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Meng D, Liang C, Zheng Y, Wang X, Liu K, Lin Z, Zhu Q, Zhao X. The value of gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase for predicting post-hepatectomy liver failure in HCC patients. Eur Radiol 2022; 32:8608-8616. [PMID: 35639146 DOI: 10.1007/s00330-022-08874-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/22/2022] [Accepted: 05/12/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine the value of gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase for predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). METHODS Patients with HCC who underwent gadobenate dimeglumine-enhanced hepatobiliary magnetic resonance imaging prior to hepatectomy were collected in two centers. The relative enhancement ratio of the biliary system (REB) and the liver to muscle ratio (LMR) were measured at the hepatobiliary phase. Potential risk factors for PHLF were analyzed by logistic regression. The capacity of the REB and LMR to predict PHLF was analyzed via receiver operating characteristic curve. RESULTS Of the 221 patients, post-hepatectomy liver failure occurred in 60 patients (27.1%). The REB was an independent risk factor for PHLF (odds ratio [OR] = 0.127 [0.047-0.348], p < 0.001). Although the LMR tended to be associated with PHLF (p = 0.063), it was not an independent risk factor in the multivariable analysis (OR = 0.624 [0.023-16.709], p = 0.779). Moreover, the area under the receiver operating characteristic curve of the REB and LMR was 0.87 and 0.60. The most appropriate cutoff value for the REB was 2.21. The HCC patients with the REB ≤ 2.21 had a higher incidence of post-hepatectomy liver failure than those with the REB > 2.21 (60.0% versus 8.5%, p < 0.001). CONCLUSIONS Gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase was valuable in predicting post-hepatectomy liver failure in HCC patients. KEY POINTS • The relative enhancement ratio of the biliary system (REB) was an independent risk factor for post-hepatectomy liver failure in HCC patients. • HCC patients with the REB ≤ 2.21 had significantly higher incidence of post-hepatectomy liver failure than those with the REB > 2.21 (60.0% versus 8.5%).
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Affiliation(s)
- Dongxiao Meng
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong province, China.,Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Changhu Liang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.,Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong province, China
| | - Yuanwen Zheng
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.,Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong province, China
| | - Keke Liu
- Shandong Academy of Clinical Medicine, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Zhengyu Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian province, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong province, China.,Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China. .,Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, 250021, Shandong province, China.
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Paisant A, Vilgrain V, Riou J, Oberti F, Sutter O, Laurent V, Rodes A, Guiu B, Cassinotto C, Trillaud H, Bricault I, Michalak S, Bruno O, Ronot M, Aubé C. Comparison of extracellular and hepatobiliary MR contrast agents for the diagnosis of small HCCs. J Hepatol 2020; 72:937-945. [PMID: 31870951 DOI: 10.1016/j.jhep.2019.12.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The aim of this study was to use a head-to-head nodule comparison to compare the performance of extracellular contrast agent MRI (ECA-MRI) with that of hepatobiliary contrast agent MRI (HBA-MRI) for the non-invasive diagnosis of small hepatocellular carcinomas (HCCs). METHODS Between August 2014 and October 2017, 171 patients with cirrhosis, each with 1 to 3 nodules measuring 1-3 cm, were enrolled across 8 centers. All patients underwent both an ECA-MRI and an HBA-MRI within a month. A non-invasive diagnosis of HCC was made when a nodule exhibited arterial phase hyper-enhancement (APHE) with washout at the portal venous phase (PVP) and/or delayed phase (DP) for ECA-MRI, or the PVP and/or HB phase (HBP) for HBA-MRI. The gold standard was defined by using a previously published composite algorithm. RESULTS A total of 225 nodules, of which 153 were HCCs and 72 were not, were included. The sensitivites of both MRI techniques were similar. Specificity was 83.3% (95% CI 72.7-91.1) for ECA-MRI and 68.1% (95% CI 56.0-78.6) for HBA-MRI. In terms of HCC diagnosis on ECA-MRI, 138 nodules had APHE, 84 had washout at PVP, and 104 at DP; on HBA-MRI, 128 nodules had APHE, 71 had washout at PVP, and 99 at HBP. For nodules 2-3 cm in size, sensitivity and specificity were similar between the 2 approaches. For nodules 1-2 cm in size, specificity dropped to 66.1% (95% CI 52.2-78.2) for HBA-MRI vs. 85.7% (95% CI 73.8-93.6) for ECA-MRI. CONCLUSIONS HBA-MRI specificity is lower than that of ECA-MRI for diagnosing small HCCs in patients with cirrhosis. These results raise the question of the proper use of HBA-MRI in algorithms for the non-invasive diagnosis of small HCCs. LAY SUMMARY There are 2 magnetic resonance imaging (MRI)-based approaches available for the non-invasive diagnosis of hepatocellular carcinoma (HCC), using either extracellular or hepatobiliary contrast agents. The current results showed that the sensitivity of MRI with hepatobiliary contrast agents was similar to that with extracellular contrast agents, but the specificity was lower. Thus, hepatobiliary contrast agent-based MRI, although detailed in international guidelines, should be used with caution for the non-invasive diagnosis of HCC. CLINICAL TRIAL NUMBER NCT00848952.
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Affiliation(s)
- Anita Paisant
- Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France.
| | - Valérie Vilgrain
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France
| | - Jérémie Riou
- Université d'Angers, UFR Santé, 49000 Angers, France; MINT UMR INSERM 1066, CNRS 6021, Université d'Angers, 49000 Angers, France
| | - Frédéric Oberti
- Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France; Service de Gastroenterologie et Hépatologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France
| | - Olivier Sutter
- Service de Radiologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis (AP-HP), 93140 Bondy, France
| | - Valérie Laurent
- Département de Radiologie, Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, 54500 Vandoeuvre-lès-Nancy, France
| | - Agnès Rodes
- Département de Radiologie, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004 Lyon, France
| | - Boris Guiu
- Département de Radiologie, INSERM U896, CHU Saint-Eloi, Université de Montpellier, 34295 Montpellier, France
| | - Christophe Cassinotto
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France
| | - Hervé Trillaud
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France; Universitaire de Bordeaux, EA Imotion, F-33000 Bordeaux, France
| | - Ivan Bricault
- Département d'Imagerie, Radiologie et Imagerie Médicale, CHU, 38000 Grenoble, France; Laboratory of Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications, Université 38000 Grenoble Alpes, Grenoble, France
| | - Sophie Michalak
- Département d'Anatomopatologie, Centre Hospitalier Universitaire d'Angers, Université d'Angers, 49933 Angers, France
| | - Onorina Bruno
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France
| | - Maxime Ronot
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France
| | - Christophe Aubé
- Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France
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Kamali M, Clarke SE, Costa AF. Evaluation of liver MRI examinations with two dosages of gadobenate dimeglumine: a blinded intra-individual study. Abdom Radiol (NY) 2020; 45:36-44. [PMID: 31372778 DOI: 10.1007/s00261-019-02158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE There is discrepancy in the literature regarding the optimal dose of gadobenate for liver MRI. We evaluated the quality of liver MRIs performed in the same individual using two dosages. METHODS With ethics approval, this retrospective study evaluated sixty patients who underwent liver MRIs between July 2015 and May 2017 (low dose, 0.06 mmol/kg) and May 2017 and September 2018 (standard dose, 0.10 mmol/kg). Regions of interest were drawn over the aorta, portal veins, and liver on unenhanced and post-contrast phases; relative enhancement values were compared (paired t-tests). Two blinded radiologists graded the arterial and portal venous sequences of each MRI from 1 to 4 (1 = suboptimal, 2 = adequate, 3 = good, 4 = excellent); grades were compared overall and in cirrhotic and non-cirrhotic subgroups (Wilcoxon signed-rank test). Radiologists graded each MRI pair from 1 to 5 (1 = substantially inferior, 2 = slightly inferior, 3 = equivalent, 4 = slightly improved, 5 = substantially improved). Inter-reader agreement was assessed (kappa statistic). RESULTS Relative enhancement increased significantly with the standard dose for all structures on all phases (p < 0.05). For both radiologists and both post-contrast phases, individual grades of the low- and standard-dose MRIs were similar, including the cirrhotic and non-cirrhotic subgroups (p > 0.05). Compared to the low-dose MRIs, the number of standard-dose MRIs graded 1-5 were 9, 31, 97, 88, and 11 for all patients, and 6, 13, 26, 45, and 6 in cirrhotics. Inter-observer agreement was fair-moderate (Κ range 0.23-0.45). CONCLUSIONS Although the standard dose of gadobenate yields greater relative enhancement, there is overall little improvement in subjective imaging quality. A trend towards better image quality is observed in cirrhotics.
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Affiliation(s)
- Mahsa Kamali
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
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Continuous Hepatic Arterial Multiphase Magnetic Resonance Imaging During Free-Breathing. Invest Radiol 2018; 53:596-601. [DOI: 10.1097/rli.0000000000000459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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5
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Roux M, Pigneur F, Baranes L, Calderaro J, Chiaradia M, Decaens T, Kastahian S, Charles-Nelson A, Tselikas L, Costentin C, Laurent A, Azoulay D, Mallat A, Rahmouni A, Luciani A. Differentiating focal nodular hyperplasia from hepatocellular adenoma: Is hepatobiliary phase MRI (HBP-MRI) using linear gadolinium chelates always useful? Abdom Radiol (NY) 2018; 43:1670-1681. [PMID: 29110059 DOI: 10.1007/s00261-017-1377-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To assess the value of Hepatobiliary phase MRI (HPB-MRI) to differentiate FNH and HCA, and evaluate its impact on diagnostic accuracy, diagnostic confidence, inter-observer variability, and patient clinical management. METHODS Forty-nine patients referred for Gd-BOPTA-enhanced MRI were retrospectively included in this IRB-approved study, with a total of 119 lesions-90 FNH and 29 HCA. Two observers separately assessed in 2 distinct randomized reading sessions the performance of MRI with (HBP-MRI) or without (conventional MRI) the use of HBP images. Each lesion was ranked with a 5-point scale (from 1 Typical FNH to 5 Certainly not a FNH). Sensitivity, specificity, overall accuracy, and inter-observer agreement for the differentiation of FNH from HCA were calculated and compared between conventional and HBP-MRI. RESULTS Both sensitivity (respective values of 38.9% and 97.8%), overall accuracy (respective values of 53.8% and 98.3%), and inter-observer agreement (respective values of Kappa 0.56 and 0.88) were significantly higher using HBP-MRI than with conventional MRI, with unchanged specificity (100%). The sensitivity of conventional MRI for the diagnosis of FNH was significantly lower in lesions ≤ 3 cm (20% vs. 88%). Overall, HBP could have changed lesion management in 59/119 cases (49.5%), including 53 FNH and 6 HCA with no impact in 60/119 lesions (50.5%) including all 35 lesions classified as scores 1 and 2 for the diagnosis of FNH. CONCLUSIONS The clinical impact of HBP-MRI is mostly important for smaller than 3-cm FNH, and more limited in larger FNH lesions as well as for HCA diagnosis for which conventional MRI is already accurate. The use of extracellular contrast agents upfront could limit the required use of linear HBP contrast agents for benign hepatocellular lesion characterization. On HBP, all FNH appeared hypointense compared to adjacent liver while close to 97% of HCA appeared hypointense.
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Affiliation(s)
- Marion Roux
- Service de Radiodiagnostic et Radiologie interventionnelle, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Frederic Pigneur
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - Laurence Baranes
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Julien Calderaro
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Pathology, AP-HP, 94010, Creteil, France
| | - Mélanie Chiaradia
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Thomas Decaens
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Sandrine Kastahian
- Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France
| | - Anaïs Charles-Nelson
- Groupe Henri Mondor Albert Chenevier, Unite de Recherche Clinique (URC), AP-HP, 94010, Creteil, France
| | - Lambros Tselikas
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - Charlotte Costentin
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Alexis Laurent
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France
| | - Daniel Azoulay
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Liver Surgery, AP-HP, 94010, Creteil, France
| | - Ariane Mallat
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, AP-HP, 94010, Creteil, France
| | - Alain Rahmouni
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
| | - Alain Luciani
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
- Faculte de Medecine de Creteil, Universite Paris Est Creteil, 94010, Creteil, France
- INSERM Unite U 955, Equipe 18, 94010, Creteil, France
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How Do Different Indices of Hepatic Enhancement With Gadoxetic Acid Compare in Predicting Liver Failure and Other Major Complications After Hepatectomy? J Comput Assist Tomogr 2018; 42:380-386. [DOI: 10.1097/rct.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Costa AF, Tremblay St-Germain A, Abdolell M, Smoot RL, Cleary S, Jhaveri KS. Can contrast-enhanced MRI with gadoxetic acid predict liver failure and other complications after major hepatic resection? Clin Radiol 2017; 72:598-605. [PMID: 28274510 DOI: 10.1016/j.crad.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/09/2017] [Accepted: 02/06/2017] [Indexed: 12/17/2022]
Abstract
AIM To determine whether a combination of clinical factors, the future liver remnant (FLR) ratio, and hepatic uptake of gadoxetic acid can be used to predict post-hepatectomy liver failure (PHLF) and other major complications (OMC). MATERIALS AND METHODS Sixty-five consecutive patients who underwent pre-hepatectomy gadoxetic acid-enhanced magnetic resonance imaging (MRI) between October 2010 and December 2013 were included. The relative liver enhancement (RLE) of gadoxetic acid was calculated from regions of interest on MRI, and FLR ratios were obtained from computed tomography (CT). PHLF and OMC were defined by the International Study Group of Liver Surgery criteria and Clavien-Dindo grade of ≥3, respectively. Multivariate logistic regression modelling was performed to identify predictors of PHLF and OMC, including RLE, FLR ratio, age, sex, chemotherapy history, intra-operative blood loss, and intra-operative transfusion. RESULTS Nine patients experienced PHLF and another nine patients experienced OMC. RLE was comparable to the FLR ratio in predicting PHLF (areas under the receiver operating characteristic [AUROC] curves, 0.665 and 0.705), but performed poorly in predicting OMCs (AUROCs, 0.556 and 0.702). Combining all clinical and imaging parameters as predictors yielded the best performing predictive models (AUROCs, 0.875 and 0.742 for PHLF and OMC, respectively). CONCLUSION A model based on clinical parameters, the FLR ratio, and RLE of gadoxetic acid may improve pre-hepatectomy risk assessment.
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Affiliation(s)
- A F Costa
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Canada.
| | - A Tremblay St-Germain
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - M Abdolell
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - R L Smoot
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - S Cleary
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - K S Jhaveri
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Canada
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Tselikas L, Pigneur F, Roux M, Baranes L, Costentin C, Roche V, Calderaro J, Herin E, Laurent A, Zafrani E, Azoulay D, Mallat A, Rahmouni A, Luciani A. Impact of hepatobiliary phase liver MRI versus Contrast-Enhanced Ultrasound after an inconclusive extracellular gadolinium-based contrast-enhanced MRI for the diagnosis of benign hepatocellular tumors. Abdom Radiol (NY) 2017; 42:825-832. [PMID: 27704147 DOI: 10.1007/s00261-016-0921-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the added values of hepatobiliary phase (HBP) MRI and contrast-enhanced ultrasound (CEUS) in addition to inconclusive extracellular gadolinium-based contrast-enhanced MRI (CE-MRI) to characterize benign hepatocellular tumors (BHT). METHODS Eighty-three BHT-46 focal nodular hyperplasia (FNH) and 37 hepatocellular adenomas (HCA)-with inconclusive CE-MRI in 54 patients (43 women and 11 men, mean age 42 years old ± 14.8) were retrospectively analyzed. All patients underwent both HBP-MRI and CEUS. Two radiologists independently reviewed 2 sets of images, SET-1: CE-MRI and HBP-MRI; SET-2: CE-MRI and CEUS, and classified lesions as "definite FNH," "possible FNH," or "definitely not FNH." Sensitivity (Se) and specificity (Spe) were compared between the two sets; subgroup analyses according to the lesion's size were performed. RESULTS Regardless of lesion size, the respective Se and Spe of both datasets were not statistically different (95.7 and 100% vs. 76.1 and 94.6% for set-1 and -2 respectively; p = 0.18). For lesions larger than 35 mm, although both sets had similar specificity (100%), sensitivity was higher for SET-1 (100% vs. 40%); p = 0.04. Tumor classifications using SET-1 and SET-2 could have changed patient management in 35/54 (64.8%) and 33/54 (61.1%) of all patients, respectively. CONCLUSIONS HBP-MRI or CEUS should be performed after an inconclusive CE-MRI. Both can change patient management by avoiding unnecessary biopsy or surveillance. The use of HBP-MRI should be advocated over CEUS in larger (>35 mm) lesions.
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Affiliation(s)
- Lambros Tselikas
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Frederic Pigneur
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Marion Roux
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurence Baranes
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Charlotte Costentin
- Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
| | - Vincent Roche
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Julien Calderaro
- Department of Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
- Universite Paris Est Creteil, Créteil, 94010, France
| | - Edouard Herin
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexis Laurent
- Universite Paris Est Creteil, Créteil, 94010, France
- Liver Surgery Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
- INSERM IMRB Unit U 955, Equipe 18, Créteil, 94010, France
| | - Elie Zafrani
- Department of Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
| | - Daniel Azoulay
- Universite Paris Est Creteil, Créteil, 94010, France
- Liver Surgery Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
| | - Ariane Mallat
- Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, Créteil, 94010, France
- Universite Paris Est Creteil, Créteil, 94010, France
| | - Alain Rahmouni
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
- Universite Paris Est Creteil, Créteil, 94010, France
| | - Alain Luciani
- Imagerie Medicale, CHU Henri Mondor, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.
- Universite Paris Est Creteil, Créteil, 94010, France.
- INSERM IMRB Unit U 955, Equipe 18, Créteil, 94010, France.
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AlObaidy M, Ramalho M, Busireddy KKR, Dale BM, Burke LM, Altun E, Liu B, Semelka RC. Surrogate arterial phase imaging using a long duration (≈1.5 min) radial acquisition T1-weighted sequence: an alternative in patients unable to breath-hold. Acta Radiol 2016; 57:955-63. [PMID: 26567963 DOI: 10.1177/0284185115616294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/17/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pediatric and adult patients unable to suspend respiration generally undergo magnetic resonance (MR) examinations that lack arterial phase imaging, which is a phase that provides substantial information on disease processes. An MR strategy that provides this type of information may be of considerable value. PURPOSE To describe and assess the feasibility and enhancement quality of early-phase imaging utilizing long-duration radial 3D-GRE imaging by initiating the sequence prior to starting contrast injection. MATERIAL AND METHODS Thirty-three consecutive patients (10 men, 23 women; 50.7 ± 25.5 years) underwent free-breathing gadolinium-enhanced radial 3D-GRE, with sequence initiation 30 s prior to contrast injection. Late hepatic arterial (LHA) phase was chosen for comparison. Images were evaluated for enhancement and overall image quality. Organ enhancement was calculated. Sub-group analysis was performed. RESULTS Twenty-two examinations of radial 3D-GRE sequences were acquired during the LHA phase. Organ enhancement scores were of satisfactory to good quality (range, 3.32-3.82). There was a significant trend of superior overall enhancement quality scores in pediatrics and examinations performed at 3 T (P = 0.0225 and 0.0001, respectively). CONCLUSION Arterial phase abdominal MR imaging is feasible using conventional radial 3D-GRE by adopting this simplistic proposed approach, which may allow arterial-phase imaging in patients unable to breath-hold.
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Affiliation(s)
- Mamdoh AlObaidy
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Miguel Ramalho
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kiran KR Busireddy
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian M Dale
- Siemens Medical Solutions, Inc., Morrisville, NC, USA
| | - Lauren M Burke
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Baodong Liu
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Jin YJ, Lee SH, Cho SG, Kim JH, Lee JW, Lee KY, Shin WY. Prediction of postoperative liver failure using gadoxetic acid-enhanced magnetic resonance imaging in patients with hepatocellular carcinoma. J Gastroenterol Hepatol 2016; 31:1349-56. [PMID: 26916616 DOI: 10.1111/jgh.13327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND We intended to determine the usefulness of gadoxetic acid-enhanced magnetic resonance (MR) imaging on preoperative prediction of the risk of postoperative liver failure (PLF) using measurement of relative liver enhancement (RLE) in patients who underwent surgical resection of hepatocellular carcinoma (HCC). METHODS A total of 121 HCC patients who had underwent gadoxetic acid-enhanced MRI before surgery between January 2012 and April 2015 at our hospital was retrospectively analyzed. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma in each liver segment before and 20 min after intravenous administration of gadoxetic acid. PLF was defined based on the "50-50 criteria" (prothrombin time <50% and serum bilirubin >5 mg/dL on 5 days after surgery). RESULTS Of the 121 patients, 74 (61.2%) patients had liver cirrhosis, clinically. Median tumor size 2.8 cm (range, 1-14 cm), 106 (87.6%) patients had a single HCC, and 101 (83.5%) patients had HCC within Milan criteria. Based on the "50-50 criteria", PLF was observed in 7 (5.8%) patients. Mean RLE was significantly lower in patients with PLF than those without it (55.9% vs 85.5%, P < 0.01). In a multivariate analysis, decreased RLE was a significant independent risk factor for PLF in HCC patients (odds ratio 0.97, P = 0.03). Optimal cut-off RLE value was 82.36. CONCLUSIONS RLE was significantly lower in patients with PLF than those without it. Measurement of RLE using gadoxetic acid-enhanced MR imaging before surgery can be useful for prediction of PLF in HCC patients who receive surgical treatment.
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Affiliation(s)
- Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Seung Ho Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Jun Ho Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Kun Young Lee
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Woo Young Shin
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
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11
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Huh J, Kim SY, Yeh BM, Lee SS, Kim KW, Wu EH, Wang ZJ, Zhao LQ, Chang WC. Troubleshooting Arterial-Phase MR Images of Gadoxetate Disodium-Enhanced Liver. Korean J Radiol 2015; 16:1207-15. [PMID: 26576109 PMCID: PMC4644741 DOI: 10.3348/kjr.2015.16.6.1207] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/28/2015] [Indexed: 12/22/2022] Open
Abstract
Gadoxetate disodium is a widely used magnetic resonance (MR) contrast agent for liver MR imaging, and it provides both dynamic and hepatobiliary phase images. However, acquiring optimal arterial phase images at liver MR using gadoxetate disodium is more challenging than using conventional extracellular MR contrast agent because of the small volume administered, the gadolinium content of the agent, and the common occurrence of transient severe motion. In this article, we identify the challenges in obtaining high-quality arterial-phase images of gadoxetate disodium-enhanced liver MR imaging and present strategies for optimizing arterial-phase imaging based on the thorough review of recent research in this field.
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Affiliation(s)
- Jimi Huh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143-0628, USA
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - En-Haw Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Taoyuan County 333, Taiwan
| | - Z Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143-0628, USA
| | - Li-qin Zhao
- Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Chou Chang
- Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
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12
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Girometti R. 3.0 Tesla magnetic resonance imaging: A new standard in liver imaging? World J Hepatol 2015; 7:1894-1898. [PMID: 26244063 PMCID: PMC4517148 DOI: 10.4254/wjh.v7.i15.1894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/17/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
An ever-increasing number of 3.0 Tesla (T) magnets are installed worldwide. Moving from the standard of 1.5 T to higher field strength implies a number of potential advantage and drawbacks, requiring careful optimization of imaging protocols or implementation of novel hardware components. Clinical practice and literature review suggest that state-of-the-art 3.0 T is equivalent to 1.5 T in the assessment of focal liver lesions and diffuse liver disease. Therefore, further technical improvements are needed in order to fully exploit the potential of higher field strength.
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13
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Neri E, Bali MA, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves FC, Grazioli L, Helmberger T, Lee JM, Manfredi R, Martì-Bonmatì L, Matos C, Merkle EM, Op De Beeck B, Schima W, Skehan S, Vilgrain V, Zech C, Bartolozzi C. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 2015; 26:921-31. [PMID: 26194455 PMCID: PMC4778143 DOI: 10.1007/s00330-015-3900-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/07/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
Abstract
Objectives To develop a consensus and provide updated recommendations on liver MR imaging and the clinical use of liver-specific contrast agents. Methods The European Society of Gastrointestinal and Abdominal Radiology (ESGAR) formed a multinational European panel of experts, selected on the basis of a literature review and their leadership in the field of liver MR imaging. A modified Delphi process was adopted to draft a list of statements. Descriptive and Cronbach’s statistics were used to rate levels of agreement and internal reliability of the consensus. Results Three Delphi rounds were conducted and 76 statements composed on MR technique (n = 17), clinical application of liver-specific contrast agents in benign, focal liver lesions (n = 7), malignant liver lesions in non-cirrhotic (n = 9) and in cirrhotic patients (n = 18), diffuse and vascular liver diseases (n = 12), and bile ducts (n = 13). The overall mean score of agreement was 4.84 (SD ±0.17). Full consensus was reached in 22 % of all statements in all working groups, with no full consensus reached on diffuse and vascular diseases. Conclusions The consensus provided updated recommendations on the methodology, and clinical indications, of MRI with liver specific contrast agents in the study of liver diseases. Key points • Liver-specific contrast agents are recommended in MRI of the liver. • The hepatobiliary phase improves the detection and characterization of hepatocellular lesions. • Liver-specific contrast agents can improve the detection of HCC.
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Affiliation(s)
- E Neri
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy.
| | - M A Bali
- Department of Radiology, Hôpital Erasme, MRI Clinics, Bruxelles, Belgium
| | - A Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, The General Hospital of the Medical University of Vienna, Vienna, Austria
| | - P Boraschi
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - G Brancatelli
- Department of Radiology, University of Palermo, Palermo, Italy
| | - F Caseiro Alves
- Medical Imaging Department and Faculty of Medicine, University Hospital of Coimbra, Coimbra, Portugal
| | - L Grazioli
- Department of Radiology, Spedali Civili di Brescia, Brescia, Italy
| | - T Helmberger
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Klinikum Bogenhausen, Academic Teaching Hospital of the Technical University, Munich, Germany
| | - J M Lee
- Division of Abdominal Imaging, Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - R Manfredi
- Department of Radiology, University of Verona, Verona, Italy
| | - L Martì-Bonmatì
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - C Matos
- Department of Radiology, Hôpital Erasme, MRI Clinics, Bruxelles, Belgium
| | - E M Merkle
- Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Switzerland
| | - B Op De Beeck
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - W Schima
- Department of Diagnostic and Interventional Radiology, KH Goettlicher Heiland, Krankenhaus der Barmherzigen Schwestern and Sankt Josef-Krankenhaus, Vienna, Austria
| | - S Skehan
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - V Vilgrain
- Radiology Department, Assistance Publique-Hôpitaux de Paris, APHP, Hôpital Beaujon, Clichy, Paris, France
| | - C Zech
- Abteilungsleiter Interventionelle Radiologie, Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Basel, Switzerland
| | - C Bartolozzi
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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14
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Roux M, Pigneur F, Calderaro J, Baranes L, Chiaradia M, Tselikas L, Decaens T, Costentin C, Laurent A, Azoulay D, Mallat A, Zafrani ES, Rahmouni A, Luciani A. Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI. J Magn Reson Imaging 2015; 42:1249-58. [PMID: 25851028 DOI: 10.1002/jmri.24897] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/11/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). MATERIALS AND METHODS Thirty-eight patients bearing 67 lesions (40 FNH; 27 HCA) were retrospectively included in this Institutional Review Board-approved study. The same volumetric interpolated breath-hold examination (VIBE) T1 -weighted sequences were performed before and after contrast injection on a 1.5T MRI, with HBP images acquired with a mean delay of 80 minutes (range 60-120 min). After a visual assessment of lesions enhancement (qualitative HBP analysis), the HBP signal intensity ratio (SIR) and the lesion-to-liver contrast enhancement ratio (LLCER) were calculated for each lesion by two observers (Mann-Whitney test). The sensitivities, specificities (receiver operating characteristic [ROC] curve analysis) and interobserver correlation (intraclass coefficient, ICC) of quantitative HBP analysis were determined. RESULTS All FNH and 44.4% of HCA appeared hyper- or isointense relative to the adjacent liver on qualitative HBP analysis. The mean SIR (P < 0.01) and LLCER (P < 0.0001) of FNH were significantly higher than that of HCA. The area under the ROC curve for the differentiation of FNH from HCA with LLCER was 0.98 for both observers. With a cutoff value of -0.3%-observer 1 with highest experience- LLCER assessment provided respective sensitivity and specificity values of 100% and 96.2% for the differentiation of FNH from HCA. The ICC was 0.7 for SIR measurements and 0.8 for LLCER measurements. CONCLUSION Quantitative LLCER assessment allows an accurate differentiation of FNH from HCA, even in hyper- or isointense HCA on HBP images.
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Affiliation(s)
- Marion Roux
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Frederic Pigneur
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Julien Calderaro
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Laurence Baranes
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Mélanie Chiaradia
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Lambros Tselikas
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Thomas Decaens
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Charlotte Costentin
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Alexis Laurent
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Daniel Azoulay
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Ariane Mallat
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Elie-Serge Zafrani
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Alain Rahmouni
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Alain Luciani
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France.,INSERM Unite U 955, Equipe 17, Molecular Mechanisms of Liver Fibrosis, Creteil, France
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15
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Geisel D, Lüdemann L, Fröling V, Malinowski M, Stockmann M, Baron A, Gebauer B, Seehofer D, Prasad V, Denecke T. Imaging-based evaluation of liver function: comparison of ⁹⁹mTc-mebrofenin hepatobiliary scintigraphy and Gd-EOB-DTPA-enhanced MRI. Eur Radiol 2014; 25:1384-91. [PMID: 25447973 DOI: 10.1007/s00330-014-3536-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare Gd-EOB-enhanced MRI and (99m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) as imaging-based liver function tests for separate evaluation of right (RLL) and left liver lobe (LLL) function. METHODS Fourteen patients underwent Gd-EOB-enhanced MRI and (99m)Tc-mebrofenin HBS after portal vein embolization within 24 h. Relative enhancement (RE) and hepatic uptake index (HUI) were determined from MRI; and T max, T 1/2 and mebrofenin uptake were determined from HBS, all values separately for RLL and LLL. RESULTS Mebrofenin uptake correlated significantly with HUI and RE for both liver lobes. There was strong correlation of mebrofenin uptake with HUI for RLL (r (2) = 0.802, p = 0.001) and RE for LLL (r (2) = 0.704, p = 0.005) and moderate correlation with HUI for LLL (r (2) = 0.560, p = 0.037) and RE for RLL (r (2) = 0.620, p = 0.018). Correlating the percentage share of RLL function derived from MRI (with HUI) with the percentage of RLL function derived from mebrofenin uptake revealed a strong correlation (r (2) = 0.775, p = 0.002). CONCLUSIONS Both RE and HUI correlate with mebrofenin uptake in HBS. The results suggest that Gd-EOB-enhanced MRI and (99m)Tc-mebrofenin HBS may equally be used to separately determine right and left liver lobe function. KEY POINTS • Information about liver function can be acquired with routine Gd-EOB-MRI. • Gd-EOB-MRI and (99m) Tc-mebrofenin HBS show elevated function of non-embolized lobe. • Gd-EOB-MRI and (99m) Tc-mebrofenin HBS can determine lobar liver function.
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Affiliation(s)
- Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
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Inter- and intra-individual comparative study of two gadolinium-based agents: A pilot study. ACTA ACUST UNITED AC 2014; 40:865-74. [DOI: 10.1007/s00261-014-0248-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A. Liver Failure after Major Liver Resection: Risk Assessment by Using Preoperative Gadoxetic Acid–enhanced 3-T MR Imaging. Radiology 2013. [DOI: 10.1148/radiology.13130210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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18
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Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A. Liver failure after major liver resection: risk assessment by using preoperative Gadoxetic acid-enhanced 3-T MR imaging. Radiology 2013; 269:777-86. [PMID: 23942606 DOI: 10.1148/radiol.13130210] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine if gadoxetic acid-enhanced magnetic resonance (MR) imaging with measurement of relative liver enhancement (RLE) on hepatobiliary phase images can allow preoperative assessment of the risk of liver failure after major liver resection. MATERIALS AND METHODS The local institutional review committee approved this retrospective analysis and waived written informed consent. The study included 73 patients (39 men; median age, 64.4 years) who underwent gadoxetic acid-enhanced 3-T MR imaging before resection of three or more liver segments. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid. RLE was assessed in each liver segment and the mean value of all segments was used for analysis. Posthepatectomy liver failure was defined according to the "50-50 criteria" (ie, prothrombin time <50% and serum bilirubin >50 µmol/L on postoperative day 5) and the International Study Group of Liver Surgery (ISGLS) classification. The association of RLE and liver failure was tested with univariate and multivariate logistic regression analysis. In addition to RLE, the latter also included demographic, clinical, operative, and histologic variables. RESULTS Patients with liver failure according to the 50-50 criteria (n = 3) had significantly lower RLE (54.5%) than those without (125.6%) (P = .009). According to ISGLS criteria, RLE was 112.5% in patients with grade A liver failure (n = 20), 88.4% in patients with grade B (n = 7), 41.7% (n = 2) in patients with grade C, and 136.5% (P < .001) in those without liver failure. In a logistic regression analysis, RLE was inversely related to the probability of liver failure according to the 50-50 (P = .02) and ISGLS (P < .001) criteria. In a multivariate analysis, RLE was independently associated with a higher probability of liver failure according to ISGLS classification (P = .003). CONCLUSION Gadoxetic acid-enhanced MR imaging can help with the assessment of the risk for liver failure after major liver resection.
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Affiliation(s)
- Andreas Wibmer
- From the Departments of Radiology (A.W., R.N., A.B.S.) and Surgery (A.M.P., T.G., M.S.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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19
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Geisel D, Lüdemann L, Keuchel T, Malinowski M, Seehofer D, Stockmann M, Hamm B, Gebauer B, Denecke T. Increase in left liver lobe function after preoperative right portal vein embolisation assessed with gadolinium-EOB-DTPA MRI. Eur Radiol 2013; 23:2555-60. [PMID: 23652847 DOI: 10.1007/s00330-013-2859-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To prospectively evaluate the early development of regional liver function after right portal vein embolisation (PVE) with Gd-EOB-DTPA-enhanced MRI in patients scheduled for extended right hemihepatectomy. METHODS Ten patients who received a PVE before an extended hemihepatectomy were examined before and 14 days after PVE using Gd-EOB-DTPA-enhanced MRI of the liver. In these sequences representative region of interest measurements were performed in the embolised right (RLL) and the non-embolised left liver lobe (LLL). The volume as well as hepatic uptake index (HUI) was calculated independently for each lobe. RESULTS Relative enhancement 14 days after PVE decreased in the RLL and increased significantly in the LLL (P < 0.05). Average hepatic uptake index (HUI) for RLL was significantly lower 14 days after PVE than before PVE (P < 0.05) and significantly higher for LLL (P < 0.05). CONCLUSIONS A significant shift of contrast uptake from the right to the left liver lobe can be depicted as early as 14 days after right PVE by using Gd-EOB-DTPA-enhanced MRI, which could reflect the redirected portal venous blood flow and the rapid utilisation of a hepatic functional reserve. KEY POINTS • Preoperative portal vein embolisation (PVE) is widely performed before right-sided hepatic resection. • PVE increases intravenous contrast medium uptake in the left lobe of liver. • The hepatic uptake index for the left liver lobe increases rapidly after PVE. • Left liver lobe function increase may be visualised by Gd-EOB-DTPA-enhanced MRI.
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Affiliation(s)
- Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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20
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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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