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Zhuo LY, Xing LH, Ma X, Zhang Y, Ma ZP, Yin XP, Wang JN. Differentiating Between an Atypical Hepatic Abscess and Tumor Metastasis Using Magnetic Resonance Imaging and Hepatobiliary Phase Imaging. Infect Drug Resist 2021; 14:3263-3274. [PMID: 34429624 PMCID: PMC8380289 DOI: 10.2147/idr.s318291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To identify diffusion-weighted imaging (DWI) patterns and conspicuity discrepancies on hepatobiliary phase imaging (HBPI) to distinguish atypical hepatic abscesses from hepatic metastases. Materials and Methods This retrospective study recruited 31 patients with 43 atypical hepatic abscesses and 32 patients with 35 hepatic metastases who underwent gadobenate dimeglumine-enhanced magnetic resonance imaging. All lesions were confirmed by pathological or clinical diagnosis. For the qualitative and quantitative analyses, the signal intensity, DWI pattern, apparent diffusion coefficient, degree of perilesional edema, perilesional hyperemia, perilesional signal on HBPI, conspicuity, size discrepancy between sequences, contrast-to-noise ratio, signal-to-noise ratio, and relative enhancement ratio on dynamic phases were independently assessed by two radiologists. Significant findings for differentiating the two groups were identified via univariate and multivariate analyses with a nomogram for predicting atypical hepatic abscesses. The interobserver agreement was also analyzed for each variable. Results The multivariate analysis revealed that the conspicuity discrepancy (odds ratio [OR] 34.78, 95% confidence interval [CI] 2.09–579.47, p = 0.013) and non-peripheral high signal intensity (SI) rim on DWI (OR 67.46, 95% CI 2.64, 1723.20, p = 0.011) were significant independent factors for predicting atypical hepatic abscesses. They were also shown to be high predictor points on the nomogram. When any of the set criteria were satisfied, 97.7% of atypical hepatic abscesses were correctly identified, with a specificity of 65.7%. When both criteria were combined, the specificity was up to 100%, with a sensitivity of 44.9%. Conclusion Conspicuity discrepancy and a non-peripheral high SI rim on DWI are reliable and meaningful features that can distinguish atypical hepatic abscesses from hepatic metastases.
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Affiliation(s)
- Li-Yong Zhuo
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Li-Hong Xing
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xi Ma
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Yu Zhang
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Ze-Peng Ma
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xiao-Ping Yin
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Jia-Ning Wang
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
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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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Mamone G, Marrone G, Caruso S, Carollo V, Gentile G, Crino' F, Milazzo M, Luca A. Intrahepatic mass-forming cholangiocarcinoma: enhancement pattern on Gd-BOPTA-MRI with emphasis of hepatobiliary phase. ACTA ACUST UNITED AC 2016; 40:2313-22. [PMID: 25962708 DOI: 10.1007/s00261-015-0445-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To describe the Gd-BOPTA MRI findings of intrahepatic mass-forming type cholangiocarcinomas (IMCs), with emphasis on the hepatobiliary phase (HBP). METHODS We reviewed retrospectively 29 IMC patients who underwent Gd-BOPTA-MRI between June, 2004 and June, 2014. Images were acquired prior to, and after, administration of 15-20 mL of Gd-BOPTA in the dynamic phase (arterial phase, portal venous phase, and 3-5 min phase), 10-15-min late phase, and 2-3 h HBP phase. RESULTS In the dynamic phase, 27 (93%) lesions showed a peripheral rim-like enhancement in the arterial and portal venous phases, followed by progressive filling-in on the delayed images. In 14 (56%) cases, a hypointense peripheral rim was identified in the 10-15-min late phase, delineating a target pattern. In the HBP, the cholangiocarcinoma showed a diffuse, mainly central and inhomogeneous enhancement (cloud of enhancement) in 28 (96%) patients; in 23 (79%) cases, there was an association between cloud appearance and a hypointense peripheral rim, showing a target pattern. CONCLUSIONS Gd-BOPTA MRI pattern of IMC on dynamic study is similar to that of conventional extracellular agents, that is peripheral enhancement with progressive and concentric filling of contrast material on delayed phases. At 10-15 min delayed phases, IMC shows often a peripheral hypointense rim consistent with a target appearance. In the HBP, due to progressive central enhancement (cloud) and peripheral hypointense rim, an higher number of tumors show a target appearance; this pattern is not specific and would also be expected to be seen in metastases from adenocarcinoma.
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Affiliation(s)
- Giuseppe Mamone
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy.
| | - Gianluca Marrone
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Settimo Caruso
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Vincenzo Carollo
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Giovanni Gentile
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Francesca Crino'
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Mariapina Milazzo
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
| | - Angelo Luca
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) - University of Pittsburgh Medical Center (UPMC), Via Ernesto Tricomi 5, 90127, Palermo, Italy
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Added value of diffusion-weighted MRI for evaluating viable tumor of hepatocellular carcinomas treated with radiotherapy in patients with chronic liver disease. AJR Am J Roentgenol 2014; 202:92-101. [PMID: 24370133 DOI: 10.2214/ajr.12.10212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the added value of diffusion-weighted imaging (DWI) to the diagnostic performance of conventional MRI in diagnosing viable hepatocellular carcinoma (HCC) tumors treated with radiotherapy in patients with chronic liver disease. MATERIALS AND METHODS Twenty-nine patients with viable tumor and 35 patients without viable tumor were enrolled. We assessed the signal intensity of viable tumor compared with irradiated liver on MRI and DWI. Signal intensity ratios and apparent diffusion coefficient (ADC) ratios of viable tumor to nonirradiated liver were also assessed on DWI with ADC maps. Two observers reviewed conventional MRI and combined MRI and DWI and rated them using a 5-point scale. Diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve. RESULTS Viable tumors showed hyperintensity on T2-weighted and arterial phase images (16/29 [55.2%]) and hypointensity on portal (22/29 [75.9%]), 3-minute late (19/29 [65.5%]), and hepatobiliary phase (23/29 [79.3%]) images. Twenty-seven (93.1%) viable tumors showed hyperintensity on DWI and hypointensity on ADC maps. Mean signal intensity ratios and ADC ratios of viable tumor on DWI with ADC maps were significantly higher and lower than those of irradiated liver. Diagnostic performance (area under the ROC curve) improved significantly after adding DWI, and interobserver agreement was moderate for conventional MRI (κ = 0.450) and good after adding DWI (κ = 0.748). CONCLUSION Adding DWI to conventional MRI can improve the detection of viable HCC tumors treated with radiotherapy compared to conventional MRI alone.
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Phongkitkarun S, Limsamutpetch K, Tannaphai P, Jatchavala J. Added value of hepatobiliary phase gadoxetic acid-enhanced MRI for diagnosing hepatocellular carcinoma in high-risk patients. World J Gastroenterol 2013; 19:8357-8365. [PMID: 24363528 PMCID: PMC3857460 DOI: 10.3748/wjg.v19.i45.8357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/06/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the added value of hepatobiliary phase (HBP) gadoxetic acid-enhanced magnetic resonance imaging (MRI) in evaluating hepatic nodules in high-risk patients.
METHODS: The institutional review board approved this retrospective study and waived the requirement for informed consent. This study included 100 patients at high risk for hepatocellular carcinoma (HCC) and 105 hepatic nodules that were larger than 1 cm. A blind review of two MR image sets was performed in a random order: set 1, unenhanced (T1- and T2-weighted) and dynamic images; and set 2, unenhanced, dynamic 20-min and HBP images. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared for the two image sets. Univariate and multivariate analyses were performed on the MR characteristics utilized to diagnose HCC.
RESULTS: A total of 105 hepatic nodules were identified in 100 patients. Fifty-nine nodules were confirmed to be HCC. The diameter of the 59 HCCs ranged from 1 to 12 cm (mean: 1.9 cm). The remaining 46 nodules were benign (28 were of hepatocyte origin, nine were hepatic cysts, seven were hemangiomas, one was chronic inflammation, and one was focal fat infiltration). The diagnostic accuracy significantly increased with the addition of HBP images, from 88.7% in set 1 to 95.5% in set 2 (P = 0.002). In set 1 vs set 2, the sensitivity and NPV increased from 79.7% to 93.2% and from 78.9% to 91.8%, respectively, whereas the specificity and PPV were not significantly different. The hypointensity on the HBP images was the most sensitive (93.2%), and typical arterial enhancement followed by washout was the most specific (97.8%). The multivariate analysis revealed that typical arterial enhancement followed by washout, hyperintensity on T2-weighted images, and hypointensity on HBP images were statistically significant MRI findings that could diagnose HCC (P < 0.05).
CONCLUSION: The addition of HBP gadoxetic acid-enhanced MRI statistically improved the diagnostic accuracy in HCCs larger than 1 cm. Typical arterial enhancement followed by washout and hypointensity on HBP images are useful for diagnosing HCC.
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Park HJ, Kim SH, Jang KM, Lee SJ, Park MJ, Choi D. Differentiating hepatic abscess from malignant mimickers: value of diffusion-weighted imaging with an emphasis on the periphery of the lesion. J Magn Reson Imaging 2013; 38:1333-41. [PMID: 23559325 DOI: 10.1002/jmri.24112] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/12/2013] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate the efficacy of diffusion-weighted imaging (DWI) in differentiating hepatic abscess from malignant mimickers with an emphasis on periphery of the lesions. MATERIALS AND METHODS Thirty-nine patients with hepatic abscess and 74 patients with malignant hepatic tumors were included, who underwent gadoxetic acid-enhanced MRI. For qualitative and quantitative analysis, signal intensities and apparent diffusion coefficient (ADC) values of the periphery were assessed. Two observers reviewed DWI and ADC maps rated using a 5-point scale. Diagnostic performance was evaluated using the receiver operating characteristics (ROC) curve analysis. RESULTS The periphery of hepatic abscesses was T1-hypointense, arterial hyperintense, and hypointense on hepatobiliary phase less frequently than that of malignant tumors (P < 0.05). No hepatic abscesses showed peripheral washout on 3-min late phase compared with malignant tumors (59.5%) (P < 0.001). Both groups showed hyperintense rims on DWI, but, 37(94.9%) abscesses revealed rims with high ADC values compared with one (1.4%) malignant tumor (P < 0.001). Mean ADC values of abscesses (1.47 × 10(-3) mm(2) /s ± 0.36 [standard deviation]) were significantly higher than those of malignancies (0.68 × 10(-3) mm(2) /s ± 0.20). Diagnostic performance (area under the ROC curve [Az]) of DWI in identifying hepatic abscess was 0.986 and 0.982 for each observer. CONCLUSION In addition to conventional MRI, DWI is helpful in differentiating hepatic abscess from malignant mimickers.
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Affiliation(s)
- Hyun Jeong Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
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Hyperintense lesions on gadoxetate disodium-enhanced hepatobiliary phase imaging. AJR Am J Roentgenol 2013; 199:W575-86. [PMID: 23096201 DOI: 10.2214/ajr.11.8205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to illustrate various focal hepatic lesions that may show hyperintensity on hepatobiliary phase images on gadoxetate disodium-enhanced MRI. CONCLUSION Hyperintense lesions on gadoxetate disodium-enhanced MRI include focal nodular hyperplasia (FNH) or FNH-like nodules, hepatocellular adenoma, dysplastic nodules, and hepatocellular carcinoma. Understanding the contrast enhancement patterns on hepatobiliary phase images and other imaging findings is important to ensure correct diagnosis.
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Péporté ARJ, Sommer WH, Nikolaou K, Reiser MF, Zech CJ. Imaging features of intrahepatic cholangiocarcinoma in Gd-EOB-DTPA-enhanced MRI. Eur J Radiol 2012; 82:e101-6. [PMID: 23159401 DOI: 10.1016/j.ejrad.2012.10.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study is to describe the imaging features of intrahepatic cholangiocarcinoma in Gd-EOB-DTPA-enhanced MRI and to determine whether it results in improved tumour conspicuity of cholangiocarcinoma. MATERIALS AND METHODS Fifty-four patients with histologically proven intrahepatic cholangiocarcinoma underwent MRI of the liver using a 1.5T MR-scanner with Gadoxetic acid disodium (Gd-EOB-DTPA; Eovist/Primovist, Bayer Healthcare, Berlin, Germany). The standard imaging protocol included a T2w multi-shot TSE sequence with fat saturation (fs), a T2w single shot sequence without fs and a T1w 3D GRE sequences with fs (unenhanced and arterial, portovenous, late venous and hepatobiliary phase). Two board certified radiologists experienced in liver MRI (5 and 10 years experience) evaluated retrospectively all MRI scans qualitatively and quantitatively. Signal was measured with region-of-interests (ROI) and signal-to-noise (SNR) as well as contrast-to-noise (CNR) was calculated. Statistical significance was tested with an ANOVA and a pairwise Wilcoxon rank test. RESULTS All intrahepatic cholangiocarcinomas presented as hypointense lesions in the late venous and hepatobiliary phase. Images in the hepatobiliary phase showed the highest lesion conspicuity, i.e. n=9 blurred (16.6%), n=31 moderate (57.4%) and n=14 sharp (26%). This was significantly higher than the lesion conspicuity of all other sequences or phases. Furthermore, the CNR was the highest in this sequence with 76.8±51.3, with significantly higher values than the CNR of the unenhanced T1w sequence (CNR: 35.6±21.0; p<0.0001) and the arterial phase images (CNR: 53.6±36.8; p<0.001). The hepatobiliary phase images showed a SNR of 97.3±59.7 (p<0.001) and thus was significantly different from the unenhanced T1w sequence (SNR: 60.4±35.3; p<0.001), whereas the increase in SNR from the late venous to hepatobiliary phase was neglectable, indicating that no liver-specific contrast uptake is present in cholangiocarcinoma. CONCLUSION Intrahepatic cholangiocarcinoma presents as a hypointense lesion in Gd-EOB-DTPA-enhanced MRI in late venous phase images. The lesion conspicuity as well as CNR was highest in the hepatobiliary phase. Consequently, hepatobiliary phase images in Gd-EOB-DTPA-enhanced MRI images might be helpful for therapy planning due to the exact depiction of the tumour borders.
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Affiliation(s)
- Anne R J Péporté
- Department of Clinical Radiology, University Hospital Munich-Grosshadern, Ludwig-Maximilians University, Munich, Germany
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Jaw TS, Chen SH, Wang YM, Hsu JS, Kuo YT, Chiu YY, Tsai KB, Hsieh TJ, Liu GC. Comparison of Gd-Bz-TTDA, Gd-EOB-DTPA, and Gd-BOPTA for dynamic MR imaging of the liver in rat models. Kaohsiung J Med Sci 2012; 28:130-7. [PMID: 22385605 DOI: 10.1016/j.kjms.2011.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/10/2011] [Indexed: 10/14/2022] Open
Abstract
To evaluate the competitive potential of a new lipophilic paramagnetic complex, Gd-Bz-TTDA [4-benzyl-3,6,10-tri (carboxymethyl)-3,6,10-triazado-decanedioic acid] compared with two other commercially available MR hepatobiliary contrast agents, gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA), dynamic MR imaging studies were performed on normal and hepatocellular carcinoma (HCC) rat models using a 1.5-Tesla MR scanner. The results indicate that normal rats that were injected with 0.1 mmol/kg Gd-Bz-TTDA showed significantly more intense and persistent liver enhancement than those that were injected with the same dose of Gd-EOB-DTPA or Gd-BOPTA. All of these agents showed similar enhancement patterns in the implanted HCC. The liver-lesion contrast-to-noise ratios were higher and more persistent in rats that were injected with Gd-Bz-TTDA. These results indicate that Gd-Bz-TTDA is comparable with the commercially available hepatobiliary agents, Gd-EOB-DTPA and Gd-BOPTA, and can result in more intense and prolonged liver enhancement while still providing better liver-lesion discrimination. These results warrant further large-scale studies.
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Affiliation(s)
- Twei-Shiun Jaw
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Lee MH, Kim SH, Kim H, Lee MW, Lee WJ. Differentiating focal eosinophilic infiltration from metastasis in the liver with gadoxetic acid-enhanced magnetic resonance imaging. Korean J Radiol 2011; 12:439-49. [PMID: 21852904 PMCID: PMC3150671 DOI: 10.3348/kjr.2011.12.4.439] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 03/11/2011] [Indexed: 12/23/2022] Open
Abstract
Objective To determine the most useful findings of gadoxetic acid-enhanced 3.0 Tesla (T) MRI for differentiating focal eosinophilic infiltration (FEI) from hepatic metastasis with verification of their usefulness. Materials and Methods Pathologically or clinically proven 39 FEIs from 25 patients and 79 hepatic metastases from 51 patients were included in the study. Gadoxetic acid-enhanced 3.0T MRI was performed in all cancer patients. Size differences measured between T2-weighted and hepatobiliary-phase images for lesions > 1 cm and morphologic findings (margin, shape, signal intensity on T1- and T2-weighted images, enhancement pattern on dynamic images, and target appearance on hepatobiliary-phase images) were compared between two groups via Student's t test as well as univariate and multivariate analyses. Diagnostic predictive values of two observers for differentiating two groups were assessed before (session 1) and after (session 2) recognition of results. Results Mean size difference (2.1 mm) in FEIs between the two images was significantly greater than for metastases (0.7 mm) (p < 0.05). An ill-defined margin and isointensity on T1-weighted images were independently significant morphologic findings (p < 0.05) for differentiating the two groups. All observers achieved a higher diagnostic accuracy in session 2 (97% and 98%) than session 1 (92% and 89%) with statistical significance in observer 2 (p < 0.05). All observers had significantly higher sensitivities (95%) and negative predictive values (NPVs) (98%) in session 2 than in session 1 (sensitivity, 74% in two observers; NPV, 89% and 88%) (p < 0.05). Conclusion With the size change, an ill-defined margin and isointensity on T1-weighted images are the most useful findings for differentiating FEI from hepatic metastasis on gadoxetic acid-enhanced 3.0T MRI.
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Affiliation(s)
- Mi Hee Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Seoul, Korea
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Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol 2011; 46:225-39. [PMID: 21102346 DOI: 10.1097/rli.0b013e3181feee3a] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate hepatobiliary phase magnetic resonance imaging with gadobenate dimeglumine for differentiation of benign hypervascular liver lesions from malignant or high-risk lesions. METHODS AND MATERIALS Retrospective assessment was performed of 550 patients with 910 hypervascular lesions (302 focal nodular hyperplasia [FNH], 82 nodular regenerative hyperplasia [NRH], 59 hepatic adenoma or liver adenomatosis [HA/LA], 329 hepatocellular carcinomas [HCC], 12 fibrolamellar-HCC [FL-HCC], 21 peripheral cholangiocarcinomas [PCC], 105 metastases). Imaging was performed before and during the arterial, portal-venous, equilibrium, and hepatobiliary phases after gadobenate dimeglumine administration (0.05 mmol/kg). Histologic confirmation was available for ≥1 lesion per patient, except for patients with suspected FNH (diagnosis based on characteristic enhancement/follow-up). Lesion differentiation (benign/malignant) on the basis of contrast washout and lesion enhancement (hypo-/iso-/hyperintensity) was assessed (sensitivity, specificity, accuracy, PPV, and NPV) relative to histology or final diagnosis. RESULTS On portal-venous or equilibrium phase images, washout was not seen for 208 of 526 (39.5%) malignant (HCC, FL-HCC, PCC, metastases) and high-risk (HA/LA) lesions. Conversely, only 5 of 384 (1.3%) true benign lesions (FNH/NRH) showed washout. Taking washout as indicating malignancy, the sensitivity, specificity, and accuracy for malignant lesion identification during these phases was 61.8%, 98.7%, and 77.4%. On hepatobiliary phase images, 289 of 302 FNH, 82 of 82 NRH, 1 of 59 HA or LA, 62 of 341 HCC or FL-HCC, and 2 of 105 metastases were hyperintense or isointense. Taking iso- or hyperintensity as an indication for lesion benignity, the sensitivity, specificity, accuracy, PPV, and NPV for benign lesion identification was 96.6%, 87.6%, 91.4%, 85.1%, and 97.3%, respectively. CONCLUSIONS Hepatobiliary phase imaging with gadobenate dimeglumine is accurate for distinguishing benign lesions from malignant or high-risk lesions. Biopsy should be considered for hypointense lesions on hepatobiliary phase images after gadobenate dimeglumine.
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Lee MJ, Kim MJ, Yoon CS, Song SY, Park K, Kim WS. The T2-shortening effect of gadolinium and the optimal conditions for maximizing the CNR for evaluating the biliary system: a phantom study. Korean J Radiol 2011; 12:358-64. [PMID: 21603295 PMCID: PMC3088853 DOI: 10.3348/kjr.2011.12.3.358] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 02/08/2011] [Indexed: 11/15/2022] Open
Abstract
Objective Clear depiction of the common bile duct is important when evaluating neonatal cholestasis in order to differentiate biliary atresia from other diseases. During MR cholangiopancreatography, the T2-shortening effect of gadolinium can increase the contrast-to-noise ratio (CNR) of the bile duct and enhance its depiction. The purpose of this study was to confirm, by performing a phantom study, the T2-shortening effect of gadolinium, to evaluate the effect of different gadolinium chelates with different gadolinium concentrations and different magnetic field strengths for investigating the optimal combination of these conditions, and for identifying the maximum CNR for the evaluation of the biliary system. Materials and Methods MR imaging using a T2-weighted single-shot fast spin echo sequence and T2 relaxometry was performed with a sponge phantom in a syringe tube. Two kinds of contrast agents (Gd-DTPA and Gd-EOB-DTPA) with different gadolinium concentrations were evaluated with 1.5T and 3T scanners. The signal intensities, the CNRs and the T2 relaxation time were analyzed. Results The signal intensities significantly decreased as the gadolinium concentrations increased (p < 0.001) with both contrast agents. These signal intensities were higher on a 3T (p < 0.001) scanner. The CNRs were higher on a 1.5T (p < 0.001) scanner and they showed no significant change with different gadolinium concentrations. The T2 relaxation time also showed a negative correlation with the gadolinium concentrations (p < 0.001) and the CNRs showed decrease more with Gd-EOB-DTPA (versus Gd-DTPA; p < 0.001) on a 3T scanner (versus 1.5T; p < 0.001). Conclusion A T2-shortening effect of gadolinium exhibits a negative correlation with the gadolinium concentration for both the signal intensities and the T2 relaxation time. A higher CNR can be obtained with Gd-DTPA on a 1.5T MRI scanner.
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Affiliation(s)
- Mi-Jung Lee
- Department of Radiology and the Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, Seoul 120-752, Korea
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Park Y, Kim SH, Kim SH, Jeon YH, Lee J, Kim MJ, Choi D, Lee WJ, Kim H, Koo JH, Lim HK. Gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI versus gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for preoperatively detecting hepatocellular carcinoma: an initial experience. Korean J Radiol 2010; 11:433-40. [PMID: 20592927 PMCID: PMC2893314 DOI: 10.3348/kjr.2010.11.4.433] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 04/09/2010] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study was designed to compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine-enhanced MRI for preoperatively detecting hepatocellular carcinoma (HCC). MATERIALS AND METHODS Eighteen consecutive patients (17 men and one woman, age range: 31-73 years) with 22 HCCs underwent examinations with gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI on a 3.0-Tesla unit. The diagnosis of HCC was established after surgical resection and pathological conformation. Three observers independently reviewed each MR image in a random order on a tumor-by-tumor basis. The diagnostic accuracy of these techniques for the detection of HCC was assessed by performing an alternative free-response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive values were evaluated. RESULTS The average value of the area under the ROC curve (Az) for gadoxetic acid enhanced MRI (0.887) was not significantly different from the Az (0.899) for gadobenate dimeglumine-enhanced MRI (p > 0.05). The overall sensitivities of gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI were 80% and 83%, respectively, with no significant difference (p > 0.05). The differences of the positive predictive values for the two contrast agents for each observer were not statistically significant (p > 0.05). CONCLUSION The diagnostic performance of gadoxetic acid-enhanced MRI and gadobenate dimeglumine-enhanced MRI for preoperatively detecting HCC is quite similar.
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Affiliation(s)
- Yulri Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Ferucarbotran-Enhanced Magnetic Resonance Imaging Versus Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for the Preoperative Detection of Hepatocellular Carcinoma. J Comput Assist Tomogr 2010; 34:127-34. [DOI: 10.1097/rct.0b013e3181b1587a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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