Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography

Comparison of the Ability of Gadobenate Dimeglumine and Gadolinium Ethoxybenzyl Dimeglumine to Display the major Features for Noninvasively Diagnosing Hepatocellular Carcinoma According to the LI-RADS 2018v

OBJECTIVE

To compare the ability of gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA) and gadobenate dimeglumine (Gd-BOPTA) to display the 3 major features recommended by the Liver Imaging Reporting and Data System (LI-RADS 2018v) for diagnosing hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

In this retrospective study, we included 98 HCC lesions that were scanned with either Gd-EOB-DTPA-MR or Gd-BOPTA-M.For each lesion, we collected multiple variables, including size and enhancement pattern in the arterial phase (AP), portal venous phase (PVP), transitional phase (TP), delayed phase (DP), and hepatobiliary phase (HBP). The lesion-to-liver contrast (LLC) was measured and calculated for each phase and then compared between the 2 contrast agents. A P value < .05 was considered statistically significant. The display efficiency of the LLC between Gd-BOPTA and Gd-EOB-DTPA for HCC features was evaluated by receiver operating characteristic (ROC) curve analysis.

RESULTS

Between Gd-BOPTA and Gd-EOB-DTPA, significant differences were observed regarding the display efficiency for capsule enhancement and the LLC in the AP/PVP/DP (P < .05), but there was no significant difference regarding the LLC in the TP/HBP. Both Gd-BOPTA and Gd-EOB-DTPA had good display efficiency in each phase (AUCmin > 0.750). When conducting a total evaluation of the combined data across the 5 phases, the display efficiency was excellent (AUC > 0.950).

CONCLUSION

Gd-BOPTA and Gd-EOB-DTPA are liver-specific contrast agents widely used in clinical practice. They have their own characteristics in displaying the 3 main signs of HCC. For accurate noninvasive diagnosis, the choice of agent should be made according to the specific situation.

Evaluation of qualitative and quantitative imaging features of hepatic hemangiomas with and without pseudo-washout sign on gadoxetic acid-enhanced MRI: a descriptive and comparative study

BACKGROUND

Hepatic hemangiomas are the most common benign liver tumors. It is important to know the imaging features of hemangiomas on gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI).

PURPOSE

To evaluate the qualitative and quantitative imaging features of hemangiomas on GA-enhanced MRI, and to compare imaging features of hemangiomas with and without pseudo-washout sign (PWS).

MATERIAL AND METHODS

We retrospectively included 93 cases of hemangioma that underwent GA-enhanced MRI. The presence of an enhancement pattern in the arterial phase (AP) and PWSs in the transitional phase (TP) were evaluated. Signal-to-norm ratios (SINorm) of hemangiomas, liver parenchyma, and portal vein (PV) as well as contrast-to-norm ratio (CNorm) were assessed. Additionally, hemangiomas with and without PWSs were defined as two separate subgroups, and imaging features were compared.

RESULTS

Of the 93 cases of hemangiomas, 49 (52.6%) had PWSs in the TP. The mean SINorms of hemangiomas showed the highest value in the AP (P < 0.05). The mean CNorms showed positive values in the AP, and gradually decreased (P < 0.05). Hemangiomas with PWSs were significantly rapidly enhanced and smaller in size (P < 0.05), and the mean SINorms was lower in the TP (P = 0.023). While the mean CNorms showed a significant difference in the AP between subgroups (P < 0.001), the enhancement pattern was equal to that of the PV.

CONCLUSION

When evaluating GA-enhanced MRI, radiologists should utilize quantitative measures in addition to qualitative assessment and should be aware that SI matching with PV in all phases can be a distinguishing finding in the diagnosis of hemangioma.

Gd-EOB-DTPA Enhanced MRI Features of Liver Hemangiomatosis Coexistent with GCH

OBJECTIVES

This study aimed to clarify features of giant cavernous hemangioma (GCH) and liver hemangiomatosis, existing simultaneously on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).

METHOD

A total of 17 patients with reported hepatic hemangiomatosis between 2015 and 2017 were identified retrospectively. All our patients underwent pre-contrast MRI, triphasic (atrial, portal, venous) Gd-EOB-DTPA dynamic enhancement and hepatobiliary phase (20 minutes delayed). The location, size, morphology and signal characteristics on T1-weighted (T1WI) and T2-weighted images (T2WI), and Gd-EOB-DTPA-enhanced MRI of liver hemangiomatosis were evaluated.

RESULTS

Hemangiomatosis involved the liver adjacent to the edge of the GCH with no normal liver tissue found in 13 cases; in the other 4 patients, a small area of normal liver tissue separated GCH from hemangiomatosis was seen. On non-contrast MRI images, hemangionmatosis presented as numerous microcystic lesions, with low signal intensity on T1WI and high signal intensity on T2WI, compared with unaffected liver. After administration of Gd-EOB-DTPA, heterogeneous enhancement was presented in the arterial phase, during portal and venous phase imaging, becoming more homogeneous. 11 cases showed hypointensity in the hepatobiliary phase (6 cases with intratumor necrosis), and 6 cases showed hyper-intensity in the hepatobiliary phase with a remaining unfilled portion.

CONCLUSION

Hemangiomatosis is extremely rare in the liver adjacent to a GCH. MRI is of great diagnostic and clinical value for this kind of tumor according to the configuration, size, signal, and style of enhancement, but the final diagnosis depends on pathology. Gd-EOB-DTPA-enhanced MRI may help in diagnosing hemangiomatosis coexistent with GCH.

Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases

BACKGROUND

Although contrast-enhanced magnetic resonance imaging (MRI) using gadoxetic acid has been shown to have higher accuracy, sensitivity, and specificity for the detection and characterization of hepatic metastases compared with other modalities, the long examination time would limit the broad indication. Several abbreviated enhanced MRI (Ab-MRI) protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases. However, an optimal protocol has not been established, and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography (CE-CT), which is the preoperative imaging of colorectal cancer staging in clinical settings, to determine the best therapeutic strategy.

AIM

To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.

METHODS

Study participants comprised 87 patients (51 males, 36 females; mean age, 67.2 ± 10.8 years) who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021. Each exam was independently reviewed by two readers in three reading sessions: (1) Only single-shot fast spin echo (FSE) T2-weighted or fat-suppressed-FSE-T2-weighted, diffusion-weighted, and hepatobiliary-phase images (Ab-MRI protocol 1 or 2); (2) all acquired MRI sequences (standard protocol); and (3) a combination of an Ab-MRI protocol (1 or 2) and CE-CT. Diagnostic performance was then statistically analyzed.

RESULTS

A total of 380 Lesions were analyzed, including 195 metastases (51.4%). Results from the two Ab-MRI protocols were similar. The sensitivity, specificity, and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI (P > 0.05), while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone, although the difference was not significant (P > 0.05), and were quite similar to those from standard MRI (P > 0.05).

CONCLUSION

The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol. Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.

Comparison of gadoxetate disodium-enhanced MRI sequences for measuring hepatic observation size and its implication of LI-RADS classification

PURPOSE

We aimed to determine the optimal image sequence for measurement of hepatic observations on gadoxetate disodium-enhanced MRI in comparison with pathologic measurement, and to evaluate its clinical impact on the Liver Imaging Reporting and Data System (LI-RADS) v2018 classification.

METHODS

Two hundred and fifty-three patients (279 hepatic observations) who underwent gadoxetate disodium-enhanced MRI and subsequent hepatectomy were retrospectively included. Two radiologists independently evaluated the visualization score (five-point scale) and size of each observation on six MRI sequences (T1-weighted, T2-weighted, arterial-phase, portal venous-phase, transitional-phase [TP], and hepatobiliary-phase [HBP] images) and assigned a LI-RADS category. Correlations between MRI and pathologic measurements were evaluated using Pearson correlation coefficients. A repeated measures analysis of variance with Bonferroni post hoc comparison tests was used to compare the visualization scores and absolute differences between MRI sequences and pathologic measurements. The LI-RADS classification according the size measurement of each MRI sequence was compared using Cochran's Q test with a post hoc McNemar's test.

RESULTS

Of the MRI sequences, HBP had the highest visualization score (4.1 ± 0.6) and correlation coefficient (r = 0.965). The absolute difference between MRI and pathologic measurement was lowest on TP (2.3 mm ± 2.2), followed by HBP (2.4 mm ± 2.1). In the LI-RADS classifications, HBP did not have any non-visible observations. Regarding LR-3, LR-4, and LR-5, there was no significantly different LI-RADS classification among the six MRI sequences (p ≥ 0.122).

CONCLUSION

Hepatobiliary-phase images are clinically useful for measuring hepatic observations on gadoxetate disodium-enhanced MRI, especially regarding visibility and correlation with pathologic findings.

Differentiating Between an Atypical Hepatic Abscess and Tumor Metastasis Using Magnetic Resonance Imaging and Hepatobiliary Phase Imaging

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.

Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study

Background

There is currently a lack of consensus regarding the clinical features, diagnosis, treatment indications and options, and risk assessment of hepatic hemangioma patients.

Methods

This was a multicenter, real-world study that analyzed a large number of hepatic hemangioma cases in China and included patient data on epidemiology, diagnosis, treatment methods, and outcomes.

Results

A total of 5,143 patients hospitalized for hepatic hemangioma were included, of whom 34.42% were male and 65.58% were female. The age distribution was concentrated between 30 and 60 years old, accounting for 87.41% of the patients. Among the hepatic hemangioma patients, 60.8% had only one tumor, with the most common pathological type being cavernous hemangioma (96.07% of cases). The treatment motivations and indications included anxiety, obvious clinical symptoms, rapid tumor growth, unclear diagnoses and acute emergencies. Overall, 41.4% of the patients were treated for psychological reasons, while 30.59% were treated because they presented obvious (primarily nonspecific) clinical symptoms. Hepatic resection was the main therapeutic method and was based on various indications. There were a small number of patients with Kasabach-Merritt syndrome, according to its generally recognized definition.

Conclusions

Most patients in this study who were hospitalized for hepatic hemangioma did not meet the indications for requiring treatment. Surveillance is the recommended course of action for definitively diagnosed hepatic hemangioma, and a new classification system is needed to standardize the diagnosis of this condition.

Gadoxetic acid-enhanced MRI for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: can hypointensity on the late portal venous phase be used as an alternative to washout?

PURPOSE

To investigate the added value of considering hypointensity on late portal venous phase (LPVP) images as washout for diagnosis of hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in patients with chronic liver disease (CLD).

METHODS

This retrospective study comprised 97 patients at high risk for HCC who underwent Gd-EOB-MRI including unenhanced, multi-arterial phase, conventional portal venous phase (CPVP, 60 s), and LPVP (mean, 99.9 ± 9.1 s; range, 90-119 s) images. A total of 115 hepatic lesions were identified by histopathological or clinical diagnosis. Three independent radiologists assessed the MRI images by consensus. Diagnosis of HCC was made using criteria of arterial hyperenhancement and hypointensity relative to the surrounding liver parenchyma (1) on CPVP or (2) on CPVP and/or LPVP images. The generalized estimating equation was used to compare diagnostic performance for HCC between Criterion 1 and 2.

RESULTS

In 82 HCCs, the frequency of hypointensity differed significantly between the CPVP and LPVP images (64.6% [53/82] vs. 84.1% [69/82], P < 0.001). Among 33 non-HCCs, two cHCC-CCs showed additional hypointensity on LPVP than CPVP images (33.3% [11/33] vs. 39.4% [13/33], P = 0.500). Criterion 2 provided significantly greater sensitivity for diagnosing HCC than Criterion 1 (54.9% [45/82] vs. 74.4% [61/82], P < 0.001), with relatively little reduction in specificity (90.9% [30/33] vs. 84.8% [28/33], P = 0.145).

CONCLUSION

Additional use of LPVP hypointensity as washout could significantly improve sensitivity for HCC diagnosis when utilizing Gd-EOB-MRI in patients with CLD, without a significant decrease in specificity.

Intrahepatic mass-forming cholangiocarcinoma growing in a giant hepatic hemangioma: A case report

RATIONALE

Hepatic hemangioma (HH) is a common benign tumor with a high number of normal or abnormal blood vessels. Intrahepatic cholangiocarcinoma (ICC) is a relatively common malignant primary hepatic carcinoma (10%-15%) with high incidence rate and high fatality, yet low discovery rate in the early stages. Ultrasonography (US), computed tomography, and magnetic resonance imaging (MRI) are frequently used and indispensable imaging techniques for the diagnosis of hepatic lesions. It is possible to differentiate a liver lesion from HH with high accuracy owing to their different patterns and hemodynamic characteristics.

PATIENT CONCERNS

A 59-year-old Asian woman was referred to hospital for a hepatic mass, which was 9.0 × 6.5 cm in size, The patient was tested positive for hepatitis B antigen but negative for serum alpha-fetoprotein and carbohydrate antigen 199 and had a slightly elevated carcinoembryonic antigen level (3.56 ng/ml).

DIAGNOSIS

Liver US and MRI were performed. Grey-scale US revealed a huge heterogeneous mass on the right lobe with a point and line-like blood flow signal on Doppler US. Dynamic contrast-enhanced MRI showed heterogeneous annular nodular enhancement in the arterial phase. An initial diagnosis of HH was made based on the clinical history and imaging results; however, histopathologic examination of the liver lesions revealed modest to severe atypical hyperplasia of intrahepatic bile duct epithelium, cancerization, and mid to high differentiated mass-forming type cholangiocarcinoma combined with focal organized hemangioma.

INTERVENTIONS

The intrahepatic mass-forming cholangiocarcinoma (IMCC) lesion was considered a focal organization of hemangioma during operation and was surgically removed. No routine chemotherapy was performed after the operation.

OUTCOMES

The IMCC recurred 23 months after surgery, with elevated serum CA19-9 and CA125. Liver damage was evident, and the patient developed jaundice. The patient was discharged without active treatment and died in 4 months.

LESSONS

Although preoperative imaging of focal hepatic lesions is indispensable, intraoperative frozen section analysis and histopathological examination remain essential for definitive diagnosis. This is particularly important for high-risk patients and those with suspected malignancy.

Comparison of the Enhancement Pattern of Hepatic Hemangioma on Magnetic Resonance Imaging Performed With Gd-EOB-DTPA Versus Gd-BOPTA

PURPOSE

To compare magnetic resonance imaging (MRI) findings with gadoxetic acid and gadobenate dimeglumine for the diagnosis of hepatic hemangiomas.

MATERIALS AND METHODS

In this retrospective study, we included 26 hemangiomas (mean size was 14 mm ± 10 mm) in 19 patients (mean age 60 ± 14 years) scanned with both gadobenate dimeglumine MRI and gadoxetic acid MRI. For each patient, we collected multiple lesion variables including location, number, size and enhancement pattern on arterial, portal venous, 3-minute and hepatobiliary phases with both gadoxetic acid and gadobenate dimeglumine. The enhancement pattern with the two contrast agents was then compared.

RESULTS

The typical enhancement pattern of hepatic hemangiomas was more common-though not statistically significant-with gadobenate dimeglumine compared to gadoxetic acid (57% [15 of 26] vs 42% [11 of 26], respectively; P = 0.4057 for both peripheral globular discontinuous enhancement in the arterial phase and centripetal fill-in in the portal venous phase). A significantly higher number of hemangiomas showed centripetal fill-in or hyperintensity in the 3-minute phase with gadobenate dimeglumine compared to gadoxetic acid (88% [23 of 26) vs 58% [15 of 26]; P = 0.0266). A pseudo washout sign in the 3-minute phase was detected in one of the 5 flash-filling hemangiomas with gadoxetic acid, but not gadobenate dimeglumine. All hemangiomas were hypointense in the hepatobiliary phase with both gadobenate dimeglumine and gadoxetic acid.

CONCLUSIONS

The enhancement pattern of hepatic hemangiomas may vary depending on the hepatobiliary agent, with more frequent lack of the typical pattern with gadoxetic acid compared to gadobenate dimeglumine.

User and system pitfalls in liver imaging with LI-RADS

The Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging, created specifically for patients at risk for hepatocellular carcinoma. Over the past years, LI-RADS has been progressively implemented into clinical practice, but pitfalls remain related to user error and inherent limitations of the system. User pitfalls include the inappropriate application of LI-RADS to a low-risk patient population, incorrect measurement techniques, inaccurate assumptions about LI-RADS requirements, and improper usage of LI-RADS terminology and categories. System pitfalls include areas of discordance with the Organ Procurement and Transplantation Network (OPTN) as well as pitfalls related to rare ancillary features. This article reviews common user pitfalls in applying LI-RADS v2018 and how to avoid preventable errors and also highlights deficiencies of the current version of LI-RADS and how it might be improved in the future. Level of Evidence:3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2019;50:1673-1686.

Liver assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging in primary biliary cholangitis patients

PURPOSE

To evaluate the feasibility of utilizing gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the assessment of Child-Pugh class and for differentiating between patients with primary biliary cholangitis (PBC) and posthepatitic cirrhosis.

MATERIALS AND METHODS

45 PBC patients and 45 posthepatitic cirrhosis patients were enrolled and Gd-EOB-DTPA-enhanced MRI was applied. The average relative signal enhancement (RE) of the liver and average contrast to noise ratio (CNR) of common bile duct at 4, 20, and 50 min between different Child-Pugh classes of PBC patients were compared. The RE and CNR in all timepoints in patients with the same Child-Pugh class were compared between PBC patients and posthepatitic cirrhosis patients.

RESULTS

The RE of liver and CNR of common bile duct at 4, 20, and 50 min was significantly different between all Child-Pugh classes of PBC patients_. There were also no significant differences in the RE of liver and CNR of common bile duct in all timepoints between patients with PBC and posthepatitic cirrhosis in the same Child-Pugh class.

CONCLUSION

Gd-EOB-DTPA-enhanced MRI is feasible for liver function assessment in PBC patients. However, the ability of this modality in differentiating liver cirrhosis of different etiologies requires further investigation.

The value of gadoxetic acid-enhanced MRI for differentiation between hepatic microabscesses and metastases in patients with periampullary cancer

OBJECTIVES

We aimed to identify features that differentiate hepatic microabscess from hepatic metastasis on gadoxetic acid-enhanced MRI in patients with periampullary cancer.

METHODS

We included 72 patients (31 patients with 83 hepatic microabscesses and 41 patients with 71 hepatic metastases) who had a history of periampullary cancer and underwent gadoxetic acid-enhanced MRI. Image analysis was performed for margin, signal intensity, rim enhancement, perilesional hyperaemia, pattern on DWI and dynamic phases, and size discrepancy between sequences by consensus of two observers.

RESULTS

Multivariate analysis revealed that the following significant parameters favour microabscess: a history of bile duct cancer, perilesional hyperaemia, persistent arterial rim enhancement through the transitional phase (TP), and size discrepancy between T1WI and T2WI and between T1WI and hepatobiliary phase image (HBPI). The diagnostic accuracy for microabscess was highest (90.9%) when showing a size discrepancy ≥30% between T1WI and HBPI or persistent arterial rim enhancement through the TP. When the lesion was positive for both these variables, specificity reached 100%.

CONCLUSION

The combination of a size discrepancy between T1WI and HBPI and persistent arterial rim enhancement through the TP represents a reliable MRI feature for distinguishing between hepatic microabscess and metastasis in patients with periampullary cancer.

KEY POINTS

• Gadoxetic acid-enhanced MRI is useful for distinguishing hepatic microabscess from metastasis. • Hepatic microabscess showed significant size discrepancy ≥30% between T1WI and HBPI. • Arterial rim enhancement persistent through the TP indicates hepatic microabscess.

The diagnostic advantage of EOB-MR imaging over CT in the detection of liver metastasis in patients with potentially resectable pancreatic cancer

BACKGROUND

Liver metastases (LMs) are sometimes diagnosed intraoperatively, even when multidetector-row computed tomography (MDCT) reveals no LM in the staging of pancreatic cancer (PC). Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MR imaging) may have a role to play in the detection of LM.

METHODS

The present study included a total of 201 patients who underwent an EOB-MR imaging examination before undergoing surgical resection for pancreatic cancer that was determined to be radiologically-resectable by MDCT. Intrahepatic lesions that were considered suspected to be liver metastases following an EOB-MR imaging examination were defined as possible lesions (PLs). All PLs were evaluated by a pathological examination or through close follow-up examinations. The diagnostic ability of EOB-MR imaging was assessed. The predictive factors for liver metastasis were evaluated.

RESULTS

Thirty-seven PLs were noted in 17 patients: 31 PLs were true LMs, and six were benign lesions (3 hemangiomas and 3 abscesses). Nine LMs were newly detected during surgery and were not detected by preoperative EOB-MR imaging. The diagnostic ability of EOB-MR imaging was as follows: sensitivity, 77.5%; specificity, 94.7%; positive predictive value, 83.8%; negative predictive value, 92.3%; and accuracy, 90.2%. A multivariate analysis revealed that the presence of PL on EOB-MR imaging was the only independent risk factor for intraoperative liver metastasis (P < 0.001).

CONCLUSION

EOB-MR imaging was useful in detecting tiny liver metastases from pancreatic cancer in cases that were determined to be radiologically resectable by MDCT.

Washout appearance in Gd-EOB-DTPA-enhanced MR imaging: A differentiating feature between hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase and focal nodular hyperplasia-like nodules

PURPOSE

To identify the most reliable imaging features for differentiating hepatocellular carcinoma with paradoxical uptake on the hepatobiliary phase (HCC_para ) from focal nodular hyperplasia (FNH)-like nodules using Gd-EOB-DTPA-enhanced MRI.

MATERIALS AND METHODS

This was a retrospective study. Twenty patients with HCC_para and 21 patients with FNH-like nodules were included. The following MRI features were evaluated using 3.0 Tesla unit by two radiologists: signal intensity (SI) on T1-, T2-, and diffusion-weighted imaging (DWI), arterial enhancement pattern, washout appearance on the portal venous phase (PVP) and/or transitional phase (TP), uptake pattern on the hepatobiliary phase (HBP), "T2 scar," "EOB scar," and chemical shift on in- and out-of-phase images. Multivariate logistic regression analysis was performed to assess MRI features for prediction of HCC_para .

RESULTS

Compared with FNH-like nodules, HCC_para had significantly more frequent heterogeneous T1 SI (P < 0.0001), T2 hyperintensity (P = 0.032), heterogeneous arterial enhancement (P < 0.0001), washout appearance on the PVP and/or TP (P < 0.0001), heterogeneous uptake on the HBP (P < 0.0001), absence of "EOB scar" (P < 0.0001), and hyperintensity on DWI (P = 0.004). Multivariate logistic regression analysis revealed washout appearance as the only independent imaging feature associated with HCC_para (odds ratio, 7.019; P = 0.042). Washout appearance also showed the best diagnostic performance with a sensitivity of 90% and a specificity of 100%.

CONCLUSION

Washout appearance on the PVP and/or TP is the most reliable imaging feature for differentiating HCC_para from FNH-like nodules.

LEVEL OF EVIDENCE

3 J. MAGN. RESON. IMAGING 2017;45:1599-1608.

Enhancements in hepatobiliary imaging: the spectrum of gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid usages in hepatobiliary magnetic resonance imaging

Gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a unique hepatocyte-specific contrast agent approved for clinical use in the United States in 2008. Gd-EOB-DTPA-enhanced MR has shown to improve detection and characterization of hepatic lesions. Gd-EOB-DTPA is now being routinely used in daily clinical practice worldwide. Therefore, it is important for radiologists to be familiar with the potential uses and pitfalls of Gd-EOB-DTPA, which extends beyond the assessment of focal hepatic lesions. The purpose of this article is to review the various usages of Gd-EOB-DTPA in hepatobiliary MR imaging.

Hepatic hemangioma -review-

Hepatic hemangiomas are benign tumors of the liver consisting of clusters of blood-filled cavities, lined by endothelial cells, fed by the hepatic artery. The vast majority of HH are asymptomatic, most often being discovered incidentally during imaging investigations for various unrelated pathologies. Typical hemangiomas, the so-called capillary hemangiomas, range from a few mm to 3 cm, do not increase in size over time and therefore are unlikely to generate future symptomatology. Small (mm-3 cm) and medium (3 cm-10 cm) hemangiomas are well-defined lesions, requiring no active treatment beside regular follow-ups. However, the so-called giant liver hemangiomas, of up to 10 cm (most commonly) and even 20+ cm in size (according to occasional reports) can, and usually will develop symptoms and complications that require prompt surgical intervention or other kind of therapy. HH belong to the class of hepatic "incidentalomas", so-called because they are diagnosed incidentally, on imaging studies performed as routine examinations or for other reasons than the evaluation of a possible liver mass. Less than half of HH present with overt clinical symptoms, consisting, most often, of upper abdominal pain (this is usually the case for large lesions, which cause the distension of Glisson's capsule). Hepatic hemangiomas require a careful diagnosis to differentiate from other focal hepatic lesions, co-occurring diagnoses are also possible.

Does Gadoxetic acid-enhanced 3.0T MRI in addition to 64-detector-row contrast-enhanced CT provide better diagnostic performance and change the therapeutic strategy for the preoperative evaluation of colorectal liver metastases?

OBJECTIVES

To compare diagnostic performance in the detection of colorectal liver metastases between 64-detector-row contrast-enhanced CT (CE-CT) alone and the combination of CE-CT and gadoxetic acid-enhanced MRI (EOB-MRI) at 3.0T, and to assess whether EOB-MRI in addition to CE-CT results in a change to initially planned operative strategy.

METHODS

A total of 39 patients (27 men, mean age 65 years) with 85 histopathologically confirmed liver metastases were included. At EOB-MRI, unenhanced (T1- and T2-weighted), dynamic, and hepatocyte-phase images were obtained. At CE-CT, four-phase dynamic contrast-enhanced images were obtained. One on-site reader and three off-site readers independently reviewed both CE-CT alone and the combination of CE-CT and EOB-MRI. Sensitivity, positive predictive value, and alternative free-response receiver operating characteristic (AFROC) method were calculated. Differences in therapeutic strategy before and after the EOB-MRI examination were also evaluated.

RESULTS

Sensitivity and area under the AFROC curve with the combination of CE-CT and EOB-MRI were significantly superior to those with CE-CT alone. Changes in surgical therapy were documented in 13 of 39 patients.

CONCLUSIONS

The combination of CE-CT and EOB-MRI may provide better diagnostic performance than CE-CT alone for the detection of colorectal liver metastases, and EOB-MRI in addition to CE-CT resulted in changes to the planned operative strategy in one-third of the patients.

KEY POINTS

• Accurate preoperative imaging is essential for surgical planning and successful hepatic resection. • Combination of CE-CT and EOB-MRI is useful to detect colorectal liver metastases. • EOB-MRI combined with CE-CT contributes to determine the correct therapeutic strategy.

Management of giant liver hemangiomas: an update

Liver hemangiomas are the most common benign liver tumors and are usually incidental findings. Liver hemangiomas are readily demonstrated by abdominal ultrasonography, computed tomography or magnetic resonance imaging. Giant liver hemangiomas are defined by a diameter larger than 5 cm. In patients with a giant liver hemangioma, observation is justified in the absence of symptoms. Surgical resection is indicated in patients with abdominal (mechanical) complaints or complications, or when diagnosis remains inconclusive. Enucleation is the preferred surgical method, according to existing literature and our own experience. Spontaneous or traumatic rupture of a giant hepatic hemangioma is rare, however, the mortality rate is high (36-39%). An uncommon complication of a giant hemangioma is disseminated intravascular coagulation (Kasabach-Merritt syndrome); intervention is then required. Herein, the authors provide a literature update of the current evidence concerning the management of giant hepatic hemangiomas. In addition, the authors assessed treatment strategies and outcomes in a series of patients with giant liver hemangiomas managed in our department.