboratory GE Healthcare; Hino Japan
- Department of Medical Physics, Biomedical Engineering and Medicine; University of Wisconsin; Madison Wisconsin USA
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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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Kantarcı M, Pirimoglu B, Karabulut N, Bayraktutan U, Ogul H, Ozturk G, Aydinli B, Kizrak Y, Eren S, Yilmaz S. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography. Eur Radiol 2013; 23:2713-22. [PMID: 23695221 PMCID: PMC3769590 DOI: 10.1007/s00330-013-2880-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/20/2013] [Accepted: 03/24/2013] [Indexed: 02/07/2023]
Abstract
Objective To evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks. Methods Ninety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated. Results Accuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05. Conclusions Gd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile. Key Points • Magnetic resonance cholangiography (MRC) does not always detect bile leakage and cysto-biliary communications. • Gd-EOB-DTPA-enhanced MRC helps by demonstrating extravasation of contrast material into fluid collections. • Gd-EOB-DTPA-enhanced MRC also demonstrates the leakage site and bile duct injury type. • Combined Gd-EOB-DTPA-enhanced and T2w-MRC can provide comprehensive information about biliary system. • Gd-EOB-DTPA-enhanced MRC is non-invasive and does not use ionising radiation.
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Affiliation(s)
- Mecit Kantarcı
- School of Medicine, Department of Radiology, Atatürk University, Erzurum, Turkey,
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Gupta RT. Evaluation of the Biliary Tree and Gallbladder With Hepatocellular MR Contrast Agents. Curr Probl Diagn Radiol 2013; 42:67-76. [DOI: 10.1067/j.cpradiol.2012.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Effect of Flip Angle for Optimization of Image Quality of Gadoxetate Disodium–Enhanced Biliary Imaging at 1.5 T. AJR Am J Roentgenol 2013; 200:90-6. [DOI: 10.2214/ajr.12.8722] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma. Int J Hepatol 2013; 2013:374170. [PMID: 23606972 PMCID: PMC3623472 DOI: 10.1155/2013/374170] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/24/2013] [Indexed: 12/22/2022] Open
Abstract
HEPATOCELLULAR ADENOMAS (HCAS) ARE CURRENTLY CATEGORIZED INTO DISTINCT GENETIC AND PATHOLOGIC SUBTYPES AS FOLLOWS: inflammatory hepatocellular adenoma, hepatocyte-nuclear-factor-1-alpha (HNF-1 α -mutated) hepatocellular adenoma, and β -catenin-mutated hepatocellular adenomas; the fourth, defined as unclassified subtype, encompasses HCAs without any genetic abnormalities. This classification has accepted management implications due to different risks of haemorrhage and malignant transformation of the four subtypes. Imaging guided biopsy and/or surgical resection very important in obtaining definitive characterization; nevertheless, MRI with intra-extravascular and hepatobiliary (dual phase) agents, is an important tool not only in differential subtypes definition but even in surveillance with early identification of complications and discovery of some signs of HCA malignant degeneration. Inflammation, abnormal rich vascularisation, peliotic areas, and abundant fatty infiltration are pathologic findings differently present in the HCA subtypes and they may be detected by multiparametric MRI approach. Lesion enlargement and heterogeneity of signal intensity and of contrast enhancement are signs to be considered in malignant transformation. The purpose of this paper is to present the state of the art of MRI in the diagnosis of HCA and subtype characterization, with particular regard to morphologic and functional information available with dual phase contrast agents, and to discuss differential diagnosis with the most common benign and malignant lesions mimicking HCAs.
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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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Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium. AJR Am J Roentgenol 2012; 199:35-43. [PMID: 22733891 DOI: 10.2214/ajr.11.7757] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The purpose of this article is to report the results from a multicenter retrospective MRI study comparing gadobenate dimeglumine and gadoxetate disodium for diagnosis of hepatic focal nodular hyperplasia (FNH). MATERIALS AND METHODS Thirty patients (28 women and two men; mean age, 37.1 years) with hepatic FNH who underwent both gadobenate dimeglumine- and gadoxetate disodium-enhanced MRI at 1.5 T were assessed. MRI was performed during the arterial, portal venous, late venous, and hepatobiliary contrast-enhanced phases (10 and 20 minutes or 1-3 hours after contrast administration, respectively, for gadoxetate disodium and gadobenate dimeglumine). Qualitative (lesion conspicuity score) and quantitative (lesion signal intensity [SI] ratio and lesion contrast ratio) assessments were performed. RESULTS In 30 patients, 51 FNHs were assessed (mean size 3.1 ± 1.5 cm). There was equivalent qualitative lesion conspicuity in the arterial phase between the two contrast agents and higher qualitative lesion conspicuity and SI ratio in the hepatobiliary phase with gadoxetate disodium (p < 0.002). Lesion contrast ratio was significantly higher in the arterial and late venous phases with gadobenate dimeglumine (p < 0.009), with no difference in the portal venous and hepatobiliary phases between the two contrast agents (p > 0.22). CONCLUSION These results indicate an advantage for gadobenate dimeglumine for detection of FNH at the dynamic phase and for gadoxetate disodium at the hepatobiliary phase. However, the equivalent or better qualitative lesion conspicuity coupled with the ability to obtain a comprehensive evaluation of the liver within a standard 30-minute imaging window suggests that gadoxetate disodium may be a better choice for diagnosis of FNH.
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Frydrychowicz A, Lubner MG, Brown JJ, Merkle EM, Nagle SK, Rofsky NM, Reeder SB. Hepatobiliary MR imaging with gadolinium-based contrast agents. J Magn Reson Imaging 2012; 35:492-511. [PMID: 22334493 DOI: 10.1002/jmri.22833] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The advent of gadolinium-based "hepatobiliary" contrast agents offers new opportunities for diagnostic magnetic resonance imaging (MRI) and has triggered great interest for innovative imaging approaches to the liver and bile ducts. In this review article we discuss the imaging properties of the two gadolinium-based hepatobiliary contrast agents currently available in the U.S., gadobenate dimeglumine and gadoxetic acid, as well as important pharmacokinetic differences that affect their diagnostic performance. We review potential applications, protocol optimization strategies, as well as diagnostic pitfalls. A variety of illustrative case examples will be used to demonstrate the role of these agents in detection and characterization of liver lesions as well as for imaging the biliary system. Changes in MR protocols geared toward optimizing workflow and imaging quality are also discussed. It is our aim that the information provided in this article will facilitate the optimal utilization of these agents and will stimulate the reader's pursuit of new applications for future benefit.
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Affiliation(s)
- Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, University of Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Nagle SK, Busse RF, Brau AC, Brittain JH, Frydrychowicz A, Iwadate Y, Reeder SB. High resolution navigated three-dimensional T₁-weighted hepatobiliary MRI using gadoxetic acid optimized for 1.5 Tesla. J Magn Reson Imaging 2012; 36:890-9. [PMID: 22648633 DOI: 10.1002/jmri.23713] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/27/2012] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To determine optimal delay times and flip angles for T1-weighted hepatobiliary imaging at 1.5 Tesla (T) with gadoxetic acid and to demonstrate the feasibility of using a high-resolution navigated optimized T1-weighted pulse sequence to evaluate biliary disease. MATERIALS AND METHODS Eight healthy volunteers were scanned at 1.5T using a T1-weighted three-dimensional (3D)-SPGR pulse sequence following the administration of 0.05 mmol/kg of gadoxetic acid. Navigator-gating enabled acquisition of high spatial resolution (1.2 × 1.4 × 1.8 mm(3) , interpolated to 0.7 × 0.7 × 0.9 mm(3) ) images in approximately 5 min of free-breathing. Multiple breath-held acquisitions were performed at flip angles between 15° and 45° to optimize T1 weighting. To evaluate the performance of this optimized sequence in the setting of biliary disease, the image quality and biliary excretion of 51 consecutive clinical scans performed to assess primary sclerosing cholangitis (PSC) were evaluated. RESULTS Optimal hepatobiliary imaging occurs at 15-25 min, using a 40° flip angle. The image quality and visualization of biliary excretion in the PSC scans were excellent, despite the decreased liver function in some patients. Visualization of reduced excretion often provided diagnostic information that was unavailable by conventional magnetic resonance cholangiopancreatography (MRCP). CONCLUSION High-resolution navigated 3D-SPGR hepatobiliary imaging using gadoxetic acid and optimized scan parameters is technically feasible and can be clinically useful, even in patients with decreased hepatobiliary function.
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Affiliation(s)
- Scott K Nagle
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA.
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Frydrychowicz A, Jedynak AR, Kelcz F, Nagle SK, Reeder SB. Gadoxetic acid-enhanced T1-weighted MR cholangiography in primary sclerosing cholangitis. J Magn Reson Imaging 2012; 36:632-40. [PMID: 22581411 DOI: 10.1002/jmri.23683] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/20/2012] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To investigate the value of gadoxetic acid-enhanced three-dimensional T1-weighted MR cholangiography (T1w-MRC) in comparison to three-dimensional T2-weighted MR cholangiopancreaticography (T2w-MRCP) in patients with primary sclerosing cholangitis (PSC). MATERIALS AND METHODS Thirty-four MR exams in 29 patients (46.0 ± 16.1 years; 19 men, 10 women) scanned within a 14-month period were retrospectively included. Two abdominal radiologists independently evaluated image quality regarding image contrast, image quality degradation due to artifacts, and visualization quality of ducts. The order of biliary tree branches that were visualized and reader preference toward each method were recorded. Helpfulness of T1w-MRC was scored in consensus. Confirmatory endoscopic retrograde cholangiopancreaticography (ERCP) performed within 3 months of the MR examination was available in 8 patients. RESULTS Image quality of T1w-MRC and T2w-MRCP was graded good to excellent in all cases. There were advantages for both T1w-MRC (functional information, less degradation due to artifacts) and T2w-MRCP (higher order of visualized branches, better branch depiction). Both readers showed preference for T2w-MRCP; however, both readers found gadoxetic acid-enhanced T1w-MRC helpful in the majority of cases. CONCLUSION Gadoxetic acid-enhanced T1w-MRC is complementary to, but should not replace, T2w-MRCP. T1w-MRC is a useful adjunct to T2w-MRCP for morphologic evaluation and provides additional diagnostic information.
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Affiliation(s)
- Alex Frydrychowicz
- Clinic for Radiology and Nucelar Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Dahlqvist Leinhard O, Dahlström N, Kihlberg J, Sandström P, Brismar TB, Smedby O, Lundberg P. Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study. Eur Radiol 2011; 22:642-53. [PMID: 21984449 DOI: 10.1007/s00330-011-2302-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 09/12/2011] [Accepted: 09/18/2011] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To develop and evaluate a procedure for quantifying the hepatocyte-specific uptake of Gd-BOPTA and Gd-EOB-DTPA using dynamic contrast-enhanced (DCE) MRI. METHODS Ten healthy volunteers were prospectively recruited and 21 patients with suspected hepatobiliary disease were retrospectively evaluated. All subjects were examined with DCE-MRI using 0.025 mmol/kg of Gd-EOB-DTPA. The healthy volunteers underwent an additional examination using 0.05 mmol/kg of Gd-BOPTA. The signal intensities (SI) of liver and spleen parenchyma were obtained from unenhanced and enhanced acquisitions. Using pharmacokinetic models of the liver and spleen, and an SI rescaling procedure, a hepatic uptake rate, K (Hep), estimate was derived. The K (Hep) values for Gd-EOB-DTPA were then studied in relation to those for Gd-BOPTA and to a clinical classification of the patient's hepatobiliary dysfunction. RESULTS K (Hep) estimated using Gd-EOB-DTPA showed a significant Pearson correlation with K (Hep) estimated using Gd-BOPTA (r = 0.64; P < 0.05) in healthy subjects. Patients with impaired hepatobiliary function had significantly lower K (Hep) than patients with normal hepatobiliary function (K (Hep) = 0.09 ± 0.05 min(-1) versus K (Hep) = 0.24 ± 0.10 min(-1); P < 0.01). CONCLUSIONS A new procedure for quantifying the hepatocyte-specific uptake of T (1)-enhancing contrast agent was demonstrated and used to show that impaired hepatobiliary function severely influences the hepatic uptake of Gd-EOB-DTPA. KEY POINTS • The liver uptake of contrast agents may be measured with standard clinical MRI. • Calculation of liver contrast agent uptake is improved by considering splenic uptake. • Liver function affects the uptake of the liver-specific contrast agent Gd-EOB-DTPA. • Hepatic uptake of two contrast agents (Gd-EOB-DTPA, Gd-BOPTA) is correlated in healthy individuals. • This method can be useful for determining liver function, e.g. before hepatic surgery.
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Affiliation(s)
- O Dahlqvist Leinhard
- Center for Medical Image Science and Visualization (CMIV), Linköping University, SE-58185, Linköping, Sweden
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Frydrychowicz A, Nagle SK, D'Souza SL, Vigen KK, Reeder SB. Optimized high-resolution contrast-enhanced hepatobiliary imaging at 3 tesla: a cross-over comparison of gadobenate dimeglumine and gadoxetic acid. J Magn Reson Imaging 2011; 34:585-94. [PMID: 21751288 DOI: 10.1002/jmri.22713] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 06/07/2011] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) performance of 0.05 mmol/kg gadoxetic acid and 0.1 mmol/kg gadobenate dimeglumine for dynamic and hepatobiliary phase imaging. In addition, flip angles (FA) that maximize relative contrast-to-noise performance for hepatobiliary phase imaging were determined. MATERIALS AND METHODS A cross-over study in 10 volunteers was performed using each agent. Imaging was performed at 3 Tesla (T) with a 32-channel phased-array coil using breathheld 3D spoiled gradient echo sequences for SNR and CNR analysis, and for FA optimization of hepatobiliary phase imaging. RESULTS Gadobenate dimeglumine (0.1 mmol/kg) had superior SNR performance during the dynamic phase, statistically significant for portal vein and hepatic vein in the portal venous and venous phase (for all, P < 0.05) despite twice the approved dose of gadoxetic acid (0.05 mmol/kg), while gadoxetic acid had superior SNR performance during the hepatobiliary phase. Optimal FAs for hepatobiliary phase imaging using gadoxetic acid and gadobenate dimeglumine were 25-30° and 20-30° for relative contrast liver versus muscle (surrogate for nonhepatocellular tissues), and 45° and 20° (relative contrast liver versus biliary structures), respectively. CONCLUSION Gadobenate dimeglumine may be preferable for applications that require dynamic phase imaging only, while gadoxetic acid may be preferable when the hepatobiliary phase is clinically important. Hepatobiliary phase imaging with both agents benefits from flip angle optimization.
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Affiliation(s)
- Alex Frydrychowicz
- Department of Radiology, University of Wisconsin-Madison, Wisconsin 73727, USA
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