gadoxetic-acid-disodium and Carcinoma--Hepatocellular

The aim of the current study was to investigate whether hypointense hepatocellular carcinoma (HCC) in the hepatobiliary phase (HBP) on gadoxetic acid-enhanced MRI at pretreatment is a potential prognostic marker for tumor recurrence within 3 years after surgery conducted for a curative purpose (resection or liver transplantation).. Systematic review was performed in the PubMed, Embase, Cochrane Library, and LILACS databases. Original articles focused on evaluating HCC signal intensity (SI) in HBP, as well as recurrence at least 3 years after surgery were included in the study. Odds ratio (OR) was measured based on the inverse variance method and the random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included articles.. Five studies with 718 patients, in total, were analyzed. The odds ratio of disease recurrence in patients with hypointense HCC in the HBP, within 3 years after surgery, was 3.12 times higher than that observed in patients with hyperintense HCC in the HBP (OR 3.12; 95% CI 1.27-7.68; p = 0.01). Heterogeneity was classified as intermediate (I. Hypointense HCC in the HBP on gadoxetic acid-enhanced MRI at pretreatment has increased the likelihood of tumor recurrence in patients subjected to resection or liver transplantation. HCC SI in the HBP is a potential non-invasive imaging biomarker associated with patient prognosis.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Retrospective Studies

Background The Liver Imaging Reporting and Data System (LI-RADS) CT and MRI algorithm applies equally to CT, MRI with extracellular contrast agents (ECA-MRI), and MRI with gadoxetate (Gx-MRI). Purpose To estimate pooled percentages of hepatocellular carcinoma (HCC) and overall malignancy for each LI-RADS category with CT and MRI. Materials and Methods MEDLINE and EMBASE databases were searched for research articles (January 2014-April 2021) reporting the percentages of observations in each LI-RADS category with use of versions 2014, 2017, or 2018. Study design, population characteristics, imaging modality, reference standard, and numbers of HCC and non-HCC malignancies in each category were recorded. A random-effects model evaluated the pooled percentage of HCC and overall malignancy for each category. Results There were 49 studies with 9620 patients and a total 11 562 observations, comprising 7921 HCCs, 1132 non-HCC malignancies, and 2509 benign entities. No HCC or non-HCC malignancies were reported with any modality in the LR-1 category. The pooled percentages of HCC for CT, ECA-MRI, and Gx-MRI, respectively, were 10%, 6%, and 1% for LR-2 (

Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

Gadoxetic disodium (Primovist) is a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent with increasing popularity with its unique dual dynamic and excretory properties in focal liver lesion detection and characterisation. In-depth knowledge of its diagnostic utility and pitfalls in hepatocellular carcinoma (HCC) and liver metastases is crucial in facilitating clinical management. The current article reviews the pearls and pitfalls in these aspects with highlights from the latest research evidence. Pearls for common usage of Primovist in HCC includes detection of precursor cancer lesions in cirrhotic patients. Hepatobiliary phase hypointensity precedes arterial phase hyperenhancement (APHE) in hepatocarcinogenesis. Hepatobiliary phase hypointense nodules without APHE can represent early or progressed hepatocellular carcinoma (HCC) and high-grade dysplastic nodules. In addition, Primovist is useful to differentiate HCC from pseudolesions. Pitfalls in diagnosing HCC include transient tachypnoea in the arterial phase, rare hepatobiliary phase hyperintense HCC, and decompensated liver cirrhosis compromising image quality. Primovist is currently the most sensitive technique in diagnosing liver metastases before curative hepatic resection. Other patterns of enhancement of liver metastases, "disappearing" liver metastases are important pitfalls. Radiologists should be aware of the diagnostic utility, limitations, and potential pitfalls for the common usage of hepatobiliary specific contrast agent in liver MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Recent advances in systemic therapy have had major impacts on treatment strategies for hepatocellular carcinoma (HCC). The 2022 Barcelona Clinic Liver Cancer (BCLC) guidelines incorporate a new section on clinical decision-making for personalized medicine, although the first treatment suggested by the BCLC guidelines is based on solid scientific evidence. More than ever before, the appropriate treatment strategy must be selected prior to the initiation of therapy for HCC. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA-MRI) is essential for liver imaging and the hepatobiliary phase (HBP) of EOB-MRI reflects the expression of organic anion transporting polypeptide (OATP) transporters. Molecules associated with OATP expression are relevant in the molecular classification of HCC subclasses, and EOB-MRI is becoming increasingly important with advances in the molecular and genetic understanding of HCC. In this review, we describe imaging findings for the pretreatment prediction of response to standard therapies for HCC based on the BCLC algorithm using the HBP of EOB-MRI, with specific attention to the molecular background of OATPs. A more complete understanding of these findings will help radiologists suggest appropriate treatments and clinical follow-ups and could lead to the development of more personalized treatment strategies in the future. CLINICAL RELEVANCE STATEMENT: In the coming era of personalized medicine, HBP of EOB-MRI reflecting molecular and pathological factors could play a predictive role in the therapeutic efficacy of HCC and contribute to treatment selection. KEY POINTS: • Imaging features of hepatobiliary phase predict treatment efficacy prior to therapy and contribute to treatment choice. • Wnt/β-catenin activation associated with organic anion transporting polypeptide expression is involved in the tumor immune microenvironment and chemo-responsiveness. • Peritumoral hypointensity of hepatobiliary phase reflecting microvascular invasion affects the therapeutic efficacy of locoregional to systemic therapy.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Organic Anion Transporters; Retrospective Studies; Tumor Microenvironment

The 10th Global Forum for Liver Magnetic Resonance Imaging (MRI) was held as a virtual 2-day meeting in October 2021, attended by delegates from North and South America, Asia, Australia, and Europe. Most delegates were radiologists with experience in liver MRI, with representation also from specialists in liver surgery, oncology, and hepatology. Presentations, discussions, and working groups at the Forum focused on the following themes: • Gadoxetic acid in clinical practice: Eastern and Western perspectives on current uses and challenges in hepatocellular carcinoma (HCC) screening/surveillance, diagnosis, and management • Economics and outcomes of HCC imaging • Radiomics, artificial intelligence (AI) and deep learning (DL) applications of MRI in HCC. These themes are the subject of the current manuscript. A second manuscript discusses multidisciplinary tumor board perspectives: how to approach early-, mid-, and late-stage HCC management from the perspectives of a liver surgeon, interventional radiologist, and oncologist (Taouli et al, 2023). Delegates voted on consensus statements that were developed by working groups on these meeting themes. A consensus was considered to be reached if at least 80% of the voting delegates agreed on the statements. CLINICAL RELEVANCE STATEMENT: This review highlights the clinical applications of gadoxetic acid-enhanced MRI for liver cancer screening and diagnosis, as well as its cost-effectiveness and the applications of radiomics and AI in patients with liver cancer. KEY POINTS: • Interpretation of gadoxetic acid-enhanced MRI differs slightly between Eastern and Western guidelines, reflecting different regional requirements for sensitivity vs specificity. • Emerging data are encouraging for the cost-effectiveness of gadoxetic acid-enhanced MRI in HCC screening and diagnosis, but more studies are required. • Radiomics and artificial intelligence are likely, in the future, to contribute to the detection, staging, assessment of treatment response and prediction of prognosis of HCC-reducing the burden on radiologists and other specialists and supporting timely and targeted treatment for patients.

Topics: Artificial Intelligence; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Retrospective Studies; Sensitivity and Specificity

Although main criteria like non-rim enhancement in the arterial phase, non-peripheral washout, enhancing envelope, lesion size, and threshold growth have definitions and interpretations in the Liver Imaging Reporting and Data System, there are still some problems and pitfalls that clinicians and radiologists need to understand and avoid when assessing the main criteria based on gadoxetate disodium in clinical work-up. This article reviews the existing problems and current solutions in the assessment of the main criteria based on the hepatic contrast agent gadoxetate disodium.. 虽然肝脏影像报告与数据系统中有对其主要征象：动脉期非环状强化、非周边廓清、强化包膜、病变大小及阈值增长的定义和解释，但在临床工作中基于钆塞酸二钠评估主要征象时仍有一些问题与陷阱需要临床医师与放射科医师了解与规避。现就基于肝细胞对比剂钆塞酸二钠评估主要征象时存在的问题和目前的解决方法予以综述。.

Topics: Carcinoma, Hepatocellular; Contrast Media; Hepatocytes; Humans; Liver Neoplasms

Microvascular invasion (MVI) is a major risk factor for early recurrence in patients with hepatocellular carcinoma (HCC). Preoperative accurate evaluation of the presence of MVI could enormously benefit its treatment and prognosis.. To evaluate and compare the diagnostic performance of two imaging features (non-smooth tumor margin and peritumor hypointensity) in the hepatobiliary phase (HBP) to preoperatively diagnose the presence of MVI in HCC.. Original articles were collected from Medline/PubMed, Web of Science, EMBASE, and the Cochrane Library up to 17 January 2021 linked to gadoxetate disodium-enhanced magnetic resonance imaging (MRI) on 1.5 or 3.0 T. The pooled sensitivity, specificity, and summary area under the receiver operating characteristic curve (AUC) were calculated and meta-regression analyses were performed.. A total of 14 original articles involving 2193 HCCs were included. The pooled sensitivity and specificity of non-smooth tumor margin and peritumor hypointensity were 73% and 61%, and 43% and 90%, respectively, for the diagnosis of MVI in HCC. The summary AUC of non-smooth tumor margin (0.74) was comparable to that of peritumor hypointensity (0.76) (. This meta-analysis showed moderate and comparable accuracy for predicting MVI in HCC using either non-smooth tumor margin or peritumor hypointensity in HBP. Four discovered covariates accounted for the heterogeneity.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Margins of Excision; Neoplasm Invasiveness; Retrospective Studies

Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid (Gd- EOB-DTPA) has become a widely used liver-specific contrast agent worldwide, but its value and limitations as a diagnostic technique with Hepatocellular Carcinoma (HCC), have not been assessed.. A review of the latest evidence available on the diagnostic value of Gd-EOB-DTPA- enhanced MRI for the evaluation of HCC is reported.. A systematic, comprehensive literature search was conducted with PubMed, Scopus, EMBASE, the Web of Science, the Cochrane Library, CNKI, vip, wanfangdata and CBM from inception to June 31, 2020. The QUADAS-2 tool was used to evaluate the quality of the included studies. Pooled Sensitivity (SEN), Pooled Specificity (SPE), pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (dOR) and summary receiver operating characteristic (SROC) curves were calculated to assess the diagnostic value of the individual diagnostic tests.. A total of 47 articles were included, involving a total of 6362 nodules in 37 studies based on per-lesion studies. There were 13 per-patient studies, including a total of 1816 patients. The results of the meta-analysis showed that the per-lesion studies pooled weighted values were SEN 0.90 [95% confidence interval (CI): 0.87-0.92], SPE 0.92 (95% CI: 0.90-0.94), PLR 11.6 (95% CI: 8.8-15.2), NLR 0.11 (95% CI: 0.09-0.14) and dOR 107.0 (95% CI: 74.0-155.0). The AUC of the SROC curve was 0.96. The per-patient studies pooled weighted values were SEN 0.84 [95% confidence interval (CI): 0.78-0.89], SPE 0.92 (95% CI: 0.88-0.94), PLR 10.4 (95% CI: 7.4-14.6), NLR 0.17 (95% CI: 0.12-0.24) and dOR 61.0 (95% CI: 42.0-87.0). The AUC of the SROC curve was 0.95 and subgroup analyses were performed.. The diagnostic value of Gd-EOB-DTPA for HCC was quantitatively evaluated in a per-lesion study and a per-patient study using a systematic review of the literature. A positive conclusion was drawn: Gd-EOB-DTPA-enhanced imaging is a valuable diagnostic technique for HCC. The size of the nodules and the selection of the imaging diagnostic criteria may affect the diagnostic sensitivity.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

To determine the performance of diagnostic algorithm of adding hepatobiliary phase (HBP) images in Gd-EOB-DTPA-enhanced MRI for the detection of hepatocellular carcinoma (HCC) measuring up to 3 cm in patients with chronic liver disease.. We searched multiple databases from inception to April 10, 2020, to identify studies on using Gd-EOB-DTPA-enhanced MRI for the diagnostic accuracy of HCC (≤ 3 cm) in patients with chronic liver disease. The diagnostic algorithm of Gd-EOB-DTPA-enhanced MRI with HBP for HCC was defined as a nodule showing hyperintensity during arterial phase and hypointensity during the portal venous, delayed, or hepatobiliary phases. For gadoxetic acid-enhanced MRI without HBP, the diagnostic criteria were a nodule showing arterial enhancement and hypointensity on the portal venous or delayed phases. The data were extracted to calculate summary estimates of sensitivity, specificity, diagnostic odds ratio, likelihood ratio, and summary receiver operating characteristic (sROC) by using a bivariate random-effects model.. Twenty-nine studies with 2696 HCC lesions were included. Overall Gd-EOB-DTPA-enhanced MRI with HBP had a sensitivity of 87%, specificity of 92%, and the area under the sROC curve of 95%. The summary sensitivity of Gd-EOB-DTPA-enhanced MRI with HBP was significantly higher than that without HBP (84% vs 68%, p = 0.01).. Gd-EOB-DTPA-enhanced MRI with HBP showed higher sensitivity than that without HBP and had comparable specificity for diagnosis of HCC in patients with chronic liver disease.. • Hypointensity on HBP is a major feature for diagnosis of HCC. • Extending washout appearance to the transitional or hepatobiliary phase on Gd-EOB-DTPA provides favorable sensitivity and comparable specificity for diagnosis HCC. • The summary sensitivity of gadoxetic acid-enhanced MRI with HBP was significantly higher than that without HBP (84% vs 68%, p = 0.01) for diagnosis of HCC in patients with chronic liver disease.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Locoregional treatments, as alternatives to surgery, play a key role in the management of hepatocellular carcinoma (HCC). Liver magnetic resonance imaging (MRI) enables a multiparametric assessment, going beyond the traditional dynamic computed tomography approach. Moreover, the use of hepatobiliary agents can improve diagnostic accuracy and are becoming important in the diagnosis and follow-up of HCC. However, the main challenge is to quickly identify classical responses to loco-regional treatments in order to determine the most suitable management strategy for each patient. The aim of this review is to provide a summary of the most common and uncommon liver MRI findings in patients who underwent loco-regional treatments for HCC, with a special focus on ablative therapies (radiofrequency, microwaves and cryoablation), trans-arterial chemoembolization, trans-arterial radio-embolization and stereotactic ablative radiotherapy techniques, considering the usefulness of gadoxetate disodium (Gd-EOB-DTPA) contrast agent.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA; Gadoxetic acid; Gadoxetate disodium) is a hepatocyte-specific MR contrast agent. It acts as an extracellular contrast agent in the early phase after intravenous injection, and then is taken up by hepatocytes later. Using this contrast agent, we can evaluate the hemodynamics of the liver and liver tumors, and can therefore improve the detection and characterization of hepatocellular carcinoma (HCC). Gd-EOB-DTPA helps in the more accurate detection of hypervascular HCC than by other agents. In addition, Gd-EOB-DTPA can detect hypovascular HCC, which is an early stage of the multi-stage carcinogenesis, with a low signal in the hepatobiliary phase. In addition to tumor detection and characterization, Gd-EOB-DTPA contrast-enhanced MR imaging can be applied for liver function evaluation and prognoses evaluation. Thus, Gd-EOB-DTPA plays an important role in the diagnosis of HCC. However, we have to employ optimal imaging techniques to improve the diagnostic ability. In this review, we aimed to discuss the characteristics of the contrast media, optimal imaging techniques, diagnosis, and applications.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The 9th International Forum for Liver Magnetic Resonance Imaging (MRI) was held in Singapore in September 2019, bringing together radiologists and allied specialists to discuss the latest developments in and formulate consensus statements for liver MRI, including the applications of gadoxetic acid-enhanced imaging.. As at previous Liver Forums, the meeting was held over 2 days. Presentations by the faculty on days 1 and 2 and breakout group discussions on day 1 were followed by delegate voting on consensus statements presented on day 2. Presentations and discussions centered on two main meeting themes relating to the use of gadoxetic acid-enhanced MRI in primary liver cancer and metastatic liver disease.. Gadoxetic acid-enhanced MRI offers the ability to monitor response to systemic therapy and to assist in pre-surgical/pre-interventional planning in liver metastases. In hepatocellular carcinoma, gadoxetic acid-enhanced MRI provides precise staging information for accurate treatment decision-making and follow-up post therapy. Gadoxetic acid-enhanced MRI also has potential, currently investigational, indications for the functional assessment of the liver and the biliary system. Additional voting sessions at the Liver Forum debated the role of multidisciplinary care in the management of patients with liver disease, evidence to support the use of abbreviated imaging protocols, and the importance of standardizing nomenclature in international guidelines in order to increase the sharing of scientific data and improve the communication between centers.. • Gadoxetic acid-enhanced MRI is the preferred imaging method for pre-surgical or pre-interventional planning for liver metastases after systemic therapy. • Gadoxetic acid-enhanced MRI provides accurate staging of HCC before and after treatment with locoregional/biologic therapies. • Abbreviated protocols for gadoxetic acid-enhanced MRI offer potential time and cost savings, but more evidence is necessary. The use of gadoxetic acid-enhanced MRI for the assessment of liver and biliary function is under active investigation.

Topics: Carcinoma, Hepatocellular; Consensus; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Retrospective Studies; Sensitivity and Specificity

The purpose of this study was to identify and compare the diagnostic performance of gadolinium-ethoxybenzyl-diethyltriethylenetriacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in hepatocellular carcinoma (HCC).Two researchers searched PubMed, EMBASE, and Cochrane Library databases from the inception of each database to 10 February 2020, to find comparative studies of Gd-EOB-DTPA-MRI and CEUS in detection of HCC.The study included eight studies (374 patients). MRI is superior to CEUS in diagnostic sensitivity of HCC, P = .03. The diagnostic sensitivity of MRI in lesions with a diameter of less than 30 mm was significantly higher than that of CEUS, P = .04. MRI and CEUS had no significant difference in diagnostic specificity of HCC, P = .95. Summary Receiver Operating Characteristics (SROC) of MRI showed a larger than that of CEUS, but with P > .05.Gd-EOB-DTPA-MRI showed higher sensitivity than CEUS for hepatocellular carcinoma lesions, especially for lesions of less than 30 mm across.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Observational Studies as Topic; Ultrasonography

Magnetic resonance imaging (MRI) is the first-line tool for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We performed a meta-analysis to compare the performance of MRI using extracellular contrast agents (ECA-MRI) with that using gadoxetic acid (EOB-MRI) for diagnosing HCC.. We searched multiple databases for studies comparing the diagnostic performance of ECA-MRI with that of EOB-MRI in patients with suspected HCC until 31 May 2020. The bivariate random-effects model was used to pool the performance and further subgroup analysis was performed.. Eight studies were included evaluating a total of 1002 patients. ECA-MRI revealed significantly higher per-lesion sensitivity in the diagnosis of HCC than EOB-MRI did (0.76 vs 0.63, P = .002). For modified EOB-MRI (mEOB-MRI) using extended washout to the transitional phase (TP) or hepatobiliary phase (HBP), the sensitivity increased compared with that of EOB-MRI using restrictive washout in the portal venous phase (PVP) (0.74 vs 0.63, P = .07). No significant difference among the specificities of ECA-MRI, EOB-MRI, and mEOB-MRI (0.96, 0.98, and 0.93, respectively) was found. The sensitivity for lesions < 20 mm was significantly lower than that for lesions ≥ 20mm (0.66 vs 0.87, P = .01) only for ECA-MRI, which achieved higher sensitivity in Asian patients or with a 3.0 T scanner.. ECA-MRI outperforms EOB-MRI in per-lesion sensitivity for diagnosing HCC, whereas mEOB-MRI shows a trend towards improved sensitivity compared with EOB-MRI with slightly decreased specificity. Registration: Prospero CRD42020189680.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To perform a systematic review and meta-analysis to determine intrahepatic distant recurrence (IDR) risk of hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on pretreatment gadoxetic acid-enhanced MRI in patients with hepatocellular carcinoma (HCC) treated with either hepatectomy or radiofrequency ablation (RFA).. PubMed and EMBASE databases were searched up to April 6, 2019. We included studies that evaluated HBP hypointense nodules without APHE as risk factors for IDR in HCC patients treated with either hepatectomy or RFA. Hazard ratios (HR) were meta-analytically pooled using random effects model. Subgroup analyses stratified to clinicopathologic variables were performed to explore heterogeneity. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool.. Eight studies with 842 patients were analyzed. The overall pooled HR for IDR was 2.44 (95% CI, 1.99-2.98) and were 2.14 (95% CI, 1.66-2.76) and 3.07 (95% CI, 2.19-4.31) for patients that underwent hepatectomy and RFA, respectively. No significant heterogeneity was present (I. HBP hypointense nodules without APHE are risk factors for IDR in HCC patients treated with either RFA or hepatectomy. Stratification of patient management with regard to performing additional tests or treatment for these nodules and modification of proper follow-up strategies may be required in patients with HCC who have these nodules on pretreatment gadoxetic acid-enhanced MRI.. • HBP hypointense nodules without APHE constitute an entity that is unique in gadoxetic acid-enhanced MRI. • HBP hypointense nodules without APHE are risk factors for IDR in HCC patients treated with either RFA or hepatectomy. • Stratification of management and modification of proper follow-up strategies may be required in HCC patients who have these nodules on pretreatment gadoxetic acid-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Prognosis

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) plays important roles in diagnosis of hepatic lesions because of its superiority in the detectability of small lesions, its differentiation ability, and its utility for the early diagnosis of hepatocellular carcinoma (HCC). In HCC, expression of organic anion transporting polypeptide (OATP) 1B3 correlates with the enhancement ratio in the hepatobiliary phase. Gadoxetic acid-enhanced MRI, an indirect molecular imaging method, reflects OATP1B3 expression in HCC. OATP1B3 expression gradually decreases from the dysplastic nodule stage to advanced HCC. Decreased expression is a sensitive marker of multistep hepatocarcinogenesis, especially in the early stages. Hypervascular HCCs commonly show hypointensity in the hepatobiliary phase corresponding to a decrease in OATP1B3; however, approximately 10% of HCCs show hyperintensity due to OATP1B3 overexpression. This hyperintense HCC shows less aggressive biological features and has a better prognosis than hypointense HCC. Hyperintense HCC can be classified into a genetic subtype of HCC with a mature hepatocyte-like molecular expression. OATP1B3 expression and the less aggressive nature of hyperintense HCC are regulated by the molecular interaction of β-catenin signaling and hepatocyte nuclear factor 4α, a tumor suppressor factor. Gadoxetic acid-enhanced MR imaging has the potential to be an imaging biomarker for HCC. KEY POINTS: • The hepatobiliary phase is a sensitive indirect indicator of organic anion transporting polypeptide1B3 (OATP1B3) expression in hepatocellular carcinoma (HCC). • The OATP1B3 expression, namely, enhancement in the hepatobiliary phase, decreases from the very early stage of hepatocarcinogenesis, contributing to early diagnosis of HCC. • HCC showing hyperintensity on the hepatobiliary phase is a peculiar genetic subtype of HCC with OATP1B3 overexpression, a less aggressive nature, and mature hepatocyte-like molecular/genetic features.

Topics: beta Catenin; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatocyte Nuclear Factor 4; Hepatocytes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Molecular Imaging; Prognosis; Retrospective Studies; Solute Carrier Organic Anion Transporter Family Member 1B3

Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver, and its morbidity and mortality have been increasing in recent years. The early diagnosis and prompt treatment of small HCC are crucial to improve the prognosis and quality of life of patients. In China, hepatitis B virus infection is the main cause. HCC with a single tumor nodule of ≤ 3 cm in diameter, or HCC with a number of nodules, in which each nodule is ≤ 2 cm in diameter, with a total diameter of ≤ 3 cm, is considered as small HCC. The MRI liver-specific contrast agent can detect small HCC at the early stage. This has important clinical implications for improving the survival rate of patients.. Gd-EOB-DTPA-enhanced MRI can significantly improve the sensitivity and specificity of the detection of HBV-related small hepatocellular carcinoma, providing an important basis for the clinical selection of appropriate personalized treatment. Gd-EOB-DTPA-enhanced MRI can reflect the degree of HCC differentiation, and the evaluation of HCC on Gd-EOB-DTPA-enhanced MRI would be helpful for the selection of the treatment and prognosis of HCC patients. The present study reviews the progress of the application of Gd-EOB-DTPA in the early diagnosis of small HCC, its clinical treatment, the prediction of the degree of differentiation, and the assessment of recurrence and prognosis of HCC, including the pharmacoeconomics and application limitations of Gd-EOB-DTPA. The value of the application of HCC with the Gd-EOB-DTPA was summarized to provide information for improving the quality of life and prolonging the survival of patients.. Gd-EOB-DTPA-enhanced MRI has the diagnostic capability for small HCC with a diameter of ≤ 2 cm. This will have a broader application prospect in the early diagnosis of small liver cancer with a diameter of ≤ 1 cm in the future. The relationship between GD-EOB-DTPA-MRI and the degree of HCC differentiation has a large research space, and Gd-EOB-DTPA is expected to become a potential tool for the preoperative prediction and postoperative evaluation of HCC, which would be beneficial for more appropriate treatments for HCC patients.

Topics: Carcinoma, Hepatocellular; China; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Prognosis; Quality of Life

The use of liver magnetic resonance imaging is increasing thanks to its multiparametric sequences that allow a better tissue characterization, and the use of hepatobiliary contrast agents. This review aims to evaluate gadoxetic acid enhanced magnetic resonance imaging in the diagnosis and staging of cholangiocarcinoma and its different clinical and radiological classifications proposed in the literature. We also analyze the epidemiology, risk factors in correlation with clinical findings and laboratory data.

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Use of gadoxetate disodium, a hepatobiliary gadolinium-based agent, in patients with chronic parenchymal liver disease offers the advantage of improved sensitivity for detecting hepatocellular carcinoma (HCC). Imaging features of liver observations on gadoxetate-enhanced MRI may also serve as biomarkers of recurrence-free and overall survival following definitive treatment of HCC. A number of technical and interpretative pitfalls specific to gadoxetate exist, however, and needs to be recognized when protocoling and interpreting MRI exams with this agent. This article reviews the advantages and pitfalls of gadoxetate use in patients at risk for HCC, and the potential impact on Liver Imaging Reporting and Data System (LI-RADS) imaging feature assessment and categorization. Level of Evidence: 5 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:1236-1252.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Radiology Information Systems

Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis. Gadoxetic acid-enhanced MRI is useful for the evaluation of earlystage HCC, diagnosis of HCC precursor lesions, and highly sensitive diagnosis of HCC. Furthermore, functional information provided by gadoxetic acid-enhanced MRI can aid in the characterization of focal liver lesions. For example, whereas lesions lack functioning hepatocytes appear hypointense in the hepatobiliary phase, preserved or enhanced expression of organic anion transporting polypeptides in some HCCs as well as focal nodular hyperplasia lead to hyperintensity in the hepatobiliary phase; and a targetoid appearance on transitional phase or hepatobiliary phase imaging can be helpful for identifying the histopathological composition of tumors. While gadoxetic acid-enhanced MRI may improve the sensitivity of HCC diagnosis and provide new insights into the characterization of focal liver lesions, there are many challenges associated with its use. This article reviews the pros and cons of HCC diagnosis with gadoxetic acid-enhanced MRI and discuss some clues in the radiological differentiation of HCC from HCC mimickers.

Topics: Angiomyolipoma; beta Catenin; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The purpose of this study was to determine the relative diagnostic benefit of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) over contrast-enhanced multi-detector computed tomography (CEMDCT) for the detection of hepatocellular carcinoma (HCC).. Two investigators searched multiple databases from inception to January 8, 2019, for studies comparing Gd-EOB-DTPA-enhanced MRI with CEMDCT in adults suspected of HCC. Two reviewers independently selected studies and extracted data.. Eight studies were included enrolling 498 patients. MRI showed significantly higher sensitivity than CT (0.85 vs. 0.68). There was no significant difference in the specificity of MRI and CT (0.94 vs. 0.93). The negative likelihood ratio and positive likelihood ratio of MRI and CT were not significantly different (0.16 vs. 0.15 and 14.7 vs. 11.2, respectively). The summary receiver operating characteristics (SROC) of MRI was higher than that of CT at 0.96 vs. 0.91. In the subgroup analysis with a lesion diameter below 2 cm, the sensitivity of MRI was significantly higher than that of CT (0.79 vs. 0.46).. Gd-EOB-DTPA-enhanced MRI showed higher sensitivity and overall diagnostic accuracy than CEMDCT especially for hepatocellular carcinoma lesions smaller than 2 cm.. • Gd-EOB-DTPA-enhanced MRI can detect small lesions of hepatocellular carcinoma. • Gd-EOB-DTPA-enhanced MRI showed higher sensitivity and overall diagnostic accuracy than CEMDCT in patients with hepatocellular carcinoma. • Eight prospective studies showed that Gd-EOB-DTPA-enhanced MRI provides greater diagnostic confidence.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Prospective Studies; ROC Curve; Sensitivity and Specificity

Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Ultrasonography

Hepatocellular carcinomas (HCCs) frequently recur despite initial successful surgical resection or local ablation therapy. Diagnostic methods for small HCCs have improved with the introduction of gadoxetic acid-enhanced liver magnetic resonance imaging and diffusion-weighted imaging (DWI). Currently, sub-centimeter recurrent nodules showing typical hallmark imaging findings of HCC are frequently detected in patients with a treatment history for HCC. With five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and DWI, and low signal intensity on hepatobiliary phase, sub-centimeter recurrent HCC can be diagnosed with high accuracy. Although more information is needed to determine the treatment of choice, local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seem to be promising as they are effective and safe for the management of sub-centimeter recurrent HCCs.

Topics: Ablation Techniques; Carcinoma, Hepatocellular; Cone-Beam Computed Tomography; Contrast Media; Diffusion Magnetic Resonance Imaging; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Neoplasm Recurrence, Local; Treatment Outcome; Ultrasonography, Interventional

The purpose of this study is to evaluate the outcomes of hypovascular hypointense nodules in the hepatobiliary phase of gadoxetic acid-enhanced MRI and the risk factors for the hypervascular transformation of the nodules through a systematic review and meta-analysis.. We searched the Ovid-MEDLINE and EMBASE databases for published studies of hypovascular hypointense nodules in patients with chronic liver disease. The pooled proportions of the overall and cumulative incidence rates at 1, 2, and 3 years for the transformation of hypovascular hypointense nodules into hypervascular hepatocellular carcinomas (HCCs) were assessed by using random-effects modeling. Metaregression analysis was performed.. Sixteen eligible studies with 944 patients and 1819 hypovascular hypointense nodules in total were included. The pooled overall rate of hypervascular transformation was 28.2% (95% CI, 22.7-33.6%; I. Hypovascular hypointense nodules detected in the hepatobiliary phase of gadoxetic acid-enhanced MRI carry a significant potential of transforming into hypervascular HCCs. The size of nodules is a significant risk factor for hypervascular transformation.

Topics: Biliary Tract; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging

Early detection of small hepatocellular carcinoma (HCC) lesions can improve longterm patient survival. A systematic review and meta-analysis of the diagnostic performance of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) was performed in diagnosing small HCCs measuring up to 2 cm (≤2 cm). Two investigators searched multiple databases for studies in which the performances of either Gd-EOB-DTPA-enhanced MRI or MDCT were reported with sufficient data to construct 2 × 2 contingency tables for diagnosing HCCs up to 2 cm on a per-lesion or per-patient level. Diagnostic performances were quantitatively pooled by a bivariate random-effect model with further meta-regression and subgroup analyses. A total of 27 studies (14 on Gd-EOB-DTPA-enhanced MRI, 9 on MDCT, and 4 on both) were included, enrolling a total of 1735 patients on Gd-EOB-DTPA-enhanced MRI and 1781 patients on MDCT. Gd-EOB-DTPA-enhanced MRI demonstrated significantly higher overall sensitivity than did MDCT (0.96 versus 0.65; P < 0.01), without substantial loss of specificity (0.94 versus 0.98; P > 0.05). Area under the summary receiver operating characteristic curve was 0.97 with Gd-EOB-DTPA-enhanced MRI and 0.85 with MDCT. Regarding Gd-EOB-DTPA-enhanced MRI, sensitivity was significantly higher for studies from non-Asian countries than Asian countries (0.96 versus 0.93; P < 0.01), for retrospective studies than prospective studies (0.95 versus 0.91; P < 0.01), and for those with Gd-EOB-DTPA injection rate ≥ 1.5 mL/s than that of <1.5 mL/s (0.97 versus 0.90; P < 0.01). In conclusion, Gd-EOB-DTPA-enhanced MRI demonstrated higher sensitivity and overall diagnostic accuracy than MDCT, and thus should be the preferred imaging modality for diagnosing small HCCs measuring up to 2 cm. Liver Transplantation 23 1505-1518 2017 AASLD.

Topics: Carcinoma, Hepatocellular; Contrast Media; Early Detection of Cancer; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Multidetector Computed Tomography; ROC Curve

To establish the relative diagnostic accuracy of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI) compared with contrast-enhanced computed tomography (CE-CT), dynamic MRI (D-MRI), gadopentetic acid-enhanced MRI (GP-MRI), or gadobenic acid-enhanced MRI (GB-MRI) in the characterization of hepatocellular carcinoma (HCC).. PubMed, EMBASE, the Cochrane Library, and the University of York CRD databases were searched to February 29 2016 for any studies that compared the diagnostic accuracy of GA-MRI to CE-CT, D-MRI, GP-MRI, or GB-MRI in patients with known or suspected HCC. Diagnostic accuracy outcomes (true positive, true negative, false positive, false negative) were extracted and analyzed using the bivariate model of Reitsma et al (2005).. In studies comparing GA-MRI to CE-CT in patients with any-sized lesions, estimated sensitivities were 0.881 (95% confidence interval [CI] = 0.766, 0.944) and 0.713 (95% CI = 0.577, 0.819) respectively. Estimated specificities were 0.926 (95% CI = 0.829, 0.97) and 0.918 (95% CI = 0.829, 0.963), respectively. This difference was not statistically significant. In studies including patients with small lesions GA-MRI was superior to CE-CT, with estimated sensitivities of 0.919 (95% CI = 0.834, 0.962) and 0.637 (95% CI = 0.565, 0.704 and estimated specificities of 0.936 (95% CI = 0.882, 0.966) and 0.971 (95% CI = 0.937, 0.987), respectively. In studies comparing GA-MRI to D-MRI in patients with any-sized lesions estimated sensitivities were 0.907 (95% CI = 0.870, 0.934) and 0.820 (95% CI = 0.776, 0.857); estimated specificities were 0.929 (95% CI = 0.877, 0.961) and 0.934 (95% CI = 0.881, 0.964).. GA-MRI has superior diagnostic ability to CE-CT in patients with small lesions. In patients with any-sized lesions there is no evidence that GA-MRI is superior to either CE-CT to D-MRI.. 3 J. Magn. Reson. Imaging 2017;45:281-290.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Organometallic Compounds; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Utilization Review

To date, despite many scientific evidences, the guidelines of the principal hepatological societies, such as the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver, do not recognize the diagnostic superiority of magnetic resonance imaging (MRI) over computed tomography in the diagnosis of hepatocellular carcinoma (HCC) and, for the most part, do not contemplate the use of hepatospecific contrast media, such as gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB). The aim of this paper was to analyze the recent results of EOB-MRI in the study of chronic liver disease and the differences between the American Association for the Study of Liver Diseases and the Japan Society of Hepatology guidelines, of which the latter represents the most consolidated experience on EOB-MRI use for HCC diagnosis. Finally, a new diagnostic algorithm for HCC in patients under surveillance for chronic liver disease was formulated, which contemplates the use of EOB. This new diagnostic algorithm is based on the Japan Society of Hepatology algorithm but goes beyond it by adapting it to the Western world, taking into account both the difference between the two and the latest results concerning the diagnosis of HCC. This new diagnostic algorithm for HCC is proposed in order to provide useful diagnostic tools to all those Western countries where the use of EOB (more expensive than extracellular contrast media) is widespread but in which common strategies to manage the nodules that this new contrast agent allows identifying have not been available to date.

Topics: Aged; Algorithms; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Gastroenterology; Humans; Japan; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Practice Guidelines as Topic; Societies, Medical; Western World

Gadoxetic acid improves detection and characterization of focal liver lesions in cirrhotic patients and can estimate liver function in patients undergoing liver resection. The purpose of this article is to describe the optimal gadoxetic acid study protocol for the liver, the unique characteristics of gadoxetic acid, the differences between gadoxetic acid and extra-cellular gadolium chelates, and the differences in phases of enhancement between cirrhotic and normal liver using gadoxetic acid. We also discuss how to obtain and recognize an adequate hepatobiliary phase.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging

Hepatocellular carcinoma is the most common primary hepatic malignant tumor. With widespread use of liver imaging, various cirrhosis-related nodules are frequently detected in patients with chronic liver disease, while diverse hypervascular hepatic lesions are incidentally detected but undiagnosed on dynamic computed tomography and magnetic resonance imaging (MRI). However, use of hepatocyte-specific MR contrast agents with combined perfusion and hepatocyte-selective properties have improved diagnostic performance in detection and characterization of focal liver lesions. Meanwhile, the enhancement patterns observed during dynamic phases using hepatocyte-specific agents may be different from those observed during MRI using conventional extracellular fluid agents, leading to confusion in diagnosis. Therefore, we discuss useful tips for the differentiation of hepatocellular carcinoma from similar lesions in patients with and without chronic liver disease using liver MRI with hepatocyte-specific agents.

Topics: Adenoma, Liver Cell; Angiomyolipoma; Bile Duct Neoplasms; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Focal Nodular Hyperplasia; Gadolinium DTPA; Hemangioma; Hepatocytes; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging

The purpose of this study was to directly (head-to-head) compare the per-lesion diagnostic performance of contrast-enhanced computed tomography (CT) (also referred to as CT hereafter) and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging (also referred to as MRI hereafter) for the detection of hepatocellular carcinoma (HCC). Studies reporting direct per-lesion comparison data of contrast-enhanced multidetector CT and Gd-EOB-DTPA-enhanced MR imaging that were published between January 2000 and January 2015 were analyzed. The data of each study were extracted. Systematic review, paired meta-analysis, and subgroup analysis were performed. Twelve studies including 627 patients and 793 HCC lesions were analyzed. The sensitivity estimates of MRI and CT were, respectively, 0.86 (95% CI 0.76-0.93) and 0.70 (95% CI 0.58-0.80), with significant difference (P < 0.05). The sensitivity estimates were both 0.94 (95% CI 0.92-0.96) (Chi-square 4.84, degrees of freedom = 1, P > 0.05). In all subgroups, Gd-EOB-DTPA-enhanced MR imaging was more sensitive than multidetector CT for the detection of HCC, and specificity estimates of both tests maintained at a similarly high level in all conditions: sensitivity estimates of both tests were reduced in studies where patients were diagnosed with HCC solely by liver explant or in those where HCC lesions were small (≤2 cm, especially when ≤1 cm). But in all situations, sensitivities of MRI were higher than those of CT with or without significance. Gd-EOB-DTPA-enhanced MR imaging showed better per-lesion diagnostic performance than multidetector CT for the diagnosis of HCC in patients with cirrhosis and in small hepatic lesions.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Multidetector Computed Tomography

Hepatocellular carcinoma (HCC) develops via multistep hepatocarcinogenesis, during which hypovascular/early HCC precedes the typical hypervascular HCC. The hypovascular HCC lacks the typical hallmark imaging features of HCC, such as late arterial phase enhancement and portal venous washout, limiting early detection using conventional extracellular contrast agents for dynamic magnetic resonance imaging (MRI) or computed tomography (CT) imaging. In recent years, gadolinium-based contrast agents with hepatobiliary uptake have garnered interest from radiologists and hepatologists due to their potential for improved detection of HCC during hepatobiliary phase MRI. Lesions with reduced or absent hepatocyte function appear hypointense in the hepatobiliary phase of gadoxetic acid-enhanced MRI. This behavior can be exploited for earlier detection of hypovascular HCC. This review describes the general characteristics and advantages of gadoxetic acid for the diagnosis of HCC with a particular focus on hypovascular/early HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The Liver Imaging Reporting and Data System (LI-RADS) was introduced with the goal of standardizing the diagnosis of hepatocellular carcinoma. The 2014 version of LI-RADS incorporates the use of hepatobiliary contrast agents (HBAs) into the diagnostic algorithm, including gadoxetate disodium and gadobenate dimeglumine. Three new ancillary features are introduced: hepatobiliary phase (HBP) hypointensity and HBP hypointense rim favor malignancy, while HBP isointensity favors benignity. HBP hyperintensity favors neither malignancy nor benignity. In this review, we describe how to use these new features as well as numerous pitfalls associated with the use ofHBAs, including hemangiomas, cholangiocarcinomas, and focal confluent fibrosis. Importantly, findings on the HBP are not included as major criteria and therefore the criteria for the diagnosis of LI-RADS 5 observations remain unchanged, and so congruence with the Organ Procurement Transplant Network system remains intact. Additionally, we review how the major features in LI-RADS, arterial phase hyperenhancement, threshold growth, and washout and capsule appearance, may be affected with HBAs. Notably with HBAs, hypointensity on the delayed phase, termed the transitional phase, does not qualify as washout appearance due to the possibility of early parenchymal enhancement. It is hoped that the incorporation of HBAs into LI-RADS will help create consistency when interpreting HBA enhanced MRIs.

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms

To perform a systematic review of the contrast behaviour of HCC on Gd-EOB-DTPA hepato-biliary phase MRI.. This review was completed in accordance with the recommendations outlined in the preferred reporting items for systematic reviews statement. In all reports, qualitative analysis of signal intensity (SI) of HCC on hepato-biliary phase was performed: the relative SI of HCC. When available, a quantitative analysis of tumour enhancement was evaluated.. A total of 106 studies were retrieved, of which 41 met the inclusion criteria. The total number of patients was 2550, with 3132 HCC. MRI showed 3110 HCC (22 non-detected). 2692/3110 (87 %) HCC were hypointense on Gd-EOB-DTPA-enhanced hepatocyte-phase MRI, 134 (4 %) isointense; 106 (3 %) hyperintense and 178 (6 %) iso-hyperintense. In 26 articles, 1653 HCCs were classified as follows: 519 well-differentiated, 883 moderately differentiated, 251 poorly differentiated. Among well-differentiated HCC, 445 (86 %) were hypointense, 12 isointense (2 %), 9 hyperintense (2 %), 53 iso/hyperintense (10 %). Among moderately differentiated HCC, 774 (88 %) were hypointense, 8 isointense (1 %), 27 hyperintense (3 %), 74 iso/hyperintense (8 %). Among poorly differentiated HCCs, 245 (98 %) were hypointense, one isointense, one hyperintense and four iso-hyperintense (2 %). We found a Chi-square (χ (2)) equivalent to 25,082 (p < 0.001).. The percentage of lesions iso/hyper/iso-hyper is the same when considering well-differentiated and moderately differentiated HCC; when considering poorly differentiated HCC, the percentage of lesions iso/hyper/iso-hyper is significantly lower. Conversely, the percentage of lesions hypointense is significantly more represented in poorly differentiated HCC compared to well-differentiated and moderately differentiated HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The purpose of this meta-analysis was to compare the diagnostic accuracy of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and multidetector-row computed tomography (MDCT) for hepatocellular carcinoma (HCC).Medline, Cochrane, EMBASE, and Google Scholar databases were searched until July 4, 2014, using combinations of the following terms: gadoxetic acid disodium, Gd-EOB-DTPA, multidetector CT, contrast-enhanced computed tomography, and magnetic resonance imaging. Inclusion criteria were as follows: confirmed diagnosis of primary HCC by histopathological examination of a biopsy specimen; comparative study of MRI using Gd-EOB-DTPA and MDCT for diagnosis of HCC; and studies that provided quantitative outcome data. The pooled sensitivity and specificity of the 2 methods were compared, and diagnostic accuracy was assessed with alternative-free response receiver-operating characteristic analysis.Nine studies were included in the meta-analysis, and a total of 1439 lesions were examined. The pooled sensitivity and specificity for 1.5T MRI were 0.95 and 0.96, respectively, for 3.0T MRI were 0.91 and 0.96, respectively, and for MDCT were 0.74 and 0.93, respectively. The pooled diagnostic odds ratio for 1.5T and 3.0T MRI was 242.96, respectively, and that of MDCT was 33.47. To summarize, Gd-EOB-DTPA-enhanced MRI (1.5T and 3.0T) has better diagnostic accuracy for HCC than MDCT.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Radionuclide Imaging; Sensitivity and Specificity

Gadoxetic acid disodium (Gd-EOB-DTPA) is a magnetic resonance imaging (MRI) contrast agent to target the liver cells with normal function. In clinical practice, the Gd-EOB-DTPA produces high quality hepatocyte specific image 20 minutes after intravenous injection, so DWI sequence is often performed after the conventional dynamic scanning. However, there are still some disputes about whether DWI sequence will provide more effective diagnostic information in clinical practice. This study aimed to explore the diagnostic value of combining Gd-EOB-DTPA-enhanced MRI and DWI in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.. A systematic literature search was performed in the PubMed and Cochrane library database up to March 2015. The quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of studies. Heterogeneous test on the included literature was performed by using the software Review Manager 5.3. The MetaDiSc 1.4 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio; meanwhile the summary receiver operating characteristics (SROC) curve was drawn to compare the diagnostic performance.. A total of 13 literatures were included in this study. In 8 literatures regarding HCC diagnosis based on Gd-EOB-DTPA-enhanced MRI, the pooled sensitivity: 0.90 (95% confidence interval (CI): 0.88-0.93); specificity: 0.89 (95% CI: 0.85-0.92); positive likelihood ratio: 8.60 (95% CI: 6.20-11.92); negative likelihood ratio: 0.10 (95% CI: 0.08-0.14) were obtained. The area under curve (AUC) and Q values were 0.96 and 0.90, respectively. In 5 literatures relating to HCC diagnosis by combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence, the pooled sensitivity: 0.88 (95% CI: 0.85-0.91), specificity: 0.96 (0.94-0.97), positive likelihood ratio: 19.63 (12.77-30.16), negative likelihood ratio: 0.10 (0.07-0.14) were obtained. The AUC value was 0.9833 and Q value was 0.9436. The AUC value of comprehensive evaluation method was significantly higher than that of Gd-EOB-DTPA-enhanced MRI alone(P<0.05).. Combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence significantly improves in both the diagnostic accuracy and specificity of chronic liver disease-associated HCC.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Male; Middle Aged; ROC Curve; Sensitivity and Specificity

To evaluate the diagnostic value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for hepatocellular carcinoma (HCC).. A systematic, comprehensive literature search was conducted in PubMed (2004 [Gd-EOB-DTPA was first approved in Europe in 2004] to April 2013), Embase (2004 to April 2013), Web of Science (2004 to April 2013), and the Cochrane Library (2004 to April 2013). The Quality Assessment of Diagnostic Studies (QUADAS) items was used to evaluate the quality of the included studies. Stata 12.0 was used to analyze the data. Pooled sensitivity (SEN), pooled specificity (SPE), pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (dOR), and summary receiver operating characteristic (SROC) curves were calculated to assess the diagnostic value of the individual diagnostic tests.. A total of 11 articles were included, involving 1578 nodules from four countries. The results of the meta-analysis showed that the pooled SEN, SPE, and SROC curve values were 0.92 (95% confidence interval [CI]: 0.89-0.94) 0.95 (95% CI: 0.93-0.97), and 0.98 (95% CI: 0.95-0.99), respectively, and subgroup analyses were performed.. Gd-EOB-DTPA-enhanced MRI has value for the detection of HCC; in particular, it has high sensitivity for the detection of lesions larger than 10 mm.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Internationality; Liver Neoplasms; Magnetic Resonance Imaging; Male; Observer Variation; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity

To determine the accuracy of magnetic resonance imaging (MRI) with gadoxetic acid disodium for the detection of hepatocellular carcinoma (HCC).. Various databases were searched for original articles published before May 2013. Studies were selected, which performed MRI with gadoxetic acid disodium to detect and diagnose HCC and which presented sufficient data to allow construction of contingency tables. For each study, the true-positive, false-positive, true-negative, and false-negative values were extracted or derived, and 2 × 2 contingency tables were constructed. The heterogeneity test, the threshold effect test, the publication bias analysis, and subgroup analyses were performed.. From 623 citations, 18 were included in the meta-analysis with a total of 2572 lesions. We detected heterogeneity between studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity was 0.91 (95% confidence interval [CI], 0.90-0.93), the specificity was 0.94 (95% CI, 0.93-0.96), the positive likelihood ratio was 12.31 (95% CI, 7.66-19.78), the negative likelihood ratio was 0.10 (95% CI, 0.07-0.13), and the diagnostic odds ratio was 159.72 (95% CI, 91.72-276.08). The area under the receiver operating characteristic curve was 0.98 (95% CI, 0.96-0.99).. MRI with gadoxetic acid disodium is a noninvasive and no radiation exposure imaging modality with high sensitivity and specificity for the detection of HCC. Nonetheless, it should be applied cautiously in liver nodule <1 cm, and large-scale well-designed trials are necessary to assess its clinical value.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Hepatocellular carcinoma (HCC) is a major health concern, and early HCC diagnosis is a primary radiological concern. The goal of imaging liver cirrhosis is the early identification of high-grade dysplastic nodules/early HCC since their treatment is associated with a higher chance of radical cure and lower recurrence rates. The newly introduced MRI contrast agent gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, Gd-EOB-DTPA) has enabled the concurrent assessment of tumor vascularity and hepatocyte-specific contrast enhancement during the hepatobiliary phase (HBP), which can help to detect and characterize smaller HCCs and their precursors. HBP-EOB-MRI identifies hypovascular HCC nodules that are difficult to detect using ultrasonography or computed tomography, which do not show the diagnostic HCC hallmarks of arterial washin and portal/delayed washout. During the HBP, typical HCC and early HCC appear hypointense on EOB-MRI, whereas low-grade dysplastic or regenerative nodules appear as iso- or hyperintense lesions. The diagnostic accuracy of EOB-MRI for the diagnosis of early HCC is approximately 95-100%. One third of hypovascular hypointense nodules in HBP become hypervascular 'progressed' HCC, with a 1- and 3-year cumulative incidence of 25 and 41%, respectively. Therefore, these hypovascular nodules should be strictly followed up or definitely treated as typical HCC. Due to this capability of identifying the precursors and biological behavior of HCC, EOB-MRI has rapidly become a key imaging tool for the diagnosis of HCC and its precursors, despite the scarce MRI availability throughout Europe. With increasing experience, EOB-MRI may eventually be established as the diagnostic imaging modality of choice in this setting. Full recognition by the Western EASL-AASLD guidelines is expected.

Topics: Aged; Carcinoma, Hepatocellular; Early Detection of Cancer; Europe; Female; Gadolinium DTPA; Humans; Italy; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Practice Guidelines as Topic; Precancerous Conditions; Radiographic Image Enhancement; Role; Sensitivity and Specificity; Severity of Illness Index

Surveillance and diagnostic algorithms for hepatocellular carcinoma (HCC) have already been described in guidelines published by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver and the European Organisation for Research and Treatment of Cancer (EASL-EORTC), and the Japan Society of Hepatology (JSH), but the content of these algorithms differs slightly. The JSH algorithm mainly differs from the other two algorithms in that it is highly sophisticated and considers the functional imaging techniques of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI) and Sonazoid contrast-enhanced ultrasound (CEUS) to be very important diagnostic modalities. In contrast, the AASLD and EASL-EORTC algorithms are less advanced and suggest that a diagnosis be made based solely on hemodynamic findings using dynamic CT/MRI and biopsy findings. A consensus meeting regarding the JSH surveillance and diagnostic algorithm was held at the 50th Liver Cancer Study Group of Japan Congress, and a 2014 update of the algorithm was completed. The new algorithm reaffirms the very important role of EOB-MRI and Sonazoid CEUS in the surveillance and diagnosis of liver cancer and is more sophisticated than those currently used in the United States and Europe. This is now an optimized algorithm that can be used to diagnose early-stage to classical HCC easily and highly accurately.

Topics: Algorithms; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Early Detection of Cancer; Ferric Compounds; Gadolinium DTPA; Health Care Surveys; Humans; Iron; Japan; Liver Neoplasms; Magnetic Resonance Imaging; Mass Screening; Oxides; Population Surveillance; Practice Patterns, Physicians'; Tomography, X-Ray Computed; Ultrasonography

To determine the accuracy of MR imaging with gadoxetic acid disodium (Gd-EOB-DTPA) for the detection of hepatocelluar carcinoma (HCC).. A systematic search was performed in PUBMED, EMBASE, Web of Science, Cochrane Library and the Chinese Biomedical Literature Database up to March 2013 to identify studies about evaluation of Gd-EOB-DTPA enhanced MR imaging in patients suspected of having HCC. The data were extracted to perform heterogeneity test and threshold effect test and to calculate sensitivity, specificity, diagnostic odds ratio, predictive value, and areas under summary receiver operating characteristic curve (AUC).. From 601 citations, 10 were included in the meta-analysis. The methodological quality of the 10 studies was good. Overall HCC: There was significant heterogeneity in the pooled analysis (I(2) = 69.4%, P = 0.0005), and the pooled weighted values were determined to be sensitivity: 0.91 (95% confidence interval (CI): 0.89, 0. 93); specificity: 0.95 (95% CI: 0.94, 0.96); diagnostic odds ratio: 169.94 (95% CI: 108.84, 265.36); positive likelihood ratio: 15.75 (95% CI: 7.45, 33.31); negative likelihood ratio: 0.10 (95% CI: 0.06, 0.15). The AUC was 0.9778. HCC in cirrhosis: The estimates were to be sensitivity: 0.91 (95% CI: 0.88, 0.93); specificity: 0.93 (95% CI: 0.89, 0.95); diagnostic odds ratio: 234.24 (95% CI: 33.47, 1639.25); positive likelihood ratio: 15.08 (95% CI: 2.20, 103.40); negative likelihood ratio: 0.08 (95% CI: 0.03, 0.21). The AUC was 0.9814. ≤20 mm HCC: The AUC was 0.9936. There was no notable publication bias.. This meta-analysis suggests that MR imaging with Gd-EOB-DTPA has high diagnostic accuracy for the detection of HCC, especially for ≤20 mm HCC. This technique shows good prospect in diagnosis of HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Publication Bias; ROC Curve

Liver-specific magnetic resonance (MR) contrast agents are increasingly used in evaluation of the liver. They are effective in detection and morphological characterization of lesions, and can be useful for evaluation of biliary tree anatomy and liver function. The typical appearances and imaging pitfalls of various tumours at MR imaging performed with these agents can be understood by the interplay of pharmacokinetics of these contrast agents and transporter expression of the tumour. This review focuses on the applications of these agents in oncological imaging.

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Gadolinium DTPA; Hemangioma; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA, Primovist in Europe and Eovist in the USA) is a liver-specific magnetic resonance imaging contrast agent that has up to 50% hepatobiliary excretion in the normal liver. After intravenous injection, Gd-EOB-DTPA distributes into the vascular and extravascular spaces during the arterial, portal venous and late dynamic phases, and progressively into the hepatocytes and bile ducts during the hepatobiliary phase. The hepatocyte uptake of Gd-EOB-DTPA mainly occurs via the organic anion transporter polypeptides OATP1B1 and B3 located at the sinusoidal membrane and biliary excretion via the multidrug resistance-associated proteins MRP2 at the canalicular membrane. Because of these characteristics, Gd-EOB-DTPA behaves similarly to non-specific gadolinium chelates during the dynamic phases, and adds substantial information during the hepatobiliary phase, improving the detection and characterization of focal liver lesions and diffuse liver disease. This information is particularly relevant for the detection of metastases, and for the detection and characterization of nodular lesions in liver cirrhosis, including early hepatocellular carcinomas. Finally, GD-EOB-DTPA-enhanced magnetic resonance imaging may provide quantitative assessment regarding liver perfusion and hepatocyte function in diffuse liver diseases. The full potential of GD-EOB-DTPA-enhanced magnetic resonance imaging has to be established further. It is already clear that GD-EOB-DTPA-enhanced magnetic resonance imaging provides anatomic and functional information in the setting of focal and diffuse liver disease that is unattainable with magnetic resonance imaging enhanced with non-specific contrast agents.

Topics: Bile Duct Diseases; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging

Superior soft-tissue contrast affords magnetic resonance imaging (MRI) some advantages compared to computed tomography (CT) in both detection and characterization of focal liver lesions. Because of its relatively recently introduction into clinical practice, a growing number of articles in the literature have demonstrated the usefulness of the hepatobiliary-specific MRI contrast agent gadoxetic acid disodium (Gd-EOB-DTPA) in liver imaging. The purpose of this review is to demonstrate the typical enhancement patterns of the most common liver lesions using Gd-EOB-DTPA in daily clinical scenarios and briefly describe its mechanism of action. Radiologists interpreting liver MRI studies with this agent must be familiar with the appearance of focal lesions in the hepatocyte phase to avoid misinterpretation.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed

This article is a review of magnetic resonance imaging (MRI) of incidental focal liver lesions. This review provides an overview of liver MRI protocol, diffusion-weighted imaging, and contrast agents. Additionally, the most commonly encountered benign and malignant lesions are discussed with emphasis on imaging appearance and the diagnostic performance of MRI based on a review of the literature.

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diffusion Magnetic Resonance Imaging; Focal Nodular Hyperplasia; Gadolinium DTPA; Hemangioma; Hepatocytes; Humans; Incidental Findings; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

The diagnostic imaging of hepatocellular carcinoma (HCC) has recently undergone marked progress. The advent of the ultrasound (US) contrast agent Sonazoid, approved in January 2007, and magnetic resonance imaging (MRI) with the liver-specific MRI contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-MRI), approved in January 2008, are of particular significance. Sonazoid contrast-enhanced US (Sonazoid-CEUS) is useful not only for the diagnosis of HCC, but also for guiding treatment and assessing treatment response. Sonazoid-CEUS has proven to be particularly effective for screening and staging, which used to be considered impossible with CEUS, through the introduction of the newly developed diagnostic technique of defect reperfusion imaging. It is still not possible if other vascular agents such as SonoVue and Definity are used. In particular, Gd-EOB-DTPA-MRI has been suggested to be much more reliable in the differentiation of early HCC from precancerous dysplastic nodules than any other modalities such as multidetector raw computed tomography, dynamic MRI, and superparamagnetic iron oxide-MRI. A decrease in contrast uptake in the hepatocyte phase observed on EOB-MRI is strongly suggestive of cancer, and the absence of early staining in the arterial phase suggests early HCC. The differential diagnostic capacity of Gd-EOB-DTPA-MRI is considered to far exceed that of what were previously the most useful imaging techniques, computed tomography (CT) during hepatic arteriography or CT during arterial portography, and to be comparable to that of the pathological diagnosis by pathologists specialized in liver.

Topics: Angiography; Carcinoma, Hepatocellular; Diagnostic Imaging; Ferric Compounds; Gadolinium DTPA; Humans; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Oxides; Positron-Emission Tomography; Tomography, X-Ray Computed; Ultrasonography, Doppler

Detection, characterization, staging, and treatment monitoring are major roles in imaging diagnosis in liver cancers. Contrast-enhanced ultrasonography (CEUS) using microbubble contrast agents has expanded the role of US in the detection and diagnosis of liver nodules in patients at high risk of hepatocellular carcinoma (HCC). CEUS provides an accurate differentiation between benign and malignant liver nodules, which is critical for adequate management of HCC and is also useful for guidance of percutaneous local therapy of HCC and postprocedure monitoring of the therapeutic response. The technology of multidetector-row computed tomography (MDCT) has increased spatial and temporal resolutions of computed tomography (CT). It has made possible a more precise evaluation of the hemodynamics of liver tumor, and the diagnostic accuracy of dynamic MDCT has improved. Perfusion CT can measure tissue perfusion parameters quantitatively and can assess segmental hepatic function. Dynamic MDCT with high spatial and temporal resolution enables us to reconstruct 3- and 4-dimensional imaging, which is very useful for pretreatment evaluation. Dual-energy CT makes possible the differentiation of materials and tissues in images obtained based on the differences in iodine and water densities. Monochromatic images, which can be reconstructed by dual-energy CT data, provide some improvement in contrast and show a higher contrast-to-noise ratio for hypervascular HCCs. Dynamic magnetic resonance imaging with fast imaging sequence of 3-dimensional Fourier transformation T(1)-weighted gradient echo and nonspecific contrast medium can show high detection sensitivity of hypervascular HCC. However, the hepatic tissue-specific contrast medium, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, has become an essential contrast medium for liver imaging because of its higher diagnostic ability. It may replace CT during hepatic arteriography and during arterioportography.

Topics: Angiography; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Microbubbles; Multidetector Computed Tomography; Tomography, X-Ray Computed; Ultrasonography

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The majority of HCCs develop in cirrhotic livers, and the early detection and characterization of this entity is very important. Pathologically, human HCC develops in a multistep fashion in the following sequence: from low-grade dysplastic nodule (LGDN), to high-grade dysplastic nodule (HGDN), early HCC, well-differentiated HCC, nodule-in-nodule HCC, and, finally, to moderately differentiated HCC. Differentiation between early HCC and DN is the most important issue in the clinical setting. CT during hepatic angiography (CTHA) and CT during arterial portography (CTAP) are the most sensitive tools in the differentiation of premalignant/borderline lesions (LGDN and HGDN) and early HCC. Recent progress in imaging modality, especially Sonazoidenhanced US and Gd-EOB-DTPA MRI, is starting to play a very important role in the imaging of multistep hepatocarcinogenesis, resulting in changing the therapeutic strategy of these nodular lesions associated with liver cirrhosis.

Topics: Angiography; Carcinoma, Hepatocellular; Disease Progression; Ferric Compounds; Gadolinium DTPA; Humans; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Oxides; Portography; Tomography, X-Ray Computed; Ultrasonography

We aimed to prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed Tomography (CECT) for hepatocellular carcinoma (HCC) detection and liver transplant (LT) eligibility assessment in cirrhotic patients with explant histopathology correlation.. In this prospective, single-institution ethics-approved study, 101 cirrhotic patients were enrolled consecutively from the pre-LT clinic with written informed consent. Patients underwent CECT and EOB-MRI alternately every 3 months until LT or study exclusion. Two blinded radiologists independently scored hepatic lesions on CECT and EOB-MRI utilizing the liver imaging reporting and data system (LI-RADS) version 2018. Liver explant histopathology was the reference standard. Pre-LT eligibility accuracies with EOB-MRI and CECT as per Milan criteria (MC) were assessed in reference to post-LT explant histopathology. Lesion-level and patient-level statistical analyses were performed.. Sixty patients (49 men; age 33-72 years) underwent LT successfully. One hundred four non-treated HCC and 42 viable HCC in previously treated HCC were identified at explant histopathology. For LR-4/5 category lesions, EOB-MRI had a higher pooled sensitivity (86.7% versus 75.3%, p <  0.001) but lower specificity (84.6% versus 100%, p <  0.001) compared to CECT. EOB-MRI had a sensitivity twice that of CECT (65.9% versus 32.2%, p <  0.001) when all HCC identified at explant histopathology were included in the analysis instead of imaging visible lesions only. Disregarding the hepatobiliary phase resulted in a significant drop in EOB-MRI performance (86.7 to 72.8%, p <  0.001). EOB-MRI had significantly lower pooled sensitivity and specificity versus CECT in the LR5 category with lesion size < 2 cm (50% versus 79%, p = 0.002 and 88.9% versus 100%, p = 0.002). EOB-MRI had higher sensitivity (84.8% versus 75%, p <  0.037) compared to CECT for detecting < 2 cm viable HCC in treated lesions. Accuracies of LT eligibility assessment were comparable between EOB-MRI (90-91.7%, p = 0.156) and CECT (90-95%, p = 0.158).. EOB-MRI had superior sensitivity for HCC detection; however, with lower specificity compared to CECT in LR4/5 category lesions while it was inferior to CECT in the LR5 category under 2 cm. The accuracy for LT eligibility assessment based on MC was not significantly different between EOB-MRI and CECT.. ClinicalTrials.gov Identifier: NCT03342677 , Registered: November 17, 2017.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

The purpose of this study is to establish microvascular invasion (MVI) prediction models based on preoperative contrast-enhanced ultrasound (CEUS) and ethoxybenzyl-enhanced magnetic resonance imaging (EOB-MRI) in patients with a single hepatocellular carcinoma (HCC) ≤ 5 cm.. Patients with a single HCC ≤ 5 cm and accepting CEUS and EOB-MRI before surgery were enrolled in this study. Totally, 85 patients were randomly divided into the training and validation cohorts in a ratio of 7:3. Non-radiomics imaging features, the CEUS and EOB-MRI radiomics scores were extracted from the arterial phase, portal phase and delayed phase images of CEUS and the hepatobiliary phase images of EOB-MRI. Different MVI predicting models based on CEUS and EOB-MRI were constructed and their predictive values were evaluated.. Since univariate analysis revealed that arterial peritumoral enhancement on the CEUS image, CEUS radiomics score, and EOB-MRI radiomics score were significantly associated with MVI, three prediction models, namely the CEUS model, the EOB-MRI model, and the CEUS-EOB model, were developed. In the validation cohort, the areas under the receiver operating characteristic curve of the CEUS model, the EOB-MRI model, and the CEUS-EOB model were 0.73, 0.79, and 0.86, respectively.. Radiomics scores based on CEUS and EOB-MRI, combined with arterial peritumoral enhancement on CEUS, show a satisfying performance of MVI predicting. There was no significant difference in the efficacy of MVI risk evaluation between radiomics models based on CEUS and EOB-MRI in patients with a single HCC ≤ 5 cm.. Radiomics models based on CEUS and EOB-MRI are effective for MVI predicting and conducive to pretreatment decision-making in patients with a single HCC within 5 cm.. • Radiomics scores based on CEUS and EOB-MRI, combined with arterial peritumoral enhancement on CEUS, show a satisfying performance of MVI predicting. • There was no significant difference in the efficacy of MVI risk evaluation between radiomics models based on CEUS and EOB-MRI in patients with a single HCC ≤ 5 cm.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

Topics: Aged; Bayes Theorem; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Retrospective Studies

The purpose of this study was to establish a model for predicting the prognosis of patients with microvascular invasion (MVI)-negative hepatocellular carcinoma (HCC) based on qualitative and quantitative analyses of Gd-EOB-DTPA magnetic resonance imaging (MRI).. Consecutive patients with MVI-negative HCC who underwent preoperative Gd-EOB-DTPA MRI between January 2015 and December 2019 were retrospectively enrolled.In total, 122 patients were randomly assigned to the training and validation groups at a ratio of 7:3. Univariate and multivariate logistic regression analyses were performed to identify significant clinical parameters and MRI features, including quantitative and qualitative parameters associated with prognosis, which were incorporated into a predictive nomogram. The end-point of this study was recurrence-free survival. Outcomes were compared between groups using the Kaplan-Meier method with the log-rank test.. During a median follow-up period of 58.86 months, 38 patients (31.15 %) experienced recurrence. Multivariate analysis revealed that lower relative enhancement ratio (RER), hepatobiliary phase hypointensity without arterial phase hyperenhancement, Liver Imaging Reporting and Data System category, mild-moderate T2 hyperintensity, and higher aspartate aminotransferase levels were risk factors associated with prognosis and then incorporated into the prognostic model. C-indices for training and validation groups were 0.732 and 0.692, respectively. The most appropriate cut-off value for RER was 1.197. Patients with RER ≤ 1.197 had significantly higher postoperative recurrence rates than those with RER > 1.197 (p = 0.004).. The model integrating qualitative and quantitative imaging parameters and clinical parameters satisfactorily predicted the prognosis of patients with MVI-negative HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis; Retrospective Studies

Gadoxetic acid uptake on hepatobiliary phase MRI has been shown to correlate with ß-catenin mutation in patients with HCC, which is associated with resistance to certain therapies. This study aimed to evaluate the prognostic value of gadoxetic acid uptake on hepatobiliary phase MRI in patients with advanced HCC receiving sorafenib.. 312 patients with available baseline hepatobiliary phase MRI images received sorafenib alone or following selective internal radiation therapy (SIRT) within SORAMIC trial. The signal intensity of index tumor and normal liver parenchyma were measured on the native and hepatobiliary phase MRI images, and relative tumor enhancement higher than relative liver enhancement were accepted as high gadoxetic acid uptake, and its prognostic value was assessed using univariate and multivariate Cox proportional hazard models.. The median OS of the study population was 13.4 (11.8-14.5) months. High gadoxetic acid uptake was seen in 51 (16.3%) patients, and none of the baseline characteristics was associated with high uptake. In univariate analysis, high gadoxetic acid uptake was significantly associated with shorter overall survival (10.7 vs. 14.0 months, p = 0.005). Multivariate analysis confirmed independent prognostic value of high gadoxetic acid uptake (HR, 1.7 [1.21-2.3], p = 0.002), as well as Child-Pugh class (p = 0.033), tumor diameter (p = 0.002), and ALBI grade (p = 0.015).. In advanced HCC patients receiving sorafenib (alone or combined with SIRT), high gadoxetic acid uptake of the tumor on pretreatment MRI, a surrogate of ß-catenin mutation, correlates with shorter survival. Gadoxetic acid uptake status might serve in treatment decision-making process.

Topics: Biomarkers; Carcinoma, Hepatocellular; Catenins; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Molecular Imaging; Retrospective Studies; Sorafenib

The value of gadoxetic acid in the diagnosis of hepatocellular carcinoma (HCC), based on perfusion criteria, is under dispute. This post-hoc analysis of the prospective, phase II, randomized, controlled SORAMIC study compared the accuracy of gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) (arterial, portovenous, and venous phase only) versus contrast-enhanced computed tomography (CT) for stratifying patients with HCC to curative ablation or palliative treatment. Two reader groups (radiologists, R1 and R2) performed blind reads of CT and gadoxetic acid-enhanced MRI (contrast dynamics only). A truth panel, with access to clinical and imaging follow-up data, served as reference. Primary endpoint was non-inferiority (margin: 5% points) of MRI vs. CT (lower 95% confidence interval [CI] > 0.75) in a first step and superiority (complete 95% CI > 1) in a second step. The intent-to-treat population comprised 538 patients. Accuracy of treatment decisions was 73.4% and 70.8% for CT (R1 and R2, respectively) and 75.1% and 70.3% for gadoxetic acid-enhanced dynamic MRI. Non-inferiority but not superiority of gadoxetic acid-enhanced dynamic MRI versus CT was demonstrated (odds ratio 1.01; CI 0.97-1.05). Despite a theoretical disadvantage in wash-out depiction, gadoxetic acid-enhanced dynamic MRI is non-inferior to CT in accuracy of treatment decisions for curative ablation versus palliative strategies. This outcome was not subject to the use of additional MR standard sequences.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Perfusion; Prospective Studies

We aimed to investigate the value of performing gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) radiomics for preoperative prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) based on multiple sequences.. We randomly allocated 165 patients with HCC who underwent partial hepatectomy to training and validation sets. Stepwise regression and the least absolute shrinkage and selection operator algorithm were used to select significant variables. A clinicoradiological model, radiomics model, and combined model were constructed using multivariate logistic regression. The performance of the models was evaluated, and a nomogram risk-prediction model was built based on the combined model. A concordance index and calibration curve were used to evaluate the discrimination and calibration of the nomogram model.. The tumour margin, peritumoural hypointensity, and seven radiomics features were selected to build the combined model. The combined model outperformed the radiomics model and the clinicoradiological model and had the highest sensitivity (90.89%) in the validation set. The areas under the receiver operating characteristic curve were 0.826, 0.755, and 0.708 for the combined, radiomics, and clinicoradiological models, respectively. The nomogram model based on the combined model exhibited good discrimination (concordance index = 0.79) and calibration.. The combined model based on radiomics features of Gd-EOB-DTPA enhanced MRI, tumour margin, and peritumoural hypointensity was valuable for predicting HCC microvascular invasion. The nomogram based on the combined model can intuitively show the probabilities of MVI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Tumor-infiltrating CD8 cells and expression of programmed cell death ligand 1 (PD-L1) are immune checkpoint markers in patients with hepatocellular carcinoma (HCC). We aimed to determine the ability of preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI) findings to predict CD8 cell density and PD-L1 expression in HCC.. A total of 120 patients with HCC who underwent 3.0-T gadoxetic acid-enhanced MRI before curative resection from January 2016 to June 2020 were enrolled and divided into a training set (n = 84) and a testing set (n = 36). Thirty-four patients with advanced stage HCC who received anti-PD-1 inhibitor between January 2017 and April 2020 and underwent pretreated gadoxetic acid-enhanced MRI scans were enrolled in an independent validation set. PD-L1 expression and CD8 cell infiltration were assessed with immunohistochemical staining, respectively. Two radiologists blinded to pathology results evaluated the pretreated MR features in consensus. Logistic regression and the receiver operating characteristic curve (ROC) analyses were used to determine the value of image features to predict high CD8 cell density, PD-L1 positivity and the combination of high CD8 cell density and PD-L1 positivity in HCC in the training set and validated the findings in the testing set. The associations of MRI predictors with the objective response to immunotherapy were assessed in the independent validation.. In the training set, the independent MRI predictors were irregular tumor margin (ITM, P = 0.008) and peritumoral low signal intensity (PLSI) on hepatobiliary phase (HBP) images (P < 0.001) for PD-L1 positivity, absence of an enhancing capsule (AEC, P = 0.001) and PLSI on HBP images (P = 0.025) for high CD8 cell density, and PLSI on HBP images (P = 0.001) and ITM (P = 0.023) for the both. The area under the curves (AUCs) of the predictive models for evaluating PD-L1 positivity, high CD8 cell density and the combination of high CD8 cell density and PD-L1 positivity were 0.810 and 0.809, 0.740 and 0.728, and 0.809 and 0.874 in the training and testing set, respectively. The objective response was demonstrated to be associated with the combination of PLSI on HBP images and ITM (PHI, P = 0.004), and the combination of PLSI on HBP images and AEC (PHA, P = 0.012) in the independent validation set.. Pretreated MRI features have the potential to identify patients with HCC in an immune-activated state and predict outcomes of immunotherapy. Trial registration The study was retrospectively registered on March 5, 2020 with registration no. [2020] 02-012-01.

Topics: Adult; Aged; Aged, 80 and over; B7-H1 Antigen; Carcinoma, Hepatocellular; CD8-Positive T-Lymphocytes; Contrast Media; Female; Gadolinium DTPA; Gene Expression Regulation, Neoplastic; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Regression Analysis; Retrospective Studies; ROC Curve; Treatment Outcome; Young Adult

To develop a prediction model that combined magnetic resonance images (MRI)-based radiomics features with clinical factors to predict recurrence-free survival (RFS) of hepatocellular carcinoma (HCC) patients treated with surgical resection.. HCC patients treated with surgical resection (n = 153) were randomly divided into training (n = 107) and validation (n = 46) datasets. The volumes of interest were manually outlined around the lesion and additional 2 mm and 5 mm peritumoral areas were created with automated dilatation in MRI to extract tumoral (T) and peritumoral (PT) radiomics features. The radiomics models were constructed using least absolute shrinkage and selection operator Cox regression. The combined model incorporated clinical factors and radiomics features using multivariable Cox regression based on the Akaike information criterion principle. Predictive performance of different models were evaluated by receiver operating characteristic (ROC) curves, decision curves, and calibration curves.. Among the radiomics models, similar performance was observed in the 2 mm and 5 mm PT models (C-index both 0.657), which were better than the T model or T + PT model (C-index 0.607 and 0.641, respectively) in the validation dataset, whereas the model combined with the three identified clinical risk factors showed the best performance (C-index 0.725). Results of the ROC curves, decision curves, and the calibration curves indicated that the combined model and the derived nomogram had better prediction performance, greater clinical benefits, and fair calibration efficiency.. The prediction model that combined MRI radiomics signatures with clinical factors can effectively predict the prognosis of patients with HCC treated with surgical resection.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Retrospective Studies

Recently revised international guidelines for hepatocellular carcinoma (HCC) suggest that patients with inadequate ultrasonography be assessed by alternative imaging modalities. Non-enhanced MRI has potential as a surveillance tool based on the short scan times required and the absence of contrast agent-associated risks. This study compared the performance of non-enhanced MRI and ultrasonography for HCC surveillance in high-risk patients.. We included 382 high-risk patients in a prospective cohort who underwent 1 to 3 rounds of paired gadoxetic acid-enhanced MRI and ultrasonography. Non-enhanced MRI, consisting of diffusion-weighted imaging (DWI) and T2-weighted imaging, was simulated and retrospectively analyzed, with results considered positive when lesion(s) ≥1 cm showed diffusion restriction or mild-moderate T2 hyperintensity. Ultrasonography results were retrieved from patient records. HCC was diagnosed histologically and/or radiologically. Sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) were evaluated using generalized estimating equations.. Forty-eight HCCs were diagnosed in 43 patients. Per-lesion and per-exam sensitivities of non-enhanced MRI were 77.1% and 79.1%, respectively, which were higher than those achieved with ultrasonography (25.0% and 27.9%, respectively, p <0.001). Specificities of non-enhanced MRI (97.9%) and ultrasonography (94.5%) differed significantly (p <0.001). NPV was higher for non-enhanced MRI (99.1%) than ultrasonography (96.9%). Per-lesion and per-exam PPVs were higher for non-enhanced MRI (56.9% and 61.8%, respectively) than for ultrasonography (16.7% and 17.7%, respectively). The estimated scan time of non-enhanced MRI was <6 min.. Based on its good performance, short scan times, and the lack of contrast agent-associated risks, non-enhanced MRI is a promising option for HCC surveillance in high-risk patients.. Recently revised international guidelines for hepatocellular carcinoma (HCC) suggest that selected patients with inadequate surveillance on ultrasonography be assessed by alternative imaging modalities such as computed tomography or magnetic resonance imaging (MRI). Herein, we show that MRI without contrast agents performed significantly better than ultrasonography for HCC surveillance in high-risk patients. Given this good performance, as well as short scan times and the lack of contrast agent-associated risks, non-enhanced MRI is a promising option for HCC surveillance in high-risk patients.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Republic of Korea; Retrospective Studies; Ultrasonography

We conducted a prospective study using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) to determine whether sustained virological response (SVR) by direct-acting anti-viral (DAA) drugs suppresses hepatocarcinogenesis in patients with hepatitis C virus (HCV) infection.. To use serial Gd-EOB-MRI to assess the impact of DAAs on hepatocarcinogenesis.. Between February 2008 and December 2018, 1083 consecutive patients with HCV infection underwent Gd-EOB-MRI. Of these, 719 patients were enrolled, including 210 patients in the 'Non-DAA group', who did not receive DAAs before the introduction of DAAs, and 509 patients in the 'DAA group', who achieved SVR after the introduction of DDAs. Factors associated with hepatocarcinogenesis were analysed by a Cox proportional hazard model. In addition, hepatocarcinogenesis was classified into two types, 'multistep' and 'de novo', on the basis of Gd-EOB-MRI findings. Factors associated with each type were analysed by Fine and Gray proportional hazards models.. Hepatocarcinogenesis was observed in 67 of 719 (9.3%) patients. Factors associated with hepatocarcinogenesis were male gender, albumin-bilirubin (ALBI) grade 2 or 3, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) ≥5%, the presence of nonhypervascular hypointense nodules (NHHNs) and Non-DAA group. Of 67 patients, multistep hepatocarcinogenesis occurred in 58 patients (86.6%) and de novo hepatocarcinogenesis occurred in nine patients (13.4%). Factors associated with multistep hepatocarcinogenesis were male gender and Non-DAA group.. The eradication of HCV by DAA therapy reduces multistep hepatocarcinogenesis.

Topics: Aged; alpha-Fetoproteins; Antiviral Agents; Bilirubin; Carcinoma, Hepatocellular; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Hepatitis C; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Serum Albumin; Sex Characteristics; Sustained Virologic Response

To investigate the imaging features observed in preoperative Gd-EOB-DTPA-dynamic enhanced MRI and correlated with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients.. 66 HCCs in 60 patients with preoperative Gd-EOB-DTPA-dynamic enhanced MRI were retrospectively analyzed. Features including tumor size, signal homogeneity, tumor capsule, tumor margin, peritumor enhancement during mid-arterial phase, peritumor hypointensity during hepatobiliary phase, signal intensity ratio on DWI and apparent diffusion coefficients (ADC), T1 relaxation times, and the reduction rate between pre- and postcontrast enhancement images were assessed. Correlation between these features and histopathological presence of MVI was analyzed to establish a prediction model.. Histopathology confirmed that MVI were observed in 17 of 66 HCCs. Univariate analysis showed tumor size (. Large tumor size, irregular tumor margin, and peritumor enhancement in preoperative Gd-EOB-DTPA-dynamic enhanced MRI can predict the presence of MVI in HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neovascularization, Pathologic; Retrospective Studies

This study aimed to evaluate the accuracy of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) in predicting eligibility for liver transplantation in patients with hepatocellular carcinoma (HCC) based on Milan criteria (MC).. We reviewed Gd-EOB-MRI of 44 patients who underwent liver transplantation for HCC with cirrhosis for the presence/size of HCCs, vascular invasion, and transplant eligibility based on MC. Hepatocellular carcinoma was diagnosed based on conventional radiological hallmarks (arterial enhancement and washout) or the modified criteria.. Among 44 patients, 16 was beyond MC. Sensitivity, specificity, and accuracy of conventional radiological hallmark and the modified criteria for predicting eligibility by MC were 31.3%, 96.3%, and 72.7%, and 68.8%, 96.3%, and 86.4%, respectively.. Gd-EOB-MRI showed high specificity but poor sensitivity for assessing transplant eligibility based on MC when adopting the conventional radiological hallmarks of HCC. Our modified criteria showed significantly better sensitivity and accuracy than the conventional radiological hallmarks.

Topics: Carcinoma, Hepatocellular; Contrast Media; Eligibility Determination; Female; Gadolinium DTPA; Guideline Adherence; Humans; Image Enhancement; Internationality; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Patient Selection; Practice Guidelines as Topic; Reproducibility of Results; Sensitivity and Specificity

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has an important role in preoperative evaluation of hepatocellular carcinoma (HCC). However, no studies have prospectively performed intraindividual comparison of gadoxetic acid-enhanced 3T MRI and multidetector-row computed tomography (MDCT) with histopathological examination for the detection of HCCs. We prospectively compared the efficacies of gadoxetic acid-enhanced MRI and multiphasic contrast-enhanced MDCT with that of histopathological examination, used as a reference standard, for the detection of HCC in surgical candidates.. The study was approved by the institutional review boards at each of four centers. Patients scheduled to undergo multiphasic CT, gadoxetic acid-enhanced MRI, and liver surgery were prospectively included in this study. The diagnostic abilities of MRI and CT were evaluated and compared on the basis of sensitivity and positive predictive value for detection of and differentiation between HCCs and benign lesions.. Fifty-four patients with 83 histopathologically confirmed HCCs were included in the study. Combined interpretation of the dynamic and hepatobiliary phases of gadoxetic acid-enhanced MRI showed statistically higher sensitivity for lesion detection (83 %) than did interpretation of multiphasic MDCT images (70 %; p < 0.001). The mean area under each alternative free-response receiver operating characteristics curve was significantly higher for MR images (0.927) than for CT images (0.864, p < 0.01).. The sensitivity for preoperative detection of HCCs was higher for gadoxetic acid-enhanced MRI than for multiphasic MDCT imaging.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnostic Errors; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Predictive Value of Tests; Sensitivity and Specificity

To clarify the detectability of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI at 3 T with dual-source parallel radiofrequency (RF) excitation.. Twelve patients with 26 HCCs who each underwent multidetector row CT (MDCT), gadoxetic acid-enhanced MRI with dual-source parallel RF excitation, and angiography-assisted CT prior to living related-liver transplantation. Three blinded readers independently reviewed the images obtained by each imaging technique for the presence of HCC on a segment-by-segment basis using a five-point confidence scale. The area under the receiver operating characteristic curve (Az), sensitivity, and specificity were compared among the three techniques.. The Az values of gadoxetic acid-enhanced MRI were highest for all readers, although no significant difference in Az value among the three methods was obtained. No significant differences in sensitivity or specificity were observed among the three techniques for each reader.. Gadoxetic acid-enhanced MRI at 3 T with dual-source parallel RF excitation has relatively high-level diagnostic potential for the detection of HCC in patients with severe liver dysfunction, which was equivalent to that of MDCT and angiography-assisted CT. Dual-source parallel RF excitation would have a clinical impact on 3 T MRI of the liver.

Topics: Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed

To compare the utility of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA), a liver-specific magnetic resonance (MR) imaging contrast agent, versus gadobutrol for treatment response evaluation of hepatocellular carcinoma (HCC) after radioembolization.. This prospective study included 50 patients with HCC undergoing radioembolization. All patients underwent contrast-enhanced computed tomography (CT) and MR imaging with gadobutrol and Gd-EOB-DTPA on 2 consecutive days before radioembolization and 30 days, 90 days, 180 days, and 270 days after radioembolization. The standard of reference indicating tumor progression was CT combined with either α-fetoprotein or γ-glutamyltransferase. Gadobutrol-enhanced MR imaging, Gd-EOB-DTPA-enhanced MR imaging without late phase imaging (Gd-EOB-DTPA-), and Gd-EOB-DTPA-enhanced MR imaging with late phase imaging (Gd-EOB-DTPA+) were evaluated by 2 radiologists in consensus using a 4-point scale: 1 = definitely no tumor progression; 2 = probably no tumor progression; 3 = probably tumor progression; 4 = definitely tumor progression. Diagnostic accuracy was assessed with receiver operating characteristic analysis.. Tumor progression was detected in 14 of 82 study visits according to the reference standard. Pairwise comparison of the area under the curve showed a tendency toward a larger area under the curve for Gd-EOB-DTPA+ compared with gadobutrol (P = .056). Sensitivity and specificity were higher in Gd-EOB-DTPA+ (0.929 and 0.971) than in Gd-EOB-DTPA- (0.786 and 0.941) or gadobutrol (0.643 and 0.956). In 2 cases, tumor progression was detected by Gd-EOB-DTPA+ and by an increase in α-fetoprotein, but not by CT, gadobutrol, or Gd-EOB-DTPA-.. Gd-EOB-DTPA+ MR imaging was not inferior to gadobutrol-enhanced MR imaging in therapy response evaluation after radioembolization and may allow a more accurate detection of early HCC recurrence in single cases.

Topics: Aged; Aged, 80 and over; alpha-Fetoproteins; Area Under Curve; Carcinoma, Hepatocellular; Contrast Media; Embolization, Therapeutic; Female; Gadolinium DTPA; gamma-Glutamyltransferase; Germany; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Organometallic Compounds; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; ROC Curve; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

To determine MR-imaging features for the differentiation between hepatocellular carcinoma (HCC) and benign hepatocellular tumors in the non-cirrhotic liver.. 107 consecutive patients without liver cirrhosis (46 male; 45 ± 14 years) who underwent liver resection due to suspicion of HCC were included in this multi-center study. The following imaging features were assessed: lesion diameter and demarcation, satellite-lesions, central-scar, capsule, fat-content, hemorrhage, vein-infiltration and signal-intensity (SI) on native T1-, T2- and dynamic-enhanced T1-weighted images (center versus periphery). In addition, contrast-media (CM) uptake in the liver specific phase was analyzed in a sub-group of 42 patients.. Significant differences between HCC (n=55) and benign lesions (n=52) were shown for native T1-, T2- and dynamic-enhanced T1-SI, fat-content, and satellite-lesions (all, P<.05). Independent predictors for HCC were T1-hypointensity (odds-ratio, 4.81), T2-hypo-/hyperintensity (5.07), lack of central tumor-enhancement (3.36), and satellite-lesions (5.78; all P<0.05). Sensitivity and specificity of HCC was 91% and 75% respectively for two out-of four independent predictors, whereas specificity reached 98% for all four predictors. Sub-analysis, showed significant differences in liver specific CM uptake between HCC (n=18) and benign lesions (n=24; P<0.001) and revealed lack of liver specific CM uptake (odds-ratio, 2.7) as additional independent feature for diagnosis of HCC.. Independent MRI features indicating HCC are T1-hypointensity, T2-hypo- or hyperintensity, lack of central tumor-enhancement, presence of satellite-lesions and lack of liver specific CM-uptake. These features may have the potential to improve the diagnosis of HCC in the non-cirrhotic liver.

Topics: Adenoma, Liver Cell; Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Hepatitis C; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

The survival of patients with hepatocellular carcinoma (HCC) is often individually different even after surgery for early-stage tumors. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) has been introduced recently to evaluate hepatic lesions with regard to vascularity and the activity of the organic anion transporter OATP1B3. Here we report that Gd-EOB-DTPA-enhanced MRI (EOB-MRI) in combination with serum alpha-fetoprotein (AFP) status reflects the stem/maturational status of HCC with distinct biology and prognostic information. Gd-EOB-DTPA uptake in the hepatobiliary phase was observed in ∼15% of HCCs. This uptake correlated with low serum AFP levels, maintenance of hepatocyte function with the up-regulation of OATP1B3 and HNF4A expression, and good prognosis. By contrast, HCC showing reduced Gd-EOB-DTPA uptake with high serum AFP levels was associated with poor prognosis and the activation of the oncogene FOXM1. Knockdown of HNF4A in HCC cells showing Gd-EOB-DTPA uptake resulted in the increased expression of AFP and FOXM1 and the loss of OATP1B3 expression accompanied by morphological changes, enhanced tumorigenesis, and loss of Gd-EOB-DTPA uptake in vivo. HCC classification based on EOB-MRI and serum AFP levels predicted overall survival in a single-institution cohort (n=70), and its prognostic utility was validated independently in a multi-institution cohort of early-stage HCCs (n=109).. This noninvasive classification system is molecularly based on the stem/maturation status of HCCs and can be incorporated into current staging practices to improve management algorithms, especially in the early stage of disease.

Topics: Aged; alpha-Fetoproteins; Animals; Carcinoma, Hepatocellular; Cohort Studies; Female; Gadolinium DTPA; Hepatocyte Nuclear Factor 4; Humans; Japan; Liver; Liver Neoplasms; Male; Mice, Inbred NOD; Mice, SCID; Middle Aged; Organic Anion Transporters, Sodium-Independent; Prognosis; Solute Carrier Organic Anion Transporter Family Member 1B3

To compare the fixed-time- and the test-injection method with respect to the image quality of hypervascular hepatocellular carcinoma (HCC) and the adequacy of timing of the hepatic arterial phase (HAP) in Gd-EOB-DTPA (EOB) enhanced MRI.. We studied 63 patients with computed tomography (CT) -proven hypervascular HCC: 30 (group 1) were scanned HAP using the fixed-time delay method (protocol 1); in the other 33 (group 2), we applied the test-injection method (protocol 2). We compared the protocols with respect with tumor-to-liver contrast (TLC), contrast-to-noise-ratio (CNR), and relative enhancement of the liver and tumor (REL , RET ) during HAP. Two radiologists compared the adequacy of HAP, image contrast, image noise, and overall image quality.. Under protocol 2, TLC, CNR, and REL and RET of hypervascular HCC were significantly higher (P < 0.01). The proportion of optimal HAP was significantly higher for protocol 2 than protocol 1 (P < 0.01). The visual score of the image contrast and the overall image quality were significantly higher in group 2 than group 1 (P = 0.02 and P = 0.01, respectively).. At EOB-enhanced hepatic dynamic MRI, the test-injection method yielded better image quality of hypervascular HCC and improved adequacy of timing of HAP.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Injections, Intra-Arterial; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Reproducibility of Results; Sensitivity and Specificity

To determine the relative wash-out of hepatocellular carcinomas and dysplastic nodules using Kupffer-phase sonography with Sonazoid (Daiichi-Sankyo, Tokyo, Japan) enhancement and hepatobiliary-phase gadoxetic acid-enhanced magnetic resonance imaging (MRI) in the evaluation of the histopathologic grades of individual nodules.. This retrospective study included 66 consecutive patients with 78 histologically confirmed hepatocellular carcinomas and dysplastic nodules. In patients with carcinomas, 33 were well differentiated; 29 were moderately differentiated; and 11 were poorly differentiated; and there were 5 dysplastic nodules. All patients underwent both gadoxetic acid-enhanced MRI and Sonazoid-enhanced sonography. The interval between the two imaging examinations was less than 30 days. Six radiologists independently reviewed both images and rated the degree of relative wash-out between the tumorous and nontumorous areas on Kupffer- and hepatobiliary-phase images using a continuous rating scale. We compared these results with the histopathologic grade of each nodule, and the results were then analyzed with multireader multicase receiver operating characteristic analysis.. The average Kupffer-phase (P < .001) and hepatobiliary-phase (P = .004) rating scores increased as the carcinomas became less differentiated (Kruskal-Wallis test). The diagnostic accuracies of the average area under the receiver operating characteristic curve, which were estimated using the confidence levels of the relative wash-out of the Kupffer- and hepatobiliary-phase images, were 0.705 and 0.785 for dysplastic nodules versus well-, moderately, and poorly differentiated carcinomas (P = .517), 0.791 and 0.687 for dysplastic nodules and well-differentiated carcinomas versus moderately and poorly differentiated carcinomas (P = .093), and 0.871 and 0.716 for dysplastic nodules and well-and moderately differentiated carcinomas versus poorly differentiated carcinomas (P = .005), respectively.. Kupffer-phase Sonazoid-enhanced sonography and hepatobiliary-phase gadoxetic acid-enhanced MRI may be useful in estimating the histologic grade, although Kupffer-phase Sonazoid-enhanced sonography may be more accurate in distinguishing hepatocellular carcinomas, especially moderately and poorly differentiated types.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Ferric Compounds; Gadolinium DTPA; Humans; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Male; Oxides; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography

To prospectively evaluate the safety and efficacy of combined unenhanced and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging compared with unenhanced MR imaging and triphasic contrast-enhanced spiral computed tomography (CT) for the detection and characterization of focal liver lesions.. The study was reviewed and approved by the institutional review board at each of the 15 centers involved in the study, and informed written consent was given by all patients. In total, 178 patients with suspected focal hepatic lesions (based, in most patients, on CT, tumor marker and ultrasound examinations) underwent combined MR imaging with a single, rapid injection of Gd-EOB-DTPA 0.025 mmol/kg, including T1-weighted dynamic and delayed MR images 20 to 40 minutes postinjection. Triphasic contrast-enhanced CT, the comparator examination, was performed within 4 weeks of MR imaging. Standard of references (SOR) were resection histopathology and intraoperative ultrasonography, or combined CT during arterial portography and CT hepatic arteriography; in cases where, although the major lesions were treated, some lesion(s) were not treated, follow-up superparamagnetic iron oxide-enhanced MR imaging was additionally performed. All images were assessed for differences in lesion detection and characterization (specific lesion type) by on-site readers and 3, blinded (off-site) reviewers. All adverse events (AEs) occurring within 72 hours after Gd-EOB-DTPA administration were reported.. Overall, 9.6% of patients who received Gd-EOB-DTPA reported 21 drug-related AEs. A total of 151 patients were included in the efficacy analysis. Combined MR imaging showed statistically higher sensitivity in lesion detection (67.5%-79.5%) than unenhanced MR imaging (46.5%-59.1%; P < 0.05 for all). Combined MR imaging also showed higher sensitivity in lesion detection than CT (61.1%-73.0%), with the results being statistically significant (P < 0.05) for on-site readers and 2 of 3 blinded readers. Higher sensitivity in lesion detection with combined MR imaging compared with CT was also clearly demonstrated in the following subgroups: lesions with a diameter

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Dextrans; Female; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Image Enhancement; Japan; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged; Prospective Studies; Tomography, Spiral Computed

To assess the diagnostic value of gadoxetic acid-enhanced magnetic resonance (MR) imaging in follow-up of patients with hepatocellular carcinomas (HCCs) who were treated with radiofrequency (RF) ablation and to compare it with that of four-phase multi-detector row computed tomography (CT).. From July 2007 to May 2008, 36 patients (43 HCCs) were enrolled who were treated with RF ablation (tumor size, 20-47 mm; mean, 24.5 mm) and underwent gadoxetic acid-enhanced MR imaging and four-phase (precontrast, arterial, portal venous, and equilibrium) multidetector CT for follow-up. Two radiologists independently reviewed these images, and conspicuity of tumor margins and detection of residual or recurrent tumor were assessed on a five-point scale with receiver operating characteristic (ROC) curve analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated.. The mean conspicuity value of tumor margins was significantly higher on MR imaging than on multidetector CT (P < .001). The degree of differentiation between residual/recurrent tumor and hyperemia was significantly greater on MR imaging (P < .001). The mean area under the ROC curve was significantly higher with MR imaging (P = .015), as were sensitivity, specificity, PPV, NPV, and accuracy of detection rate (mean, 100%, 96.2%, 82.4%, 100%, and 96.7%, respectively, vs 41.7%, 56.8%, 13.5%, 85.7%, and 54.7% for multidetector CT). The interobserver agreement rate for MR imaging was higher (0.919) than for multidetector CT (0.672; P < .05).. Diagnostic accuracy, conspicuity of tumor margins, and detection rate of residual or recurrent tumor were found to be better with gadoxetic acid-enhanced MR imaging than with four-phase multidetector CT.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; Treatment Outcome

The objective of our study was to prospectively evaluate quantitatively and qualitatively the enhancement patterns of cirrhotic liver tissue and hepatocellular carcinoma (HCC) after administration of the hepatocyte-specific contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) on dynamic MRI and to determine the time point of maximum liver-to-lesion contrast.. Twenty-five patients with HCC in liver cirrhosis underwent 1.5-T MRI. T2-weighted turbo spin-echo and T1-weighted 3D gradient-echo sequences before and between 15 seconds and 20 minutes after the injection of 10 mL of Gd-EOB-DTPA were performed. Signal-to-noise ratios (SNRs) of liver parenchyma and liver-to-lesion contrast-to-noise ratios (CNRs) were calculated and plotted over time. Enhancement patterns of HCC were characterized qualitatively by two radiologists.. The SNR of liver parenchyma increased significantly at 15 seconds and 60 seconds after contrast injection and remained stable thereafter. HCC showed positive CNR during the arterial phase and increasingly negative CNR during the further time course (p < 0.05). The maximum absolute CNR was found at 20 minutes after contrast injection. There was no correlation between the degree of enhancement at any time point and tumor grade. On qualitative evaluation, 16 HCCs showed arterial enhancement with early washout, and five showed arterial enhancement with late washout. In the remaining four HCCs, enhancement persisted until 20 minutes. Lesion conspicuity at 20 minutes after contrast injection was at least equal to or higher than it was on the remaining sequences in 19 of the 25 patients.. After Gd-EOB-DTPA injection, most HCCs showed typical arterial enhancement with early washout. Liver-to-lesion contrast was best at 20 minutes.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To evaluate the ability of contrast-enhanced magnetic resonance imaging (MRI) with Gd-EOB-DTPA in comparison with non-enhanced imaging and spiral computed tomography (CT) to provide additional information for classification and characterization of hepatocellular carcinoma.. Forty patients with histopathology-proven hepatocellular carcinoma were selected for this subgroup analysis from a phase-III multicenter study in 235 patients with known or suspected liver lesions. The primary analysis was comparison of the proportion of hepatocellular carcinoma correctly classified and characterized by combined pre-/post-contrast MRI compared with pre-contrast MRI alone or with spiral CT. All images were evaluated on site, and in a blinded reading by three independent readers off site.. In the on-site evaluation, the lesions were correctly classified as a malignant tumor with combined MRI in 90.3%, with pre-contrast imaging alone in 82.9% and with spiral CT in 87.8% (n.s.). The proportion of correct characterization (lesion type diagnosis) with combined MRI was 85.4%, 75.6% for pre-contrast imaging, and 77.5% for spiral CT (n.s.), respectively. In the blinded reading, one reader showed a significant increase in the proportion of correctly characterized lesions by 27% (P<0.05). The other two readers showed a reduction in the proportion of correct characterization by 12% and 15%, respectively (n.s.).. With regard to lesion classification, no difference was found between combined pre-/post-contrast MRI and spiral CT. A non-significant trend in favor of Gd-EOB-DTPA-enhanced MRI with regard to characterization of hepatocellular carcinoma was found, although the CT scans were not optimized as the MRI scans.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Europe; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Prospective Studies; Reproducibility of Results; Tomography, Spiral Computed

The purpose of this study was to evaluate the utility of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the quantitative evaluation of hepatocellular carcinoma (HCC) and dysplastic nodules in the hepatobiliary phase.. The subjects comprised 12 patients with 27 lesions (22 HCCs and 5 dysplastic nodules). Chemical-shift-selective fat-suppressed T1-weighted sequences were obtained before and 10, 20, and 40 min after the injection of Gd-EOB-DTPA. Quantitative analyses were performed with the enhancement ratio of the lesion and the contrast-to-noise (C/N) ratio.. The enhancement ratios of the HCCs were 44.0+/-36.5, 44.7+/-46.8, and 47.7+/-52.8 (%) at 10, 20, and 40 min, respectively, after the injection of Gd-EOB-DTPA. The enhancement ratios of the dysplastic nodules were 36.2+/-34.3, 44.3+/-37.3, and 40.1+/-46.8 (%). The C/N ratios of the HCCs were 0.2+/-6.6 for the precontrast image, and -9.2+/-12.6, -9.9+/-14.8, and -12.7+/-15.7 at 10, 20, and 40 min, respectively, after the injection of Gd-EOB-DTPA. The C/N ratios of the dysplastic nodules were 1.4+/-8.0, -13.7+/-11.1, -13.3+/-7.6, and -13.1+/-10.4. No significant differences were found between the HCCs and the dysplastic nodules in the enhancement ratio and the C/N ratio. Only two HCCs showed a positive C/N ratio value, and these HCCs were pathologically confirmed to be a well differentiated and a moderately differentiated carcinoma, respectively.. HCCs and some of the dysplastic nodules showed hypointensity in the hepatobiliary phase in Gd-EOB-DTPA-enhanced MRI. No specific enhancement was observed, regardless of tumor differentiation.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Double-Blind Method; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies

Our objective was to study Gd-EOB-DTPA for the characterization of focal liver lesions by means of dynamic MR imaging. A double-blind and randomized dose-ranging phase-2 clinical trial was performed in 31 patients (liver metastases n = 23, hepatocellular carcinoma n = 4, and hemangioma n = 4) at a field strength of 1.0 Tesla. Gd-EOB-DTPA (Schering AG, Berlin, Germany) was administered as an IV bolus (12.5, 25, or 50 micromol/kg body weight) with dynamic T1-weighted MRI during the distribution and cellular uptake of the contrast agent at multiple time points up to 45 min post contrast. Dynamic changes in tumor signal intensity, tumor-liver contrast, enhancement patterns, side effects, and adverse events were evaluated. Monitoring of vital signs revealed no significant changes during bolus injection of Gd-EOB-DTPA. Liver metastases demonstrated an inhomogeneous uptake of Gd-EOB-DTPA during the distribution phase with a washout effect on delayed images > 3 min and highest tumor-liver contrast 20 and 45 min post contrast. Hepatocellular carcinomas showed prolonged enhancement as compared with metastases and hemangiomas. Hemangiomas exhibited an early peripheral-nodular enhancement with subsequent partial or complete filling, persisting enhancement < 10 min following injection of Gd-EOB-DTPA, and delayed washout as compared with liver metastases. Initial clinical experience suggests that Gd-EOB-DTPA as a bolus injectable hepatobiliary MR contrast agent may offer useful features for the characterization of focal liver lesions.

Topics: Carcinoma, Hepatocellular; Contrast Media; Double-Blind Method; Female; Gadolinium; Gadolinium DTPA; Hemangioma; Humans; Injections, Intravenous; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Pentetic Acid

To compare the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) and gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) in the diagnosis of focal liver lesions.. Thirty-one patients with focal liver lesions underwent T2- and T1-weighted spin-echo magnetic resonance (MR) imaging and fast low-angle shot two-dimensional MR imaging before, during, and after intravenous administration of three different doses of Gd-EOB-DTPA (12.5, 25, and 50 mumol per kilogram body weight). Gd-DTPA-enhanced imaging (dose, 0.1 mmol per kilogram body weight) was performed in the same patients within 1 week of Gd-EOB-DTPA imaging.. During the perfusion phase (the 3 minutes after injection of contrast material), the dynamic enhancement characteristics seen after injection of 25 and 50 mumol of Gd-EOB-DTPA were similar to those seen with Gd-DTPA. At the lowest dose of Gd-EOB-DTPA (12.5 mumol), the dynamic enhancement characteristics were not comparable to those seen with Gd-DTPA. During the hepatobiliary phase (1.5 minutes to 4 hours after injection), Gd-EOB-DTPA-enhanced images yielded a dose-independent, statistically significant improvement in the detection rate of additional metastases, hepatocellular carcinomas, and hemangiomas compared with unenhanced and Gd-DTPA-enhanced images (P < .05).. Gd-EOB-DTPA-enhanced MR imaging enables improved detection of hepatic lesions over Gd-DTPA-enhanced MR imaging while providing comparable differential diagnostic information.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Double-Blind Method; Female; Gadolinium; Gadolinium DTPA; Hemangioma; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Pentetic Acid; Prospective Studies

To investigate the impact of preoperative gadoxetate disodium (EOB) MRI-based radiomics on predicting glypican 3 (GPC3)-positive expression and the relevant recurrence-free survival (RFS) of HCC ≤ 5 cm.. Between January 2014 and October 2018, 259 patients with solitary HCC ≤ 5 cm who underwent hepatectomy and preoperative EOB-MRI were retrieved. Multivariate logistic regression was implemented to identify independent predictors for GPC3. By combining five feature selection strategies and three classifiers, 15 GPC3-oriented radiomics models could be constructed, the best of which with independent clinicoradiologic predictors was integrated into the comprehensive nomogram.. GPC3 was an independent risk factor of postoperative recrudescence for HCC. Alpha-fetoprotein >20 ng/mL, homogenous T2 signal and hypointensity on hepatobiliary phase were independently related to GPC3-positive expression in the clinicoradiologic model. With 10 features selected by support vector machines-recursive feature elimination, logistic regression-based classifier achieved the best performance among 15 radiomics models. After five-fold cross-validation, our comprehensive nomogram acquired better average area under receiver operating characteristic curves (training and validation cohorts: 0.931 vs. 0.943) than the clinicoradiologic algorithm (0.738 vs. 0.739) and the optimal radiomics model (0.943 vs. 0.931). Net reclassification indexes further demonstrated the superiority of GPC3 nomogram over clinicoradiologic and radiomics algorithms (46.54%, p < 0.001; 7.84%, p = 0.207). Meanwhile, higher radiomics score significantly shortened the median RFS (from >77.9 to 48.2 months, p = 0.044), which was analogue to that of the histological GPC3-positive phenotype (from >73.9 to 43.2 months, p < 0.001).. Preoperative EOB-MRI radiomics-based nomogram satisfactorily distinguished GPC3 status and outcomes of solitary HCC ≤ 5 cm.

Topics: Carcinoma, Hepatocellular; Contrast Media; Glypicans; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

The visualization score of hepatobiliary-phase (HBP) images has been introduced as an image quality index for gadoxetic acid-enhanced MRI. It may be associated with hepatic function and could have an implication on the diagnostic accuracy for hepatocellular carcinoma (HCC).. To investigate the association between the visualization score of gadoxetic acid-enhanced MRI and clinical factors and to evaluate its effect on the diagnostic accuracy for HCC ≤ 3.0 cm.. Retrospective.. A total of 493 focal lesions from 397 patients.. A 5-T or 3.0 -T with pre/postcontrast T1-weighted 3D gradient echo sequence, and T2-weighted fast spin-echo sequence ASSESSMENT: Child-Pugh classification and albumin-bilirubin (ALBI) score were assessed. Three readers evaluated the visualization score of each MRI examination (A, no or minimal; B, moderate; and C, severe limitations), and major features (arterial-phase hyperenhancement, washout, enhancing capsule, threshold growth) and ancillary features of each focal lesion.. Univariable and multivariable logistic regression analyses were performed to determine significant clinical factors associated with a suboptimal visualization score (B or C). Generalized estimating equations were used to compare the sensitivity and specificity for diagnosing HCC between the two group (visualization score A vs. B or C). A P value < 0.05 was considered statistically significant.. Of the 397 MRI examinations, the incidence of suboptimal visualization score was 13%. A suboptimal visualization score was significantly associated with Child-Pugh classification B or C (adjusted odds ratio [OR] = 15.2) and ALBI grade 2 or 3 (OR = 4.7). Compared with the visualization score A group, the suboptimal visualization score group showed significantly lower sensitivity (56.8% vs. 75.2%) and less frequent washout in HCC (62.2% vs. 84.0%).. The visualization score on gadoxetic acid-enhanced MRI can be an important image quality index and the diagnostic accuracy for HCC ≤ 3.0 cm may not be sufficient in the suboptimal visualization score group.. 3 TECHNICAL EFFICACY STAGE: 3.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Retrospective Studies; Sensitivity and Specificity

The aim of this study was to compare compressed sensing (CS) and view sharing (VS) techniques for single breath-hold multiarterial phase imaging with respect to image quality and focal liver observation detectability during gadoxetic acid-enhanced magnetic resonance imaging in patients at high risk for hepatocellular carcinoma (HCC).. A total of 385 patients who underwent gadoxetic acid-enhanced magnetic resonance imaging, including triple arterial phases using either CS (n = 224) or VS (n = 161) techniques, were retrospectively included. Among them, 117 patients had 171 focal liver observations (median diameter, 1.3 cm), which were classified according to Liver Imaging Reporting and Data System version 2018. The acquisition rate of optimally timed late arterial phase (LAP) was assessed, and image quality, including respiratory motion artifact and observation conspicuity, was rated on a 4-point scale by 3 radiologists. The Mann-Whitney U test and nonparametric test for repeated measures data were used for image quality and observation conspicuity analysis. The jackknife alternative free-response receiver operating characteristics method was used to compare the observation detectability between the 2 techniques.. The CS technique showed significantly higher acquisition rate of optimally timed LAP without transient severe motion (82.1% [184/224] vs 71.4% [115/161]; P = 0.013) than the VS technique. The CS technique also demonstrated significantly improved overall image quality (3.42 ± 0.70 vs 2.97 ± 0.61; P < 0.001) compared with the VS technique. Regarding the detection of hyperenhancing observations, there was no significant difference between the figure of merits of CS and VS techniques (0.660 vs 0.665; P = 0.890). However, the CS technique showed a higher detection rate in Liver Imaging Reporting and Data System M (LR-M, probably or definitely malignant but not HCC specific) observations than the VS technique (100.0% [9/9] vs 44.4% [8/18]; P = 0.009).. The CS technique tended to provide optimally timed LAP without transient severe motion and demonstrated greater detection rate of LR-M observations than the VS technique in patients at high risk of HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To investigate the imaging findings of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) on CT and MRI, and examine their diagnostic performance and prognostic significance.. We retrospectively enrolled 220 consecutive patients who underwent hepatic resection between June 2009 and December 2013 for single treatment-naïve HCC, who have preoperative CT and gadoxetic acid-enhanced MRI. Independent reviews of histopathology and imaging were performed by two reviewers. Previously reported imaging findings, LI-RADS category, and CT attenuation of MTM-HCC were investigated. The diagnostic performance of the MTM-HCC diagnostic criteria was compared across imaging modalities.. MTM-HCC was associated with ≥ 50% arterial phase hypovascular component, intratumoral artery, arterial phase peritumoral enhancement, and non-smooth tumor margin on CT and MRI (p < .05). Arterial phase hypovascular components were less commonly observed on MRI subtraction images than on CT or MRI, while non-rim arterial phase hyperenhancement and LR-5 were more commonly observed on MRI subtraction images than on MRI (p < .05). MTM-HCC showed lower tumor attenuation in the CT arterial phase (p = .01). Rhee's criteria, defined as ≥ 50% hypovascular component and ≥ 2 ancillary findings (intratumoral artery, arterial phase peritumoral enhancement, and non-smooth tumor margin), showed similar diagnostic performance for MRI (sensitivity, 41%; specificity, 97%) and CT (sensitivity, 31%; specificity, 94%). Rhee's criteria on CT were independent prognostic factors for overall survival.. The MRI diagnostic criteria for MTM-HCC are applicable on CT, showing similar diagnostic performance and prognostic significance. For MTM-HCC, arterial phase subtraction images can aid in the HCC diagnosis by depicting subtle arterial hypervascularity.. • MTM-HCC on CT demonstrated previously described MRI findings, including arterial phase hypovascular component, intratumoral artery, arterial phase peritumoral enhancement, and necrosis. • The MRI diagnostic criteria for MTM-HCC were also applicable to CT, showing comparable diagnostic performance and prognostic significance. • On arterial phase subtraction imaging, MTM-HCC more frequently demonstrated non-rim enhancement and LR-5 and less frequently LR-M than MRI arterial phase, which may aid in the diagnosis of HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To develop a radiomics-based hepatocellular carcinoma (HCC) grade classifier model based on data from gadoxetic acid-enhanced MRI.. This retrospective study included 137 patients who underwent hepatectomy for a single HCC and gadoxetic acid-enhanced MRI within 60 days before surgery. HCC grade was categorized as low or high (modified Edmondson-Steiner grade I-II vs. III-IV). We used the hepatobiliary phase (HBP), portal venous phase, T2-weighted image(T2WI), and T1-weighted image(T1WI). From the volume of interest in HCC, 833 radiomic features were extracted. Radiomic and clinical features were selected using a random forest regressor, and the classification model was trained and validated using a random forest classifier and tenfold stratified cross-validation. Eight models were developed using the radiomic features alone or by combining the radiomic and clinical features. Models were validated with internal enrolled data (internal validation) and a dataset (28 patients) at a separate institution (external validation). The area under the curve (AUC) of the validation results was compared using the DeLong test.. In internal and external validation, the HBP radiomics-only model showed the highest AUC (internal 0.80 ± 0.09, external 0.70 ± 0.09). In external validation, all models showed lower AUC than those for internal validation, while the T2WI and T1WI models failed to predict the HCC grade (AUC 0.30-0.58) in contrast to the internal validation results (AUC 0.67-0.78).. The radiomics-based machine learning model from gadoxetic acid-enhanced liver MRI could distinguish between low- and high-grade HCCs. The radiomics-only HBP model showed the best AUC among the eight models, good performance in internal validation, and fair performance in external validation.

Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Machine Learning; Magnetic Resonance Imaging; Retrospective Studies

Topics: Adenoma, Liver Cell; Adult; beta Catenin; Carcinoma, Hepatocellular; Contrast Media; Female; Hedgehog Proteins; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

To investigate direct radiation dose-related and inflammation-mediated regional hepatic function losses after stereotactic body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC) and poor liver function.. Twenty-four patients with HCC enrolled on an IRB-approved adaptive SBRT trial had liver dynamic gadoxetic acid-enhanced magnetic resonance imaging and blood sample collections before and 1 month after SBRT. Gadoxetic acid uptake rate (k1) maps were quantified for regional hepatic function and coregistered to both 2-Gy equivalent dose and physical dose distributions. Regional k1 loss patterns from before to after SBRT were analyzed for effects of dose and patient using a mixed-effects model and logistic function and were associated with pretherapy liver-function albumin-bilirubin scores. Plasma levels of tumor necrosis factor α receptor 1 (TNFR1), an inflammation marker, were correlated with mean k1 losses in the lowest dose regions by Spearman rank correlation.. The whole group had a k1 loss rate of 0.4%/Gy (2-Gy equivalent dose); however, there was a significant random effect of patient in the mixed-effect model (P < .05). Patients with poor and good liver functions lost 50% of k1 values at 12.5 and 57.2 Gy and 33% and 16% of k1 values at the lowest dose regions (<5 Gy), respectively. The k1 losses at the lowest dose regions of individual patients were significantly correlated with their TNFR1 levels after SBRT (P < .02).. The findings suggest that regional hepatic function losses after SBRT in patients with HCC include both direct radiation dose-dependent and inflammation-mediated effects, which could influence how to manage these patients to preserve their liver function after SBRT.

Topics: Carcinoma, Hepatocellular; Humans; Inflammation; Liver Neoplasms; Radiosurgery; Receptors, Tumor Necrosis Factor, Type I; Retrospective Studies

Topics: Adenoma, Liver Cell; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Vessels encapsulating tumor clusters (VETC) pattern is a novel microvascular pattern associated with poor outcomes of hepatocellular carcinoma (HCC). Preoperative estimation of VETC has potential to improve treatment decisions.. To develop and validate a nomogram based on gadoxetate disodium-enhanced MRI for estimating VETC in HCC and to evaluate whether the estimations are associated with recurrence after hepatic resection.. Retrospective.. A total of 320 patients with HCC and histopathologic VETC pattern assessment from three centers (development cohort:validation cohort = 173:147).. A3.0  T/turbo spin-echo T2-weighted, spin-echo echo-planar diffusion-weighted, and 3D T1-weighted gradient-echo sequences.. A set of previously reported VETC- and/or prognosis-correlated qualitative and quantitative imaging features were assessed. Clinical and imaging variables were compared based on histopathologic VETC status to investigate factors indicating VETC pattern. A regression-based nomogram was then constructed using the significant factors for VETC pattern. The nomogram-estimated VETC stratification was assessed for its association with recurrence.. Fisher exact test, t-test or Mann-Whitney test, logistic regression analyses, Harrell's concordance index (C-index), nomogram, Kaplan-Meier curves and log-rank tests. P value < 0.05 was considered statistically significant.. Pathological VETC pattern presence was identified in 156 patients (development cohort:validation cohort = 83:73). Tumor size, presence of heterogeneous enhancement with septations or with irregular ring-like structures, and necrosis were significant factors for estimating VETC pattern. The nomogram incorporating these indicators showed good discrimination with a C-index of 0.870 (development cohort) and 0.862 (validation cohort). Significant differences in recurrence rates between the nomogram-estimated high-risk VETC group and low-risk VETC group were found (2-year recurrence rates, 50.7% vs. 30.3% and 49.6% vs. 31.8% in the development and validation cohorts, respectively).. The nomogram integrating gadoxetate disodium-enhanced MRI features was associated with VETC pattern preoperatively and with postoperative recurrence in patients with HCC.. 4 TECHNICAL EFFICACY: Stage 2.

Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

Multiple arterial-phase magnetic resonance imaging (MA-MRI) was introduced to overcome the limitations of gadoxetic acid-enhanced MRI, but its clinical impacts on hepatocellular carcinoma (HCC) diagnosis have not been well assessed. We investigated whether MA-MRI with gadoxetic acid could improve the diagnosis of HCC ≤3.0 cm in comparison with single arterial-phase MRI (SA-MRI).. This retrospective study included 397 patients from two tertiary institutions who underwent gadoxetic acid-enhanced MRI (243 patients with 271 lesions in cohort-1 underwent SA-MRI, and 154 patients with 166 lesions in cohort-2 underwent MA-MRI). The patients had 437 hepatic lesions ≤3.0 cm with pathologic confirmation. The arterial-phase image quality and diagnostic performance of SA-MRI and MA-MRI were analysed and compared. To minimize the effects of selection bias because of potential confounding between the two groups, propensity score-matching was additionally performed.. MA-MRI showed a significantly higher percentage of optimal arterial-phase timing (94.2% vs. 74.5%, p < .001) and lower incidence of inadequate examinations (1.3% vs. 5.8%, p = .034) than SA-MRI. MA-MRI had a significantly higher non-rim arterial-phase hyperenhancement (APHE) detection rate (94.9% vs. 85.5%, p = .005) and sensitivity for diagnosing HCC (87.4% vs. 70.0%, p < .001) than SA-MRI, but no significant difference in specificity (92.9% vs. 93.1%, p = .966). In 123 pairs of propensity score-matched patients, MA-MRI had significantly higher sensitivity (89.1% vs. 74.5%, p = .006) than SA-MRI with equal specificity (92.3% vs. 92.3%, p > .999).. Compared with SA-MRI, MA-MRI with gadoxetic acid can detect more non-rim APHE and significantly improve sensitivity for diagnosing HCC ≤3.0 cm, without a significant decrease in specificity.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Lymphatic congestion is known to play an important role in the development of late Fontan complications. This study aimed to (1) develop a gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) contrast three-dimensional heavily T2-weighed MR technique that can detect abnormal lymphatic pathway in the abdomen while simultaneously evaluating hepatocellular carcinoma (HCC) and to (2) propose a new classification of abnormal abdominal lymphatic pathway using a non-invasive method in adults with Fontan circulation. Twenty-seven adults with Fontan circulation who underwent Gd-EOB-DTPA abdominal MR imaging were prospectively enrolled in this study. We proposed MR lymphangiography that suppresses the vascular signal on heavily T2-weighted imaging after EOB contrast. The patients were classified as follows: grade 1 with almost no lymphatic pathway, grade 2 with a lymphatic pathway mainly around the bile duct and liver surface, and grade 3 with a lymphatic pathway mainly around the vertebral body and inferior vena cava. The grade 3 group showed the lowest oxygen saturation level, highest central venous pressure, highest incidence of massive ascites, HCC, and focal nodular hyperplasia. This group also tended to have patients with the oldest age and highest cardiac index; however, the difference was not statistically significant. As for the blood test, the grade 3 group showed the lowest platelet count and serum albumin level and the highest fibrosis-4 index. A novel technique, Gd-EOB-DTPA MR lymphangiography, can detect abnormal abdominal lymphatic pathways in Fontan circulation, which can reflect the severity of failing Fontan.

Topics: Abdomen; Adult; Carcinoma, Hepatocellular; Contrast Media; Fontan Procedure; Gadolinium DTPA; Humans; Liver Neoplasms; Lymphography; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy

Accurate diagnosis of subcentimeter hepatocellular carcinoma (HCC) is a challenge also with gadoxetic acid-enhanced MRI (EOB-MRI). This study aimed to assess the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) for subcentimeter HCC and to determine whether new diagnostic criteria (washout either on portal venous phase (PVP) or transitional phase (TP)) would improve the diagnostic performance.. We evaluated 240 subcentimeter observations in 225 consecutive treatment-naïve patients at risk of HCC. Final diagnoses were 132 HCCs (all by pathology) and 108 non-HCC (41 by pathology and 67 by follow-up). Two radiologists assessed MR imaging features and assigned LI-RADS categories. A variety of diagnostic criteria were developed by combining significant MRI features based on washout on PVP or TP. Diagnostic performance was compared.. Non-rim arterial phase hyperenhancement (non-rim APHE), washout on PVP or TP, and hepatobiliary-phase hypointensity were significant predictors for subcentimeter HCC diagnosis according to multivariable analysis. One criterion (non-rim APHE and washout on PVP or TP) yielded higher sensitivity (68.2% vs. 56.8%, p = 0.011) with comparable specificity (91.7% vs. 92.6%, p > 0.999) compared to the LR-4 category. This criterion had improved sensitivity (68.2% vs. 49.2%, p < 0.001) and slightly decreased specificity (91.7% vs. 94.4%, p = 0.250) compared to non-rim APHE with washout on PVP.. LI-RADS exhibits modest diagnostic performance for subcentimeter HCC. Our new criterion (non-rim APHE and non-peripheral washout on PVP or TP) may increase the diagnostic sensitivity without compromised specificity compared to the LR-4 category.. • The LR-4 category shows modest diagnostic performance for the diagnosis of subcentimeter HCC on EOB-MRI with a sensitivity and specificity of 56.8% and 92.6%, respectively. • Non-rim APHE, non-peripheral washout on PVP or TP, and HBP hypointensity were independent predictors for the diagnosis of subcentimeter HCC. • The combination of non-rim APHE and non-peripheral washout on PVP or TP improves the sensitivity from 56.8 to 68.2% (p = 0.011) with comparable specificity (91.7 vs. 92.6%, p > 0.999).

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To identify the characteristic diagnostic features of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) in Fontan-associated liver disease (FALD) patients using dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).. Thirty-one FALD patients (mean age, 28.3 ± 7.2 years) with liver nodules who underwent dynamic Gd-EOB-DTPA-enhanced MRI were enrolled prospectively. Twenty-five patients (mean age, 72.8 ± 11.4 years) with hepatitis C virus (HCV)-related HCC constituted the control group. The tumour-to-liver signal intensity (SI) ratio was measured at 30, 60, 100, 180 seconds and 15 minutes, and the SI ratio was compared among FALD-HCC, FALD-FNH, and HCV-HCC.. FALD-HCC exhibited weak early enhancement with mild washout in late phases. FALD-FNH exhibited marked early enhancement that continued until the late phases. The SI ratio was significantly lower for FALD-HCC than for FALD-FNH in all phases. The SI ratio was significantly lower for FALD-HCC than for HCV-HCC only at 30 seconds (p<0.05), whereas poorer washout was seen in FALD-HCC than HCV-HCC in other phases. In 15 minutes, FALD-HCC had a significantly lower SI ratio compared to FALD-FNH (p<0.001).. The time course of Gd-EOB-DTPA-enhanced MRI signal intensity in FALD-HCC was different from that in FALD-FNH or HCV-HCC. This imaging finding may be useful adjunctive information to distinguish FALD-HCC from FALD-FNH.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Focal Nodular Hyperplasia; Gadolinium; Gadolinium DTPA; Hepatitis C; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Retrospective Studies; Young Adult

To investigate added value of late portal venous phase (LPVP) for identification of enhancing capsule (EC) on gadoxetate disodium-enhanced MRI (GD-MRI) for diagnosing hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD).. This retrospective study comprised 116 high-risk patients with 128 pathologically proven HCCs who underwent GD-MRI including arterial phase, conventional portal venous phase (CPVP, 60 s), LPVP (mean, 104.4 ± 6.7 s; range, 90-119 s), and transitional phase (TP, 3 min). Two independent radiologists assessed the presence of major HCC features, including EC on CPVP and/or TP (CPVP/TP) and EC on LPVP. The frequency of EC was compared on GD-MRI between with and without inclusion of LPVP. The radiologists assigned Liver Imaging Reporting and Data System (LI-RADS) v2018 categories before and after identifying EC on LPVP.. Of the total 128 HCCs, 74 and 73 revealed EC on CPVP/TP for reviewer 1 and 2, respectively. After inclusion of LPVP, each reviewer identified seven more EC [Reviewer 1, 57.8% (74/128) vs. 63.3% (81/128); Reviewer 2, 57.0% (73/128) vs. 62.5% (80/128); P = 0.016, respectively]. Sensitivities of LR-5 assignment for diagnosing HCCs were not significantly different in GD-MRI with or without LPVP for EC identification [Reviewer 1, 71.9% (92/128) vs. 72.7% (93/128); Reviewer 2, 75.0% (96/128) vs. 75.8% (97/128); P = 1.000, respectively].. Including the LPVP in GD-MRI may improve identification of EC of HCC in patients with CLD. However, LI-RADS v2018 using GD-MRI showed comparable sensitivity for diagnosing HCC regardless of applying LPVP for EC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To evaluate the recall rate and performance of free-breathing T1W dynamic imaging in patients who underwent gadoxetic acid-enhanced liver MRI.. We retrospectively reviewed patients who underwent free-breathing dynamic T1WI liver MRI using Cartesian (XD-VIBE) or self-gated radial (SG-GRASP) sequences at two institutions. Four radiologists independently reviewed the overall image quality, streak, and motion artifacts for precontrast, arterial, and portal venous phases on a 4-point scale. Hepatic observations were annotated and assessed according to LI-RADS v2018.. In total, 360 patients were included (XD-VIBE [n = 253], SG-GRASP [n = 107]). The overall image quality of free-breathing T1WI was 3.4 ± 0.4, 3.2 ± 0.4, and 3.5 ± 0.4 for precontrast, arterial, and portal venous phases, respectively. The actual recall rate was 0.6% (2/360). The SG-GRASP group showed fewer motion artifacts and more streak artifacts than the XD-VIBE group in all phases (p < 0.001 for all). The overall image quality was not significantly different between the two sequences in arterial (3.2 ± 0.4 in both, p = 0.607) and portal venous phases (3.5 ± 0.4 in XD-VIBE, 3.4 ± 0.4 in SG-GRASP, p = 0.214). Two sequences did not show significant differences in the lesion detection rate (figure of merit, FOM: 0.67 vs. 0.68, p = 0.876) or diagnostic performance for hepatocellular carcinoma (FOM: 0.55 vs. 0.62, p = 0.105).. Both XD-VIBE and SG-GRASP provided sufficient image quality for patients at risk of developing motion artifacts, without significant differences in image quality or the lesion detection rate between sequences.. • The overall image quality of free-breathing T1-weighted images using Cartesian or radial sequences was 3.4 ± 0.4, 3.2 ± 0.4, and 3.5 ± 0.4 for precontrast, arterial, and portal venous phases, respectively. • Only 0.3% (1/360) had undiagnostic exams and the actual recall rate was 0.6% (2/360) in patients who underwent free-breathing dynamic T1WI. • The overall lesion detection rate was 0.67 without a significant difference between Cartesian and radial sequences (figure of merit: 0.67 vs. 0.68, respectively, p = 0.876).

Topics: Artifacts; Carcinoma, Hepatocellular; Contrast Media; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To assess qualitative and quantitative analysis of gadoxetate disodium-enhanced hepatobiliary phase MR imaging (MRI) and assess the performance of classification and regression tree analysis for the differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA).. This retrospective study was approved by our local ethics committee. One hundred seventy patients suspected of having FNH or HCA underwent gadoxetate disodium-enhanced MRI. The reference standard was either pathology or follow-up imaging. Two readers reviewed images to identify qualitative imaging features and measure signal intensity on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), signal intensity ratio (SIR), and relative signal enhancement ratio (RSER) were calculated. A classification and regression tree (CART) analysis was developed.. Eighty-five patients met the inclusion criteria, with a total of 97 FNHs and 43 HCAs. For qualitative analysis, the T1 signal intensity on the hepatobiliary phase provided the highest overall classification performance (91.9% sensitivity, 90.1% specificity, and 90.9% accuracy). For quantitative analysis, RSER in the hepatobiliary phase with a threshold of 0.723 provided the highest classification performance (92.6% sensitivity and 89.4% specificity) to differentiate FNHs from HCAs. A CART model based on five qualitative imaging features provided an accuracy of 94.4% (95% confidence interval 90.0-98.9%).. Gadoxetate disodium-enhanced hepatobiliary phase provides high diagnostic performance as demonstrated in quantitative and qualitative analysis in differentiation of FNH and HCA, supported by a CART decision model.

Topics: Adenoma, Liver Cell; Amines; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To investigate the predictive value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) features on the pathologic grade, microvascular invasion (MVI), and cytokeratin-19 (CK19) expression in hepatocellular carcinomas (HCC), and to evaluate their association with postoperative recurrence of HCC.. This retrospective study included 147 patients with surgically confirmed HCCs who underwent gadoxetic-enhanced MRI. The lesions were evaluated quantitatively in terms of the relative enhancement ratio (RER), and qualitatively based on imaging features and clinical parameters. Logistic regression analyses were performed to investigate the value of these parameters in predicting the pathologic grade, MVI, and CK19 in HCC. Predictive factors for postoperative recurrence were determined using a Cox proportional hazards model.. Peritumoral enhancement (odds ratio [OR], 3.396; p = 0.025) was an independent predictor of high pathologic grades. Serum protein induced by vitamin K absence or antagonist (PIVKA) level > 40 mAU/mL (OR, 3.763; p = 0.018) and peritumoral hypointensity (OR, 4.343; p = 0.003) were independent predictors of MVI. Predictors of CK19 included serum alpha-fetoprotein (AFP) level > 400 ng/mL (OR, 4.576; p = 0.005), rim enhancement (OR, 5.493; p = 0.024), and lower RER (OR, 0.013; p = 0.011). Peritumoral hypointensity (hazard ratio [HR], 1.957; p = 0.027) and poor pathologic grades (HR, 2.339; p = 0.043) were independent predictors of recurrence.. We demonstrated the value of preoperative gadoxetic-enhanced MRI in predicting aggressive pathological features of HCC. Poor pathologic grades and peritumoral hypointensity may independently predict the recurrence of HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To analyze alterations of the liver appearance during the hepatobiliary phase of individuals with type 2 diabetes who are receiving gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI). Fifty-seven individuals who received Gd-EOB-DTPA-enhanced MRI and had normal liver and renal function but did not have (control group) or have type 2 diabetes (observation group) were retrospectively included in this study. The liver enhancement ratio (LER) and contrast between liver parenchyma and portal vein (LPC) were calculated from hepatobiliary phase images. Utilizing liver to kidney signal intensity, signs of the biliary system, and signs of the portal vein, a functional liver imaging score (FLIS) was calculated. Wilcoxon rank-sum test was used to assess the between-group differences in LER, LPC, and FLIS. FLIS constituent ratios between the two groups were tested using the χ

Topics: Carcinoma, Hepatocellular; Contrast Media; Diabetes Mellitus, Type 2; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

The goal of medical imaging is not only to identify the entity "hepatocellular adenoma," but to detect typical magnetic resonance (MR) patterns of the subtypes so that lesions with a higher malignant transformation rate could be differentiated from those that should just be controlled.. To evaluate the differentiation between subtypes of hepatocellular adenomas using hepatobiliary specific contrast agent (Gd-EOB-DTPA) in MR imaging.. A total of 11 patients with 39 lesions with histologically proven hepatocellular adenomas were evaluated. Of the, 34 were inflammatory hepatocellular adenomas (IHCA) and 5 were HNF1α adenomas. No β-catenin-mutated adenoma was found. In all patients, a standard protocol considering the guidelines of the international consensus conference of Gd-EOB-DTPA was performed in a 1.5-T scanner. Besides a qualitative analysis of all sequences, we measured the quantitative signal intensity (SI) ratio in all examinations.. Subtyping of hepatocellular adenomas using Gd-EOB-DTPA is possible due to qualitative and quantitative analyses regarding T1W precontrast and portalvenous phase. In addition, the SI ratio and liver-to-lesion contrast ratio in the arterial phase gave additional qualitative information for differentiation.

Topics: Adenoma; Adenoma, Liver Cell; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Liver Neoplasms; Magnetic Resonance Imaging; Mice; Organic Anion Transporters

To investigate the value of pre-operative gadoxetate disodium (Gd-EOB-DTPA) enhanced MRI predicting early post-operative recurrence (< 2 years) of hepatocellular carcinoma (HCC) with different degrees of pathological differentiation.. Retrospective analysis of pre-operative MR imaging features of 177 patients diagnosed as suffering from HCC and that underwent radical resection. Multivariate logistic regression assessment was adopted to assess predictors for HCC recurrence with different degrees of pathological differentiation. The area under the curve (AUC) of receiver operating characteristics (ROC) was utilized to assess the diagnostic efficacy of the predictors.. Among the 177 patients, 155 (87.5%) were males, 22 (12.5%) were females; the mean age was 49.97 ± 10.71 years. Among the predictors of early post-operative recurrence of highly-differentiated HCC were an unsmooth tumor margin and an incomplete/without tumor capsule (p = 0.037 and 0.033, respectively) whereas those of early post-operative recurrence of moderately-differentiated HCC were incomplete/without tumor capsule, peritumoral enhancement along with peritumoral hypointensity (p = 0.006, 0.046 and 0.004, respectively). The predictors of early post-operative recurrence of poorly-differentiated HCC were peritumoral enhancement, peritumoral hypointensity, and tumor thrombosis (p = 0.033, 0.006 and 0.021, respectively). The AUCs of the multi-predictor diagnosis of early post-operative recurrence of highly-, moderately-, and poorly-differentiated HCC were 0.841, 0.873, and 0.875, respectively. The AUCs of the multi-predictor diagnosis were each higher than for those predicted separately.. The imaging parameters for predicting early post-operative recurrence of HCC with different degrees of pathological differentiation were different and combining these predictors can improve the diagnostic efficacy of early post-operative HCC recurrence.

Topics: Adult; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

The accurate prediction of post-hepatectomy early recurrence in patients with hepatocellular carcinoma (HCC) is crucial for decision-making regarding postoperative adjuvant treatment and monitoring. We aimed to explore the feasibility of deep learning (DL) features derived from gadoxetate disodium (Gd-EOB-DTPA) MRI, qualitative features, and clinical variables for predicting early recurrence.. In this bicentric study, 285 patients with HCC who underwent Gd-EOB-DTPA MRI before resection were divided into training (n = 195) and validation (n = 90) sets. DL features were extracted from contrast-enhanced MRI images using VGGNet-19. Three feature selection methods and five classification methods were combined for DL signature construction. Subsequently, an mp-MR DL signature fused with multiphase DL signatures of contrast-enhanced images was constructed. Univariate and multivariate logistic regression analyses were used to identify early recurrence risk factors including mp-MR DL signature, microvascular invasion (MVI), and tumor number. A DL nomogram was built by incorporating deep features and significant clinical variables to achieve early recurrence prediction.. MVI (p = 0.039), tumor number (p = 0.001), and mp-MR DL signature (p < 0.001) were independent risk factors for early recurrence. The DL nomogram outperformed the clinical nomogram in the training set (AUC: 0.949 vs. 0.751; p < 0.001) and validation set (AUC: 0.909 vs. 0.715; p = 0.002). Excellent DL nomogram calibration was achieved in both training and validation sets. Decision curve analysis confirmed the clinical usefulness of DL nomogram.. The proposed DL nomogram was superior to the clinical nomogram in predicting early recurrence for HCC patients after hepatectomy.. • Deep learning signature based on Gd-EOB-DTPA MRI was the predominant independent predictor of early recurrence for hepatocellular carcinoma (HCC) after hepatectomy. • Deep learning nomogram based on clinical factors and Gd-EOB-DTPA MRI features is promising for predicting early recurrence of HCC. • Deep learning nomogram outperformed the conventional clinical nomogram in predicting early recurrence.

Topics: Carcinoma, Hepatocellular; Contrast Media; Deep Learning; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

Preoperative assessment of the degree of liver fibrosis is important to determine treatment strategies. In this study, galactosyl human serum albumin single-photon emission-computed tomography and ethoxybenzyl (EOB) contrast-enhanced magnetic resonance imaging (MRI) were used to assess the changes in hepatocyte function after liver fibrosis, and the standardized uptake value (SUV) was combined with gadolinium EOB-diethylenetriaminepentaacetic acid to evaluate its added value for liver fibrosis staging. A total of 484 patients diagnosed with hepatocellular carcinoma who underwent liver resection between January 2010 and August 2018 were included. Resected liver specimens were classified based on pathological findings into nonfibrotic and fibrotic groups (stratified according to the Ludwig scale). Galactosyl human serum albumin-single-photon emission-computed tomography and EOB contrast-enhanced MRI examinations were performed, and the mean SUVs (SUVmean) and contrast enhancement indices (CEIs) were obtained. The diagnostic value of the acquired SUV and CEIs for fibrosis was assessed by calculating the area under the receiver operating characteristic curve (AUC). In the receiver operating characteristic analysis, SUV + CEI showed the highest AUC in both fibrosis groups. In particular, in the comparison between fibrosis groups, SUV + CEI showed significantly higher AUCs than SUV and CEI alone in discriminating between fibrosis (F3 and 4) and no or mild fibrosis (F0 and 2) (AUC: 0.879, vs SUV [P = 0.008], vs. CEI [P = 0.023]), suggesting that the combination of SUV + CEI has greater diagnostic performance than the individual indices. Combining the SUV and CEI provides high accuracy for grading liver fibrosis, especially in differentiating between grades F0 and 2 and F3-4. SUV and gadolinium EOB-diethylenetriaminepentaacetic acid-enhanced MRI can be noninvasive diagnostic methods to guide the selection of clinical treatment options for patients with liver diseases.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Tomography, Emission-Computed, Single-Photon

One subtype of hepatocellular carcinoma (HCC), with cytokeratin 19 expression (CK19+), has shown to be more aggressive and has a poor prognosis. However, CK19+ is determined by immunohistochemical examination using a surgically resected specimen. This study is aimed at establishing a radiomics signature based on preoperative gadoxetic acid-enhanced MRI for predicting CK19 status in HCC.. A total of 110 patients were included. The incidence of CK19(+) HCC was 17% (19/110). Alpha fetoprotein was the only significant clinicopathological variable different between CK19(-) and CK19(+) groups. A majority of the selected radiomics features were wavelet filter-derived features. The AUCs of the three radiomics signatures based on arterial, portal venous, and hepatobiliary phases were 0.70 (95% CI: 0.56-0.83), 0.83 (95% CI: 0.73-0.92), and 0.89 (95% CI: 0.82-0.96), respectively. The three radiomics signatures were integrated, and the fusion signature yielded an AUC of 0.92 (95% CI: 0.86-0.98) and was used as the final model for CK19(+) prediction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the fusion signature was 0.84, 0.89, 0.88, 0.62, and 0.96, respectively. The Hosmer-Lemeshow test showed a good fit of the fusion signature (. The established radiomics signature based on preoperative gadoxetic acid-enhanced MRI could be an accurate and potential imaging biomarker for HCC CK19(+) prediction.

Topics: Biomarkers; Carcinoma, Hepatocellular; Contrast Media; Humans; Keratin-19; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

Little is known about the performance of abbreviated MRI (AMRI) for secondary surveillance of recurrent hepatocellular carcinoma (HCC) after curative treatment.. To evaluate the detection performance of AMRI for secondary surveillance of HCC after curative treatment.. Retrospective.. A total of 243 patients (183 men and 60 women; median age, 65 years) who underwent secondary surveillance for HCC using gadoxetic acid-enhanced MRI after more than 2 year of disease-free period following curative treatment, including surgical resection or radiofrequency ablation (RFA).. A 3.0 T/noncontrast AMRI (NC-AMRI) (T2-weighted fast spin-echo, T1-weighted gradient echo, and diffusion-weighted images), hepatobiliary phase AMRI (HBP-AMRI) (T2-weighted fast spin-echo, diffusion-weighted, and HBP images), and full-sequence MRI ASSESSMENT: Four board-certified radiologists independently reviewed NC-AMRI, HBP-AMRI, and full-sequence MRI sets of each patient for detecting recurrent HCC.. Per-lesion sensitivity, per-patient sensitivity and specificity for HCC detection at each set were compared using generalized estimating equation.. A total of 42 recurred HCCs were confirmed in the 39 patients. The per-lesion and per-patient sensitivities did not show significant differences among the three image sets for either reviewer (P ≥ 0.358): per-lesion sensitivity: 59.5%-83.3%, 59.5%-85.7%, and 59.5%-83.3%, and per-patient sensitivity: 53.9%-83.3%, 56.4%-85.7%, and 53.9%-83.3% for NC-AMRI, HBP-AMRI, and full-sequence MRI, respectively. Per-lesion pooled sensitivities of NC-AMRI, HBP-AMRI, and full-sequence MRI were 72.6%, 73.2%, and 73.2%, with difference of -0.6% (95% confidence interval: -6.7, 5.5) between NC-AMRI and full-sequence MRI and 0.0% (-6.1, 6.1) between HBP-AMRI and full-sequence MRI. Per-patient specificity was not significantly different among the three image sets for both reviewers (95.6%-97.1%, 95.6%-97.1%, and 97.6%-98.5% for NC-AMRI and HBP-AMRI, respectively; P ≥ 0.117).. NC-AMRI and HBP-AMRI showed no significant difference in detection performance to that of full-sequence gadoxetic acid-enhanced MRI during secondary surveillance for HCC after more than 2-year disease free interval following curative treatment. Based on its good detection performance, short scan time, and lack of contrast agent-associated risks, NC-AMRI is a promising option for the secondary surveillance of HCC.. 3.. Stage 2.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Retrospective Studies; Sensitivity and Specificity

To assess the predictive value of preoperative gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI) features and postoperative histopathological grading for early recurrence of hepatocellular carcinoma (HCC) without microvascular invasion (MVI) after curative hepatectomy.. A total of 85 MVI-negative HCC cases were retrospectively analyzed. Cox analyses were used to identify the independent predictors of early recurrence (within a 24 months span). The clinical prediction Model-1 or Model-2 was established without or with postoperative pathological factor, respectively. Nomogram models were constructed and receiver operating characteristic (ROC) curve analysis was used to assess the models' predictive ability. Internal validation of the prediction models for early HCC recurrence was performed using a bootstrap re-sampling approach.. In the multivariate cox regression analysis, Edmondson-Steiner grade, peritumoral hypointensity on hepatobiliary phase (HBP), and relative intensity ratio (RIR) in HBP were identified as independent variables associated with early recurrence. The C-index of the nomogram models and internal validation were both between 0.7 and 0.8, showing good model fitting and calibration effects. The area under the ROC curve (AUC) was 0.781 for Model-1 based on the two preoperative MRI factors. When a third factor, the Edmondson-Steiner grade, was included (Model-2), the AUC increased to 0.834, and the sensitivity increased from 71.4 to 96.4%.. Edmondson-Steiner grade, peritumoral hypointensity on HBP, and RIR on HBP can help predict early recurrence of MVI-negative HCC. In comparison with Model-1 (only imaging features), Model-2 (imaging features + histopathological grades) increases the sensitivity in predicting early recurrence of HCC without MVI.. Preoperative GA-enhanced MRI signs are of great value in predicting early postoperative recurrence of HCC without MVI, and a combined pathological model was established to evaluate the feasibility and effectiveness of this technique.

Topics: Carcinoma, Hepatocellular; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Models, Statistical; Neoplasm Invasiveness; Prognosis; Retrospective Studies

To evaluate the value of using enhancing capsule (EC) or modified capsule appearance as a major feature in LI-RADS for diagnosing HCC ≤ 3.0 cm on gadoxetate disodium-enhanced MRI (Gd-EOB-MRI), and to explore the relationship between the imaging features and the histological fibrous capsule.. This retrospective study enrolled 342 hepatic lesions ≤ 3.0 cm in 319 patients that underwent Gd-EOB-MRIs from January 2018 to March 2021. During dynamic phases and hepatobiliary phase, the modified capsule appearance added the nonenhancing capsule (NEC) (modified LI-RADS + NEC) or corona enhancement (CoE) (modified LI-RADS + CoE) to EC as an alternative capsule appearance. Inter-reader agreement of imaging features was assessed. The diagnostic performances of LI-RADS, LI-RADS with EC ignored, and two modified LI-RADS were compared, followed by Bonferroni correction. Multivariable regression analysis was performed to identify the independent features associated with the histological fibrous capsule.. The inter-reader agreement on EC (0.64) was lower than that on the NEC alternative (0.71) but better than that on CoE alternative (0.58). For HCC diagnosis, compared to LI-RADS, LI-RADS with EC ignored showed significantly lower sensitivity (72.7% vs. 67.4%, p < 0.001) with comparable specificity (89.3% vs. 90.7%, p = 1.000). Two modified LI-RADS showed slightly higher sensitivity and lower specificity than LI-RADS, without statistical significance (all p ≥ 0.006). The AUC was highest with modified LI-RADS + NEC (0.82). Both EC and NEC were significantly associated with the fibrous capsule (p < 0.05).. EC appearance improved the diagnostic sensitivity of LI-RADS for HCC ≤ 3.0 cm on Gd-EOB-MRI. Considering NEC as an alternative capsule appearance allowed for better inter-reader reliability and comparable diagnostic ability.. • Using the enhancing capsule as a major feature in LI-RADS significantly improved the sensitivity of diagnosing HCC ≤ 3.0 cm without reducing specificity on gadoxetate disodium-enhanced MRI. • Compared to the corona enhancement, the nonenhancing capsule might be a preferable alternative capsule appearance for diagnosing HCC ≤ 3.0 cm. • Capsule appearance should be considered a major feature in LI-RADS for diagnosing HCC ≤ 3.0 cm, regardless whether the capsule appears to be enhancing or nonenhancing.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To develop and validate risk scoring systems using gadoxetic acid-enhanced liver MRI features and clinical factors that predict recurrence-free survival (RFS) of a single hepatocellular carcinoma (HCC).. Consecutive 295 patients with treatment-naïve single HCC who underwent curative surgery were retrospectively enrolled from two centers. Cox proportional hazard models developed risk scoring systems whose discriminatory powers were validated using external data and compared to the Barcelona Clinic Liver Cancer (BCLC) or American Joint Committee on Cancer (AJCC) staging systems using Harrell's C-index.. Independent variables-tumor size (per cm; hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.02-1.13; p = 0.005), targetoid appearance (HR, 1.74; 95% CI: 1.07-2.83; p = 0.025), radiologic tumor in vein or tumor vascular invasion (HR, 2.59; 95% CI: 1.69-3.97; p < 0.001), the presence of a nonhypervascular hypointense nodule on the hepatobiliary phase (HR, 4.65; 95% CI: 3.03-7.14; p < 0.001), and pathologic macrovascular invasion (HR, 2.60; 95% CI: 1.51-4.48; p = 0.001)-with tumor markers (AFP ≥ 206 ng/mL or PIVKA-II ≥ 419 mAU/mL) derived pre- and postoperative risk scoring systems. The risk scores showed comparably good discriminatory powers in the validation set (C-index, 0.75-0.82) and outperformed the BCLC (C-index, 0.61) and AJCC staging systems (C-index, 0.58; ps < 0.05). The preoperative scoring system stratified the patients into low-, intermediate-, and high-risk for recurrence, whose 2-year recurrence rate was 3.3%, 31.8%, and 85.7%, respectively.. The developed and validated pre- and postoperative risk scoring systems can estimate RFS after surgery for a single HCC.. • The risk scoring systems predicted RFS better than the BCLC and AJCC staging systems (C-index, 0.75-0.82 vs. 0.58-0.61; ps < 0.05). • Five variables-tumor size, targetoid appearance, radiologic tumor in vein or vascular invasion, the presence of a nonhypervascular hypointense nodule on the hepatobiliary phase, and pathologic macrovascular invasion-combined with tumor markers derived risk scoring systems predicting postsurgical RFS for a single HCC. • In the risk scoring system using preoperatively-available factors, patients were classified into three distinct risk groups, with 2-year recurrence rates in the low-, intermediate-, and high-risk groups being 3.3%, 31.8%, and 85.7% in the validation set.

Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Risk Factors

To develop and validate an effective algorithm, based on classification and regression tree (CART) analysis and LI-RADS features, for diagnosing HCC ≤ 3.0 cm with gadoxetate disodium‑enhanced MRI (Gd-EOB-MRI).. We retrospectively included 299 and 90 high-risk patients with hepatic lesions ≤ 3.0 cm that underwent Gd-EOB-MRI from January 2018 to February 2021 in institution 1 (development cohort) and institution 2 (validation cohort), respectively. Through binary and multivariate regression analyses of LI-RADS features in the development cohort, we developed an algorithm using CART analysis, which comprised the targeted appearance and independently significant imaging features. On per-lesion basis, we compared the diagnostic performances of our algorithm, two previously reported CART algorithms, and LI-RADS LR-5 in development and validation cohorts.. Our CART algorithm, presenting as a decision tree, included targetoid appearance, HBP hypointensity, nonrim arterial phase hyperenhancement (APHE), and transitional phase hypointensity plus mild-moderate T2 hyperintensity. For definite HCC diagnosis, the overall sensitivity of our algorithm (development cohort 93.2%, validation cohort 92.5%; P < 0.006) was significantly higher than those of Jiang's algorithm modified LR-5 (defined as targetoid appearance, nonperipheral washout, restricted diffusion, and nonrim APHE) and LI-RADS LR-5, with the comparable specificity (development cohort: 84.3%, validation cohort: 86.7%; P ≥ 0.006). Our algorithm, providing the highest balanced accuracy (development cohort: 91.2%, validation cohort: 91.6%), outperformed other criteria for identifying HCCs from non-HCC lesions.. In high-risk patients, our CART algorithm developed with LI-RADS features showed promise for the early diagnosis of HCC ≤ 3.0 cm with Gd-EOB-MRI.

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To evaluate the role of ancillary features (AFs) of Liver Imaging Reporting and Data System (LI-RADS) in the diagnostic performance of small HCC (≤ 20 mm) on gadoxetic acid-enhanced MRI.. A total of 154 patients with 183 hepatic observations were analysed in this retrospective study. Observations were categorized using only major features (MFs) and combined MFs and AFs. Independently significant AFs were identified through logistic regression analysis, and upgraded LR-5 criteria were developed using these as new MFs. The diagnostic performance of the modified LI-RADS (mLI-RADS) was calculated and compared with that of LI-RADS v2018 using McNemar's test.. Restricted diffusion, transitional and hepatobiliary phase hypointensity were independently significant AFs. The mLI-RADS a, c, e, g, h and i (upgraded LR-4 lesions that were categorized using only MFs to LR-5 using a certain or any one, two, three of the above AFs as new MFs) yielded a significantly greater sensitivity than that of the LI-RADS v2018 (68.0%, 69.1%, 69.1%, 69.1%, 69.1%, 68.0% vs. 61.9%, all p < 0.05), whereas the specificities were not significantly different (84.9%, 86.0%, 84.9%, 83.7%, 84.9%, 87.2% vs. 88.4% all p > 0.05). When independently significant AFs were used to upgrade the LR-4 nodules categorized by combined MFs and AFs (mLI-RADS b, d and f), the sensitivities were improved, but the specificities were decreased (all p < 0.05).. Independently significant AFs may be used to upgrade an observation from LR-4 (categorized only using MFs) to LR-5, which can improve diagnostic performance for small HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Gadoxetic acid is an MRI contrast agent that has specific applications in the study of hepatobiliary disease. After being distributed in the vascular and extravascular spaces during the dynamic phase, gadoxetic acid is progressively taken up by hepatocytes and excreted to the bile ducts during the hepatobiliary phase. The information derived from the enhancement characteristics during dynamic and hepatobiliary phases is particularly relevant in the detection and characterization of focal liver lesions and in the evaluation of the structure and function of the liver and biliary system. The use of new MRI sequences and advanced imaging techniques (eg, relaxometry, multiparametric imaging, and analysis of heterogeneity), the introduction of artificial intelligence, and the development of biomarkers and radiomic and radiogenomic tools based on gadoxetic acid-enhanced MRI findings will play an important role in the future in assessing liver function, chronic liver disease, and focal liver lesions; in studying biliary pathologic conditions; and in predicting treatment responses and prognosis. © RSNA, 2023

Topics: Artificial Intelligence; Carcinoma, Hepatocellular; Contrast Media; Diagnostic Techniques, Digestive System; Digestive System Diseases; Gadolinium DTPA; Gallbladder Diseases; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Stereotactic body radiation therapy (SBRT) produces excellent local control for patients with hepatocellular carcinoma (HCC). However, the risk of toxicity for normal liver tissue is still a limiting factor. Normal tissue complication probability (NTCP) models have been proposed to estimate the toxicity with the assumption of uniform liver function distribution, which is not optimal. With more accurate regional liver functional imaging available for individual patient, we can improve the estimation and be more patient-specific.. To develop normal tissue complication probability (NTCP) models using pre-/during-treatment (RT) dynamic Gadoxetic Acid-enhanced (DGAE) MRI for adaptation of RT in a patient-specific manner in hepatocellular cancer (HCC) patients who receive SBRT.. 24 of 146 HCC patients who received SBRT underwent DGAE MRI. Physical doses were converted into EQD2 for analysis. Voxel-by-voxel quantification of the contrast uptake rate (k1) from DGAE-MRI was used to quantify liver function. A logistic dose-response model was used to estimate the fraction of liver functional loss, and NTCP was estimated using the cumulative functional reserve model for changes in Child-Pugh (C-P) scores. Model parameters were calculated using maximum-likelihood estimations. During-RT liver functional maps were predicted from dose distributions and pre-RT k1 maps with a conditional Wasserstein generative adversarial network (cWGAN). Imaging prediction quality was assessed using root-mean-square error (RMSE) and structural similarity (SSIM) metrics. The dose-response and NTCP were fit on both original and cWGAN predicted images and compared using a Wilcoxon signed-rank test.. Logistic dose response models for changes in k1 yielded D50 of 35.2 (95% CI: 26.7-47.5) Gy and k of 0.62 (0.49-0.75) for the whole population. The high baseline ALBI (poor liver function) subgroup showed a significantly smaller D50 of 11.7 (CI: 9.06-15.4) Gy and larger k of 0.96 (CI: 0.74-1.22) compared to a low baseline ALBI (good liver function) subgroup of 54.8 (CI: 38.3-79.1) Gy and 0.59 (CI: 0.48-0.74), with p-values of < 0.001 and = 0.008, respectively, which indicates higher radiosensitivity for the worse baseline liver function cohort. Subset analyses were also performed for high/low baseline CP subgroups. The corresponding NTCP models showed good agreement for the fit parameters between cWGAN predicted and the ground-truth during-RT images with no statistical differences for low ALBI subgroup.. NTCP models which incorporate voxel-wise functional information from DGAE-MRI k1 maps were successfully developed and feasibility was demonstrated in a small patient cohort. cWGAN predicted functional maps show promise for estimating localized patient-specific response to RT and warrant further validation in a larger patient cohort.

Topics: Carcinoma, Hepatocellular; Deep Learning; Humans; Liver Neoplasms; Probability; Radiosurgery; Radiotherapy Dosage

We aimed to develop and evaluate a modified Liver Imaging Reporting and Data System (LI-RADS) version 2018 using significant ancillary features for diagnosing hepatocellular carcinoma (HCC) < 1.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging (MRI).. Patients who underwent preoperative gadoxetate disodium-enhanced MRI for focal solid nodules < 2.0 cm within 1 month of MRI between January 2016 and December 2020 were retrospectively analyzed. Major and ancillary features were compared between HCCs of < 1.0 cm and 1.0-1.9 cm using the chi-square test. Significant ancillary features associated with HCC < 1.0 cm were determined by univariable and multivariable logistic regression analysis. The sensitivity and specificity of LR-5 were compared between LI-RADS v2018 and our modified LI-RADS (applying the significant ancillary feature) using generalized estimating equations.. Of 796 included nodules, 248 were < 1.0 cm and 548 were 1.0-1.9 cm. HCC < 1.0 cm less frequently showed an enhancing capsule (7.1% vs. 31.1%, p < .001) and threshold growth (0% vs. 8.3%, p = .007) than HCC of 1.0-1.9 cm. Restricted diffusion was the only ancillary feature significant for diagnosing HCC < 1.0 cm (adjusted odds ratio = 11.50, p < .001). In the diagnosis of HCC, our modified LI-RADS using restricted diffusion had significantly higher sensitivity than LI-RADS v2018 (61.8% vs. 53.5%, p < .001), with similar specificity (97.3% vs. 97.8%, p = .157).. Restricted diffusion was the only significant independent ancillary feature for diagnosing HCC < 1.0 cm. Our modified LI-RADS using restricted diffusion can improve the sensitivity for HCC < 1.0 cm.. • The imaging features of hepatocellular carcinoma (HCC) < 1.0 cm differed from those of HCC of 1.0-1.9 cm. • Restricted diffusion was the only significant independent ancillary feature for HCC < 1.0 cm. • Modified Liver Imaging Reporting and Data System (LI-RADS) with the addition of restricted diffusion can improve the sensitivity for HCC < 1.0 cm.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To assess the value of nonenhancing capsule by adding to enhancing capsule in gadoxetic acid-enhanced MRI (EOB-MRI) in comparison with contrast-enhanced CT (CE-CT) for diagnosing histological capsule in hepatocellular carcinoma (HCC). One-hundred fifty-one patients with HCC who underwent both CE-CT and EOB-MRI were retrospectively reviewed. Liver Imaging-Reporting and Data System (LI-RADS) v2018 imaging features, including enhancing and nonenhancing capsule were evaluated by two readers in CE-CT and EOB-MRI. Frequencies of each imaging feature were compared between CE-CT and EOB-MRI. The area under the receiver operating characteristic (AUC) curve for the diagnosis of histological capsule was compared across the following three imaging criteria: (1) enhancing capsule in CE-CT, (2) enhancing capsule in EOB-MRI, and (3) enhancing/nonenhancing capsule in EOB-MRI. Enhancing capsule in EOB-MRI was significantly less frequently depicted than that in CE-CT (p < 0.001 and = 0.016 for reader 1 and 2). Enhancing/nonenhancing capsule in EOB-MRI achieved a similar frequency of enhancing in CE-CT (p = 0.590 and 0.465 for reader 1 and 2). Adding nonenhancing capsule to enhancing capsule in EOB-MRI significantly increased AUCs (p < 0.001 for both readers) and achieved similar AUCs compared with enhancing capsule in CE-CT (p = 0.470 and 0.666 for reader 1 and 2). Adding nonenhancing capsule to the definition of capsule appearance can improve the diagnosis of capsule in EOB-MRI for the diagnosis of histological capsule in HCC and decrease discordance of capsule appearance between EOB-MRI and CE-CT.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on gadoxetic acid-enhanced MRI (GA-MRI) may be nonmalignant cirrhosis-associated nodules or hepatocellular carcinomas (HCCs). We aimed to characterize HBP hypointense nodules without APHE on GA-MRI by performing contrast-enhanced ultrasound using perfluorobutane (PFB-CEUS).. In this prospective, single-center study, participants at high-risk of HCC having HBP hypointense nodules without APHE at GA-MRI were enrolled. All participants underwent PFB-CEUS; if APHE and late, mild washout or washout in the Kupffer phase were present, the diagnosis of HCC was established according to the v2022 Korean guidelines. The reference standard consisted of histopathology or imaging. The sensitivity, specificity, and positive/negative predictive values of PFB-CEUS for detecting HCC were calculated. Associations between clinical/imaging features and the diagnosis of HCC were evaluated with logistic regression analyses.. In total, 67 participants (age, 67.0 years ± 8.4; 56 men) with 67 HBP hypointense nodules without APHE (median size, 1.5 cm [range, 1.0-3.0 cm]) were included. The prevalence of HCC was 11.9% (8/67). The sensitivity, specificity, and positive and negative predictive values of PFB-CEUS for detecting HCC were 12.5%(1/8), 96.6%(57/59), 33.3%(1/3) and 89.1%(57/64), respectively. Mild-moderate T2 hyperintensity on GA-MRI (odds ratio, 5.756; P = 0.042) and washout in the Kupffer phase on PFB-CEUS (odds ratio, 5.828; P = 0.048) were independently associated with HCC.. Among HBP hypointense nodules without APHE, PFB-CEUS was specific for detecting HCC, which had a low prevalence. Mild-moderate T2 hyperintensity on GA-MRI and washout in the Kupffer phase on PFB-CEUS may be useful to detect HCC in those nodules.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Prospective Studies

The study was to develop a Gd-EOB-DTPA-enhanced MRI radiomics model for differentiating atypical intrahepatic mass-forming cholangiocarcinoma (aIMCC) from poorly differentiated hepatocellular carcinoma (pHCC).. A total of 134 patients (51 aIMCC and 83 pHCC) who underwent Gadoxetic acid-enhanced MRI between March 2016 and March 2022 were enrolled in this study and then randomly assigned to the training and validation cohorts by 7:3 (93 patients and 41 patients, respectively). The radiomics features were extracted from the hepatobiliary phase of Gadoxetic acid-enhanced MRI. In the training cohort, the SelectKBest and the least absolute shrinkage and selection operator (LASSO) were used to select the radiomics features. The clinical, radiomics, and clinical-radiomics model were established using four machine learning algorithms. The performance of the model was evaluated by the receiver operating characteristic (ROC) curve. Comparison of the radiomics and clinical-radiomics model was done by the Delong test. The clinical usefulness of the model was evaluated using decision curve analysis (DCA).. In 1132 extracted radiomic features, 15 were selected to develop radiomics signature. For identifying aIMCC and pHCC, the radiomics model constructed by random forest algorithm showed the high performance (AUC = 0.90) in the training cohort. The performance of the clinical-radiomics model (AUC = 0.89) was not significantly different (P = 0.88) from that of the radiomics model constructed by random forest algorithm (AUC = 0.86) in the validation cohort. DCA demonstrated that the clinical-radiomics model constructed by random forest algorithm had a high net clinical benefit.. The clinical-radiomics model is an effective tool to distinguish aIMCC from pHCC and may provide additional value for the development of treatment plans.

Topics: Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Humans; Liver Neoplasms; Machine Learning; Magnetic Resonance Imaging; Retrospective Studies

To assess inter-observer agreement and accuracy of LI-RADS v2018 for differentiating tumor in vein (TIV) from bland thrombus on gadoxetic acid-enhanced magnetic resonance imaging (Gx-MRI). Secondarily, to determine whether a multi-feature model improves accuracy compared to LI-RADS.. We retrospectively identified consecutive patients at risk for hepatocellular carcinoma with venous occlusion(s) reported on Gx-MRI. Five radiologists independently classified each occlusion as TIV or bland thrombus using the LI-RADS TIV criterion (enhancing soft tissue in vein). They also evaluated imaging features suggestive of TIV or bland thrombus. Intra-class correlation coefficient (ICC) was calculated for individual features. A multi-feature model was developed based on consensus scores of features with > 5% consensus prevalence and > 0.40 ICC. Sensitivity and specificity of the LI-RADS criterion and of the cross-validated multi-feature model were compared.. Ninety-eight patients with 103 venous occlusions (58 TIV, 45 bland thrombus) were included. The LI-RADS criterion provided 0.63 ICC and, depending on the reader, 0.62-0.93 sensitivity and 0.87-1.00 specificity. Five other features had > 5% consensus prevalence and > 0.40 ICC, including three LI-RADS suggestive features and two non-LI-RADS features. The optimal multi-feature model incorporated the LI-RADS criterion and one LI-RADS suggestive feature (occluded or obscured vein contiguous with malignant parenchymal mass). After cross-validation, the multi-feature model did not improve sensitivity or specificity compared to the LI-RADS criterion (P = 0.23 and 0.25, respectively).. Using Gx-MRI, the LI-RADS criterion for TIV provides substantial inter-observer agreement, variable sensitivity, and high specificity for differentiating TIV from bland thrombus. A cross-validated multi-feature model did not improve diagnostic performance.

Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Observer Variation; Retrospective Studies; Sensitivity and Specificity; Thrombosis; Vascular Diseases

To discriminate between benignities and hepatocellular carcinomas (HCCs) in patients at high risk of HCC using a novel enhancement flux analysis for gadoxetic-acid enhanced MRI.. This study retrospectively collected 181 liver nodules in 156 patients at high risk of HCC who underwent gadoxetic acid-enhanced MRI examinations with following surgical resection from 1st August 2017 to 31st December 2021 as the training set; another 42 liver nodules in 36 patients were prospectively collected from 1st January 2022 to 1st October 2022 as the test set. The time-intensity curves (TICs) of liver nodules were formed with consecutive time points: 0 s, 20 s, 1 min, 2 min, 5 min, 10 min, 15 min, and 20 min since contrast injection. A novel enhancement flux analysis was applied by using a biexponential function fitting to distinguish benignities and HCC. Besides, previously published models including maximum enhancement ratio (ER. The novel enhancement flux analysis showed the highest AUCs in the training set (0.897, 95%CI: 0.833-0.960) and the test set (0.859, 95%CI: 0.747-0.970) among all models. The AUCs of PSR, ER. The biexponential flux analysis for gadoxetic-acid enhanced MRI presents a better potential in accurate diagnosis of small HCC nodules.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To evaluate the performance of a radiomics nomogram developed based on gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) MRI for preoperative prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC), and to identify patients who may benefit from the postoperative adjuvant transarterial chemoembolization (PA-TACE).. A total of 260 eligible patients were retrospectively enrolled from three hospitals (140, 65, and 55 in training, standardized external, and non-standardized external validation cohort). Radiomics features and image characteristics were extracted from Gd-EOB-DTPA MRI image before hepatectomy for each lesion. In the training cohort, a radiomics nomogram which incorporated the radiomics signature and radiological predictors was developed. The performance of the radiomics nomogram was assessed with respect to discrimination calibration, and clinical usefulness with external validation. A score (m-score) was constructed to stratify the patients and explored whether it could accurately predict patient who benefit from PA-TACE.. A radiomics nomogram integrated with the radiomics signature, max-D(iameter)  > 5.1 cm, peritumoral low intensity (PTLI), incomplete capsule, and irregular morphology had favorable discrimination in the training cohort (AUC = 0.982), the standardized external validation cohort (AUC = 0.969), and the non-standardized external validation cohort (AUC = 0.981). Decision curve analysis confirmed the clinical usefulness of the novel radiomics nomogram. The log-rank test revealed that PA-TACE significantly decreased the early recurrence in the high-risk group (p = 0.006) with no significant effect in the low-risk group (p = 0.270).. The novel radiomics nomogram combining the radiomics signature and clinical radiological features achieved preoperative non-invasive MVI risk prediction and patient benefit assessment after PA-TACE, which may help clinicians implement more appropriate interventions.. Our radiomics nomogram could represent a novel biomarker to identify patients who may benefit from the postoperative adjuvant transarterial chemoembolization, which may help clinicians to implement more appropriate interventions and perform individualized precision therapies.. • The novel radiomics nomogram developed based on Gd-EOB-DTPA MRI achieved preoperative non-invasive MVI risk prediction. • An m-score based on the radiomics nomogram could stratify HCC patients and further identify individuals who may benefit from the PA-TACE. • The radiomics nomogram could help clinicians to implement more appropriate interventions and perform individualized precision therapies.

Topics: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Humans; Liver Neoplasms; Nomograms; Retrospective Studies

The safety risks of gadolinium (Gd

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Liver Neoplasms; Magnetic Resonance Imaging; Mice

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The indocyanine green retention rate at 15 min (ICG-R15) is a useful tool to evaluate the functional liver reserve before hepatectomy for liver cancer. Taking ICG-R15 as criteria, we investigated the ability of a machine learning (ML)-based radiomics model produced by Gd-EOB-DTPA-enhanced hepatic magnetic resonance imaging (MRI) or contrast-enhanced computed tomography (CT) image in evaluating functional liver reserve of hepatocellular carcinoma (HCC) patients.. A total of 190 HCC patients with CT, among whom 112 also with MR, were retrospectively enrolled and randomly classified into a training dataset (CT: n = 133, MR: n = 78) and a test dataset (CT: n = 57, MR: n = 34). Then, radiomics features from Gd-EOB-DTPA MRI and CT images were extracted. The features associated with the ICG-R15 classification were selected. Five ML classifiers were used for the ML-model investigation. The accuracy (ACC) and the area under curve (AUC) of receiver operating characteristic (ROC) with 95% confidence intervals (CI) were utilized for ML-model performance evaluation.. A total of 107 different radiomics features were extracted from MRI and CT, respectively. The features related to ICG-R15 which was classified into 10%, 20% and 30% were selected. In MRI groups, classifier XGBoost performed best with its AUC = 0.917 and ACC = 0.882 when the threshold was set as ICG-R15 = 10%. When ICG-R15 = 20%, classifier Random Forest performed best with AUC = 0.979 and ACC = 0.882. When ICG-R15 = 30%, classifier XGBoost performed best with AUC = 0.961 and ACC = 0.941. For CT groups, the classifier XGBoost performed best when ICG-R15 = 10% with AUC = 0.822 and ACC = 0.842. When ICG-R15 = 20%, classifier SVM performed best with AUC = 0.860 and ACC = 0.842. When ICG-R15 = 30%, classifier XGBoost performed best with AUC = 0.938 and ACC = 0.965.. Both the MRI- and CT-based machine learning models are proved to be valuable noninvasive methods for functional liver reserve evaluation.

Topics: Carcinoma, Hepatocellular; Humans; Indocyanine Green; Liver; Liver Function Tests; Liver Neoplasms; Machine Learning; Magnetic Resonance Imaging; Retrospective Studies; Tomography, X-Ray Computed

To explore the value of quantitative image features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) for predicting Gglypican-3 (GPC3) expression of single hepatocellular carcinoma (HCC) ≤3 cm.. One hundred and forty-nine patients with histopathologically confirmed HCC were included retrospectively. Quantitative image features and clinicopathological parameters were analysed. The significant predictors for GPC3 expression were identified using multivariate logistic regression analyses. Nomograms were constructed from the prediction model and the progression-free survival (PFS) rate was evaluated by the Kaplan-Meier method.. The tumour-to-liver signal intensity (SI) ratio on the hepatobiliary phase (HBP; odds ratio [OR] = 0.004; p=0.001), serum alpha-fetoprotein (AFP) > 20 ng/ml (OR=6.175; p<0.001), and non-smooth tumour margin (OR=4.866; p=0.002) were independent significant factors for GPC3 expression. When the three factors were combined, the diagnostic specificity was 97.7% (42/43). The nomogram based on the predictive model performed satisfactorily (C-index: 0.852). Kaplan-Meier curves showed that patients with GPC3-positive HCCs have lower PFS rates than patients with GPC3-negative HCCs (Log-rank test, p=0.006).. The tumour-to-liver SI ratio on the HBP combined with serum AFP >20 ng/ml and non-smooth tumour margin are potential predictive factors for GPC3 expression of small HCC ≤3cm. GPC3 expression is correlated with a poor prognosis in HCC patients.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Glypicans; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To evaluate the prognostic impact of dynamic gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in patients with hepatocellular carcinoma (HCC).. We retrospectively reviewed the data of 206 patients with HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI and hepatectomy and quantitatively evaluated the signal intensity ratio of the tumor to the surrounding liver tissue in the portal phase (SIRPP). We verified the survival rates and assessed the prognostic factors associated with overall survival (OS) and recurrence-free survival (RFS) using SIRPP.. Multivariate analysis revealed that the independent predictive factors for poorly-differentiated HCC were α-fetoprotein > 20 ng/mL (hazard ratio [HR]: 3.1909, 95% confidence interval [CI]: 1.3464-7.5622, p = .0084) and SIRPP ≤ 0.85 (HR: 3.7155, 95% CI: 1.521-9.076, p = .004). The 5-year OS and RFS rates in the high and low SIRPP groups were 83.2 and 52.1%, respectively (p < .0001) and 49.7 and 18.5%, respectively (p = .0003). Multivariate analysis revealed that SIRPP ≤ 0.68 was an independent prognostic factor related to OS (HR: 4.4537, 95% CI: 1.6581-11.9626, p = .003).. The SIRPP of preoperative Gd-EOB-DTPA-enhanced MRI might predict the histological differentiation and prognosis of HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To compare the imaging features, pathologic characteristics, and survival outcomes between subcentimeter and 1-2 cm hepatocellular carcinoma (HCC).. This retrospective observational study evaluated the imaging features and medical records of patients with HCC smaller than 2 cm who underwent surgical resection with preoperative gadoxetic-acid-enhanced MRI (EOB-MRI) from January 2013 to December 2021. The incidence of EOB-MRI features and pathological characteristics between the subcentimeter and 1-2 cm HCC were compared. The recurrence-free survival (RFS), including early and overall tumor recurrence, and overall survival (OS) were assessed.. A total of 223 patients (82 with subcentimeter HCC and 141 with 1-2 cm HCC, 179 men) were enrolled. Compared with 1-2 cm HCC, subcentimeter HCC showed fewer restricted diffusion (87.8 vs. 95.7%, P = 0.027), portal-phase washout (58.5% vs. 73.8%, P = 0.013), typical enhancement pattern (50.0% vs. 66.7%, P =0.014), and microvascular invasion (4.9% vs. 14.9%, P = 0.022). Patients with subcentimeter HCC had higher RFS (P = 0.027) and better OS (P = 0.029). The estimated RFS rates at 5 years was 83.3% for subcentimeter HCC and 67.3% for 1-2 cm HCC, respectively. The estimated OS rates at 5 years was 97.3% for subcentimeter HCC and 89.5% for 1-2 cm HCC, respectively.. Subcentimeter HCC showed less frequent EOB-MRI features seen typically in 1-2 cm HCC but better survival outcomes. Therefore, tailored early diagnostic criteria and immediate treatment for subcentimeter HCC may be warranted.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Prognosis; Retrospective Studies; Sensitivity and Specificity

To describe the longitudinal response in patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) and who underwent liver transplant (LT) using gadoxetate-enhanced MRI.. Five men (median age 61y, range 57-64y) with 6 HCCs treated with SBRT (median dose 50 Gy) who subsequently underwent LT were included in this retrospective study. Patients underwent gadoxetate-enhanced MRI before and after SBRT over a period of 3-18 months. Response was assessed using RECIST1.1, mRECIST, LI-RADS and image subtraction, by 2 observers in consensus. Percentage of pathologic tumor necrosis was evaluated.. LT was performed 278 days (IQR, 148-418d) after completion of SBRT and 48d after the last MRI. Histopathology demonstrated tumor necrosis of 48 ± 42% (range, 10-100%). Mean tumor size at baseline and last post-treatment MRIs pre-LT were 2.6 ± 0.8 cm and 2.4 ± 0.9 cm. Enhancing tumor component size at baseline MRI and last post-treatment MRI pre-LT were 1.6 ± 0.8 cm and 0.9 ± 1.0 cm. Responses assessed at the last LRI pre-LT were: partial response (PR, n = 3), stable disease (SD, n = 3) using RECIST1.1; complete response (CR, n = 2), partial response (PR, n = 2), stable disease (SD, n = 2) using mRECIST; and LR-TR viable (n = 4), LR-TR non-viable (n = 2) using LI-RADS. At the last MRI pre-LT, per-lesion features of arterial phase hyperenhancement (APHE, 4/6), portal venous washout (3/6) and capsule (3/6) were observed. 5/6 lesions displayed a hypointense perilesional halo on hepatobiliary phase with a mean delay of 3.1 months post-SBRT.. This case-series showed decreased size, persistent APHE, and incomplete pathologic necrosis in most HCCs treated with SBRT undergoing transplant.

Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Necrosis; Radiosurgery; Retrospective Studies

Biannual Ultrasound showed insufficient sensitivity in detecting small or early-stage hepatocellular carcinoma (HCC). Abbreviated magnetic resonance imaging (A-MRI) protocols with fewer sequences demonstrated higher HCC detection sensitivity than ultrasound with acceptable cost and examination time.. To compare the diagnostic performance of gadoxetic acid-enhanced A-MRI with a full sequence MRI (F-MRI) protocol for small HCC (≤2 cm) in cirrhotic or hepatitis B virus-infected high-risk patients.. Two hundred and four consecutive patients with 166 pathologically confirmed small HCC who underwent preoperative gadoxetic acid-enhanced MRI were retrospectively included. A-MRI set comprised T1-weighted hepatobiliary phase imaging, T2-weighted imaging, diffusion-weighted imaging and apparent diffusion coefficient mapping. Two independent radiologists blinded to clinical data assessed the A-MRI set and F-MRI set. Per-patient HCC and per-lesion HCC diagnostic performance were compared.. Per-patient HCC detection sensitivity of A-MRI set was 93.8% and 91.2% for observer 1 and observer 2, and, for the F-MRI set, the per-patient HCC detection sensitivity was 96.6% and 95.2%, respectively. There was no significant difference in per-patient sensitivity, specificity and per-lesion HCC detection sensitivity between the two imaging sets for both readers. (. A-MRI using diagnostic criteria including hypointensity on hepatobiliary phase plus mild to moderate hyperintensity on T2-weighted imaging or restricted diffusion demonstrated comparable sensitivity and specificity for small HCC compared to the F-MRI protocol in high-risk patients.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To investigate the long-term evolution of LR-2, LR-3 and LR-4 observations in patients with hepatitis B virus (HBV)-related cirrhosis based on LI-RADS v2018 and identify predictors of progression to a malignant category on serial gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI).. This retrospective study included 179 cirrhosis patients with untreated indeterminate observations who underwent Gd-EOB-MRI exams at baseline and during the follow-up period between June 2016 and December 2021. Two radiologists independently assessed the major features, ancillary features, and LI-RADS category of each observation at baseline and follow-up. In cases of disagreement, a third radiologist was consulted for consensus. Cumulative incidences for progression to a malignant category (LR-5 or LR-M) and to LR-4 or higher were analyzed for each index category using Kaplan‒Meier methods and compared using log-rank tests. The risk factors for malignant progression were evaluated using a Cox proportional hazard model.. A total of 213 observations, including 74 (34.7%) LR-2, 95 (44.6%) LR-3, and 44 (20.7%) LR-4, were evaluated. The overall cumulative incidence of progression to a malignant category was significantly higher for LR-4 observations than for LR-3 or LR-2 observations (each P < 0.001), and significantly higher for LR-3 observations than for LR-2 observations (P < 0.001); at 3-, 6-, and 12-month follow-ups, the cumulative incidence of progression to a malignant category was 11.4%, 29.5%, and 39.3% for LR-4 observations, 0.0%, 8.5%, and 19.6% for LR-3 observations, and 0.0%, 0.0%, and 0.0% for LR-2 observations, respectively. The cumulative incidence of progression to LR-4 or higher was higher for LR-3 observations than for LR-2 observations (P < 0.001); at 3-, 6-, and 12-month follow-ups, the cumulative incidence of progression to LR-4 or higher was 0.0%, 8.5%, and 24.6% for LR-3 observations, and 0.0%, 0.0%, and 0.0% for LR-2 observations, respectively. In multivariable analysis, nonrim arterial phase hyperenhancement (APHE) [hazard ratio (HR) = 2.13, 95% CI 1.04-4.36; P = 0.038], threshold growth (HR = 6.50, 95% CI 2.88-14.65; P <0.001), and HBP hypointensity (HR = 16.83, 95% CI 3.97-71.34; P <0.001) were significant independent predictors of malignant progression.. The higher LI-RADS v2018 categories had an increasing risk of progression to a malignant category during long-term evolution. Nonrim APHE, threshold growth, and HBP hypointensity were the imaging features that were significantly predictive of malignant progression.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatitis B virus; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To investigate the diagnostic value of liver imaging reporting and data system (LI-RADS) v2018 and other imaging features in dual-phenotype hepatocellular carcinoma (DPHCC), establish a prediagnostic model based on gadoxetic acid-enhanced MRI, and explore the prognostic significance after surgery of the DPHCC.. Preoperative enhanced MRI findings and the clinical and pathological data of patients with surgically confirmed HCC were analysed retrospectively. Image analysis was based on LI-RADS v2018 and other image features. Univariate analysis was used to screen for predictive factors of DPHCC, and multivariate logistic regression analysis was used to determine the predictive factors. A regression diagnostic model was established. Receiver operating characteristic (ROC) curve analysis was used to determine the critical value, area under curve (AUC), and the corresponding 95% confidence interval (95% CI). The diagnostic performance was verified by fivefold cross-validation. Cox regression analysis was used to determine the prognostic factors associated with early recurrence after surgical resection.. In total, 158 patients were included, of whom 79 had DPHCC and 79 had non-DPHCC. Multivariate analysis showed that rim arterial phase hyperenhancement (Rim APHE) and targetoid restriction were independent risk factors for DPHCC (P < 0.05). The AUC (95% CI) of the model was 0.862 (0.807-0.918), sensitivity was 81.01%, and specificity was 89.874%. Cox regression analysis showed that DPHCC, microvascular invasion, tumour diameter, and an increase of alpha-fetoprotein were independent factors for recurrence.. Rim APHE and targetoid restriction were sensitive imaging features of DPHCC before surgery, and the identification of DPHCC has important prognostic significance for early recurrence.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Phenotype; Retrospective Studies; Sensitivity and Specificity

To evaluate the added value of threshold growth (TG) for imaging criteria for diagnosing hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI.. Patients who underwent preoperative gadoxetic acid-enhanced MRI because of absence of 'definite HCC' (Liver Imaging Reporting and Data System category 5) on prior CT or MRI between January 2016 and December 2020 were retrospectively analyzed. The sensitivity and specificity for 'definite HCC' according to the criteria of the European Association for the Study of the Liver [EASL], Asian Pacific Association for the Study of the Liver [APASL], and Korean Liver Cancer Association-National Cancer Center [KLCA-NCC] were separately calculated with and without TG as a major imaging feature. The results were compared using generalized estimating equations.. Of 202 nodules in 154 patients, 19 % showed TG. When TG was used as a major imaging feature, the sensitivity of EASL were significantly higher than when it was not used (59.2 % vs. 51.4 %, p = 0.001), whereas the sensitivities of APASL and KLCA-NCC did not significantly differ. No significant difference was found in the specificities of the three imaging criteria when TG was used or not (p ≥ 0.16). Of 11 HCCs additionally detected when TG was added to EASL criteria, 9 showed transitional-phase or hepatobiliary-phase hypointensity without portal venous-phase washout.. TG had added value for improving the sensitivity of EASL criteria for gadoxetic acid-enhanced MRI without extending washout to transitional-phase or hepatobiliary-phase images.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To determine the relevant laboratory values for hepatobiliary phase (HBP) imaging and predictive factors for suboptimal HBP images on gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) for the evaluation of hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD). This study included 307 patients with CLD who underwent gadoxetic acid-enhanced liver MRI for HCC evaluation. The liver-portal vein contrast ratio and liver-spleen contrast ratio were calculated from the measurements of the HBP images. In this study, a suboptimal HBP image was defined as the presence of a bright portal vein or a liver-spleen contrast ratio of <1.5. Correlation, comparison, and receiver operating characteristic analyses were performed between the measured parameters on the HBP images and hepatic and renal function tests. The estimated glomerular filtration rate did not correlate with any measured or calculated values on the HBP images. On receiver operating characteristic analysis, the optimal cutoff value for the bright portal vein was an albumin level of 4.05 g/dL (area under the curve, 0.971; sensitivity, 65%; specificity, 82%). The optimal cutoff value of the suboptimal HBP image was a serum direct bilirubin level of 0.83 mg/dL (area under the curve, 0.830; sensitivity, 69%; specificity, 84%). On gadoxetic acid-enhanced MRI for the evaluation of HCC in patients with CLD, suboptimal HBP images were most strongly correlated with serum direct bilirubin levels. Renal function was not associated with suboptimal HBP imaging. Although the sensitivity is low, suboptimal HBP images can be predicted before gadoxetic acid-enhanced liver MRI can be performed.

Topics: Bilirubin; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study.. A total of 359 patients who underwent gadoxetic acid-enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses.. There was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = -0.215; p < 0.001) and AST (rho = -0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = -0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001).. The liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands.. • The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI and liver function is consistent in a multicenter-multivendor cohort. • Signal intensity-based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function. • However, absolute values might change between vendors.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies; Retrospective Studies

The study was to develop a Gd-EOB-DTPA-enhanced MRI radiomics model for preoperative prediction of VETC and patient prognosis in hepatocellular cancer (HCC).. The study included 182 (training cohort: 128; validation cohort: 54) HCC patients who underwent preoperative Gd-EOB-DTPA-enhanced MRI. Volumes of interest including intratumoral and peritumoral regions were manually delineated in the hepatobiliary phase images, from which 1316 radiomics features were extracted. The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to select the useful features. Clinical, intratumoral, peritumoral, combined radiomics, and clinical radiomics models were established using machine learning algorithms. The Kaplan-Meier survival analysis was used to assess early recurrence and progression-free survival (PFS) in the VETC + and VETC- patients.. In the validation cohort, the area under the curves (AUCs) of radiomics models were higher than that of the clinical model using random forest (all p < 0.05). The peritumoral radiomics model (AUC = 0.972;95% confidence interval [CI]:0.887-0.998) had significantly higher AUC than intratumoral model (AUC = 0.919; 95% CI: 0.811-0.976) (p = 0.044). There were no significant differences in AUC between intratumoral or peritumoral radiomics model (PR) and combined radiomics model (p > 0.05). Early recurrence and PFS were significantly different between the PR-predicted VETC + and VETC- HCC patients (p < 0.05). PR-predicted VETC was independent predictor of early recurrence (hazard ratio [HR]: 2.08[1.31-3.28]; p = 0.002) and PFS (HR: 1.95[1.20-3.17]; p = 0.007).. The intratumoral or peritumoral radiomics model may be useful in predicting VETC and patient prognosis preoperatively. The peritumoral radiomics model may yield an incremental value over intratumoral model.. • Radiomics models are useful for predicting vessels encapsulating tumor clusters (VETC) and patient prognosis preoperatively. • Peritumoral radiomics model may yield an incremental value over intratumoral model in prediction of VETC. • Peritumoral radiomics-model-predicted VETC was an independent predictor of early recurrence and progression-free survival.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis; Retrospective Studies

The preoperative diagnosis of microvascular invasion (MVI) for the solitary small hepatocellular carcinoma (sHCC) is crucial for the decision of surgical strategies.. To compare the kinetic parameters and diagnostic effects of two contrast agents for preoperatively predicting MVI of sHCC on multiphase enhanced magnetic resonance imaging (MRI).. Two groups of patients with known solitary sHCC underwent an enhanced MRI examination before hepatic resection: Data A (n = 61) patients underwent Gd-EOB-DTPA-enhanced MRI, and Data B (n = 41) patients had a normal contrast agent. The two sets of data were processed in the same way. Arterial peritumoral enhancement measured from multiphase enhanced MRI was analyzed using quantitative kinetic parameters, including initial signal enhancement (SE. The statistical analysis showed that the average SE. Gd-EOB-DTPA-enhanced MRI had a better quantitative kinetic parameter analysis effect for arterial peritumoral enhancement on predicting MVI of sHCC in clinical practice.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Retrospective Studies

Current major guidelines for diagnosis of hepatocellular carcinoma (HCC) based on imaging findings are different from each other and do not include clinical risk factors as a diagnostic criteria.. To developed and validated a new diagnostic score system using MRI and clinical features as applied in chronic hepatitis B patients.. Retrospective observational study.. A total of 418 treatment-naïve patients (out of 902 patients) with chronic hepatitis B having 556 lesions suspected for HCC which were eligible for curative treatment.. T1W GRE in- and opposed-phase, T2W FSE, DWI, and T1W 3D-GRE dynamic contrast-enhanced sequences at 1.5  T and 3  T.. Six radiologists with 7-22 years of experience independently evaluated MR images based on Liver Imaging Reporting and Data System (LI-RADS) version 2018.. Based on logistic regression analysis of MRI features and clinical factors, a risk score system was devised in derivation cohorts (268 patients, 352 lesions) and externally validated (150 patients, 204 lesions). The performance of the new score system was assessed by Harell's c-index. Using cutoff value of 12, maintaining positive predictive value ≥95%, the diagnostic performances of the score system were compared with those of LR-5.. The 15-point diagnostic scoring system used MRI features (lesion size, nonrim arterial phase hyperenhancement, portal venous phase hypointensity, hepatobiliary phase hypointensity, and diffusion restriction) and clinical factors (alpha-fetoprotein and platelet). It showed good discrimination in the derivation (c-index, 0.946) and validation cohorts (c-index, 0.907). Using a risk score of 12 as a cut-off, this system yielded higher sensitivity than LR-5 (derivation cohort, 76.8% vs. 52.1%; validation cohort, 73.4% vs. 49.5%) without significant decrease in specificity (derivation cohort, 93.1% vs. 97.2%, P = 0.074; validation cohort, 91.7% vs. 96.1%, P = 0.299).. A new score system showed improved sensitivity in chronic hepatitis B patients compared to LI-RADS without significant compromise in specificity. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatitis B, Chronic; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatitis B, Chronic; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

The RAF1 expression affects prognosis in patients with hepatocellular carcinoma (HCC) treated with sorafenib. We examined the expression of sorafenib-targeted gene RAF1 to ascertain its relationship with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) characteristics. We also explored the predictive potential of RAF1 expression markers in the treatment of HCC.. Sixty-five patients with HCC who underwent preoperative enhanced MRI scanning were included in this study. We analyzed the qualitative and quantitative characteristics of enhanced MRI findings in patients with HCC. Immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) analyses were used to detect the protein and mRNA expression levels of RAF1 in HCC. Correlation and logistic regression analyses were used to evaluate the relationship between these image features and the RAF1 gene expression levels in HCC.. The IHC analysis indicated a significant difference in tumor thrombus group (P = 0.037), RT-PCR results revealed a significant between-group difference for both tumor margins (P = 0.033) and capsule (P = 0.04). Binary logistic regression analysis results suggest that independent MRI predictors were regular tumor margins [P = 0.035, odds ratio (OR) = 3.145, 95% confidence interval (CI) 1.087-9.103] and thrombus (P = 0.046, OR = 4.421, 95% CI 1.024-19.08) with high RAF1expression; the tumor capsule was not an independent predictor.. We found a correlation between MRI features and the RAF1 gene expression, Regular tumor margin and the presence of tumor thrombus are indicators of high RAF1 expression in HCC. Enhanced MRI may be useful for identifying patients with HCC eligible for targeted treatment.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To evaluate whether the Liver Imaging Reporting and Data System (LI-RADS) v2018 LR-5 criteria can be modified to increase sensitivity without reducing specificity for diagnosing 10-19 mm hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. A total of 133 high-risk consecutive patients with 174 small observations (10-19 mm) detected on gadoxetic acid-enhanced MRI were retrospectively studied. LI-RADS MRI major features (MFs) and ancillary features (AFs) were reviewed by two independent radiologists in consensus. Observations were categorized using LI-RADS v2018 MFs. Independently significant AFs were identified through logistic regression analysis. Upgraded LR-5 criteria were developed by combining independently significant AFs with MFs of LR-3 or LR-4 v2018. The sensitivity and specificity of the new diagnostic criteria were compared with those of LR-5 v2018 using McNemar's test.. Three of the AFs favoring malignancy [mild-moderate T2 hyperintensity, transitional phase (TP) hypointensity and fat in mass] were independently significant features for diagnosing 10-19 mm HCC. The upgraded LR-5 criteria (mLI-RADS VII: LR-4 + mild-moderate T2 hyperintensity/TP hypointensity or LR-3 + fat in mass) yielded a significantly greater sensitivity than that of the LR-5 v2018 criteria (70.4% vs 55.1%; p < 0.001), whereas the specificity was not significantly different (94.7% vs 98.7%, p = 0.250).. Independently significant AFs may be used to upgrade an observation from LR-3/LR-4 to LR-5, which can improve the sensitivity without impairing the specificity for diagnosing 10-19 mm HCC on gadoxetic acid-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To characterize the use of portal venous or delayed phase CT as an alternative to estimate washout for the non-invasive diagnosis of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI in combination with other features.. Using gadoxetic acid-enhanced, 226 lesions were diagnosed as LR-3 or LR-4 by LI-RADS. Among them, 98 and 152 had "washout" at criteria 1 and 2, respectively. For the diagnosis of HCC, criteria 2 and 3 showed significantly higher sensitivities (67.3 and 92.5%, respectively) compared with criteria 1 (35.5%) (. Although the LI-RADS lexicon does not permit the interchange of image features among various image modalities, the sensitivity of HCC diagnosis could be improved without any decrease in specificity by adding CT image washout features.. Although the LI-RADS lexicon does not permit the interchange of image features among various image modalities, complementary use of dynamic CT in LR-3 or LR-4 categories on the basis of gadoxetic acid-enhanced MRI may contribute to major imaging feature.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To evaluate the predictive value of gadoxetic acid-enhanced MRI features (focused on Liver Imaging Reporting and Data System (LI-RADS) v2018 features and non-LI-RADS imaging features) for microvascular invasion (MVI) of hepatocellular carcinoma (HCC).. From October 2018 to December 2020, 134 patients who underwent gadoxetic acid-enhanced MRI with a pathological diagnosis of HCC after hepatectomy were enrolled in this retrospective study. Two radiologists assessed the pre-hepatectomy LI-RADS v2018 imaging features and non-LI-RADS features to identify independent predictors of MVI of HCC with a logistic regression model.. Four MRI features were found to be independent predictors of MVI: corona enhancement [odds ratio (OR) 5.787; 95% confidence interval (CI) 1.180, 28.369; p = 0.030], mosaic architecture (OR 7.097; 95% CI 1.299, 38.783; p = 0.024), nonsmooth tumor margin (OR 13.131; 95% CI 3.950, 43.649; p < 0.001), and peritumoral hypointensity on hepatobiliary phase (HBP) (OR 33.123; 95% CI 2.897, 378.688; p = 0.005). When one of four imaging features was present, the sensitivity was 93.2% (41/44), and the specificity was 71.1% (64/90).. The four imaging features including corona enhancement, mosaic architecture, nonsmooth tumor margin, and peritumoral hypointensity on HBP can be used as preoperative imaging biomarkers for predicting MVI in patients at high risk for HCC. When one of the four imaging features is present, MVI can be predicted with a sensitivity > 90%.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

The Liver Imaging Reporting and Data System (LI-RADS) is widely used for diagnosing hepatocellular carcinoma (HCC), however, with unsatisfactory sensitivity, complex ancillary features, and inadequate integration with gadoxetate disodium (EOB)-enhanced MRI.. To modify LI-RADS (mLI-RADS) on EOB-MRI.. Secondary analysis of a prospective observational study.. Between July 2015 and September 2018, 224 consecutive high-risk patients (median age, 51 years; range, 26-83; 180 men; training/testing sets: 169/55 patients) with 742 (median size, 13 mm; interquartile range, 7-27; 498 HCCs) LR-3/4/5 observations.. 3.0 T T. Three radiologists (with 5, 5, and 10 years of experience in liver MR imaging, respectively) blinded to the reference standard (histopathology or imaging follow-up) reviewed all MR images independently. In the training set, the optimal LI-RADS version 2018 (v2018) features selected by Random Forest analysis were used to develop mLI-RADS via decision tree analysis.. In an independent testing set, diagnostic performances of mLI-RADS, LI-RADS v2018, and the Korean Liver Cancer Association (KLCA) guidelines were computed using a generalized estimating equation model and compared with McNemar's test. A two-tailed P < 0.05 was statistically significant.. Five features (nonperipheral "washout," restricted diffusion, nonrim arterial phase hyperenhancement [APHE], mild-moderate T2 hyperintensity, and transitional phase hypointensity) constituted mLI-RADS, and mLR-5 was nonperipheral washout coupled with either nonrim APHE or restricted diffusion. In the testing set, mLI-RADS was significantly more sensitive (72%) and accurate (80%) than LI-RADS v2018 (sensitivity, 61%; accuracy 74%; both P < 0.001) and the KLCA guidelines (sensitivity, 64%; accuracy 74%; both P < 0.001), without sacrificing positive predictive value (mLI-RADS, 94%; LI-RADS v2018, 94%; KLCA guidelines, 92%).. In high-risk patients, the EOB-MRI-based mLI-RADS was simpler and more sensitive for HCC than LI-RADS v2018 while maintaining high positive predictive value.. 2 TECHNICAL EFFICACY: Stage 2.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

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

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Gadolinium-ethoxybenzyl-diethylene triamine pentaacetic acid (Gd-EOB-DTPA) is a newer magnetic resonance contrast that has the combined effect of conventional and liver-specific contrast. The use of Gd-EOB-DTPA may aid in management of patients with hepatocellular carcinoma (HCC) undergoing living donor liver transplant (LDLT).. We retrospectively reviewed all HCC patients who received LDLT with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) as part of a pretransplant evaluation between October 2012 and October 2016. The detection rate and impact on decision making were assessed between multidetector-row computed tomography (MDCT) and Gd-EOB-DTPA-enhanced MRI with pathology of the explanted liver being the reference standard.. We analyzed 25 patients with 80 nodules. Gd-EOB-DTPA-enhanced MRI showed superior detection rate for HCCs than MDCT (76.1% vs 35.8%). Among the 25 patients, 16 had additional HCCs detected by Gd-EOB-DTPA-enhanced MRI, which led to changes in therapeutic decisions in 11 patients. The recurrence rate and mortality rate were 4% (1 of 25). In the same period in our institution, the mortality rate was 13.9% (25 of 180) for those who did not receive Gd-EOB-DTPA-enhanced MRI as part of the pretransplant evaluation.. The use of Gd-EOB-DTPA-enhanced MRI can aid in characterization of indeterminate nodules and detect more HCCs and thus more adequate downstaging and pretransplant neoadjuvant treatment ensue, which may lower the recurrence rate after LDLT.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Liver Transplantation; Living Donors; Magnetic Resonance Imaging; Retrospective Studies

Gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) has a higher diagnostic accuracy for hepatocellular carcinoma (HCC) than computed tomography (CT). However, indications for performing EOB-MRI after dynamic CT are not well defined. Therefore, we investigated the clinical factors associated with changes in the preoperative tumor stage between dynamic CT and EOB-MRI.. A prospective cohort was conducted from January 2014 to December 2017. 156 adult patients with clinical suspicion of HCC before liver resection were enrolled and we retrospectively reviewed the images. The tumor staging was evaluated by dynamic CT and then EOB-MRI subsequently according to the TNM staging system. The changes in tumor stage between two modalities were identified, and the associated clinical factors were analyzed.. A total of 99 patients were analyzed after excluding 57 patients. 20 patients (20.2%) had changes in tumor stage between dynamic CT and EOB-MRI. The change occurred only in early stage (T1 and T2 lesions) based on dynamic CT initially. Furthermore, in univariate and multivariate analyses, albumin-bilirubin (ALBI) grade 2 and log alpha-fetoprotein (AFP) levels were associated with changes in tumor staging by EOB-MRI than those without (50% vs. 9.9%, p < 0.001 and 2.04 ± 1.35 vs. 1.40 ± 1.16, p = 0.038, respectively). Patients with changes in tumor stage also exhibited higher 1-year recurrence rate and shorter recurrence-free survival.. Changes in preoperative tumor stage between dynamic CT and EOB-MRI were associated with CT-defined early stage, ALBI grades, higher log AFP levels, and early recurrence.

Topics: Adult; alpha-Fetoproteins; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies; Retrospective Studies; Tomography, X-Ray Computed

This study aimed to establish a reliable diagnostic scoring model for the preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and biochemical indicators.. This retrospective study included 129 patients with HCC at our hospital from 2014 to 2020. Based on the intratumoral and peritumoral features on Gd-EOB-DTPA MRI and biochemical indicators, a scoring model was developed for preoperative prediction of MVI, and examined for diagnostic efficacy according to postoperative pathological results. The scoring model was further externally validated in an independent cohort of 63 HCC patients.. The scoring model based on Gd-EOB-DTPA MRI and biochemical indicators provides a reliable tool for preoperative prediction of MVI in HCC patients.. • The scoring model based on Gd-EOB-DTPA MRI and biochemical indicators is practical for preoperative prediction of MVI in HCC patients. • AGLR is an independent risk factor for MVI. • The scoring model could help implement more appropriate interventions, potentially leading to precise and individualized treatments based on the biological characteristics of the tumor.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

Hepatocellular carcinoma (HCC) patients usually achieve a complete response after treatment. This study was aimed to assess the clinical outcome of HCC patients who had achieved a complete response but later presented with elevated tumor marker levels without an identifiable recurrent tumor on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. We retrospectively reviewed the clinical outcome of 58 HCC treated patients who had achieved a complete response but later was referred to our institution's multidisciplinary tumor board for a clinically suspected hidden HCC recurrence based on elevated tumor marker levels but negative gadoxetic acid-enhanced MRI. The imaging studies, tumor markers, and clinical information were reviewed. The total follow-up period was at least 15 months after the initial negative gadoxetic acid-enhanced MRI.. Follow-up imaging studies detected an HCC lesion in 89.7% (n = 52/58) of the patients within the study period, and approximately half of the tumors (46.2%, n = 24/52) developed within 3 months. The most frequent site of recurrence was the liver (86.5%; n = 45/52), but extra-hepatic metastasis was also common (19.2%; n = 10/52). In 5.8% (n = 3/52), HCC reoccurred in the combined form of intra-hepatic and extra-hepatic recurrence. Extra-hepatic metastasis alone occurred in 13.5% (n = 7/52) of patients.. HCC frequently recurred within a short interval in patients who achieved a complete response to treatment in the presence of increased tumor marker levels, even if gadoxetic acid-enhanced MRI was negative. Under such circumstances, we suggest a short-term follow-up including, but not limited to, gadoxetic acid-enhanced MRI along with systemic evaluation.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Magnetic resonance imaging (MRI) is the most useful imaging tool for small hepatocellular carcinoma (HCC) evaluation. Patients undergoing transarterial chemoembolization (TACE) might have predictive imaging prognostic factors. This study aimed to find predictive gadoxetic acid (GA)-enhanced MRI features that affect tumor response and outcomes in patients with early HCC who underwent conventional TACE.. Among patients who underwent conventional TACE as a first-line treatment for Barcelona clinic liver cancer stage 0 or A (<3 cm), 135 patients who underwent GA-enhanced MRI before treatment were included in this retrospective study. The patients' pretreatment clinical characteristics and MRI features were evaluated. Post-treatment tumor response, progression-free survival (PFS), and overall survival (OS) were also investigated.. The median follow-up period was 47 (range: 7-133) months, with 90 (67%) patients showing complete remission (CR) at the 1-month follow-up after TACE. Tumor number (odds ratio [OR] 0.602, 95% confidence interval [CI]: 0.375-0.967), central location (OR: 0.349, 95% CI: 0.145-0.837) were inversely associated with CR achievement. Median PFS and OS time were 22 (range: 1-133) and 67 (range: 7-133) months, respectively. The MRI features affecting poor survival outcomes were tumor number (PFS: hazard ratio [HR]=1.444, 95% CI=1.124-1.854; OS: HR=1.459, 95% CI=1.018-2.090), central location (PFS: HR=1.664, 95% CI=1.038-2.667; OS: HR=1.890, 95% CI=1.021-3.497), and marginal irregularity (PFS: HR=3.099, 95% CI=1.953-4.979; OS: HR=1.985, 95% CI=1.084-3.634).. Multiplicity, central location, and marginal irregularity of HCC on GA-enhanced MRI were significant factors associated with poor prognosis of patients with early HCC after conventional TACE.

Topics: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Treatment Outcome

To evaluate the diagnostic performance of iodine-enhanced multidetector CT and gadoxetic acid-enhanced 3.0 Tesla (T) MRI for detection of hepatocellular carcinoma of patients.. Retrospective, multicentre cohort study.. The Gong'an County People's Hospital, Gong'an County, China and the First People's Hospital of Jingzhou City, China.. Reports of CT, MRI and liver biopsies/histopathology data of a total of 815 patients who at risk were reviewed.. The lesions that possessed detection in the plain scan phase, enhanced arterial phase and/or enhanced portal phase of CT images and the lesions that possessed enhancements in the plain scan phase, enhanced arterial phase, enhanced portal phase and/or hepatobiliary phases of MRI were considered hepatocellular carcinoma. The decision of hepatocellular carcinoma was made based on the current Liver Imaging and Data Reporting System for diagnosing hepatocellular carcinoma.. True positive hepatocellular carcinoma (563 vs 521, p=0.0314), true negative hepatocellular carcinoma (122 vs 91, p=0.0275), false positive hepatocellular carcinoma (88 vs 123, p=0.0121), false negative hepatocellular carcinoma (42 vs 80, p=0.0005), specificity (58.10 vs 42.52, p=0.0478) and negative clinical utility (0.1 vs 0.073, p=0.0386) were superior for gadoxetic acid-enhanced 3.0 T MRI than those of iodine-enhanced multidetector CT. Sensitivity and accuracy for gadoxetic acid-enhanced 3.0 T MRI were 93.06% and 77.40 %, respectively, and those for iodine-enhanced multidetector CT were 86.69% and 75.09 %, respectively. Likelihood to detect hepatocellular carcinoma for gadoxetic acid-enhanced 3.0 T MRI was 0-0.894 diagnostic confidence/lesion, and that for iodine-enhanced multidetector CT was 0-0.887 diagnostic confidence/lesion.. Gadoxetic acid-enhanced 3.0 T MRI facilitates the confidence of initiation of treatment of hepatocellular carcinoma.. III.. 4.

Topics: Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Gadolinium DTPA; Humans; Iodine; Liver Neoplasms; Magnetic Resonance Imaging; Multidetector Computed Tomography; Retrospective Studies; Risk Factors; Sensitivity and Specificity

With the increasing use of gadoxetic acid-enhanced MRI for HCC surveillance, hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) are frequently encountered. We investigated the rate of these nodules with hypervascular transformation, which suggests hepatocarcinogenesis, by using a prospectively collected longitudinal surveillance cohort data.. This study included 382 prospectively enrolled patients at high risk for developing HCC who underwent 1-3 rounds of bi-annual surveillance gadoxetic acid-enhanced MRI. MRI was analyzed to detect HBP hypointense nodules without APHE. Follow-up dynamic CTs and MRIs were evaluated to detect hypervascular transformation of the nodules. Cox proportional hazards regression analyses were used to find predictors for hypervascular transformation.. A total of 76 HBP hypointense nodules without APHE were found in 48 patients, giving a prevalence of 12.6% (48/382). The mean nodule size was 10.8 mm, with 43.4% (33/76) being ≥ 10 mm. Over a median follow-up of 78.6 months, 19 nodules (25.0%) showed hypervascular transformation, all of which demonstrated typical imaging features of HCC. On multivariable Cox-regression analysis, size (≥ 10 mm) was the only independent predictor of hypervascular transformation (hazard ratio, 3.31; 95% confidence interval, 1.21-9.05). The cumulative incidence of hypervascular transformation at 12 and 60 months of nodules ≥ 10 mm was 12.3% and 50.4%, respectively, while that of nodules < 10 mm was 2.5% and 13.9%, respectively.. About half of the HBP hypointense nodules ≥ 10 mm without APHE transformed to HCC at 5 years of follow-up, indicating the necessity for cautious monitoring with an augmented and extended follow-up schedule for these nodules.. • The prevalence of HBP hypointense nodules without APHE was 12.6% in a prospectively recruited population at high risk of developing HCC. • Nodule size ≥ 10 mm was significantly associated with hypervascular transformation, and approximately half of the HBP hypointense nodules ≥ 10 mm without APHE transformed to HCC during 5 years of follow-up. • Given the risk of malignant transformation, HBP hypointense nodules ≥ 10 mm without APHE should be closely monitored.

Topics: Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Contrast Media; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

Microvascular invasion (MVI) is an important risk factor in hepatocellular carcinoma (HCC), but its diagnosis mandates postoperative histopathologic analysis. We aimed to develop and externally validate a predictive scoring system for MVI.. From July 2015 to November 2020, consecutive patients underwent surgery for HCC with preoperative gadoxetate disodium (EOB)-enhanced MRI was retrospectively enrolled. All MR images were reviewed independently by two radiologists who were blinded to the outcomes. In the training centre, a radio-clinical MVI score was developed via logistic regression analysis against pathology. In the testing centre, areas under the receiver operating curve (AUCs) of the MVI score and other previous MVI schemes were compared. Overall survival (OS) and recurrence-free survival (RFS) were analysed by the Kaplan-Meier method with the log-rank test.. A total of 417 patients were included, 195 (47%) with pathologically-confirmed MVI. The MVI score included: non-smooth tumour margin (odds ratio [OR] = 4.4), marked diffusion restriction (OR = 3.0), internal artery (OR = 3.0), hepatobiliary phase peritumoral hypointensity (OR = 2.5), tumour multifocality (OR = 1.6), and serum alpha-fetoprotein >400 ng/mL (OR = 2.5). AUCs for the MVI score were 0.879 (training) and 0.800 (testing), significantly higher than those for other MVI schemes (testing AUCs: 0.648-0.684). Patients with model-predicted MVI had significantly shorter OS (median 61.0 months vs not reached, P < .001) and RFS (median 13.0 months vs. 42.0 months, P < .001) than those without.. A preoperative MVI score integrating five EOB-MRI features and serum alpha-fetoprotein level could accurately predict MVI and postoperative survival in HCC. Therefore, this score may aid in individualized treatment decision making.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Retrospective Studies

Preoperative evaluation of microvascular invasion (MVI) in small solitary hepatocellular carcinoma (HCC; maximum lesion diameter ≤ 3 cm) is important for treatment decisions.. To apply gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI to develop and validate a nomogram for preoperative evaluation of MVI in small solitary HCC and to compare the effectiveness of radiomics evaluation models based on different volumes of interest (VOIs).. Retrospective.. A total of 196 patients include 62 MVI-positive and 134 MVI-negative patients were enrolled (training cohort, n = 105; testing cohort, n = 45; external validation cohort, n = 46).. 3.0 T, fat suppressed fast-spin-echo T2-weighted and Gd-EOB-DTPA-enhanced T1-weighted magnetization-prepared rapid gradient-echo sequences.. Radiomics features were extracted on T2-weighted, arterial phase (AP), and hepatobiliary phase (HBP) images from different VOIs (VOI. One-way analysis of variance, independent t-test, Chi-square test or Fisher's exact test, Wilcoxon rank-sum test, LASSO, logistic regression analysis, area under the curve (AUC), nomograms, decision curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI) analyses, and DeLong test.. Among eight radiomics models, the fused sequences-based VOI. The CRR model nomogram could preoperatively evaluate MVI in small solitary HCC. The radiomics model based on VOI. 4 TECHNICAL EFFICACY STAGE: 2.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

Topics: Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Retrospective Studies; Sensitivity and Specificity

The diagnostic accuracy of Liver Imaging Reporting and Data System (LI-RADS) v.2018 and European Association for the Study of the Liver (EASL) criteria for the diagnosis of HCC have been widely evaluated, but their reliability should be investigated. We aimed to assess and compare the reliability of LI-RADS v.2018 and EASL criteria for the diagnosis of HCC using MRI with extracellular contrast agents (ECAs) and gadoxetic acid (GA) and determine the effect of ancillary features on LI-RADS reliability.. Ten readers reviewed MRI studies of 92 focal liver lesions measuring <3 cm acquired with ECAs and GA <1 month apart from two prospective trials, assessing EASL criteria, LI-RADS major and ancillary features, and LI-RADS categorization with and without including ancillary features. Inter-reader agreement for definite HCC diagnosis was substantial and similar for the two contrasts for both EASL and LI-RADS criteria. For ECA-MRI and GA-MRI, respectively, inter-reader agreement was k = 0.72 (95% CI, 0.63-0.81) and k = 0.72 (95% CI, 0.63-0.80); for nonrim hyperenhancement, k = 0.63 (95% CI, 0.54-0.72) and k = 0.57 (95% CI, 0.48-0.66); and for nonperipheral washout, k = 0.49 (95% CI, 0.40-0.59) and k = 0.48 (95% CI, 0.37-0.58) for enhancing capsule. The inter-reader agreement for LI-RADS after applying ancillary features remained in the same range of agreement.. Agreement for definite HCC was substantial and similar for both scoring systems and the two contrast agents in small focal liver lesions. Agreement for LI-RADS categorization was lower for both contrast agents, and including LI-RADS ancillary features did not improve agreement.

Topics: Carcinoma, Hepatocellular; Contrast Media; Data Systems; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

Transarterial. This retrospective study included 48 patients (M/F: 36/12, mean age: 62 years) with HCC treated by TARE followed by surgery with gadoxetate disodium MRI within 90 days of surgery. Two radiologists evaluated tumor response using RECIST1.1, mRECIST, EASL, and LI-RADS-TR criteria and evaluated the percentage of necrosis on subtraction during late arterial, portal venous, and hepatobiliary phases (AP/PVP/HBP). Statistical analysis included inter-reader agreement, correlation between radiologic and pathologic percentage of necrosis, and prediction of CPN using logistic regression and ROC analyses.. Histopathology demonstrated 71 HCCs (2.8 ± 1.7 cm, range: 0.5-7.5 cm) including 42 with CPN, 22 with partial necrosis, and 7 without necrosis. EASL and percentage of tumor necrosis on subtraction at the AP/PVP were independent predictors of CPN (p = 0.02-0.03). Percentage of necrosis, mRECIST, EASL, and LI-RADS-TR had fair to good performance for diagnosing CPN (AUCs: 0.78 - 0.83), with a significant difference between subtraction and LI-RADS-TR for reader 2, and in specificity between subtraction and other criteria for both readers (p-range: 0.01-0.04). Radiologic percentage of necrosis was significantly correlated to histopathologic degree of tumor necrosis (r = 0.66 - 0.8, p < 0.001).. Percentage of tumor necrosis on subtraction and EASL criteria were significant independent predictors of CPN in HCC treated with TARE. Image subtraction should be considered for assessing HCC response to TARE when using MRI.. • Percentage of tumor necrosis on image subtraction and EASL criteria are significant independent predictors of complete pathologic necrosis in hepatocellular carcinoma treated with

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Necrosis; Retrospective Studies; Yttrium Radioisotopes

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Observer Variation

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

To identify imaging features of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) using LI-RADS v2018 and other imaging features and to develop a gadoxetic acid-enhanced MRI (EOB-MRI)-based model for pretreatment prediction of MTM-HCC.. A total of 93 patients with pathologically proven HCC (39 MTM-HCC and 54 non-MTM-HCC) were retrospectively evaluated with EOB-MRI at 3 T. Imaging analysis according to LI-RADS v2018 was evaluated by two readers. Univariate and multivariate analyses were performed to determine independent predictors for MTM-HCC. Different logistic regression models were built based on MRI features, including model A (enhancing capsule, blood products in mass and ascites), model B (enhancing capsule and ascites), model C (blood products in mass and ascites), and model D (blood products in mass and enhancing capsule). Diagnostic performance was assessed by receiver operating characteristic (ROC) curves.. After multivariate analysis, absence of enhancing capsule (odds ratio = 0.102, p = 0.010), absence of blood products in mass (odds ratio = 0.073, p = 0.030), and with ascites (odds ratio = 55.677, p = 0.028) were identified as independent differential factors for the presence of MTM-HCC. Model A yielded a sensitivity, specificity, and AUC of 35.90% (21.20,52.80), 94.44% (84.60, 98.80), and 0.731 (0.629, 0.818). Model A achieved a comparable AUC than model D (0.731 vs. 0.699, p = 0.333), but a higher AUC than model B (0.731 vs. 0.644, p = 0.048) and model C (0.731 vs. 0.650, p = 0.005).. The EOB-MRI-based model is promising for noninvasively predicting MTM-HCC and may assist clinicians in pretreatment decisions.

Topics: Ascites; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Contrast-enhanced ultrasound (CEUS) and gadoxetate disodium-enhanced MRI (EOB-MRI) may synergize in profiling hepatocellular carcinoma (HCC) aggressiveness considering distinct imaging traits. This study aimed to intra-individually compare CEUS and EOB-MRI with Liver Imaging Reporting and Data System (LI-RADS) in assessing HCC aggressiveness.. From January 2015 to November 2020, consecutive at-risk patients with surgically-confirmed HCC who underwent both preoperative CEUS and EOB-MRI examinations were retrospectively enrolled. Image analyses were conducted independently by two masked radiologists for CEUS and EOB-MRI, respectively. The diagnostic performance of each modality for macrovascular invasion against pathology was evaluated and compared with the McNemar's test, while Edmondson-Steiner grade and the presence of microvascular invasion (MVI) were compared between patients with and without LR-M features on each modality.. A total of 140 patients (mean age, 51.9 years ± 11.0; 116 men) were included. Inter-modality agreement was poor (κ = -0.087 ∼ 0.139) for major LI-RADS features and moderate (κ = 0.449) for overall LI-RADS categorization, and LR-TIV and LR-M were the top sources of inter-modality variations. Although CEUS demonstrated significantly higher specificity for diagnosing macrovascular invasion (96% vs. 89%, P =.02), LR-M features on EOB-MRI were more effective in identifying higher Edmondson-Steiner grades (P =.01) and MVI (P =.02).. Marked discrepancies were found between CEUS and EOB-MRI in evaluating LI-RADS features and categories. Whereas CEUS showed superior diagnostic specificity for macrovascular invasion, LR-M features on EOB-MRI provided more information regarding tumor grade and MVI status in HCC patients.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To investigate whether Liver Imaging Reporting and Data System (LI-RADS) imaging features and non-LI-RADS imaging features can predict aggressive pathological features in adult patients with hepatocellular carcinoma (HCC).. From February 2018 to September 2021, 236 adult patients with cirrhosis or hepatitis B virus infection in which liver cancer was suspected underwent MRI within 1 month before surgery. Significant MRI findings and alpha-fetoprotein (AFP) level predicted high-grade HCC and microvascular invasion (MVI) by univariate and multivariate logistic regression models.. The study included 112 patients with histopathologically confirmed liver cancer (≤5 cm), 35 of whom (31.3%) high-grade HCC and 42 of 112 (37.5%) patients had MVI. Mosaic architecture (odds ratio [OR] = 6.031; 95% confidence interval [CI]: 1.366, 26.626; p=0.018), coronal enhancement (OR=5.878; 95% CI: 1.471, 23.489; p=0.012), and intratumoural vessels (OR=5.278; 95% CI: 1.325, 21.020; p=0.018) were significant independent predictors of high-grade HCC. A non-smooth tumour margin (OR=10.237; 95% CI: 1.547, 67.760; p=0.016), coronal enhancement (OR=3.800; 95% CI: 1.152, 12.531; p=0.028), and peritumoural hypointensity on the hepatobiliary phase (HBP; OR=10.322; 95% CI: 2.733, 38.986; p=0.001) were significant independent predictors of MVI.. In high-risk adult patients with single LR-5 HCC (≤5 cm), mosaic architecture, coronal enhancement, and intratumoural vessels are independent predictors of high-grade HCC. Non-smooth tumour margin, coronal enhancement, and peritumoural hypointensity on HBP independently predicted MVI.

Topics: Adult; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer death worldwide, and the prognosis remains dismal. In this study, two pivotal factors, microvascular invasion (MVI) and vessels encapsulating tumor clusters (VETC) were preoperatively predicted simultaneously to assess prognosis.. A total of 133 HCC patients who underwent surgical resection and preoperative gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) were included. The statuses of MVI and VETC were obtained from the pathological report and CD34 immunohistochemistry, respectively. A three-dimensional convolutional neural network (3D CNN) for single-task learning aimed at MVI prediction and for multitask learning aimed at simultaneous prediction of MVI and VETC was established by using multiphase Gd-EOB-DTPA-enhanced MRI.. The 3D CNN for single-task learning achieved an area under receiver operating characteristics curve (AUC) of 0.896 (95% CI: 0.797-0.994). Multitask learning with simultaneous extraction of MVI and VETC features improved the performance of MVI prediction, with an AUC value of 0.917 (95% CI: 0.825-1.000), and achieved an AUC value of 0.860 (95% CI: 0.728-0.993) for the VETC prediction. The multitask learning framework could stratify high- and low-risk groups regarding overall survival (p < 0.0001) and recurrence-free survival (p < 0.0001), revealing that patients with MVI+/VETC+ were associated with poor prognosis.. A deep learning framework based on 3D CNN for multitask learning to predict MVI and VETC simultaneously could improve the performance of MVI prediction while assessing the VETC status. This combined prediction can stratify prognosis and enable individualized prognostication in HCC patients before curative resection.

Topics: Carcinoma, Hepatocellular; Gadolinium; Gadolinium DTPA; Humans; Liver Neoplasms; Neoplasm Invasiveness; Neural Networks, Computer; Retrospective Studies

The aim of the study was to analyze the association between the liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the hepatobiliary phase (HBP) in cirrhotic patients and the presence of clinically significant portal hypertension (CSPH), and how these features impact on hepatocellular carcinoma (HCC) detection in the HBP.. Post-hoc analysis of a prospective cohort of 62 cirrhotic patients with newly US-detected nodule between 1-2 cm (study group). Twenty healthy subjects were used as control group. Qualitative and quantitative analysis of the liver contrast uptake in the HBP assessed by Relative Liver-Enhancement (RLE), Liver-Spleen (LSCR), Liver-Muscle (LMCR), and Liver-Kidney Contrast-Ratio (LKCR), Contrast Enhancement Index (CEI), and Hepatic Uptake (HUI), and biliary excretion, were registered. CSPH was confirmed invasively (HVPG > 10 mmHg) or by indirect parameters. The appearance of HCC at the HBP was analyzed.. Nineteen patients (30.6%) did not have CSPH. In 41 patients (66.1%) the final diagnosis was HCC. All indices were significantly higher in the control group, indicating a more intense HBP liver signal intensity compared to patients with cirrhosis, even if the comparison was restricted to patients with no CSPH. CSPH was associated to a lower rate of HCC hypointensity in the HBP (51.9%. Liver uptake of Gd-EOB-DTPA at the HBP is decreased in cirrhosis even if the liver function is minimally impaired and it falls down significantly in patients with CSPH compromising the recognition of hypointense lesions. This fact may represent a limitation for the detection of small HCC in patients with cirrhosis and CSPH.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies

Purpose To better characterize and understand the significance of focal liver reaction (FLR) development in a large cohort of patients who underwent gadoxetic acid-enhanced MRI after being treated with radiation therapy (RT) for hepatobiliary tumors. Materials and Methods This retrospective study evaluated 100 patients (median age, 65 years [first and third quartiles, 60-69 years]; 80 men) who underwent RT for hepatocellular carcinoma, bile duct tumors, or liver metastases at Mount Sinai Hospital between March 1, 2018, and February 29, 2020. CT simulation scans were fused to MRI scans obtained 1-6 months and 6-12 months after RT, using the hepatobiliary phase of the MRI. To define FLR volume, two radiation oncologists independently delineated the borders of the hypointensity observed on MRI scans in the liver region where RT was delivered. Biologically effective dose (BED) thresholds for the formation of FLRs were calculated, along with albumin-bilirubin (ALBI) scores and grades, and overall survival. Results Most patients developed FLRs, which decreased in volume over time. Median BED threshold values for FLR development were 63.6 Gy at 1-6 months and 88.7 Gy at 6-12 months. While higher baseline ALBI scores were associated with a lower rate of FLRs, there was a significant association between FLR volume and increase in ALBI score at 1-6 months (

Topics: Aged; Bilirubin; Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Radiation Injuries; Retrospective Studies

Diagnosis of hepatocellular carcinoma (HCC) on liver MRI needs analysis of multi-sequence images. However, developing computer-aided detection (CAD) for every single sequence requires considerable time and labor for image segmentation. Therefore, we developed CAD for HCC on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance imaging (MRI) using a convolutional neural network (CNN) and evaluated its feasibility on multi-sequence, multi-unit, and multi-center data.. Patients who underwent gadoxetic acid-enhanced MRI and surgery for HCC in Korea University Anam Hospital (KUAH) and Korea University Guro Hospital (KUGH) were reviewed. Finally, 170 nodules from 155 consecutive patients from KUAH and 28 nodules from 28 patients randomly selected from KUGH were included. Regions of interests were drawn on the whole HCC volume on HBP, T1-weighted (T1WI), T2-weighted (T2WI), and portal venous phase (PVP) images. The CAD was developed from the HBP images of KUAH using customized-nnUNet and post-processed for false-positive reduction. Internal and external validation of the CAD was performed with HBP, T1WI, T2WI, and PVP of KUAH and KUGH.. The figure of merit and recall of the jackknife alternative free-response receiver operating characteristic of the CAD for HBP, T1WI, T2WI, and PVP at false-positive rate 0.5 were (0.87 and 87.0), (0.73 and 73.3), (0.13 and 13.3), and (0.67 and 66.7) in KUAH and (0.86 and 86.0), (0.61 and 53.6), (0.07 and 0.07), and (0.57 and 53.6) in KUGH, respectively.. The CAD for HCC on gadoxetic acid-enhanced MRI developed by CNN from HBP detected HCCs feasibly on HBP, T1WI, and PVP of gadoxetic acid-enhanced MRI obtained from multiple units and centers. This result imply that the CAD developed using single MRI sequence may be applied to other similar sequences and this will reduce labor and time for CAD development in multi-sequence MRI.

Topics: Carcinoma, Hepatocellular; Computers; Contrast Media; Feasibility Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neural Networks, Computer; Retrospective Studies; Sensitivity and Specificity

Background Although various modifications to the Liver Imaging Reporting and Data System (LI-RADS) at gadoxetic acid-enhanced MRI have been suggested, LI-RADS shows suboptimal sensitivity for hepatocellular carcinoma (HCC) and is perceived to be too complex. Purpose To evaluate clinical usefulness of a simplified LI-RADS for diagnosing HCCs of 30 mm or smaller at gadoxetic acid-enhanced MRI. Materials and Methods Patients who underwent gadoxetic acid-enhanced MRI examination and subsequent resection, transplantation, or biopsy for focal solid nodules of 30 mm or smaller between January 2019 and December 2020 at a single tertiary referral institution were retrospectively analyzed. Two strategies for simplified LI-RADS using one size criterion (≥10 mm) were evaluated (strategy A, using classifications for nodules of 10-19 mm for nodules both 10-19 mm and ≥20 mm; strategy B, using classifications for nodules ≥20 mm for nodules both 10-19 mm and ≥20 mm). Multivariable analysis was performed to determine significant ancillary features for HCC. Generalized estimating equations were used to compare diagnostic performance for LR-5 (definite HCC) between LI-RADS version 2018 and simplified LI-RADS. The time required for LI-RADS category assignment was compared between the two systems with use of a paired

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Radiation lobectomy (RL) utilizes Yttrium-90 (Y90) radioembolization for achieving tumor control and inducing contralateral lobe hypertrophy. Our objective was to evaluate the chronological changes occurring radiologically and histopathologically after Y90 RL.. We retrospectively reviewed 22 patients with chronic liver disease who underwent Y90 RL prior to planned liver resection for hepatocellular carcinoma. Gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (EOB-MRI) was performed every 3 months.. Future liver remnant volume (FLRV) significantly increased up to 9 months after Y90 RL. Gd-EOB-DTPA uptake in the treated lobe experienced a 40% reduction in enhancement ratio (ER) during ensuing first 3 months, and never recovered. The reduced ER in the non-tumoral parenchyma was significantly correlated with increased FLRV and FLR (r = 0.41 and r = 0.35, respectively; both p < 0.01). Histopathological evaluation of non-tumor liver tissue found features of sinusoidal obstruction syndrome as an early change after Y90 RL (median 5.7 months) and parenchymal collapse as a late change (mean 11 months).. The reduced uptake of Gd-EOB-DTPA at 3 months post Y90 RL correlates with a significant increase in FLRV prior to liver resection. EOB-MRI evaluation at 3 months can guide future plan of action after Y90 RL.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

As a coreceptor in Wnt and HGF signaling, glypican-3 (GPC-3) promotes the progression of tumor and is associated with a poor prognosis in hepatocellular carcinoma (HCC). GPC-3 has evolved as a target molecule in various immunotherapies, including chimeric antigen receptor T cell. However, its evaluation still relies on invasive histopathologic examination. Therefore, we aimed to develop an easy-to-use and noninvasive risk score integrating preoperative gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) and clinical indicators to predict positive GPC-3 expression in HCC.. Consecutive patients with surgically-confirmed solitary HCC who underwent preoperative EOB-MRI between January 2016 and November 2021 were retrospectively included. EOB-MRI features were independently evaluated by two masked abdominal radiologists and the expression of GPC-3 was determined by two liver pathologists. On the training dataset, a predictive scoring system for GPC-3 was developed against pathology. A total of 278 patients (training set, n=156; internal validation set, n=39; external validation set, n=83) with solitary HCC (208 [75%] with positive GPC-3 expression) were included. Serum alpha-fetoprotein >10 ng/ml (AFP, odds ratio [OR]=2.3, four points) and five EOB-MR imaging features, including tumor size >3.0cm (OR=0.5, -3 points), nonperipheral "washout" (OR=3.0, five points), infiltrative appearance (OR=9.3, 10 points), marked diffusion restriction (OR=3.3, five points), and iron sparing in solid mass (OR=0.2, -7 points) were significantly associated with positive GPC-3 expression. The optimal threshold of scoring system for predicting GPC-3 positive expression was 5.5 points, with AUC 0.726 and 0.681 on the internal and external validation sets, respectively.. Based on serum AFP and five EOB-MRI features, we developed an easy-to-use and noninvasive risk score which could accurately predict positive GPC-3 HCC, which may help identify potential responders for GPC-3-targeted immunotherapy.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Gadolinium DTPA; Glypicans; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Risk Factors

Microvascular invasion (MVI) of small hepatocellular carcinoma (sHCC) (≤ 3.0 cm) is an independent prognostic factor for poor progression-free and overall survival. Radiomics can help extract imaging information associated with tumor pathophysiology.. To develop and validate radiomics scores and a nomogram of gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for preoperative prediction of MVI in sHCC.. In total, 415 patients were diagnosed with sHCC by postoperative pathology. A total of 221 patients were retrospectively included from our hospital. In addition, we recruited 94 and 100 participants as independent external validation sets from two other hospitals. Radiomics models of Gd-EOB-DTPA-enhanced MRI and diffusion-weighted imaging (DWI) were constructed and validated using machine learning. As presented in the radiomics nomogram, a prediction model was developed using multivariable logistic regression analysis, which included radiomics scores, radiologic features, and clinical features, such as the alpha-fetoprotein (AFP) level. The calibration, decision-making curve, and clinical usefulness of the radiomics nomogram were analyzed. The radiomic nomogram was validated using independent external cohort data. The areas under the receiver operating curve (AUC) were used to assess the predictive capability.. Pathological examination confirmed MVI in 64 (28.9%), 22 (23.4%), and 16 (16.0%) of the 221, 94, and 100 patients, respectively. AFP, tumor size, non-smooth tumor margin, incomplete capsule, and peritumoral hypointensity in hepatobiliary phase (HBP) images had poor diagnostic value for MVI of sHCC. Quantitative radiomic features (1409) of MRI scans) were extracted. The classifier of logistic regression (LR) was the best machine learning method, and the radiomics scores of HBP and DWI had great diagnostic efficiency for the prediction of MVI in both the testing set (hospital A) and validation set (hospital B, C). The AUC of HBP was 0.979, 0.970, and 0.803, respectively, and the AUC of DWI was 0.971, 0.816, and 0.801 (. AFP and conventional Gd-EOB-DTPA-enhanced MRI features have poor diagnostic accuracies for MVI in patients with sHCC. Machine learning with an LR classifier yielded the best radiomics score for HBP and DWI. The radiomics nomogram developed as a noninvasive preoperative prediction method showed favorable predictive accuracy for evaluating MVI in sHCC.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Contrast Media; Gadolinium; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nomograms; Retrospective Studies

To compare the diagnostic performance of international hepatocellular carcinoma (HCC) guidelines with gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced Computed tomography (CECT) and their impact on liver transplant (LT) allocation in cirrhotic patients with explant histopathology correlation.. In this prospective single-centre ethics-approved study, 101 cirrhotic patients were consecutively enrolled with informed consent from the pre-LT clinic. They underwent CECT and EOB-MRI alternately at three monthly intervals until LT or removal from LT list. Two abdominal radiologists, blinded to explant histopathology, independently recorded liver lesions visible on CECT and EOB-MRI. Imaging-based HCC scores were assigned to non-treated liver lesions utilizing Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian-Pacific Association for the Study of the Liver (APASL) and Korean Liver Cancer Association-National Cancer Center (KLCA) guidelines. Liver explant histopathology was the reference standard. Simulated LT eligibility was assessed as per Milan criteria (MC) in reference to explant histopathology.. One hundred and three non-treated HCC and 12 non-HCC malignancy were identified at explant histopathology in 34 patients (29 men, 5 women, age 55-73 years). Higher HCC sensitivities of statistical significance were observed with EOB-MRI for LI-RADS 4 + 5, APASL and KLCA compared to LI-RADS 5 and EASL with greatest sensitivity obtained for LIRADS 4 + 5 lesions. HCC sensitivities by all guidelines with both EOB-MRI and CECT were significantly lower if all histopathology-detected HCCs were included in the analysis, compared to imaging-visible lesions only. A significantly greater variation in HCC sensitivity was noted across the guidelines with EOB-MRI compared to CECT. No significant differences in simulated LT eligibility based on MC were observed across the HCC scoring guidelines with EOB-MRI or CECT.. HCC sensitivities are variable depending on scoring guideline, lesion size and imaging modality utilised. Prior studies that included only lesions visible on pre-operative imaging overestimate the diagnostic performance of HCC scoring guidelines. Per-lesion differences in HCC diagnosis across these guidelines did not impact patient-level LT eligibility based on MC.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

This study aimed to evaluate the predictive value of gadoxetic acid disodium magnetic resonance imaging (MRI) in the microvascular invasion (MVI) of hepatocellular carcinoma (HCC).. 87 HCC patients (2019-01-2022-01) admitted to the hospital were selected for retrospective analysis, gadoxetic acid disodium MRI scan was performed before surgery, and the patients were divided into two groups according to whether the MVI occurred, including the invasion group (. Unsmooth tumor margin, peritumoral low signal (hepatobiliary phase), peritumoral enhancement (arterial phase), and peritumoral hyperintensity ring (arterial phase) are significantly correlated with MVI in patients with HCC, which can provide a reference for the formulation and implementation of clinical interventions.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

The routine use of dynamic-contrast-enhanced MRI (DCE-MRI) of the liver using hepatocyte-specific contrast agent (HSCA) as the standard of care for the study of focal liver lesions is not widely accepted and opponents invoke the risk of a loss in near 100% specificity of extracellular contrast agents (ECA) and the need for prospective head-to-head comparative studies evaluating the diagnostic performance of both contrast agents. The Purpose of this prospective intraindividual study was to conduct a quantitative and qualitative head-to-head comparison of DCE-MRI using HSCA and ECA in patients with liver cirrhosis and HCC. Twenty-three patients with liver cirrhosis and proven HCC underwent two 3 T-MR examinations, one with ECA (gadoteric acid) and the other with HSCA (gadoxetic acid). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), wash-in, wash-out, image quality, artifacts, lesion conspicuity, and major imaging features of LI-RADS v2018 were evaluated. Wash-in and wash-out were significantly stronger with ECA compared to HSCA (P < 0.001 and 0.006, respectively). During the late arterial phase (LAP), CNR was significantly lower with ECA (P = 0.005), while SNR did not differ significantly (P = 0.39). In qualitative analysis, ECA produced a better overall image quality during the portal venous phase (PVP) and delayed phase (DP) compared to HSCA (P = 0.041 and 0.008), showed less artifacts in the LAP and PVP (P = 0.003 and 0.034) and a higher lesion conspicuity in the LAP and PVP (P = 0.004 and 0.037). There was no significant difference in overall image quality during the LAP (P = 1), in artifacts and lesion conspicuity during the DP (P = 0.078 and 0.073) or in the frequency of the three major LI-RADS v2018 imaging features. In conclusion, ECA provides superior contrast of HCC-especially hypervascular HCC lesions-in DCE-MR in terms of better perceptibility of early enhancement and a stronger washout.

Topics: Carcinoma, Hepatocellular; Chelating Agents; Contrast Media; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies; Retrospective Studies; Sensitivity and Specificity

This study aimed to evaluate the usefulness of quantitative indices obtained from deep learning analysis of gadoxetic acid-enhanced hepatobiliary phase (HBP) MRI and their longitudinal changes in predicting decompensation and death in patients with advanced chronic liver disease (ACLD).. We included patients who underwent baseline and 1-year follow-up MRI from a prospective cohort that underwent gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance between November 2011 and August 2012 at a tertiary medical center. Baseline liver condition was categorized as non-ACLD, compensated ACLD, and decompensated ACLD. The liver-to-spleen signal intensity ratio (LS-SIR) and liver-to-spleen volume ratio (LS-VR) were automatically measured on the HBP images using a deep learning algorithm, and their percentage changes at the 1-year follow-up (ΔLS-SIR and ΔLS-VR) were calculated. The associations of the MRI indices with hepatic decompensation and a composite endpoint of liver-related death or transplantation were evaluated using a competing risk analysis with multivariable Fine and Gray regression models, including baseline parameters alone and both baseline and follow-up parameters.. Our study included 280 patients (153 male; mean age ± standard deviation, 57 ± 7.95 years) with non-ACLD, compensated ACLD, and decompensated ACLD in 32, 186, and 62 patients, respectively. Patients were followed for 11-117 months (median, 104 months). In patients with compensated ACLD, baseline LS-SIR (sub-distribution hazard ratio [sHR], 0.81;. MRI indices automatically derived from the deep learning analysis of gadoxetic acid-enhanced HBP MRI can be used as prognostic markers in patients with ACLD.

Topics: Carcinoma, Hepatocellular; Deep Learning; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Prospective Studies

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in clinical practice. However, scientific evidence is lacking for recommending a particular sequence for measuring tumor size.. To retrospectively compare the size of hepatocellular carcinoma (HCC) measured on different gadoxetic acid-enhanced MRI sequences using pathology as a reference.. A total of 217 patients with single HCC who underwent gadoxetic acid-enhanced MRI before surgery were included. The size of the HCC was measured by two abdominal radiologists independently on the following sequences: T1-weighted; T2-weighted; b-500 diffusion-weighted imaging (DWI); and arterial, portal venous, transitional, and hepatobiliary phases. Tumor size measured on MRI was compared with pathological size by using Pearson correlation coefficient, independent-sample t test, and Bland-Altman plot. Agreement between two readers was evaluated with intraclass correlation coefficient (ICC).. Correlation between the MR images and pathology was high for both readers (0.899-0.955). Absolute error between MRI and pathologic assessment was lowest on hepatobiliary phase images for both readers (reader 1, 2.8±4.2 mm; reader 2, 3.2±3.4 mm) and highest on arterial phase images for reader 1 (4.9±4.4 mm) and DWI phase images for reader 2 (5.1±4.9 mm). Absolute errors were significantly different for hepatobiliary phase compared with other sequences for both readers (reader 1,. The performance of gadoxetic acid-enhanced MRI sequences varied with HCC size, and the hepatobiliary phase may be optimal among these sequences.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To determine the appropriate use of ancillary features (AFs) in upgrading LI-RADS category 3 (LR-3) to category 4 (LR-4) for hepatic nodules on gadoxetic acid-enhanced MRI.. We retrospectively analyzed MRI features of solid hepatic nodules (≤ 30 mm) categorized as LR-3/4 on gadoxetic acid-enhanced MRI. In LI-RADS diagnostic table-based-LR-3 observations, logistic regression analyses were performed to identify AFs suggestive of hepatocellular carcinomas (HCCs) rather than non-malignant nodules. Using McNemar's test, the sensitivities and specificities of the final-LR-4 category for HCC diagnosis were compared according to the principles of AF application in category adjustment.. A total of 336 hepatic nodules (191 HCCs; 145 non-malignant) in 252 patients were evaluated. Based on major HCC features, 248 nodules (123 HCCs) were assigned as table-based-LR-3 and 88 nodules (68 HCCs) as table-based-LR-4. In table-based-LR-3 observations, mild-moderate T2 hyperintensity was identified as an independent predictor of HCC as opposed to non-malignant nodules (odds ratio = 3.01, p = 0.002). For HCC diagnosis, different criteria of final-LR-4: only table-based-LR-4, allowing category upgrade using only T2 hyperintensity, or using any AFs favoring malignancy resulted in sensitivities of 35.6% (68/191), 53.9% (103/191), and 88.5% (169/191), and specificities of 86.2% (125/145), 75.9% (110/145), and 21.4% (31/145), respectively, which differed from each other (all p < 0.001).. While the application of MRI AF in LI-RADS category adjustment increases the sensitivity of LR-4 category for HCC diagnosis, it is accompanied by a significant decrease in specificity. Mild-moderate T2 hyperintensity, a significant AF indicative of HCC, may be more appropriate for upgrading LR-3 to LR-4.. • When upgrading from LR-3 to LR-4 using any MRI ancillary features favoring malignancy, LR-4 sensitivity increases but specificity decreased for HCC diagnosis. • By upgrading LR-3 to LR-4 based on MRI ancillary features found to suggest HCC rather than non-malignant nodules in multivariate analysis (i.e., mild-moderate T2 hyperintensity), LR-4 demonstrated a more balanced sensitivity and specificity for HCC diagnosis (53.9% and 75.9%, respectively).

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Probability; Retrospective Studies; Sensitivity and Specificity

Rationale and Objectives To evaluate the effectiveness of radiomics analysis based on Gd-EOB-DTPA enhanced hepatic MRI for functional liver reserve assessment in HCC patients. Materials and Methods Radiomics features were extracted from Gd-EOB-DTPA enhanced MRI images in 60 HCC patients. Boruta algorithm was performed to select features associated with indocyanine green retention rate at 15 min (ICG R15). Prediction and classification model were built by performing Random Forest regression analysis. Pearson correlation analysis and AUC of ROC were used to assess performance of the two models. Results A total of 165 radiomics features were extracted. Six radiomics features were selected to build the prediction model. A Predicted value of ICG R15 for each patient was calculated by the prediction model. Pearson correlation analysis revealed that predicted values were significantly associated with actual values of ICG R15 (R value = 0.90, p < 0.001). Nine radiomics features were selected to build the classification model. AUC of ROC revealed favorable performance of the classification model for identifying patients with ICG R15 <10% (AUC: 0.906, 95%CI: 0.900-0.913), <15% (AUC: 0.954, 95%CI: 0.950-0.958), and <20% (AUC: 0.996, 95%CI: 0.995-0.996). Conclusion Radiomics analysis of Gd-EOB-DTPA enhanced hepatic MRI can be used for assessment of functional liver reserve in HCC patients.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging

The Liver Imaging Reporting and Data System (LI-RADS) is widely accepted as a reliable diagnostic scheme for hepatocellular carcinoma (HCC) in at-risk patients. However, its application is hampered by substantial complexity and suboptimal diagnostic sensitivity.. To propose data-driven modifications to the LI-RADS version 2018 (v2018) major feature system (rLI-RADS) on gadoxetate disodium (EOB)-enhanced magnetic resonance imaging (MRI) to improve sensitivity and simplicity while maintaining high positive predictive value (PPV) for detecting HCC.. Retrospective.. Two hundred and twenty-four consecutive at-risk patients (training dataset: 169, independent testing dataset: 55) with 742 LR-3 to LR-5 liver observations (HCC: N = 498 [67%]) were analyzed from a prospective observational registry collected between July 2015 and September 2018.. 3.0 T/T2-weighted fast spin-echo, diffusion-weighted spin-echo based echo-planar and three-dimensional (3D) T1-weighted gradient echo sequences.. All images were evaluated by three independent abdominal radiologists who were blinded to all clinical, pathological, and follow-up information. Composite reference standards of either histopathology or imaging follow-up were used.. In the training dataset, LI-RADS v2018 major features were used to develop rLI-RADS based on their associated PPV for HCC. In an independent testing set, diagnostic performances of LI-RADS v2018 and rLI-RADS were computed using a generalized estimating equation model and compared with McNemar's test. A P value <0.05 was considered statistically significant.. The median (interquartile range) size of liver observations was 13 mm (7-27 mm). The diagnostic table for rLI-RADS encompassed 9 cells, as opposed to 16 cells for LI-RADS v2018. In the testing set, compared to LI-RADS v2018, rLI-RADS category 5 demonstrated a significantly superior sensitivity (76% vs. 61%) while maintaining comparably high PPV (92.5% vs. 94.1%, P = 0.126).. Compared with LI-RADS v2018, rLI-RADS demonstrated improved simplicity and significantly superior diagnostic sensitivity for HCC in at-risk patients.. 3 TECHNICAL EFFICACY STAGE: 2.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Detection of hepatocellular carcinoma using intraoperative ultrasonography (IOUS) is indispensable for successful laparoscopic hepatectomy (LH). This study was performed to evaluate patients with intraoperatively unidentified tumours undergoing LH.. Seven patients who underwent LH for hepatocellular carcinoma and whose tumours were not detected using IOUS were included in this study. Clinical features, preoperative imaging, intraoperative imaging, surgical procedures, and pathological findings were evaluated.. Using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, all the tumours were enhanced in the arterial phase and rapidly washed out, becoming hypointense to the remainder of the liver. All tumours except one were <2 cm in size. Severe liver fibrosis was observed in all cases. Tumours that were invisible on preoperative ultrasonography also could not be detected using IOUS or indocyanine green fluorescence imaging. Five patients underwent hepatectomy based on anatomical landmarks and achieved curative resection, whereas curative resection failed in two patients.. When tumours cannot be identified by IOUS, LH based on anatomical landmarks should be preferred. Importantly, invisible tumours on preoperative ultrasonography may not be identified intraoperatively during LH.

Topics: Aged; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Hepatectomy; Humans; Indocyanine Green; Laparoscopy; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging, Interventional; Male; Middle Aged; Tumor Burden; Ultrasonography, Interventional

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has shown to be superior to contrast-enhanced computed tomography (CT) in studies, there is no adequate data on its impact on overall survival and recurrence-free survival in patients with colorectal liver metastasis. Our objective was to study the benefit afforded by gadoxetic acid-enhanced MRI in patients with colorectal liver metastasis, especially in terms of overall survival and recurrence-free survival.. Patients who underwent surgical treatment for colorectal liver metastasis between January 2003 and December 2018 were divided into groups depending on the pro-operative imaging carried out. Overall survival and recurrence-free survival were compared between both groups.. Totally, 480 cases were included. Gadoxetic acid-enhanced MRI detected 220 new lesions in 123 cases. Presence of metastatic nodules was confirmed by gadoxetic acid-enhanced MRI in 33 of the 55 patients (60.0%) with indeterminate nodules on contrast-enhanced CT. Gadoxetic acid-enhanced MRI detected significantly more nodules than contrast-enhanced CT (932 vs. 673, respectively, P<0.001). There was no difference in the 5-year overall survival (P=0.390) or in the 3-month (85.1% vs. 86.7%, respectively, P=0.790), 6-month (78.0% vs. 81.7%, respectively, P=0.570), or 1-year (65.7% vs. 69.6%, respectively, P=0.446) recurrence-free survival in patients examined with contrast-enhanced CT or gadoxetic acid-enhanced MRI.. Although gadoxetic acid-enhanced MRI is more sensitive than contrast-enhanced CT, its utilization does not significantly affect the recurrence-free survival of the patient.

Topics: Carcinoma, Hepatocellular; Colorectal Neoplasms; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

This study aimed to assess the degree of differentiation of hepatocellular carcinoma (HCC) using Gd-EOB-DTPA-assisted magnetic resonance imaging (MRI) with T1 relaxometry. Thirty-three solitary HCC lesions were included in this retrospective study. This study's inclusion criteria were preoperative Gd-EOB-DTPA-assisted MRI of the liver and a histopathological evaluation after hepatic tumor resection. T1 maps of the liver were evaluated to determine the T1 relaxation time and reduction rate between the native phase and hepatobiliary phase (HBP) in liver lesions. These findings were correlated with the histopathologically determined degree of HCC differentiation (G1, well-differentiated; G2, moderately differentiated; G3, poorly differentiated). There was no significant difference between well-differentiated (950.2 ± 140.2 ms) and moderately/poorly differentiated (1009.4 ± 202.0 ms) HCCs in the native T1 maps. After contrast medium administration, a significant difference (p ≤ 0.001) in the mean T1 relaxation time in the HBP was found between well-differentiated (555.4 ± 140.2 ms) and moderately/poorly differentiated (750.9 ± 146.4 ms) HCCs. For well-differentiated HCCs, the reduction rate in the T1 time was significantly higher at 0.40 ± 0.15 than for moderately/poorly differentiated HCCs (0.25 ± 0.07; p = 0.006). In conclusion this study suggests that the uptake of Gd-EOB-DTPA in HCCs is correlated with tumor grade. Thus, Gd-EOB-DTPA-assisted T1 relaxometry can help to further differentiation of HCC.

Topics: Biliary Tract Neoplasms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To determine the optimal combination of gadoxetate disodium-enhanced magnetic resonance imaging (MRI) findings for the diagnosis of hepatocellular carcinoma (HCC) and to compare its diagnostic ability to that of dynamic computed tomography (CT) in patients with chronic liver disease.. This multi-institutional study consisted of two parts: Study 1, a retrospective study to determine the optimal combination of gadoxetate disodium-enhanced MRI findings (decision tree and logistic model) to distinguish HCC (n = 199) from benign (n = 81) or other malignant lesions (n = 95) (375 nodules in 269 patients) and Study 2, a prospective study to compare the diagnostic ability of gadoxetate disodium-enhanced MRI to distinguish HCC (n = 73) from benign (n = 15) or other malignant lesions (n = 12) with that of dynamic CT (100 nodules in 83 patients). Two radiologists independently evaluated the imaging findings (Study 1 and 2) and made a practical diagnosis (Study 2).. We identified the optimal combination of gadoxetate disodium-enhanced MRI findings for HCC diagnosis. However, its diagnostic ability was not superior to that of dynamic CT.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To evaluate the relationship between the patterns of hepatobiliary phase (HBP) contrast uptake in liver metastases on gadoxetic acid-enhanced MR imaging and overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC).. This retrospective study was approved by our institutional review board and written informed consent was waived. A total of 57 patients (30 men and 27 women; age range, 46-92 years; mean age, 64.9 ± 9.2 years) with PDAC and liver metastasis who had undergone gadoxetic acid-enhanced MR imaging were included. The internal morphologies of the nodules were classified as heterogeneous or homogeneous on HBP images (20 min). During patient-by-patient analysis, patients with both patterns of nodules were classified as belonging to the heterogeneous group. Kaplan-Meier analysis and log-rank test were conducted for univariate analysis and Cox proportional hazards regression was conducted for multivariate analysis to evaluate prognostic factors for OS in patients with PDAC and liver metastasis.. A total of 199 liver metastases were analyzed, among which 138 nodules (69%) demonstrated heterogeneous hypointensity, while 61 nodules (31%) demonstrated homogeneous hypointensity. Homogeneous hypointense nodules were encountered in 18 patients (32%; homogeneous group), heterogeneous in 29 patients (51%), and both patterns co-existed in 10 patients (17%; heterogeneous group). The heterogeneous group exhibited lower OS rates than the homogeneous group (mean OS, 48.5 months vs 23.9 months; p = 0.032).. Hepatobiliary contrast uptake pattern in liver metastasis on HBP images can be a potential imaging biomarker to predict OS in patients with PDAC and liver metastasis.. • Majority of the liver metastases were heterogeneous (69%) after gadoxetic acid-enhanced MR imaging. • Patients with heterogeneous hypointense nodules demonstrated lower overall survival rate. • Hepatobiliary contrast uptake pattern in liver metastasis is possibly associated with patients' prognosis.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Prognosis; Retrospective Studies

The current LR-5 criteria of Liver Imaging Reporting and Data System (LI-RADS) determined by only major features provide high specificity, but unsatisfactorily low sensitivity for the noninvasive diagnosis of hepatocellular carcinoma (HCC). This study aimed to identify significant ancillary features (AFs) in LI-RADS version 2018 and develop the upgraded LR-5 criteria to improve diagnostic performance on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. This retrospective study included 280 patients (366 observations including 281 HCCs) at high-risk for HCC who underwent gadoxetic acid-enhanced MRI between 2015 and 2017. Two readers evaluated major features and AFs for each observation and assigned a LI-RADS category. Independently significant AFs were identified through logistic regression analysis. Upgraded LR-5 criteria were developed by combining independently significant AFs with LR-4 assigned by major features alone. Sensitivities and specificities of the diagnostic criteria were compared using McNemar's test.. Two of the AFs favoring malignancy in general (mild-moderate T2 hyperintensity and hepatobiliary phase hypointensity) and two of the AFs favoring HCC in particular (nonenhancing "capsule" and mosaic architecture) were independently significant features for diagnosing HCC. By using the upgraded LR-5 criteria (LR-4 by major features alone + each aforementioned AF), sensitivities were significantly increased (69.4-76.9%) compared with the standard LR-5 (66.2%; all, p ≤ 0.004), whereas specificities (95.3-96.5%) were not significantly different (96.5%; all, p > 0.999).. Independently significant AFs may be used to upgrade from LR-4 to LR-5 to improve sensitivity without impairing specificity on gadoxetic acid-enhanced MRI.. • Independently significant AFs for HCC on gadoxetic acid-enhanced MRI were mild-moderate T2 hyperintensity, hepatobiliary phase hypointensity, nonenhancing "capsule," and mosaic architecture. • When LR-4 criteria by major features alone in combination with significant AFs were upgraded to LR-5, sensitivities were higher than the standard LR-5, without impairing specificity. • Independently significant ancillary features in Liver Imaging Reporting and Data System version 2018 may be used to upgrade from LR-4 to LR-5 to improve sensitivity without impairing specificity on gadoxetic acid-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Despite the clinical and genetic significance of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC), its characteristics on imaging have not been described. This study aimed to characterise MTM-HCC on gadoxetic acid-enhanced MRI and to evaluate the diagnostic accuracy and prognostic value of these imaging characteristics.. We enrolled 3 independent cohorts from 2 tertiary care centres. The 3 cohorts consisted of a total of 476 patients who underwent gadoxetic acid-enhanced MRI and surgical resection for treatment-naïve single HCCs. Independent review of histopathology and MRI by 2 reviewers was performed for each cohort, and inter-reader agreement was evaluated. Based on the result of MRI review in the training cohort (cohort 1), we developed 2 diagnostic criteria for MTM-HCC and evaluated their prognostic significance. The diagnostic performance and prognostic significance were validated in 2 validation cohorts (cohorts 2 and 3).. We developed 2 diagnostic MRI criteria (MRIC) for MTM-HCC: MRIC-1, ≥20% arterial phase hypovascular component; MRIC-2, ≥50% hypovascular component and 2 or more ancillary findings (intratumoural artery, arterial phase peritumoural enhancement, and non-smooth tumour margin). MRIC-1 showed high sensitivity and negative predictive value (88% and 95% in the training cohort, and 88% and 97% in the pooled validation cohorts, respectively), whereas MRIC-2 demonstrated moderate sensitivity and high specificity (47% and 94% in the training cohort, and 46% and 96% in the pooled validation cohorts, respectively). MRIC-2 was an independent poor prognostic factor for overall survival in both training and pooled validation cohorts.. Using gadoxetic acid-enhanced MRI findings, including an arterial phase hypovascular component, we could stratify the probability of MTM-HCC and non-invasively obtain prognostic information.. Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is a histopathologic subtype of HCC characterised by aggressive biological behaviour and poor prognosis. We developed imaging criteria based on liver MRI that could be used for the non-invasive diagnosis of MTM-HCC. HCCs showing imaging findings of MTM-HCC were associated with poor outcomes after hepatic resection.

Topics: Biopsy; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Prognosis; Republic of Korea; Sensitivity and Specificity; Survival Analysis; Tumor Burden

To compare the diagnostic performances of first and second portal venous phases (PVP1 and PVP2) in revealing washout and capsule appearance for non-invasive HCC diagnoses in gadoxetic acid-enhanced MRI (Gd-EOB-MRI).. This retrospective study included 123 at-risk patients with 160 hepatic observations (HCCs, n = 116; non-HCC malignancies, n = 18; benign, n = 26) showing arterial phase hyper-enhancement (APHE) ≥ 1 cm at Gd-EOB-MRI. The mean time intervals from gadoxetic acid injection to PVP1 and PVP2 acquisitions were 53 ± 2 s and 73 ± 3 s, respectively. After evaluating image findings independently, imaging findings and diagnoses were finalized by a consensus of two radiologists using either PVP1 or PVP2 image sets according to the LI-RADS v2018 or EASL criteria. Sensitivity, specificity, and accuracy were compared.. Among HCCs, more washout and enhancing capsule were observed in PVP2 (83.6% and 27.6%) than in PVP1 (50.9% and 19.8%) (p < 0.001, both). The PVP2 set presented significantly higher sensitivity (83.6% vs. 53.5%, LI-RADS; 82.8% vs. 50.0%, EASL; p < 0.001, both) and accuracy (0.88 vs. 0.73, LI-RADS; 0.88 vs. 0.72, EASL; p < 0.001, both) than the PVP1 set without significant specificity loss (93.2% vs. 93.2%, by LI-RADS or EASL; p = 0.32, both). None of the non-HCC malignancy was non-invasively diagnosed as HCC in both PVP image sets.. Late acquisition of PVP detected washout and enhancing capsule of HCC more sensitively than early acquisition, enabling accurate diagnoses of HCC, according to LI-RADS or EASL criteria.. • Among HCCs, more washout and enhancing capsules were observed in PVP2 than PVP1, quantitatively and qualitatively. • The portal venous phase acquired at around 70 s after contrast media administration (PVP2) provided significantly higher sensitivity and AUC value than PVP1 by using LI-RADS v2018 or EASL criteria. • More HCCs were categorized as LR-5 in PVP2 than in PVP1 images, and the specificity of PVP2 (93.5%) was comparable with PVP1 (93.5%).

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

This study aimed to assess the detection of hepatocellular carcinoma (HCC) utilizing subtraction AP (arterial phase) imaging only for T1 hyperintense observations compared with the detection of HCC on subtraction AP imaging that included T1 hyper-, iso-, and hypointense lesions on gadoxetate disodium-enhanced MRI.. This retrospective study included 234 patients (311 observations including 239 HCCs) at high risk for HCC who underwent gadoxetate disodium-enhanced MRI with subtraction AP imaging between 2015 and 2017. Arterial phase hyperenhancement (APHE) was divided into two subtypes: conventional APHE, where subtraction AP imaging is used to detect APHE only for T1 hyperintense observations; and modified APHE, where subtraction AP imaging is applied to T1 hyper-, iso-, and hypointense lesions. Two readers independently reviewed all observations and the per-observation diagnostic performances were compared using McNemar's test.. Modified nonrim APHE showed significantly higher sensitivity than conventional nonrim APHE (90.0% vs 82.8%; p < 0.001) for diagnosing HCC, without a significant difference in specificity (66.7% vs 68.1%; p > 0.999). The LR-5 category with modified nonrim APHE provided better sensitivity than the LR-5 with conventional nonrim APHE (70.3% vs 63.2%; p < 0.001), without a significant decrease in specificity (94.4% vs 95.8%; p > 0.999).. Extended application of subtraction AP imaging for T1 hypo- or isointense observations on gadoxetate disodium-enhanced MRI can improve sensitivity in the diagnosis of HCC without a significant difference in specificity.. • Modified nonrim arterial phase hyperenhancement (APHE), extended application of subtraction arterial phase imaging for T1 hypo- or isointense observation, outperforms conventional nonrim APHE. • The LR-5 category with modified nonrim APHE provided better sensitivity in diagnosing HCC than the LR-5 with conventional APHE, without a significant decrease in specificity.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To explore the role of preoperative gadoxetic acid-enhanced MRI in stratifying the risk of early recurrence in patients with LR-5 hepatocellular carcinoma (HCC) by LI-RADS v2018 after curative resection.. Between July 2015 and August 2018, this study evaluated consecutive treatment-naïve at-risk LR-5 HCC patients who underwent gadoxetic acid-enhanced MRI examination within 2 weeks before curative resection. The Cox regression analysis was performed to identify potential predictors of early recurrence. Disease-free survival (DFS) rates were analyzed and compared by using the Kaplan-Meier method and log-rank tests.. Fifty-three of 103 (51.5%) patients experienced early recurrence. Three MRI findings were significantly associated with early recurrence: corona enhancement (hazard ratio [HR]: 2.116; p = 0.013), peritumoral hypointensity on hepatobiliary phase (HBP) (HR: 2.262; p = 0.007), and satellite nodule (HR: 2.777; p = 0.005). An additional risk factor was AFP level > 400 ng/mL (HR: 1.975; p = 0.016). Based on the number of MRI predictors, LR-5 HCC patients were stratified into three subgroups: LR-5a (60/103; no predictor), LR-5b (26/103; one predictor), and LR-5c (17/103; two or three predictors), with low, medium, and high risk of early recurrence, respectively. The 2-year DFS rate of LR-5a, LR-5b, and LR-5c patients was 65.0%, 38.5%, and 5.9%, respectively, while the corresponding median DFS was undefined, 17.1 months, and 5.1 months, respectively (p < 0.001).. In at-risk LR-5 HCC patients, corona enhancement, peritumoral hypointensity on HBP, and satellite nodule could be used to preoperatively stratify the risk of early recurrence after hepatectomy.. • Corona enhancement, peritumoral hypointensity on HBP, satellite nodule, and serum AFP level > 400 ng/mL were significant predictors of early recurrence in patients with LR-5 HCC after hepatectomy. • Based on the number of predictive MRI findings, LR-5 HCC patients could be preoperatively stratified into three subgroups: LR-5a, LR-5b, and LR-5c, with significantly different risk of early recurrence and disease-free survival. • Preoperative risk stratification is essential for the identification of patients at increased risk of postoperative early recurrence, which may contribute to risk-based personalized management for LR-5 HCC patients.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Risk Assessment

It is controversial to adopt non-invasive diagnostic criteria of hepatocellular carcinoma (HCC) in subcentimeter lesions. This study was aimed to define the optimal noninvasive diagnostic criteria of subcentimeter HCC and to evaluate the effect on tumor staging.. We included 110 treatment-naïve patients at risk of HCC and eligible for curative treatment who had subcentimeter lesions (n = 136) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) performed between January 2013 and December 2013. Modified diagnostic criteria for subcentimeter HCC were developed using logistic regression analysis. Accuracies of MR staging with and without using the modified criteria were compared by generalized estimating equation test using pathologic staging as reference standards. Subgroup analysis was performed for patients with co-existing HCC ≥ 1 cm (co-HCC).. The modified criteria (presence of co-HCC, arterial phase hyperenhancement, and hypointensity on transitional phase [TP]) showed 61.5% (95% CI, 41.6-78.2) of sensitivity and 98.2% (95% CI, 93.0-99.5) of specificity. Including subcentimeter HCCs improved the accuracy of MR staging from 84.5 to 94.5% (p = 0.001). Fifty percent of subcentimeter lesions found in patients with co-HCCs were HCC, whereas 5.9% of them without co-HCCs were HCC (p = 0.001). In the subgroup with co-HCCs, the accuracy of MR staging with subcentimeter HCCs was improved from 69.0% to 92.8% (p = 0.001).. Including subcentimeter HCCs based on the modified diagnostic criteria (co-existing HCC ≥ 1 cm, arterial phase hyperenhancement, and hypointensity on TP) improved MR staging accuracy.. • Fifty percent of non-benign appearing subcentimeter lesions found in patients with co-HCCs were HCC, whereas 5.9% of them without co-HCCs were HCC (p = 0.001). • Including subcentimeter HCCs improved the accuracy of MR staging from 84.5 to 94.5% (p = 0.001).

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Staging; Retrospective Studies; Sensitivity and Specificity

The primary aim of this study was to determine the clinical and histopathological prognostic factors for patients who underwent surgical resection of multiple hepatocellular carcinomas (HCCs) of multicentric occurrence. The secondary aim of this study was to evaluate whether specific imaging-related factors, including arterial phase hyperenhancement (APHE) and the LI-RADS category of each lesion on gadoxetic acid-enhanced MRI, would provide additional prognostic information about multicentric HCCs.. In this retrospective study, 54 patients with 120 multicentric HCCs were diagnosed by surgical resection at a single tertiary hospital between 2009 and 2014. Two independent readers evaluated patients' preoperative gadoxetic acid-enhanced MR images and recorded APHE and LI-RADS category for each HCC, with discrepancies resolved through consensus sessions if necessary. Potential clinicopathologic and imaging parameters for predicting disease-free survival (DFS) and overall survival (OS) were analyzed using Cox regression analysis.. Presence of microvascular invasion (MVI) (p = 0.003) and of three or more HCCs (p = 0.013) were both independent predictors of a shorter DFS. Patients with concurrent MVI and three or more HCCs had the shortest DFS. MVI was the only statistically significant parameter (p = 0.023) predicting OS. The number of HCCs with APHE or LR-5/M category was not associated with survival.. Presence of MVI and of three or more HCCs were associated with poorer outcomes after surgical resection of multicentric HCCs. Imaging parameters on gadoxetic acid-enhanced MRI such as APHE or LI-RADS category were not associated with postsurgical outcomes.. • Patients with three or more hepatocellular carcinomas showed worse disease-free survival than those with two hepatocellular carcinomas after surgical resection. • Microvascular invasion was the only significant factor to affect both the disease-free and overall survivals of patients after surgical resection of multicentric hepatocellular carcinomas. • Preoperative MRI findings related to multicentric hepatocellular carcinomas such as arterial phase hyperenhancement and LI-RADS category of lesions did not provide significant prognostic information.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis; Retrospective Studies; Sensitivity and Specificity

Repeated transarterial chemoembolization (TACE) can be associated with loss of its efficacy and subsequent tumor progression.. To identify features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) associated with TACE refractoriness and to develop a prediction model for estimating the risk of TACE refractoriness.. Among 1025 patients with intermediate-stage hepatocellular carcinoma (HCC) who underwent TACE as a first-line treatment during 2010-2017, 427 patients who underwent preoperative gadoxetic acid-enhanced MRI were analyzed. According to the date of initial TACE, patients were divided into the development cohort (n = 211) and the test cohort (n = 216). TACE refractoriness was determined according to the Japan Society of Hepatology guidelines. Univariable and multivariable analyses were performed to investigate the association between clinical/MRI features and TACE refractoriness. The performance of the prediction model was internally and externally assessed using the C-index of discrimination and a Hosmer-Lemeshow goodness-of-fit test for calibration.. By analyzing 427 patients, we constructed a prediction model with the following independent features associated with TACE refractoriness: maximum tumor size; tumor number; peritumoral hypointensity on hepatobiliary phase (HBP); and the presence of non-hypervascular hypointense nodule on HBP. This system enabled the prediction of TACE refractoriness in the development cohort (C-index, 0.796) and the test cohort (C-index, 0.738) with good discrimination and calibration abilities.. The prediction model based on gadoxetic acid-enhanced MRI features in addition to the known predictors including tumor size and number can be used to estimate the risk of TACE refractoriness in patients with intermediate-stage HCC.

Topics: Aged; Calibration; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Disease Progression; Drug Resistance, Neoplasm; Epidemiologic Methods; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Treatment Outcome; Tumor Burden

To evaluate the postoperative prognostic value of the Liver Imaging Reporting and Data System (LI-RADS) category on gadoxetic acid-enhanced MRI and 18F-fluorodeoxyglucose PET-CT in patients with primary liver carcinomas (PLCs).. A total of 189 patients with chronic liver disease and surgically proven single PLC (42 intrahepatic cholangiocarcinomas and 21 combined hepatocellular-cholangiocarcinomas and 126 hepatocellular carcinomas [2:1 matching to non-HCC malignancies]) were retrospectively evaluated with gadoxetic acid-enhanced MRI and PET-CT. Two independent reviewers assigned an LI-RADS category for each observation. The tumor-to-liver standardized uptake value ratio (TLR) was calculated. The overall survival (OS), recurrence-free survival (RFS), and the associated factors were evaluated.. In multivariable analysis, LI-RADS category (LR-4 or LR-5 [LR-4/5] vs. LR-M; OS, hazard ratio [HR] 2.24, p = 0.006; RFS, HR 1.61, p = 0.028) and TLR (low, < 2.3 vs. high, ≥ 2.3; OS, HR 2.09, p = 0.014; RFS, HR 2.17, p < 0.001) were the independent factors for OS and RFS. For the LR-M group, the high TLR group showed lower OS and RFS rates than the low TLR group (OS, p = 0.008; RFS, p < 0.001). For the LR-4/5 group, the OS and RFS rates were not significantly different between the high TLR and low TLR groups (both p > 0.05).. Both LI-RADS category on MRI and TLR on PET-CT are associated with the postoperative prognosis of PLCs. The prognosis of PLCs classified as LR-M can be further stratified according to the TLR group, but not for the PLCs classified as LR-4/5.. • The LI-RADS category (LR-4/5 vs. LR-M) and tumor-to-liver standardized uptake value ratio (TLR, low vs. high) were independent factors for postoperative prognosis of primary liver carcinomas (PLCs). • For PLCs classified as LR-M, the TLR group helps stratify the postoperative prognosis of PLCs, with the high TLR group having a poor prognosis and the low TLR group having a better prognosis (p = 0.008 for OS and p < 0.001 for RFS). • For PLCs classified as LR-4/5, the OS and RFS rates were not significantly different between the high TLR and low TLR groups (both p > 0.05).

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Contrast Media; Fluorodeoxyglucose F18; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Positron Emission Tomography Computed Tomography; Prognosis; Retrospective Studies

Patients with hepatocellular carcinoma (HCC) receiving different treatments might have specific prognostic factors that can be captured in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI). We aimed to identify the clinical findings and HBP features with prognostic value in patients with HCC.. In this retrospective, single-institution study, we included patients with Barcelona Clinic Liver Cancer very early/early stage HCC who underwent GA-MRI before treatment. After performing propensity score matching, 183 patients received the following treatments: resection, radiofrequency ablation (RFA), and transarterial chemoembolization (TACE) (n = 61 for each). Cox regression models were used to identify clinical factors and HBP features associated with disease-free survival (DFS) and overall survival (OS).. In the resection group, large tumor size was associated with poor DFS (hazard ratio [HR] 4.159 per centimeter; 95% confidence interval [CI], 1.669-10.365) and poor OS (HR 8.498 per centimeter; 95% CI, 1.072-67.338). In the RFA group, satellite nodules on HBP images were associated with poor DFS (HR 5.037; 95% CI, 1.061-23.903) and poor OS (HR 9.398; 95% CI, 1.480-59.668). Peritumoral hypointensity on HBP images was also associated with poor OS (HR 13.062; 95% CI, 1.627-104.840). In addition, serum albumin levels and the prothrombin time-international normalized ratio were associated with DFS and/or OS. Finally, in the TACE group, no variables were associated with DFS/OS.. Different HBP features and clinical factors were associated with DFS/OS among patients with HCC receiving different treatments.. • In patients who underwent resection for HCC, a large tumor size on HBP images was associated with poor disease-free survival and overall survival. • In the RFA group, satellite nodules and peritumoral hypointensity on HBP images, along with decreased serum albumin levels and PT-INR, were associated with poor disease-free survival and/or overall survival. • In the TACE group, no clinical or HBP imaging features were associated with disease-free survival or overall survival.

Topics: Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis; Retrospective Studies

To assess gadoxetic acid (Gd-EOB-DTPA) and diffusion-weighted imaging (DWI) value in classification (benign. A total of 195 lesions (46 hepatocellular carcinomas [HCCs], 45 metastases, 32 adenomas, 37 focal nodular hyperplasias [FNHs] and 35 hemangiomas) were retrospectively evaluated in 93 patients. Three imaging datasets were compared: DWI/ apparent diffusion coefficient (ADC) (set A), Gd-EOB-DTPA (set B) and combination of both (set C). Two radiologists (R) independently classified (on a five-point ordinal scale) and characterized each lesion. The accuracy in classification and characterization was compared, and the diagnostic confidence was assessed.. The classification accuracy on set A, B and C was 86.2%, 91.3% and 91.8% (R1), and 84.6%, 91.8% and 93.3% (R2); and characterization accuracy was 67.2%, 88.2% and 87.7% (R1), and 60.5%, 88.2% and 85.6% (R2). Classification by reader 1 showed no significant difference between set A and B (. DWI may suggest benignity or malignancy of solid liver lesions, while Gd-EOB-DTPA-enhanced imaging remains superior in lesions characterization and the combination of both increases the diagnostic confidence. DWI is very helpful in the diagnosis of hepatic hemangiomas.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

The LI-RADS M (LR-M) category describes hepatic lesions probably or definitely malignant, but not specific for hepatocellular carcinoma in at-risk patients. Differentiation among LR-M entities, particularly detecting cholangiocarcinoma-containing tumors (M-CCs), is essential for treatment and prognosis. Thus, we aimed to develop diagnostic models on gadoxetate disodium-enhanced MRI comprising serum tumor markers and LI-RADS imaging features for M-CC.. Consecutive at-risk patients with LR-M lesions exclusively (no co-existing LR-4 and/or LR-5 lesions) were retrieved retrospectively from a prospectively collected database spanning 3 years. Intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (c-HCC-CCA) were classified together as M-CC. LI-RADS features determined by three independent radiologists and clinically relevant serum tumor markers were used to generate M-CC diagnostic models through logistic regression analysis against histology. Per-patient performance was evaluated using area under the receiver operating curve (AUC), sensitivity, and specificity.. Forty-five patients were included, 42.2% (19/45) with hepatocellular carcinoma, 33.3% (15/45) with ICC, 13.3% (6/45) with c-HCC-CCA, and 11.1% (5/45) with other hepatic lesions. Carbohydrate antigen (CA)19-9 > 38 U/mL, α-fetoprotein (AFP) > 4.8 ng/mL, and absence of the LI-RADS feature "blood products in mass" were significant predictors of M-CC. Combining three predictors demonstrated AUC of 0.862, sensitivity of 76%, and specificity of 88%. The risk of M-CC with all three criteria fulfilled was 98% (AUC, 0.690; sensitivity, 38%; specificity, 100%).. In at-risk patients with LR-M lesions, integrating CA19-9, AFP, and the LI-RADS feature "blood products in mass" achieved high diagnostic performance for M-CC. When all three criteria were fulfilled, the specificity for M-CC was 100%.. • In at-risk patients who had LR-M lesions exclusively (no concomitant LR-4/5 lesions), a model with carbohydrate antigen > 38 U/mL, α-fetoprotein > 4.8 ng/mL, and absence of the LI-RADS feature "blood products in mass" achieved high accuracy for diagnosing cholangiocarcinoma-containing tumors. • In patients of whom all three criteria were fulfilled, the specificity for M-CC was 100%, which might reduce or eliminate the need for biopsy confirmation.

Topics: Bile Duct Neoplasms; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis

To investigate the imaging features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate hepatic sclerosing hemangioma from malignant tumors.. This retrospective case-control study included 18 patients with sclerosing hemangioma and 54 patients with common hepatic malignant tumor, including hepatocellular carcinoma, metastatic adenocarcinoma, and cholangiocarcinoma, who were examined using gadoxetic acid-enhanced liver MRI from January 2008 to June 2019. Imaging features including signal intensity, tumor margins, enhancement pattern, and presence or absence of diffusion restriction were analyzed. Significant MRI features for predicting sclerosing hemangioma were identified using multivariable logistic regression analysis. Diagnostic performances of each imaging feature and combinations of significant imaging features were summarized.. In the multivariable analysis, irregular margins (odds ratio [OR], 10.12; 95 % confidence interval [CI], 1.27-80.94; p = 0.029), centripetal or internal nodular enhancement in the transitional phase (OR, 13.58; 95 % CI, 1.48-124.82; p = 0.021), and absence of diffusion restriction (OR, 39.20; 95 % CI, 4.82-318.49; p = 0.001) were significant imaging features for the diagnosis of sclerosing hemangioma. Presence of at least two significant imaging features had a sensitivity, specificity, and accuracy of 88.9 %, 96.3 %, and 94.4 %, respectively, for diagnosing sclerosing hemangioma.. Combinations of two or more of the significant imaging features (irregular margins, centripetal or internal nodular enhancement in the transitional phase, and absence of diffusion restriction) were effective for differentiating hepatic sclerosing hemangioma from malignant tumors using gadoxetic acid-enhanced MRI.

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Case-Control Studies; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Histiocytoma, Benign Fibrous; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To evaluate and compare the diagnostic performance of the updated HCC guidelines using gadoxetic acid-enhanced MRI.. In this study, patients at risk of HCC who underwent gadoxetic acid-enhanced MRI following US/CT surveillance were retrospectively recruited from 3 centers. Three radiologists independently evaluated hepatic nodule imaging features relevant to the diagnostic criteria outlined in each guideline. Per-lesion sensitivity, specificity, and accuracy were compared between guidelines using logistic regression with a generalized estimating equation. Inter-observer agreements on imaging features were determined using Fless κ statistics.. Altogether, 447 nodules (310 HCCs, 20 combined hepatocellular-cholangiocarcinomas, 2 cholangiocarcinomas, and 115 benign entities) measuring 1-3 cm from 386 patients were assessed. The KLCA-NCC and APASL guidelines showed the highest sensitivity (82.3-90.6%, p < .001) and accuracy (83.9-88.6%) among the five guidelines. The OPTN/UNOS guideline showed the highest specificity (94.9-97.1%), followed by the AASLD/LI-RADS, EASL, KLCA-NCC, and APASL guidelines, with significant difference only with the APASL guideline. The diagnostic performance of the updated AASLD/LI-RADS and EASL guidelines and of the KLCA-NCC and APASL guidelines was comparable (p > .05). Inter-observer agreement was substantial to almost perfect (κ = 0.73-0.87).. For the diagnosis of HCC using gadoxetic acid-enhanced MRI, the KLCA-NCC and APASL guidelines showed the highest sensitivity and accuracy. The OPTN/UNOS guideline showed the highest specificity. Acknowledging their relative strengths and weaknesses could help adapt the diagnostic criteria according to the clinical context.. • APASL and KLCA-NCC provided significantly the highest sensitivity and accuracy, followed by AASLD/LI-RADS and EASL in an endemic area for hepatitis B. • OPTN/UNOS showed the highest specificity, followed by AASLD/LI-RADS, EASL, KLCA-NCC, and APASL guidelines, with significant difference only with APASL. • Broadened definition of arterial hyperenhancement, washout, and the size of the lesion eligible to apply diagnostic criteria may improve the diagnostic performance for HCC in an endemic area for hepatitis B.

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To compare the performance of current guidelines applicable to the diagnosis of hepatocellular carcinomas (HCCs) using gadoxetic acid-enhanced magnetic resonance imaging (MRI).. Two hundred and forty-one hepatic lesions (149 HCCs, six other malignancies, 86 benign lesions) in 177 patients at risk of HCC without a history of previous treatment for hepatic malignancy in a tertiary center were retrospectively reviewed. Either histopathology results or long-term (> 24 months) follow-up images were used as a standard of reference. All lesions were categorized according to the Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Study Group-National Cancer Center (KLCSG-NCC) guidelines. The sensitivity and specificity thereof were assessed using a generalized estimation equation.. For gadoxetic acid-enhanced MRI, LI-RADS (95%, 95% confidence interval [CI] 88-98) and EASL (94%, 95% CI 86-97) yielded the highest specificity, while EASL yielded the lowest sensitivity (54% [95% CI 46-62]). APASL yielded the highest sensitivity (91% [95% CI 86-95]) with the lowest specificity (78% [95% CI 69-86]). KLCSG-NCC showed balanced sensitivity (85% [79-90]) and specificity (88% [95% CI 80-93]). Differences were more prominent in small nodules between 1 and 2 cm.. The diagnostic performance of current guidelines for HCC on gadoxetic acid-enhanced MRI was significantly different, and a potential inverse association between sensitivity and specificity was observed.. • EASL and LI-RADS yielded the highest specificity with the lowest sensitivity, whereas APASL yielded the highest sensitivity with the lowest specificity. • Differences in the diagnostic performances of guidelines were prominent in small nodules between 1 and 2 cm. • Additional evaluation of CT findings improved the diagnostic sensitivity and accuracy of EASL and LI-RADS. Although doing so decreased specificity, it remained above 89-90%.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To investigate the non-invasive prediction of hepatocellular carcinoma (HCC) with vessels encapsulating tumor clusters (VETC) based on qualitative and quantitative imaging features of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI.. 109 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA enhanced MRI and immunochemical staining for CD34 were retrospectively evaluated in our institution (the first affiliated hospital of Soochow university). Pre-operative imaging features of Gd-EOB-DTPA-enhanced MRI were qualitatively and quantitatively reviewed by radiologists. Significant variables for differentiating the VETC-positive and VETC-negative HCCs were identified in univariate and multivariate analyses. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off values for quantitative variables. The nomogram based on the coefficient of multivariate analysis was constructed to evaluate the probability of VETC-positive HCCs.. The multivariate analysis showed that the serum AST level >40 U  l. Qualitative and quantitative imaging features of Gd-EOB-DTPA-enhanced MRI integrating laboratory examination can provide good diagnostic performance.. VETC is a novel identified microvascular pattern; associations between imaging features and VETC status have not been investigated. Pre-operative diagnosis of VETC status in HCC is essential to help predict the outcome of patients and make a decision for the therapeutic schedule.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity

To develop radiomics-based nomograms for preoperative microvascular invasion (MVI) and recurrence-free survival (RFS) prediction in patients with solitary hepatocellular carcinoma (HCC) ≤ 5 cm.. Between March 2012 and September 2019, 356 patients with pathologically confirmed solitary HCC ≤ 5 cm who underwent preoperative gadoxetate disodium-enhanced MRI were retrospectively enrolled. MVI was graded as M0, M1, or M2 according to the number and distribution of invaded vessels. Radiomics features were extracted from DWI, arterial, portal venous, and hepatobiliary phase images in regions of the entire tumor, peritumoral area ≤ 10 mm, and randomly selected liver tissue. Multivariate analysis identified the independent predictors for MVI and RFS, with nomogram visualized the ultimately predictive models.. Elevated alpha-fetoprotein, total bilirubin and radiomics values, peritumoral enhancement, and incomplete or absent capsule enhancement were independent risk factors for MVI. The AUCs of MVI nomogram reached 0.920 (95% CI: 0.861-0.979) using random forest and 0.879 (95% CI: 0.820-0.938) using logistic regression analysis in validation cohort (n = 106). With the 5-year RFS rate of 68.4%, the median RFS of MVI-positive (M2 and M1) and MVI-negative (M0) patients were 30.5 (11.9 and 40.9) and > 96.9 months (p < 0.001), respectively. Age, histologic MVI, alkaline phosphatase, and alanine aminotransferase independently predicted recurrence, yielding AUC of 0.654 (95% CI: 0.538-0.769, n = 99) in RFS validation cohort. Instead of histologic MVI, the preoperatively predicted MVI by MVI nomogram using random forest achieved comparable accuracy in MVI stratification and RFS prediction.. Preoperative radiomics-based nomogram using random forest is a potential biomarker of MVI and RFS prediction for solitary HCC ≤ 5 cm.. • The radiomics score was the predominant independent predictor of MVI which was the primary independent risk factor for postoperative recurrence. • The radiomics-based nomogram using either random forest or logistic regression analysis has obtained the best preoperative prediction of MVI in HCC patients so far. • As an excellent substitute for the invasive histologic MVI, the preoperatively predicted MVI by MVI nomogram using random forest (MVI-RF) achieved comparable accuracy in MVI stratification and outcome, reinforcing the radiologic understanding of HCC angioinvasion and progression.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Retrospective Studies

To explore the role of quantitative regional liver function assessed by preoperative gadoxetic acid-enhanced MRI with computer-aided virtual hepatectomy to predict short-term outcomes after major hepatectomy for HCC.. We retrospectively reviewed the records of 133 consecutive patients with HCC who underwent preoperative gadoxetic acid-enhanced MRI and indocyanine green (ICG) test. Forty-five patients received open major hepatectomy. Liver function reserve and the future liver remnant were evaluated by computer-aided virtual hepatectomy. Global liver functional parameters included the T1 relaxation time reduction rate (T1. The T1. Preoperative gadoxetic acid-enhanced MRI with computer-aided virtual hepatectomy may facilitate optimal assessment of regional liver functional reserve to predict short-term outcomes after major hepatectomy for HCC.. • Preoperative gadoxetic acid-enhanced MRI with virtual hepatectomy and volumetric analysis can provide precise liver volume and regional functional assessment. • Quantitative regional liver function assessed by gadoxetic acid-enhanced MRI can predict the short-term outcomes after major hepatectomy in patients with HCC. • The regional liver function assessed by gadoxetic acid-enhanced MRI is an independent risk factor for postoperative major complications.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

To establish the diagnostic accuracy of the Liver Imaging Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) and compare its performance to that of international criteria from European Assofor the Study of the Liver (EASL), Japan Society of Hepatology (JSH), Asian Pacific Association for the Study of the Liver (APASL), and Organ Procurement and Transplantation Network (OPTN), and to the reporting radiologist's overall opinion regarding the probability of a nodule being a HCC by correlating with a histological diagnosis from whole liver explants.. The present single-centre, retrospective review selected participants based on the following criteria: adults (≥18 years) listed for liver transplantation in 2014/2015, with liver cirrhosis at the time of magnetic resonance imaging (MRI) with hepatocyte specific contrast agent, and at least one liver lesion ≥10 mm on MRI with histology from subsequent liver explant for comparison. Each lesion was assessed against international criteria and given a "radiologist opinion" score of 1-5 (1 = definitely benign, 5 = definitely HCC).. Total 268 patient records were reviewed, with 105 eligible lesions identified from 47 patients. Median lesion size was 15.5 mm (range 10-68 mm). Sensitivity (%), specificity (%), and positive predictive value (PPV; %) for LI-RADS LR5 was 45, 89, and 89, for LI-RADS LR4+5 + TIV was 61, 80, and 86, for EASL was 44, 86 and 86, for JSH/APASL was 64, 81, and 87, for OPTN was 36, 90, and 88, and for "radiologist impression" of probably or definitely HCC was 79, 79, and 88 respectively.. MRI has moderate sensitivity and good specificity for the diagnosis of HCC with considerable variation depending on criteria used. OPTN criteria have the best specificity, but low sensitivity. "Radiologist opinion" gives highest overall accuracy with increases in sensitivity and reduction in specificity when compared to the imaging criteria.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To investigate whether the radiomics analysis of MR imaging in the hepatobiliary phase (HBP) can be used to predict microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).. A total of 130 patients with HCC, including 80 MVI-positive patients and 50 MVI-negative patients, who underwent MR imaging with Gd-EOB-DTPA were enrolled. Least absolute shrinkage and selection operator (LASSO) regression was applied to select radiomics parameters derived from MR images obtained in the HBP 5 min, 10 min, and 15 min images. The selected features at each phase were adopted into support vector machine (SVM) classifiers to establish models. Multiple comparisons of the AUCs at each phase were performed by the Delong test. The decision curve analysis (DCA) was used to analyze the classification of MVI-positive and MVI-negative patients.. The most predictive features between MVI-positive and MVI-negative patients included 9, 8, and 14 radiomics parameters on HBP 5 min, 10 min, and 15 min images, respectively. A model incorporating the selected features produced an AUC of 0.685, 0.718, and 0.795 on HBP 5 min, 10 min, and 15 min images, respectively. The predictive model for HBP 5 min, 10 min and 15 min showed no significant difference by the Delong test. DCA indicated that the predictive model for HBP 15 min outperformed the models for HBP 5 min and 10 min.. Radiomics parameters in the HBP can be used to predict MVI, with the HBP 15 min model having the best differential diagnosis ability.

Topics: Aged; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neovascularization, Pathologic; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies

Recent studies provide evidence that hepatocellular  adenomas  (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25-50%, 50-75% and 75-100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed.. Subjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)-p < 0.001) with significantly higher uptake scores assigned to FNHs (Cut-off: 75%-100%). Typical lobulation and presence of a central scar in FNH achieved an accuracy of 0.750 or higher in at least one reader (lobulation-AUC: 0.809 (R#1); 0.736 (R#2); central scar-AUC: 0.595 (R#1); 0.784 (R#2)). The multivariate regression emphasized the discriminatory power of the Gd-EOB scoring (p = 0.001/OR:22.15 (R#1) and p < 0.001/OR:99.12 (R#2). The lesion-to-liver ratio differed significantly between FNH and HCA in the PV phase and HBP (PV: 132.9 (FNH) and 110.2 (HCA), p = 0.048 and HBP: 110.3 (FNH) and 39.2 (HCA), p < 0.001)), while the difference was not significant in arterial and transitional contrast phases (p > 0.05).. Even in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA.

Topics: Adenoma, Liver Cell; Adult; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Regression Analysis; ROC Curve; Sensitivity and Specificity

The objective of this study was to analyze the accuracy of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) for predicting microvascular invasion (MVI) in patients with small hepatocellular carcinoma (sHCC) preoperatively.. A total of 60 sHCC patients performed with preoperative Gd-EOB-DTPA-MRI in the Harbin Medical University Cancer Hospital from October 2018 to October 2019 were involved in the study. Univariate and multivariate analyses were performed by chi-square test and logistic regression analysis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Gd-EOB-DTPA-MRI were performed by receiver operating characteristic (ROC) curves.. Univariate analysis indicated that alanine aminotransferase (≥ 39.00U/L), poorly differentiated pathology, and imaging features including grim enhancement, capsule enhancement, arterial halo sign and hepatobiliary features (tumor highly uptake, halo sign, spicule sign and brush sign) were associated with the occurrence of MVI (p < 0.05). Multivariate analysis revealed that rim enhancement and hepatobiliary spicule sign were independent predictors of MVI (p < 0.05). The area under the ROC curve was 0.917 (95% confidence interval 0.838-0.996), and the sensitivity was 94.74%.. The morphologies of hepatobiliary phase imaging, especially the spicule sign, showed high accuracy in diagnosing MVI of sHCC. Rim enhancement played a significant role in diagnosing MVI of sHCC.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neoplasm Invasiveness; Predictive Value of Tests; Retrospective Studies; ROC Curve

To compare the estimated quantity of intratumor gadoxetic acid retention using T1 mapping of gadoxetic acid-enhanced magnetic resonance imaging (MRI) versus conventional processing methods for the differential diagnosis of focal liver lesions.. Seventy patients with hepatic lesions (colorectal metastasis (CRM) [n = 28], hepatocellular carcinoma (HCC) [n = 20], hemangioma [n = 12], and intrahepatic cholangiocarcinoma (ICC) [n = 10]) underwent gadoxetic acid-enhanced MRI, including pre- and post-contrast T1-weighted imaging and T1 mapping. Quantitative analyses included the lesion-to-liver signal intensity ratio (SIR) on hepatobiliary phase images, the pre- and post-contrast lesion T1 value difference (ΔT1 [ms]), and the lesion retention index (LRI [%]), which was the estimated intralesional gadoxetic acid retention calculated on pre- and post-contrast T1 maps using a two-compartment pharmacokinetic model. Results were compared between the four subcategories of focal liver lesions using the Kruskal-Wallis test, followed by the post-hoc Dunn's test and receiver operating characteristic (ROC) analysis to distinguish between pairs of the four lesion subcategories.. This study identified significant differences in the LRI of the four lesion subcategories (p <  0.01), without significant differences in ΔT1 or SIR. Post-hoc analysis demonstrated significant differences in CRM vs. hemangioma (p <  0.01), hemangioma vs. ICC (p <  0.01), and HCC vs. ICC (p =  0.047) for the LRI.. The quantity of intratumor gadoxetic acid retention estimated using pre- and post- contrast T1 mapping could distinguish focal liver lesions, unlike conventional processing methods, and captured unique lesion characteristics.

Topics: Bile Duct Neoplasms; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

By analyzing possible factors contributing to imaging misevaluation of arterial phase (AP) vascularity, we aimed to provide a more proper way to detect AP hypervascularity of hepatocellular carcinomas (HCCs) using the noninvasive imaging modalities magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS).. We retrospectively recruited 164 pathologically confirmed HCC lesions from 128 patients. Using CEUS with Sonazoid (SCEUS) and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid MRI (EOB-MRI), AP vascularity of the lesions was evaluated and inconsistencies in interpretation were examined. Indicators of margin, echogenicity, and halo and mosaic signs of lesions on grayscale US; depth of lesions on SCEUS; and tumoral homogeneity, signal contrast ratio of lesions to the surrounding area on precontrast and AP images on EOB-MRI, and histological grade were investigated.. When precontrast images were used to adjust the AP enhancement ratio, the proportion of inconsistent interpretations of AP vascularity declined from 26.2% (43/164; 29 non-hypervascularity instances using EOB-MRI and 14 using SCEUS) to 16.5% (27/164; 7 using EOB-MRI and 20 using SCEUS). Greater lesion depth (P = 0.017), ill-defined tumoral margin (P = 0.028), absence of halo sign (P = 0.034), and histologically early HCC (P = 0.007) on SCEUS, and small size (P = 0.012) and heterogeneity (P = 0.013) of lesions and slight enhancement (low AP enhancement ratio) (P = 0.018 and 0.009 before and after adjustment) on EOB-MRI, may relate to undetectable hypervascularity.. SCEUS and EOB-MRI may show discrepancies in evaluating AP vascularity in the case of deep, ill-defined, heterogeneous, slightly enhanced lesions, and histologically early HCCs. We recommend adjusting AP with precontrast images in EOB-MRI, and combining both modalities to detect hypervascularity.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Ferric Compounds; Gadolinium DTPA; Humans; Image Enhancement; Iron; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Oxides; Reproducibility of Results; Retrospective Studies; Ultrasonography

To evaluate the association between contrast patterns on gadoxetic acid-enhanced hepatobiliary phase (HBP) MR images and transporter expression in surgically resected hypovascular hepatocellular nodules including early hepatocellular carcinomas (HCCs).. Forty-two hypovascular hepatic nodules and 43 hypervascular HCCs as a control were included in this retrospective study. Contrast of the nodules on HBP images was graded as hypo-, iso-, or hyperintense. Histopathological assessment was performed in the context of multistep hepatocarcinogenesis. Immunohistochemical staining of organic anion transporter 1B3 (OATP1B3) and multidrug resistance protein 2 (MRP2) was performed. Cramer's coefficient was used to determine the linear relationship between contrast grades and transporter expression, and the Cochran-Armitage trend test was used to determine the relationship between transporter expression and progression of multistep hepatocarcinogenesis.. Moderate linear relationships between contrast grades and OATP1B3 expression were observed for both hypo- and hypervascular nodules. OATP1B3 expression was negatively correlated with the progression of multistep hepatocarcinogenesis. MRP2 expression was not associated with the contrast grades or histopathological results.. OATP1B3 expression was associated with contrast grades of hepatocellular nodules observed in HBP image of gadoxetic acid-enhanced MRI in the hypovascular hepatocellular nodules and was negatively correlated with hepatocarcinogenesis.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Cross-Sectional Studies; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Machine Learning; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neoplasm Invasiveness; Retrospective Studies; Young Adult

To identify image features of macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC) and to determine its role in predicting MTM-HCC.. Patients who underwent preoperative gadoxetic acid-enhanced MRI and with surgery proven HCC were retrospectively included. Imaging features were assessed according to Liver Imaging Reporting and Data System. Quantitative measurements were recorded. Clinical characteristics and imaging findings were compared between MTM-HCCs and non-MTM-HCCs. Predictive factors of MTM-HCC were screened with univariate analyses and then identified with multivariate logistic regression. A regression-based diagnostic model was constructed. ROC analyses were used to determine cutoff values, AUC, and corresponding 95% confidence interval (CI) of findings. The diagnostic performance was validated by 10-fold cross-validation.. Necrosis or severe ischemia was a sensitive imaging feature of MTM-HCC. Noninvasive prediction of this subtype can be achieved with good accuracy and excellent specificity when findings were combined.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Pretreatment evaluation of tumor biology and microenvironment is important to predict prognosis and plan treatment. We aimed to develop nomograms based on gadoxetic acid-enhanced MRI to predict microvascular invasion (MVI), tumor differentiation, and immunoscore.. This retrospective study included 273 patients with HCC who underwent preoperative gadoxetic acid-enhanced MRI. Patients were assigned to two groups: training (N = 191) and validation (N = 82). Univariable and multivariable logistic regression analyses were performed to investigate clinical variables and MRI features' associations with MVI, tumor differentiation, and immunoscore. Nomograms were developed based on features associated with these three histopathological features in the training cohort, then validated, and evaluated.. Predictors of MVI included tumor size, rim enhancement, capsule, percent decrease in T1 images (T1. MRI-based nomograms effectively predict tumor behaviors in HCC and may assist clinicians in prognosis prediction and pretreatment decisions.. • This study developed and validated three nomograms based on gadoxetic acid-enhanced MRI to predict MVI, tumor differentiation, and immunoscore in patients with HCC. • The pretreatment prediction of tumor microenvironment may be useful to guide accurate prognosis and planning of surgical and immunological therapies for individual patients with HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Nomograms; Retrospective Studies; Tumor Microenvironment

This study aimed to elucidate the relationship between gadoxetic acid-enhanced magnetic resonance imaging (MRI) features-enhancing capsule, corona enhancement or hypointense rim-observed in hepatocellular carcinomas (HCCs).. Of the HCCs surgically confirmed during a 5-year period (2013-2017), ≤ 3-cm lesions (n = 83) in 78 patients were evaluated. Presence of corona enhancement and enhancing capsule on multiphasic dynamic imaging and presence of hypointense rim on hepatobiliary phase imaging were determined retrospectively by two independent observers. The relationship among the three imaging features was statistically analysed and correlated with the presence of histologic fibrous capsules, tumour differentiation and gross morphologic type.. There was substantial overall interobserver agreement in determining the presence of the three imaging features. Sixty (72.3%) lesions had histologic fibrous capsule positively correlated with all three imaging features (p < 0.05). Corona enhancement was the most common (66.3%) feature followed by enhancing capsule (61.4%) and hypointense rim (33.7%), and the correspondence rate of enhancing capsule to corona enhancement was 68.6% (p = 0.004). Corona enhancement was more frequently observed in moderately differentiated HCCs than other lesions (p = 0.012) and not dependent (p = 0.465) on the tumour size, while enhancing capsule was significantly dependent on tumour size, as indicated by univariate (p < 0.001) and multivariate analyses (odds ratio, 4.241; p = 0.002).. Among the capsular features, corona enhancement might closely relate to enhancing capsule in HCCs. Corona enhancement was not dependent on tumour size and had the highest incidence of appearance on gadoxetic acid-enhanced multiphasic dynamic MRI.. • Enhancing capsule has a limited role in the LI-RADS categorisation during gadoxetic acid-enhanced MRI. • Appearance of corona enhancement is closely related to enhancing capsule and is not dependent on size of HCCs. • Corona enhancement can substitute enhancing capsule in the diagnosis of HCCs during multiple arterial and portal venous phase gadoxetic acid-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Identification of risk factors for the development of hepatocellular carcinoma (HCC) after a sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV) infection is urgently needed for HCC surveillance.. To evaluate whether the presence of non-hypervascular hypointense nodules (NHHNs) depicted by gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) before direct-acting antivirals (DAAs) therapy is a risk factor for de novo HCC development after SVR.. The presence of NHHNs was examined with EOB-MRI before the start of DAA therapy in 383 patients with HCV infection who achieved SVR. The incidence of de novo HCC after SVR was compared between patients with versus without NHHNs.. NHHNs were detected before DAA therapy in 32 patients (8.4%). The incidence of de novo HCC after SVR was significantly higher in patients with NHHNs than in those without (1-, 3-, 5-year incidence, 9.8%, 24.2% and 41.6% vs. 0%, 1.2% and 4.4%, P < 0.0001). The presence of NHHNs before DAA therapy (adjusted HR, 10.86; 95% CI, 4.03-31.64) and cirrhosis (adjusted HR, 7.23; 95% CI, 1.88-35.85) were independently associated with a higher incidence of HCC after SVR. A higher incidence of de novo HCC after SVR remained after adjustment for age, gender, regular alcohol intake, diabetes, cirrhosis, FIB-4 index and serum alpha-foetoprotein with inverse probability of treatment weighting.. This study confirmed that the presence of NHHNs before DAA therapy is a strong risk factor for the development of de novo HCC after SVR.

Topics: Antiviral Agents; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatitis C; Hepatitis C, Chronic; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Sustained Virologic Response

Topics: Aged; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

To identify the value of discrepancies in the central scar (CS)-like structure between dynamic CT and gadoxetate disodium-enhanced MRI for differentiating FNH from HCA.. This retrospective study included 113 patients with pathologically-diagnosed FNH (n = 80) or HCA (n = 37). CS-like structures were evaluated on arterial phase (AP) CT and hepatobiliary phase (HBP) MRI. Presence of the CS-like structure, its discrepancy in visibility or size between AP CT and HBP MRI and between AP and HBP MRI, and features of non-scarred tumor portion were evaluated by two radiologists. Inter-observer agreement was evaluated by intraclass correlation coefficients (ICCs) and weighted kappa. Univariable and multivariable logistic regression and ROC analysis were performed to explore features differentiating FNH from HCA.. Inter-observer agreement was moderate-to-excellent (ICCs≥0.74, kappa≥0.65). On univariable analysis, presence of CS-like structures (P < 0.001), discrepancy of the CS-like structures between AP CT and HBP MRI (73.8 % in FNH; 16.2 % in HCA, P < 0.001) and between AP and HBP MRI (70.0 % in FNH; 16.2 % in HCA, P < 0.001), and the features of non-scarred tumor portion (P ≤ 0.011) were significantly different between FNH and HCA. On multivariable analysis, the discrepancy of CS-like structures between AP CT and HBP MRI, and the absence of low SI of the non-scarred tumor portion on HBP MRI, were suggestive of FNH (P = 0.036 and P < 0.001, respectively; area under the ROC curve, 0.96 [95 % CI, 0.93-0.99]).. Evaluation of discrepancy in the visibility or size of CS-like structures between dynamic CT and gadoxetate disodium-enhanced MRI may facilitate the differentiation of FNH from HCA.

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Cicatrix; Contrast Media; Diagnosis, Differential; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan-Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.SI ratio of peritumoral tissue to normal liver in arterial phase (SIAp/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867-5.198] and pathological grades (OR = 1.437, 95% CI: 1.042-1.981). The area under the curve (AUC) of SIAp/Al was equivalent to the SI of tumor parenchyma on arterial phase (SIAt) in distinguishing low and high pathological grades. However, the AUC of SIAp/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SIAp/Al<1.1 was higher than HCC with SIAp/Al≥1.1(P = .025).The SIAp/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SIAp/Al may predict the poor prognosis of HCC after surgery.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Disease-Free Survival; Female; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Predictive Value of Tests; Preoperative Period; Prognosis; Retrospective Studies; ROC Curve

(1) To assess the quality of the arterial input function (AIF) during dynamic contrast-enhanced (DCE) MRI of the liver and (2) to quantify perfusion parameters of hepatocellular carcinoma (HCC) and liver parenchyma during the first 3 min post-contrast injection with DCE-MRI using gadoxetate disodium compared to gadobenate dimeglumine (Gd-BOPTA) in different patient populations.. In this prospective study, we evaluated 66 patients with 83 HCCs who underwent DCE-MRI, using gadoxetate disodium (group 1, n = 28) or Gd-BOPTA (group 2, n = 38). AIF qualitative and quantitative features were assessed. Perfusion parameters (based on the initial 3 min post-contrast) were extracted in tumours and liver parenchyma, including model-free parameters (time-to-peak enhancement (TTP), time-to-washout) and modelled parameters (arterial flow (F. AIF quality, modelled and model-free perfusion parameters in HCC were similar between the 2 groups (p = 0.054-0.932). Liver parenchymal flow was lower and liver enhancement occurred later in group 1 vs group 2 (F. Gadoxetate disodium provides comparable AIF quality and HCC perfusion parameters compared to Gd-BOPTA during dynamic phases. Despite delayed and decreased liver enhancement with gadoxetate disodium, LLCRs were equivalent between contrast agents, indicating similar tumour conspicuity.. • Arterial input function quality, modelled, and model-free dynamic parameters measured in hepatocellular carcinoma are similar in patients receiving gadoxetate disodium or gadobenate dimeglumine during the first 3 min post injection. • Gadoxetate disodium and gadobenate dimeglumine show similar lesion-to-liver contrast ratios during dynamic phases in patients with HCC. • There is lower portal and lower total hepatic flow and longer hepatic mean transit time and time-to-peak with gadoxetate disodium compared to gadobenate dimeglumine.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds; Perfusion; Prospective Studies

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) has high diagnostic accuracy in the detection of liver lesions. There is a demand for computer-aided detection/diagnosis software for Gd-EOB-DTPA-enhanced MRI. We propose a deep learning-based method using one three-dimensional fully convolutional residual network (3D FC-ResNet) for liver segmentation and another 3D FC-ResNet for simultaneous detection and classification of a focal liver lesion in Gd-EOB-DTPA-enhanced MRI.. We prepared a five-phase (unenhanced, arterial, portal venous, equilibrium, and hepatobiliary phases) series as the input image sets and labeled focal liver lesion (hepatocellular carcinoma, metastasis, hemangiomas, cysts, and scars) images as the output image sets. We used 100 cases to train our model, 42 cases to determine the hyperparameters of our model, and 42 cases to evaluate our model. We evaluated our model by free-response receiver operating characteristic curve analysis and using a confusion matrix.. Our model simultaneously detected and classified focal liver lesions. In the test cases, the detection accuracy for whole focal liver lesions had a true-positive ratio of 0.6 at an average of 25 false positives per case. The classification accuracy was 0.790.. We proposed the simultaneous detection and classification of a focal liver lesion in Gd-EOB-DTPA-enhanced MRI using multichannel 3D FC-ResNet. Our results indicated simultaneous detection and classification are possible using a single network. It is necessary to further improve detection sensitivity to help radiologists.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging

Nuclear protein Ki-67 indicates the status of cell proliferation and has been regarded as an attractive biomarker for the prognosis of HCC. The aim of this study is to investigate which radiomics model derived from different sequences and phases of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI was superior to predict Ki-67 expression in hepatocellular carcinoma (HCC), then further to validate the optimal model for preoperative prediction of Ki-67 expression in HCC.. This retrospective study included 151 (training cohort: n = 103; validation cohort: n = 48) pathologically confirmed HCC patients. Radiomics features were extracted from the artery phase (AP), portal venous phase (PVP), hepatobiliary phase (HBP), and T2-weighted (T2W) images. A logistic regression with the least absolute shrinkage and selection operator (LASSO) regularization was used to select features to build a radiomics score (Rad-score). A final combined model including the optimal Rad-score and clinical risk factors was established. Receiver operating characteristic (ROC) curve analysis, Delong test and calibration curve were used to assess the predictive performance of the combined model. Decision cure analysis (DCA) was used to evaluate the clinical utility.. The AP radiomics model with higher decision curve indicating added more net benefit, gave a better predictive performance than the HBP and T2W radiomic models. The combined model (AUC = 0.922 vs. 0.863) including AP Rad-score and serum AFP levels improved the predictive performance more than the AP radiomics model (AUC = 0.873 vs. 0.813) in the training and validation cohort. Calibration curve of the combined model showed a good agreement between the predicted and the actual probability. DCA of the validation cohort revealed that at a range threshold probability of 30-60%, the combined model added more net benefit compared with the AP radiomics model.. A combined model including AP Rad-score and serum AFP levels based on enhanced MRI can preoperatively predict Ki-67 expression in HCC.

Topics: alpha-Fetoproteins; Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Female; Gadolinium DTPA; Humans; Ki-67 Antigen; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; ROC Curve

Liver Imaging Reporting and Data System (LI-RADS) and European Association for the Study (EASL) criteria for hepatocellular carcinoma (HCC) diagnosis have been updated in 2018. We aimed to compare the HCC diagnostic performance of LI-RADS and EASL criteria with extracellular contrast agents-MRI (ECA-MRI) and hepatobiliary agents-MRI (HBA-MRI).. We prospectively evaluated 179 participants with cirrhosis (n = 105) or non-cirrhotic chronic hepatitis B (CHB) (n = 74) who underwent both ECA-MRI and HBA-MRI before surgery for de novo nodule(s) measuring 10-30 mm. We compared the HCC diagnostic performance of EASL and LR-5 in both MRIs.. In an analysis of 215 observations (175 HCCs, 17 non-HCC malignancies and 23 benign lesions) identified from cirrhotic or non-cirrhotic CHB participants, LR-5 with ECA-MRI provided the highest sensitivity (80.7%), followed by EASL with ECA-MRI (76.2%), LR-5 with HBA-MRI (67.3%) and EASL with HBA-MRI (63.0%, all P < .05). The specificities were comparable (89.4%-91.5%). When the analysis is limited to participants with pathological cirrhosis (123 observations), the sensitivity of LR-5 with ECA-MRI was similar to that of EASL with ECA-MRI (82.7% vs 80.2%, P = .156), but higher than LR-5 with HBA-MRI (65.1%) or EASL with HBA-MRI (62.8%, both P < .001), with comparable specificities (87.5%-91.7%).. The LR-5 with ECA-MRI yielded the highest sensitivity with a similar specificity for HCC diagnosis in cirrhosis and non-cirrhotic CHB participants, while the sensitivities of LR-5 and EASL with ECA-MRI are similar for cirrhosis participants. This indicates non-invasive diagnosis criteria can differ by contrast agents and presence of cirrhosis.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

Functional assessment of the future liver remnant (FLR) after major hepatectomy is essential but often difficult in patients with biliary malignancy, owing to obstructive jaundice and portal vein embolization. This study evaluated whether a novel index using gadoxetate disodium-enhanced MRI (EOB-MRI) could predict posthepatectomy liver failure (PHLF) after major hepatectomy for biliary malignancy.. The remnant hepatocellular uptake index (rHUI) was calculated in patients undergoing EOB-MRI before major hepatectomy for biliary malignancy. Receiver operating characteristic (ROC) curve analyses were used to evaluate the accuracy of rHUI for predicting PHLF grade B or C, according to International Study Group of Liver Surgery criteria. Multivariable logistic regression analyses comprised stepwise selection of parameters, including rHUI and other conventional indices.. This study included 67 patients. The rHUI accurately predicted PHLF (area under the curve (AUC) 0.896). A cut-off value for rHUI of less than 0.410 predicted all patients who developed grade B or C PHLF. In multivariable analysis, only rHUI was an independent risk factor for grade B or C PHLF (odds ratio 2.0 × 103, 95 per cent c.i. 19.6 to 3.8 × 107; P < 0.001). In patients who underwent preoperative portal vein embolization, rHUI accurately predicted PHLF (AUC 0.885), whereas other conventional indices, such as the plasma disappearance rate of indocyanine green of the FLR and FLR volume, did not.. The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Postoperative Complications; Retrospective Studies

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To investigate the value of preoperative gadoxetic acid-enhanced MRI for tumor staging and recurrence prediction of hepatocellular carcinoma (HCC) after primary liver transplantation (LT).. This multicenter retrospective study included 122 recipients who underwent living donor LT (LDLT) for untreated HCC and pre-transplant gadoxetic acid-enhanced MRI from January 2009 to December 2013. Disease-free survival (DFS) was evaluated. Milan criteria, tumor grade, and microvascular invasion (MVI) were analyzed on the pathological examination of the explanted liver.. The 1-, 3-, 5-, and 7-year DFS rates were 93.3%, 90.7%, 88.9%, and 86.1%, respectively. In the multivariable analysis, independent predictors of HCC recurrence were "beyond the Milan criteria" (hazard ratio [HR], 3.54; 95% confidence interval [CI], 1.13-11.12; p = 0.030) and peritumoral hypointensity on hepatobiliary phase (HBP) (HR, 18.30; 95% CI, 4.33-77.34; p < 0.001). Pre-transplant MRI yielded a 90.2% accuracy to categorize the Milan criteria when compared with the explanted liver. Peritumoral hypointensity on HBP was significantly associated with a worse tumor grade (p = 0.010) and MVI (p < 0.001). The 5-year DFS rate in patients with "beyond the Milan criteria" but the absence of peritumoral hypointensity on HBP was not different from that in patients "within the Milan criteria" (92.2% vs. 92.9%, p = 0.438).. Pre-transplant gadoxetic acid-enhanced MRI may assist in the HCC recurrence risk prediction.. • Lesions beyond the Milan criteria and peritumoral hypointensity on hepatobiliary phase (HBP) were independent predictors of HCC recurrence. • Peritumoral hypointensity on HBP significantly associated with a worse tumor grade and microvascular invasion.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Disease-Free Survival; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Predictive Value of Tests; Preoperative Care; Prognosis; Retrospective Studies; Risk Assessment

To explore the noninvasive prediction of hepatocellular carcinoma (HCC) with progenitor phenotype based on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. This retrospective study included 115 surgery-proven HCCs with preoperative gadoxetic acid-enhanced MRI from August 2015 to September 2018. Image features were reviewed. Quantitative image analysis was performed using histogram analysis. HCC with progenitor phenotype was defined as positive for either cytokeratin 19 (CK19) or epithelial cell adhesion molecule (EpCAM) expression. Statistically significant variables for identifying HCCs with progenitor phenotype were determined at multivariate analyses. ROC analyses were used to determined cutoff values and the diagnostic performance of significant variables and combinations. Prediction nomogram was constructed based on multivariate analysis.. At multivariate regression analyses, AFP ≥ 155.25 ng/mL (p < 0.001), skewness on T2WI ≤ 1.10 (p = 0.024), uniformity on pre-T1WI ≤ 0.91 (p = 0.024), irregular tumor margin (p = 0.006), targetoid appearance (p = 0.001), and the absence of mosaic architecture (p = 0.014) were significant predictors of HCCs expressing progenitor cell markers. Combing any three of those significant variables, it provides a diagnostic accuracy of 0.86 (95% CI 0.78-0.92) with sensitivity of 0.97 (95% CI 0.86-1.00), and specificity of 0.74 (95% CI 0.63-0.83). The C-index of the regression coefficient-based nomogram was 0.94 (95% CI 0.91-0.98).. Noninvasive prediction of HCCs with progenitor phenotype can be achieved with high accuracy by integrated interpretation of biochemical and radiological information, representing a handy tool for precise patient management and the prediction of prognosis.. • Qualitative image features of irregular tumor margin, targetoid appearance, and the absence of mosaic architecture are significant predictors of hepatocellular carcinoma with progenitor phenotype. • Quantitative analyses using whole-lesion histogram analysis provides additional information for the prediction of hepatocellular carcinoma with progenitor phenotype. • Noninvasive prediction of hepatocellular carcinoma with progenitor phenotype can be achieved with high accuracy by integrated interpretation of clinical information and qualitative and quantitative imaging analyses.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Epithelial Cell Adhesion Molecule; Female; Gadolinium DTPA; Humans; Keratin-19; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Nomograms; Phenotype; Retrospective Studies; ROC Curve; Sensitivity and Specificity

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Research Design; Retrospective Studies; Subtraction Technique

To evaluate the diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast agents (EC-MRI) vs. MRI with gadoxetic acid (EOB-MRI) for HCC detection in patients with liver cirrhosis using liver explant as the reference. The additional value of hepatobiliary phase (HBP) post Gadoxetic acid was also assessed.. Two-hundred seventy-seven consecutive patients who underwent liver transplantation over a 9 year period and imaging within 90 days of were retrospectively included. Imaging consisted in CT (n = 100), EC-MRI (n = 77) and EOB-MRI (n = 100), the latter subdivided into dynamic EOB-MRI and full EOB-MRI (dynamic+HBP). Three radiologists retrospectively categorized lesions ≥ 1 cm using the LI-RADSv2017 algorithm. Dynamic EOB-MRI was re-evaluated with the addition of HBP. Results were correlated with explant pathology.. Pathology demonstrated 265 HCCs (mean size 2.1 ± 1.4 cm) in 177 patients. Per-patient sensitivities were 86.3% for CT, 89.5% for EC-MRI, 92.8% for dynamic EOB-MRI and 95.2% for full EOB-MRI (pooled reader data), with a significant difference between CT and dynamic/full EOB-MRI (p = 0.032/0.002), and between EC-MRI and full EOB-MRI (p = 0.047). Per-lesion sensitivities for CT, EC-MRI, dynamic EOB-MRI and full EOB-MRI were 59.5%,78.5%,69.7% and 76.8%, respectively, with a significant difference between MRI groups and CT (p-range:0.001-0.04), and no difference between EC-MRI and dynamic EOB-MRI (p = 0.949). For HCCs 1-1.9 cm, sensitivities were 34.4%, 64.6%, 57.3% and 67.3%, respectively, with all MRI groups significantly superior to CT (p ≤ 0.01) and full EOB-MRI superior to dynamic EOB-MRI (p = 0.002).. EOB-MRI outperforms CT and EC-MRI for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. MRI methods outperform CT for detection of HCCs 1-1.9 cm.. • MRI is superior to CT for HCC detection in patients with liver cirrhosis. • EOB-MRI outperforms CT and MRI using extracellular contrast agents (EC-MRI) for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. • The addition of hepatobiliary phase images improves HCC detection when using gadoxetic acid.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; False Positive Reactions; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

National Natural Science Foundation of China; Contract grant number: 81260214.. Recent studies have highlighted the diagnostic value of Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in small hepatocellular carcinoma (HCC). Ki67 and CD34 are histologic markers that reflect the proliferation of tumor cells and the microvascular density (MVD).. To explore the diagnostic value of Gd-EOB-DTPA-enhanced MRI for Ki67 expression and MVD in HCC.. Retrospective.. In all, 180 patients with HCC.. 3.0T, Gd-EOB-DTPA-enhanced T. The T. Receiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of T. 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1755-1763.

Topics: Carcinoma, Hepatocellular; China; Contrast Media; Gadolinium DTPA; Humans; Ki-67 Antigen; Liver Neoplasms; Magnetic Resonance Imaging; Microvascular Density; Retrospective Studies

Computed tomography (CT) and magnetic resonance imaging (MRI) are used to detect hepatocellular carcinoma (HCC). We performed a prospective study to compare the diagnostic performance of CT, MRI with extracellular contrast agents (ECA-MRI), and MRI with hepatobiliary agents (HBA-MRI) in the detection of HCC using the liver imaging reporting and data system (LI-RADS).. We studied 125 participants (102 men; mean age, 55.3 years) with chronic liver disease who underwent CT, ECA-MRI, or HBA-MRI (with gadoxetic acid) before surgery for a nodule initially detected by ultrasound at a tertiary center in Korea, from November 2016 through February 2019. We collected data on major features and assigned LI-RADS categories (v2018) from CT and MRI examinations. We then compared the diagnostic performance for LR-5 for each modality alone, and in combination.. In total, 163 observations (124 HCCs, 13 non-HCC malignancies, and 26 benign lesions; mean size, 20.7 mm) were identified. ECA-MRI detected HCC with 83.1% sensitivity and 86.6% accuracy, compared to 64.4% sensitivity and 71.8% accuracy for CT (P < .001) and 71.2% sensitivity (P = .005) and 76.5% accuracy for HBA-MRI (P = .005); all technologies detected HCC with 97.4% specificity. Adding CT to either ECA-MRI (89.2% sensitivity, 91.4% accuracy; both P < .05) or HBA-MRI (82.8% sensitivity, 86.5% accuracy; both P < .05) significantly increased its diagnostic performance in detection of HCC compared with the MRI technologies alone. ECA-MRI identified arterial phase hyperenhancement in a significantly higher proportion of patients (97.6%) than CT (81.5%; P < .001) or HBA-MRI (89.5%; P = .002). ECA-MRI identified non-peripheral washout in 79.8% of patients, vs 74.2% of patients for CT and 73.4% of patients for HBA-MRI (differences not significant). ECA-MRI identified enhancing capsules in 85.5% of patients, vs 33.9% for CT (P < .001) and 41.4% for HBA-MRI (P < .001).. In a prospective study of patients with chronic liver disease and a nodule detected by ultrasound, ECA-MRI detected HCC with higher levels of sensitivity and accuracy than CT or HBA-MRI, based on LI-RADS. Diagnostic performance was best when CT was used in combination with MRI compared with MRI alone.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To compare the diagnostic performance of the 2017 (v2017) and 2018 versions (v2018) of the Liver Imaging-Reporting and Data System (LI-RADS) for hepatocellular carcinoma (HCC) using gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) and to evaluate the effect in v2018.. Treatment-naive patients at high-risk for HCC who underwent Gd-EOB-MRI were included. The LI-RADS categories were assigned according to v2017 and v2018. The diagnostic performances were compared between v2017 and v2018 according to the size and combination of imaging features.. A total of 117 patients with 137 observations were identified, including 89 HCCs; 76.2% (64/84) of observations with threshold growth were re-classified as subthreshold growth when using v2018 instead of v2017. The final categories changed in nine (14%) cases. For the combination of LR-5/LR-5V, there were no significant differences in sensitivity and specificity between the two versions (sensitivity, 64% versus 58.4%; specificity, 87.5% versus 85.4%; all p>0.05). For the combination of LR-4 and LR-5/5V, the diagnostic performance of v2018 was inferior to that of v2017 when considering only major features (accuracy, 86.1% versus 80.3%, respectively; p=0.013), particularly in observations measuring 10-20 mm, but was comparable after adding the ancillary features (accuracy, 86.9% versus 86.1%, respectively; p=1.00).. In LI-RADS v2018, although a considerable number of observations re-classified subthreshold growth, changes in the assigned categories were insignificant; overall diagnostic performance was comparable to that of v2017, but v2018 might emphasise the value of ancillary features in combination with major features for determining the probability of HCC.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Small recurrent hepatocellular carcinoma (HCC) can show atypical imaging patterns, and a specific diagnostic algorithm for HCC is lacking. This study aimed to better characterize postoperative recurrent HCCs <20 mm in size with gadoxetic acid-enhanced magnetic resonance imaging (MRI). We evaluated 373 newly developed nodules after hepatectomy in 204 HCC patients with chronic hepatitis B virus infection. The diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) version 2018 was calculated with gadoxetic acid-enhanced MRI to characterize recurrent HCC. Modified diagnostic algorithms were proposed by combining significant imaging biomarkers related to subcentimeter and 10-19 mm recurrence, and the algorithms were then compared with the LI-RADS system. A total of 256 recurrent HCCs (108 recurrent HCCs <10 mm in size; 148 recurrent HCCs 10-19 mm in size) were confirmed via histology or follow-up imaging. Nonrim arterial phase hyperenhancement (APHE) and 3 LI-RADS ancillary features (AFs; hepatobiliary phase hypointensity, mild-moderate T

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatitis B virus; Hepatitis B, Chronic; Humans; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Retrospective Studies; Sensitivity and Specificity

Microvascular invasion (MVI) is implicated in the poor prognosis of hepatocellular carcinoma (HCC). Presurgical stratifying schemes have been proposed for HCC-MVI but lack external validation.. To perform external validation and comparison of four presurgical stratifying schemes for the prediction of MVI using gadoxetic acid-based MRI in a cohort of HCC patients.. Retrospective.. Included were 183 surgically resected HCCs from patients who underwent pretreatment MRI.. This includes 1.5-3.0 T with T. A two-trait predictor of venous invasion (TTPVI), Lei model, Lee model, and Xu model were compared. We relied on preoperative characteristics and imaging findings via four independent radiologists who were blinded to histologic results, as required by the tested tools.. Tests of accuracy between predicted and observed HCC-MVI rates using receiver operating characteristic (ROC) curve and decision curve analysis. The intraclass correlation coefficient (ICC) and Cronbach's alpha statistics were used to evaluate reproducibility.. HCC-MVI was identified in 52 patients (28.4%). The average ROC curves (AUCs) for HCC-MVI predictions were 0.709-0.880, 0.714-0.828, and 0.588-0.750 for the Xu model, Lei model, and Lee model, respectively. The rates of accuracy were 60.7-81.4%, 69.9-75.9%, and 65.6-73.8%, respectively. Decision curve analyses indicated a higher benefit for the Xu and Lei models compared to the Lee model. The ICC and Cronbach's alpha index were highest in the Lei model (0.896/0.943), followed by the Xu model (0.882/0.804), and the Lee model (0.769/0.715). The TTPVI resulted in a Cronbach's alpha index of 0.606 with a sensitivity of 34.6-61.5% and a specificity of 76.3-91.6%.. Stratifying schemes relying on gadoxetic acid-enhanced MRI provide an additional insight into the presence of preoperative MVI. The Xu model outperformed the other models in terms of accuracy when performed by an experienced radiologist. Conversely, the Lei model outperformed the other models in terms of reproducibility.. 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:433-447.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Ki-67 Antigen; Liver Neoplasms; Magnetic Resonance Imaging; Microvascular Density

Topics: Angiography; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Hepatic Artery; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

We aimed to develop a radiomics-based model derived from gadoxetic acid-enhanced MR images to preoperatively identify cytokeratin (CK) 19 status of hepatocellular carcinoma (HCC).. A cohort of 227 patients with single HCC was classified into a training set (n = 159) and a time-independent validated set (n = 68). A total of 647 radiomic features were extracted from multi-sequence MR images. The least absolute shrinkage and selection operator regression and decision tree methods were utilized for feature selection and radiomics signature construction. A multivariable logistic regression model incorporating clinico-radiological features and the fusion radiomics signature was built for prediction of CK19 status by evaluating area under curve (AUC).. In the whole cohort, 57 patients were CK19 positive and 170 patients were CK19 negative. By combining 11 and 6 radiomic features extracted in arterial phase and hepatobiliary phase images, respectively, a fusion radiomics signature achieved AUCs of 0.951 and 0.822 in training and validation datasets. The final combined model integrated a-fetoprotein levels, arterial rim enhancement pattern, irregular tumor margin, and the fusion radiomics signature, with a sensitivity of 0.818 and specificity of 0.974 in the training cohort and that of 0.769 and 0.818 in the validated cohort. The nomogram based on the combined model showed satisfactory prediction performance in training (C-index 0.959) and validation (C-index 0.846) dataset.. The combined model based on a fusion radiomics signature derived from arterial and hepatobiliary phase images of gadoxetic acid-enhanced MRI can be a reliable biomarker for CK19 status of HCC.. • Arterial rim enhancement pattern and irregular tumor margin on hepatobiliary phase on gadoxetic acid-enhanced MRI can be useful for evaluating CK19 status of HCC. • A radiomics-based model performed better than the clinico-radiological model both in training and validation datasets for predicting CK19 status of HCC. • The nomogram based on the fusion radiomics signature can be easily used for CK19 stratification of HCC.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Keratin-19; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Nomograms; Preoperative Period; Retrospective Studies; Sensitivity and Specificity; Young Adult

This study was conducted in order to assess the performance of the Liver Imaging Reporting and Data System (LI-RADS) treatment response (TR) (LR-TR) categorization on gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detecting viable tumors in hepatocellular carcinoma (HCC) treated with locoregional treatment (LRT) and to investigate the added value of ancillary features (AFs) to conventional enhancement-based criteria.. This retrospective study included 183 patients with Gd-EOB-MRI after LRT for HCC and appropriate reference standards for tumor viability (84 viable and 99 nonviable). Two independent radiologists assigned per-lesion mRECIST and TR categories (TR-nonviable, TR-equivocal, or TR-viable) according to the LR-TR algorithm and modified LR-TR algorithms including mLR-TR(TP) allowing transitional phase (TP) washout and mLR-TR(AF) allowing category adjustment by applying AFs. Diagnostic performances of imaging criteria were compared using the Cochran's Q test with post hoc analysis.. For detecting viable tumors, LR-TR-viable resulted in sensitivities of 64.5%/39.3% and specificities of 98.0%/98.0% in reviewers 1/2. In comparison to LR-TR-viable, mRECIST-viable, mLR-TR(TP)-viable, and mLR-TR(AF)-viable showed significantly higher sensitivities (92.9%/94.0%, 77.4%/56.6%, and 86.9%/83.3% in reviewers 1/2) (ps < 0.001). The specificity of mRECIST-viable (73.7%/62.6%) was significantly lower than that of LR-TR-viable (ps < 0.001), while those of mLR-TR(TP)-viable and mLR-TR(AF)-viable were greater than 95% (98.0%/96.0% and 97.0%/96.0%), statistically equivalent to LR-TR-viable (ps > 0.05). TR-equivocal was least assigned on mLR-TR(AF) (1.1%/7.7%) than LR-TR (15.8%/32.2%) or mLR-TR(TP) (6.6%/23.5%) in both reviewers.. The LR-TR algorithm on Gd-EOB-MRI provides a specific diagnosis of viable tumor but with limited sensitivity. By applying AFs in the category adjustment, more sensitive and confident diagnosis can be achieved without significant loss of specificity.. • The LI-RADS treatment response (LR-TR) algorithm on Gd-EOB-MRI provides a highly specific diagnosis of viable HCC but with limited sensitivity. • The inferior sensitivity of LR-TR-viable category to that of mRECIST can be improved by applying ancillary features in the category adjustment.

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Treatment Outcome

To assess image features for diagnosing LR-M in the Liver Imaging Reporting and Data System (LI-RADS) version 2018 on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and evaluate inter-reader agreement and imaging-pathology correlation.. A total of 65 patients diagnosed as LR-M who underwent preoperative gadoxetic acid-enhanced MRI between September 2016 and March 2019 were included retrospectively. All patients were pathologically confirmed and MR images were reviewed by two radiologists without any information of patient history. The intraclass correlation coefficient (ICC) and the Chi-square test were used to evaluate inter-reader agreement and imaging-pathology correlation, respectively.. Hepatocellular carcinoma (HCC, n = 23), intrahepatic cholangiocarcinoma (CCA, n = 18), metastasis (n = 10), chronic inflammation (n = 7), combined HCC-CCA (n = 5), sarcoma (n = 1), and neuroendocrine tumor (n = 1) were confirmed. Overall ICC values showed near-perfect to substantial agreement (ranges 0.690-0.887). An assessment of a potential imaging-pathology relationship revealed that HCC, CCA, and chronic inflammation were correlated with 'not showing delayed central enhancement' (p = 0.01), 'other feature suggesting non-HCC malignancy (biliary dilatation and liver surface retraction)' (p = 0.03), and 'infiltrative appearance' (p = 0.00). One or more LR-M image features observed together with biliary dilatation or liver surface retraction, suggested CCA as high specificity (89.4%) and diagnostic accuracy (83.1%).. Most of the LR-M image features were not correlated with pathologic diagnosis. However, if one or more of the LR-M features were combined with other well-known image features, diagnostic performance of the LR-M could be improved.

Topics: Bile Duct Neoplasms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Retrospective Studies

Background The impact on survival of gadoxetic acid-enhanced MRI in addition to multiphase contrast material-enhanced CT for initial staging in patients with hepatocellular carcinoma (HCC) is unknown. Purpose To compare all-cause mortality in patients with HCC who underwent CT only, CT plus non-gadoxetic acid-enhanced MRI, or CT plus gadoxetic acid-enhanced MRI as part of their initial diagnostic work-up. Materials and Methods The authors performed a nationwide retrospective cohort study of patients diagnosed with HCC in South Korea between January 2008 and December 2010. Follow-up extended through December 2014. The primary outcome was all-cause mortality. Cox proportional hazards regression model with adjustment of confounding factors was used to estimate hazard ratios (HRs) for all-cause mortality. Results Among 30 023 patients with HCC (mean age ± standard deviation, 58.5 years ± 10.7, 23 978 men), the proportions of patients in whom HCC was diagnosed using CT only, CT plus non-gadoxetic acid-enhanced MRI, and CT plus gadoxetic acid-enhanced MRI were 56.1%, 12.9%, and 31.0%, respectively. In adjusted analysis using CT only as the reference category, the HR for mortality for CT plus gadoxetic acid-enhanced MRI was 0.64 (95% confidence interval [CI]: 0.62, 0.67;

Topics: Aged; Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Republic of Korea; Retrospective Studies

5 TECHNICAL EFFICACY STAGE: 3 CONFLICT OF INTEREST: None.. None. J. Magn. Reson. Imaging 2020;52:1279-1280.

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

To determine useful imaging features for differentiating hepatocellular carcinoma (HCC) categorised as LR-M from non-HCC malignancies in using the Liver Imaging-Reporting and Data System (LI-RADS) version 2018 on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. Patients at high-risk for HCC with surgically confirmed HCCs (n=131) and non-HCC malignancies (n=90) and who had undergone gadoxetic acid-enhanced MRI were included. LI-RADS categories were assigned to identify hepatic observations defined as LR-M by two radiologists. Major and ancillary imaging features of hepatic observation with targetoid appearance including intratumoural septa were compared between HCCs and non-HCC malignancies. A classification tree analysis (CTA) was applied to differentiate high-risk HCCs from non-HCC malignancies in the LR-M category.. A total of 36 HCCs (27.5%) and 70 non-HCC malignancies (77.8%) were assigned as LR-M. An enhancing capsule (p=0.0293), blood products in the mass (p=0.0393), non-targetoid restriction (p=0.018), and a septum (p=0.0053) were significantly predictive of HCC. On CTA, the presence of a septum was an initial predictor for a high probability of HCC followed by non-targetoid restriction. The CTA model has a sensitivity of 63.9%, specificity of 90%, and accuracy of 81.1% for differentiating HCC assigned LR-M from non-HCC malignancy.. A considerable proportion of HCCs could have been categorised as LR-M as they had a targetoid appearance on gadoxetic acid-enhanced MRI. An intratumoural septum and non-targetoid restriction as well as enhancing capsule and blood products in the mass may be useful for differentiating HCC assigned to LR-M from non-HCC malignancy on gadoxetic acid-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

To test the feasibility of non-contrast magnetic resonance imaging (MRI) in a sequential imaging study for characterizing computed tomography (CT)-detected arterial-enhancing nodules that do not washout in patients at risk of hepatocellular carcinoma (HCC).. In this retrospective study, 134 patients (mean age ± standard deviation, 56.8 ± 10.0 years) with 151 arterial enhancing-only nodules measuring up to 2 cm during multiphasic CT that were subsequently evaluated using gadoxetic acid-enhanced MRI in treatment-naïve at-risk patients from three tertiary referral centers were included. Tentative diagnostic criteria for HCC and hepatic malignancy were defined as the presence of one of eight MRI features favoring HCC in combinations of the following sequences: T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), T1-weighted dual gradient-echo in-phase and out-of-phase imaging (Dual-GRE), and hepatobiliary phase imaging (HBP). Typical hemangiomas and arterioportal shunts were excluded from the analysis. Diagnostic performance for HCC and hepatic malignancy was calculated and compared between the abbreviated MRI and full-sequence gadoxetic acid-enhanced MRI.. Of 151 nodules (mean size, 1.2 cm) 68 HCCs and 83 non-HCC benignities and malignancies were included. The combination of T2WI, DWI, and Dual-GRE showed per-lesion sensitivity, specificity, and accuracy of 88.2%, 90.4%, and 89.4%, respectively, comparable to those of full-sequence MRI. Applying the same sequence combination to diagnose hepatic malignancy had per-lesion sensitivity, specificity, and accuracy of 86.8%, 97.3%, and 92.1%. In nodules < 1 cm, adding HBP increased sensitivity by up to 13% without compromising the specificity or accuracy.. The non-contrast MRI protocol comprising T2WI, DWI, and Dual-GRE showed reasonable and comparable performance to full-sequence MRI for discriminating HCC and primary liver malignancies in CT-detected indeterminate arterial enhancing-only nodules in at-risk patients, and can be potentially used for sequential imaging in place of a full-sequence MRI. In nodules < 1 cm, HBP may still be needed to preserve sensitivity.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tertiary Care Centers; Tomography, X-Ray Computed

This study was conducted in order to assess the diagnostic accuracy of LI-RADS v2018 ancillary features (AFs) favoring malignancy applied to LR-3 and LR-4 observations on gadoxetate-enhanced MRI.. In this retrospective dual-institution study, we included consecutive patients at high risk for hepatocellular carcinoma (HCC) imaged with gadoxetate disodium-enhanced MRI between 2009 and 2014 fulfilling the following criteria: (i) at least one LR-3 or LR-4 observation ≥ 10 mm; (ii) nonrim arterial phase hyperenhancement; and (iii) confirmation of benignity or malignancy by pathology or imaging follow-up. We compared the distribution of AFs between HCCs and benign observations and the diagnostic performance for the diagnosis of HCC using univariate and multivariate analyses. Significance was set at p value < 0.05.. Two hundred five observations were selected in 155 patients (108 M, 47 F) including 167 (81.5%) LR-3 and 38 (18.5%) LR-4. There were 126 (61.5%) HCCs and 79 (28.5%) benign lesions. A significantly larger number of AFs favoring malignancy were found in LR-3 and LR-4 lesions that progressed to HCC compared to benign lesions (p < 0.001 and p = 0.003, respectively). The most common AFs favoring malignancy in HCCs were hepatobiliary phase (HBP) hypointensity (p < 0.001), transitional phase hypointensity (p < 0.001), and mild-moderate T2 hyperintensity (p < 0.001). Sensitivity and specificity of AFs for the diagnosis of HCC ranged 0.8-76.2% and 86.1-100%, respectively. HBP hypointensity yielded the highest sensitivity but also the lowest specificity and was the only AF remaining independently associated with the diagnosis of HCC at multivariate logistic regression analysis (OR 14.83, 95% CI 5.81-42.76, p < 0.001).. Among all AFs, HBP hypointensity yields the highest sensitivity for the diagnosis of HCC.. • LR-3 and LR-4 observations diagnosed as HCC have a significantly higher number of ancillary features favoring malignancy compared to observations proven to be benign. • The presence of three or more ancillary features favoring malignancy has a high specificity (96.2%) for the diagnosis of HCC. • Among all ancillary features favoring malignancy, hepatobiliary phase hypointensity yields the highest sensitivity, but also the lowest specificity for the diagnosis of HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Research Design; Retrospective Studies

The aim of this study was to evaluate the diagnostic performance of introducing diffusion-weighted imaging (DWI) as a major feature to extracellular agent (ECA)-MRI for diagnosing HCC in comparison with gadoxetic acid (hepatobiliary agent, HBA)-MRI using Liver Imaging Reporting and Data System (LI-RADS) v2018.. This was a prospective intra-individual comparison study using two different types of contrast agents for liver MRI conducted at a tertiary referral academic center. One hundred forty-seven observations in 122 patients at high risk for HCC scheduled for liver surgery were included. The sensitivity, specificity, and accuracy of LI-RADS category 5 (LR-5) for HCC diagnosis according to conventional and modified LI-RADS on ECA- and HBA-MRI were measured and compared. Modified LI-RADS incorporated hyperintensity on DWI as a major feature with ECA-MRI, and hypointensity on transitional phase (TP) and/or hepatobiliary phase (HBP) as washout appearance on HBA-MRI, respectively.. Modified LI-RADS on ECA-MRI had higher sensitivity and accuracy than modified LI-RADS on HBA-MRI (90.3% vs. 74.9%, p < 0.001; and 91.9% vs. 76.9%, p < 0.001, respectively), as well as higher specificity, although the difference did not reach statistical significance (96.0% vs. 88.0%, p = 0.157). The specificity of modified LI-RADS ECA-MRI was slightly lower than both conventional criteria but without a significant difference (96.0% vs. 100%, p = 0.317).. Using DWI findings as a major feature for modified LR-5 on ECA-MRI showed better sensitivity and accuracy than modified LR-5 on HBA-MRI, without significantly compromising specificity compared with conventional LR-5 on ECA- or HBA-MRI.. • Prospective intra-individual comparison study using two different types of contrast agents, extracellular agent (ECA) and gadoxetic acid (hepatobiliary agent, HBA), for liver MRI was conducted. • Applying diffusion restriction of a hepatic observation on ECA-MRI as a major feature of LI-RADS v2018 resulted in higher sensitivity and accuracy of LR-5 observations for HCC diagnosis than conventional LI-RADS v2018, and even compared to modified LI-RADS using modified washout on HBA-MRI. • Despite increase in sensitivity and accuracy of LR-5 observations on modified LI-RADS on ECA-MRI, the specificity was not significantly different compared with conventional LI-RADS.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Prospective Studies; ROC Curve

This study was conducted in order to compare the diagnostic performance of noncontrast and abbreviated MRI using gadoxetic acid for detecting hepatocellular carcinoma (HCC) in initially diagnosed HCC patients.. We identified 140 consecutive patients with newly diagnosed HCC (173 HCCs) within the Milan criteria, who underwent liver MRI using gadoxetic acid between 2015 and 2016. One hundred twenty-three consecutive patients without HCC who underwent liver MRI in the same period for HCC surveillance were enrolled for the control group. Two radiologists independently reviewed two MRI sets: a noncontrast set and an abbreviated set. The noncontrast set consists of T2 FSE/ssFSE, T1 in- and out-of-phase image, DWI, and the ADC map. The abbreviated set consists of T2 FSE/ssFSE, hepatobiliary phase image 20 min after gadoxetic acid injection, DWI, and the ADC map.. In a per-patient analysis, sensitivity of reviewer 1 for noncontrast and abbreviated sets was 85.7 and 90.0%, respectively. The specificity for both noncontrast and abbreviated sets was 92.7%. For reviewer 2, sensitivity of noncontrast and abbreviated sets was 86.4 and 89.3%, respectively. Per-patient specificity of reviewer 2 was 92.7% for both noncontrast and abbreviated sets. The sensitivity and specificity of two image sets were not significantly different for both reviewers. The per-tumor sensitivity of noncontrast and abbreviated sets was 81.5 and 84.4% for reviewer 1, respectively, and 79.8 and 84.4% for reviewer 2, respectively. There was no significant difference.. Noncontrast and abbreviated MRI using gadoxetic acid showed comparable diagnostic performance for detecting patients with HCCs in the early stage.. • Diagnostic performance of noncontrast MRI and abbreviated MRI using gadoxetic acid for detecting HCCs is comparable in patients with HCCs in the early stage. • Noncontrast MRI and abbreviated MRI showed high sensitivity and specificity for detecting HCCs in the early stage. • Outcomes of surveillance for HCC in high-risk patients can be improved by adopting these simplified and focused MRI protocols.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Young Adult

Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma (HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.. To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.. For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.. Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure (area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure (area under the curve: 0.894; 95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model (integrated discrimination improvement = 0.117,. A radiomics-based model of preoperative gadoxetic acid-enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Feasibility Studies; Female; Gadolinium DTPA; Hepatectomy; Hepatitis B virus; Hepatitis B, Chronic; Humans; Image Processing, Computer-Assisted; Liver; Liver Cirrhosis; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nomograms; Postoperative Complications; Preoperative Period; Retrospective Studies; ROC Curve; Young Adult

The surgical indication for non-hypervascular hypointense nodules (NHVN) detected incidentally on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) for classical hepatocellular carcinoma (HCC) is unknown. Our aim is to clarify the long-term outcomes in patients with this finding.. We reviewed the cases of 290 HCC patients, including 66 patients with NHVN, who underwent Gd-EOB-MRI prior to hepatectomy, between October 2008 and December 2017 at our center. We divided the patients into three groups: a no-NHVN group, a treated NHVN group, and an untreated NHVN group.. There was no significant difference in (RFS) or overall survival (OS) between the no-NHVN and untreated NHVN groups (p = 0.103 and 0.103, respectively). There was no significant difference between these two groups after propensity score matching. Multivariate analyses showed that microscopic intrahepatic metastases and the size of the main classical HCC, the target tumor, were independent prognostic factors of overall survival, but the presence of non-hypervascular hypointense nodules was not. There was no significant difference in RFS or OS between the treated NHVN and untreated NHVN groups (p = 0.158 and 0.109, respectively).. Non-hypervascular hypointense nodules detected incidentally on Gd-EOB-MRI associated with targeted hypervascular HCC did not reflect prognosis of HCC after hepatectomy. Surgical procedures for classical enhancing HCC may be performed even if non-hypervascular hypointense nodules adjacent to the targeted HCC cannot be removed completely.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Kaplan-Meier Estimate; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis

Metastatic gastroenteropancreatic neuroendocrine neoplasms (mGEP-NEN) are indolent malignancies which undergo frequent imaging follow-up. Hepatocellular phase (HCP) MR with hepatocellular-specific contrast agent is widely used to evaluate mGEP-NEN liver metastases but is commonly performed after a 20-min delay which prolongs scan time. The purpose of this study was to evaluate if HCP MR at 15 min offers comparable performance to 20-min delay for patients with mGEP-NEN undergoing routine imaging surveillance.. In this IRB-approved retrospective study, we evaluated 52 patients with mGEP-NEN who were imaged for routine surveillance with gadoxetate disodium (Eovist. No differences were observed for subjective image quality (R1 p = 0.86, R2 p = 0.17) or lesion conspicuity (R1 p = 0.56, R2 p = 0.74) at 15 min and 20 min for either reader. Individual-reader concordance correlation coefficient between 15 and 20 min was high for number of metastases detected (R1 = 0.9842, R2 = 0.9579) and diameter of largest metastasis (R1 = 0.9629, R2 = 0.8859).. HCP imaging at 15 min provides similar diagnostic yield to standard 20-min delay, which may help reduce the scan time and costs, and improve throughput and patient satisfaction.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neuroendocrine Tumors; Retrospective Studies

Imaging-based diagnostic systems play important roles in hepatocellular carcinoma (HCC). We aimed to compare the diagnostic performance of recently updated imaging criteria for HCCs ≤ 3.0 cm on gadoxetate disodium-enhanced magnetic resonance imaging (MRI).. 493 nodules (399 HCCs, 24 other malignancies, 70 benign) 1.0-3.0 cm from 400 patients, including 322 male (mean age 59.3 ± 9.4 years) and 78 female (mean age 61.2 ± 9.0 years), at risk for HCC who underwent gadoxetate disodium-enhanced MRI between July 2015 and December 2016 were retrospectively evaluated. Final diagnosis was determined histopathologically or clinically. The sensitivity and specificity in diagnosing HCC of the latest versions of four imaging criteria [Liver Imaging Reporting and Data System (LI-RADS), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), Korean Liver Cancer Association-National Cancer Center (KLCA-NCC)] were compared using generalized estimating equations.. In 331 only pathologically diagnosed nodules, the sensitivities of both the APASL (86.8%) and KLCA-NCC criteria (85.4%) were significantly higher than the sensitivities of the EASL (71.8%) and LR-5 (71.1%) criteria (p < 0.001 for each pairwise comparison). However, the specificity of LR-5 was significantly higher than that of APASL (92.2% vs. 70.6%, respectively; p = 0.011) but did not differ significantly from the specificities of EASL (84.3%; p = 0.634) and KLCA-NCC (78.4%; p = 0.107).. Of the four international imaging criteria, LI-RADS and EASL showed high specificity but suboptimal sensitivity for diagnosing HCCs ≤ 3 cm. However, APASL and KLCA-NCC had a higher sensitivity but a lower specificity than LI-RADS and EASL.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To compare diagnostic performances of current guidelines for the diagnosis of HCC in LT candidates using gadoxetic acid-enhanced liver MRI (Gd-EOB-MRI).. Eighty-one patients (119 HCCs and 35 non-HCCs) who underwent preoperative Gd-EOB-MRI and subsequent LT were included. Per-lesion imaging diagnoses of HCCs were made using four different guidelines (American Association for the Study of Liver Disease (AASLD), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) guidelines, and patient allocation was determined according to Milan criteria (MC). Comparisons of per-lesion sensitivity, specificity, and accuracy of patient allocation between guidelines were performed using logistic regression with generalized estimating equations.. For diagnosis of HCC, AASLD guideline showed highest specificity (97.4%), followed by EASL and KLCA-NCC guidelines (92.1% and 92.1%, p > 0.99 and = 0.15, respectively, in comparison to AASLD), while the specificity of APASL guideline was significantly lower than that of AASLD guideline (78.9% vs. 97.4%, p = 0.006). APASL and KLCA-NCC guidelines (75.9% and 65.6%) showed significantly higher sensitivities than AASLD/EASL guidelines (34.5% and 38.8%, respectively; all ps < 0.001). For organ allocation, KLCA-NCC guideline showed higher accuracy in selecting unsuitable candidates (with non-HCC malignancies or beyond MC HCCs) than EASL guideline (68.4% vs. 31.8%; p = 0.001).. For the diagnosis of HCCs using Gd-EOB-MRI, AASLD guideline provided the highest specificity, followed by EASL, KLCA-NCC, and APASL guidelines with statistically significant difference with only APASL guideline. KLCA-NCC guideline provided the most accurate selection of unsuitable LT candidates.. • AASLD/LI-RADS showed the highest specificity, followed by EASL and KLCA-NCC guidelines. • APASL and KLCA-NCC guidelines allowed more sensitive diagnoses of HCCs. • KLCA-NCC more accurately classified patients not appropriate transplantation candidates than EASL.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Sensitivity and Specificity

Anatomical sectionectomy or larger resection is known to be effective in patients with hepatocellular carcinoma (HCC) with microvascular invasion. A non-smooth tumor margin on hepatobiliary-phase gadoxetic acid disodium-enhanced magnetic resonance imaging (EOB-MRI) can predict microvascular invasion of HCC. We evaluated the usefulness of EOB-MRI for operative planning.. We evaluated 224 patients with single HCC who underwent hepatectomy between 2010 and 2013. The tumor margin was determined preoperatively. The hepatic resection was determined based on tumor location, liver function, 3D CT simulation and functional liver reserve. To control for confounding variable distributions, propensity score match was applied to compare the outcomes. Multivariate analysis was conducted to identify independent predictors of 5-year recurrence-free survival (RFS) and overall survival (OS).. Of 113 patients with a non-smooth tumor margin, 40 patients (35%) showed microscopic portal invasion. The 5-year RFS and OS rates were significantly higher after sectionectomy or larger hepatectomy (hemihepatectomy) than after segmentectomy or smaller hepatectomy (non-anatomical resection). Of 111 patients with a smooth tumor margin, eight patients (7%) showed microscopic portal invasion. The 5-year RFS and OS rates did not differ significantly between patients who underwent sectionectomy and those who underwent segmentectomy.. Our preliminary results appear to recommend that HCC with a non-smooth margin on HB-phase images is treated with anatomical sectionectomy or larger hepatectomy.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Retrospective Studies

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To evaluate diagnostic values of the liver imaging reporting and data system (LI-RADS) M (LR-M) category based on novel explicit criteria that accept both targetoid and nontargetoid LR-M features and the suggested reporting algorithm of LI-RADS v2018 to assess primary liver cancers (PLCs) on gadoxetic acid-enhanced MRI (Gd-EOB-MRI).. This retrospective study included 165 patients at high risk for hepatocellular carcinoma (HCC) with pathologically confirmed PLCs (HCC, n = 113; intrahepatic cholangiocarcinoma [iCCA], n = 23; and combined hepatocellular cholangiocarcinoma [cHCC-CCA], n = 29). Two radiologists independently analyzed Gd-EOB-MRI features and determined LI-RADS category for each tumor and categorized the likely etiology either as HCC or non-HCC malignancy if LR-M was assigned. Diagnostic performances for HCC or those for malignancy were compared according to imaging criteria.. LR-M was assigned in 95.7%/91.3% of iCCAs; 55.2%/58.6% of cHCC-CCAs; and 21.2%/17.7% of HCCs in reviewers 1/2. Combination of LR-5 plus LR-M resulted in sensitivity of 95.2%/97.6% to diagnose PLCs as malignant, which were significantly higher than that of LR-5 plus "LR-M with ≥ 1 targetoid appearances" (84.8%/91.5%, Ps < 0.01). In comparison to LR-5, LR-5 plus "LR-M of HCC as likely etiology" resulted in significant increase in sensitivity (73.5%/79.6% versus 87.6%/92.9%, Ps < 0.001) but significant decrease in specificity (76.9%/75.0% versus 57.7%/50.0%, P = 0.002 and < 0.001) in the diagnosis of HCC.. The LR-M criteria v2018 are useful to differentiate non-HCC malignancies from HCCs and to accurately diagnose PLCs as a malignancy. Reporting the likely etiology in LR-M may facilitate a more sensitive detection of HCC, but along with a considerable decrease in specificity.

Topics: Algorithms; Bile Duct Neoplasms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

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).. 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.. 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).. 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.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To determine whether hepatobiliary phase hypointensity, enhancing "capsule" and size provide prognostic information regarding the risk of progression to hepatocellular carcinoma (HCC), as well as the time to progression, of intermediate to high risk observations ≥ 10 mm with arterial phase hyperenhancement (APHE).. This retrospective dual-institution study included 160 LR-3 and 26 LR-4 observations measuring more than 10 mm and having APHE in 136 patients (mean age [SD], 57 [11] years old). A composite reference standard of pathologic analysis and imaging follow-up was used. The prognostic performance of hepatobiliary phase hypointensity, enhancing "capsule" and size (cut-off: 20 mm) for the prediction of probability of progression to HCC and median time to progression to HCC was assessed and compared by means of Log-rank test, Cox-regression and Kaplan-Meier curves.. 110 (59%) of 186 of observations progressed to HCC, 29.1% (32) progressed within 6 months, 60% (66) within 1 year and 84.5% (93) within 2 years. Hepatobiliary phase hypointensity was a significant predictor of progression to HCC (p < 0.0001, odds ratio: 20.62) but not of time to progression (p = 0.17). Median time to progression to HCC was 284 days [IQR: 266-363] and was shorter - though not significantly - for observations with enhancing "capsule" (118 days vs 301 days; p = 0.19).. Hepatobiliary phase hypointensity is an independent predictor of progression to HCC in intermediate to high risk APHE observations ≥ 10 mm.

Topics: Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Disease Progression; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Prognosis; Retrospective Studies; Time

• Abbreviated MRI (AMRI) protocols consist of acquiring only a minimal number of MRI sequences for HCC surveillance with acceptable diagnostic performance compared to complete MRI.• AMRI protocol options include non-contrast AMRI, dynamic AMRI or hepatobiliary phase AMRI post gadoxetate injection.• The best AMRI protocol for HCC surveillance needs to be defined in a large multicentre prospective study.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

To identify gadoxetate disodium-enhanced MRI features distinguishing hepatic IPT from CLM.. From February 2008 to December 2019, 162 lesions (IPT, n = 31 and CLM, n = 131) from 94 patients (mean age 65.1 ± 12.2 years; 65 men and 29 women) were retrospectively assessed for the presence or absence of obscure boundary, rim enhancement on arterial phase (AP), persistent rim enhancement during AP to transitional phase (TP), blood vessel penetration, peritumoral parenchymal enhancement on AP, peritumoral parenchymal hypointensity on hepatobiliary phase (HBP), peritumoral parenchymal hyperintensity on T2-weighted imaging (T2WI), biliary dilatation, central hypointensity with a relatively hyperintense periphery on HBP, peripheral hyperintensity on diffusion-weighted imaging (DWI) and T2WI, and lesion to liver signal intensity ratio (SIR. Central hypointensity with a relatively peripheral hyperintensity on HBP and SIR

Topics: Aged; Carcinoma, Hepatocellular; Colorectal Neoplasms; Contrast Media; Female; Gadolinium DTPA; Granuloma, Plasma Cell; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

The primary objective was to compare the performance of 3 different abbreviated MRI (AMRI) sets extracted from a complete gadoxetate-enhanced MRI obtained for hepatocellular carcinoma (HCC) screening. Secondary objective was to perform a preliminary cost-effectiveness analysis, comparing each AMRI set to published ultrasound performance for HCC screening in the USA.. This retrospective study included 237 consecutive patients (M/F, 146/91; mean age, 58 years) with chronic liver disease who underwent a complete gadoxetate-enhanced MRI for HCC screening in 2017 in a single institution. Two radiologists independently reviewed 3 AMRI sets extracted from the complete exam: non-contrast (NC-AMRI: T2-weighted imaging (T2wi)+diffusion-weighted imaging (DWI)), dynamic-AMRI (Dyn-AMRI: T2wi+DWI+dynamic T1wi), and hepatobiliary phase AMRI (HBP-AMRI: T2wi+DWI+T1wi during the HBP). Each patient was classified as HCC-positive/HCC-negative based on the reference standard, which consisted in all available patient data. Diagnostic performance for HCC detection was compared between sets. Estimated set characteristics, including historical ultrasound data, were incorporated into a microsimulation model for cost-effectiveness analysis.. The reference standard identified 13/237 patients with HCC (prevalence, 5.5%; mean size, 33.7 ± 30 mm). Pooled sensitivities were 61.5% for NC-AMRI (95% confidence intervals, 34.4-83%), 84.6% for Dyn-AMRI (60.8-95.1%), and 80.8% for HBP-AMRI (53.6-93.9%), without difference between sets (p range, 0.06-0.16). Pooled specificities were 95.5% (92.4-97.4%), 99.8% (98.4-100%), and 94.9% (91.6-96.9%), respectively, with a significant difference between Dyn-AMRI and the other sets (p < 0.01). All AMRI methods were effective compared with ultrasound, with life-year gain of 3-12 months against incremental costs of US$ < 12,000.. NC-AMRI has limited sensitivity for HCC detection, while HBP-AMRI and Dyn-AMRI showed excellent sensitivity and specificity, the latter being slightly higher for Dyn-AMRI. Cost-effectiveness estimates showed that AMRI is effective compared with ultrasound.. • Comparison of different abbreviated MRI (AMRI) sets reconstructed from a complete gadoxetate MRI demonstrated that non-contrast AMRI has low sensitivity (61.5%) compared with contrast-enhanced AMRI (80.8% for hepatobiliary phase AMRI and 84.6% for dynamic AMRI), with all sets having high specificity. • Non-contrast and hepatobiliary phase AMRI can be performed in less than 14 min (including set-up time), while dynamic AMRI can be performed in less than 17 min. • All AMRI sets were cost-effective for HCC screening in at-risk population in comparison with ultrasound.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Cost-Benefit Analysis; Diffusion Magnetic Resonance Imaging; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Young Adult

To explore the clinical value of texture analysis of MR images (multiphase Gd-EOB-DTPA-enhanced MRI and T2 weighted imaging (T2WI) to identify the differentiated degree of hepatocellular carcinoma (HCC).. One hundred four participants were enrolled in this retrospective study. Each participant performed preoperative Gd-EOB-DTPA-enhanced MR scanning. Texture features were analyzed by MaZda, and B11 program was used for data analysis and classification. The diagnosis efficiencies of texture features and conventional imaging features in identifying the differentiated degree of HCC were assessed by receiver operating characteristic analysis. The relationship between texture features and differentiated degree of HCC was evaluated by Spearman's correlation coefficient.. The grey-level co-occurrence matrix -based texture features were most frequently extracted and the nonlinear discriminant analysis was excellent with the misclassification rate ranging from 3.33 to 14.93%. The area under the curve (AUC) of the combined texture features between poorly- and well-differentiated HCC, poorly- and moderately-differentiated HCC, moderately- and well-differentiated HCC was 0.812, 0.879 and 0.808 respectively, while the AUC of tumor size was 0.649, 0.660 and 0.517 respectively. The tumor size was significantly different between poorly- and moderately-HCC (p = 0.014). The COMBINE AUC values were not increased with tumor size combined.. Texture analysis of Gd-EOB-DTPA-enhanced MRI and T2WI was valuable and might be a promising method in identifying the differentiated degree of HCC. The poorly-differentiated HCC was more heterogeneous than well- and moderately-differentiated HCC.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; ROC Curve; Software

We investigated whether functional future remnant liver volume (fFRLV), assessed using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), could evaluate regional liver function in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and help establish the indication for hepatectomy.. The subjects of this study were 12 patients with PVTT [PVTT(+) group] and 58 patients without PVTT [PVTT(-) group], from among 191 patients who underwent hepatectomy of more than one segment for HCC. We calculated the liver-to-muscle ratio (LMR) in the remnant liver, using EOB-MRI and fFRLV. Preoperative factors and surgical outcome were compared between the groups. The LMR of the area occluded by PVTT was compared with that of the non-occluded area.. The indocyanine green retention rate at 15 min (ICG-R15) and liver fibrosis indices were increased in the PVTT(+) group, but the surgical outcomes of patients in this group were acceptable, with no liver failure, no mortality, and no differences from those in the PVTT(-) group. The fFRLV in the PVTT(+) group was not significantly different from that in the PVTT(-) group (p = 0.663). The LMR was significantly lower in the occluded area than in the non-occluded area (p = 0.004), indicating decreased liver function.. Assessing fFRLV using EOB-MRI could be useful for evaluating regional liver function and establishing operative indications for HCC with PVTT.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Portal Vein; Single Photon Emission Computed Tomography Computed Tomography; Venous Thrombosis

Accurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion.. Forty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF.. Nine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF.. Gadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Failure; Liver Function Tests; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Portal Vein; Postoperative Complications; Retrospective Studies; ROC Curve

The aim of this study was to retrospectively analyze the outcome of LR-3 and LR-4 without arterial phase hyperenhancement (APHE), and identify which features could predict LR-5 progression on serial Gd-EOB-DTPA-enhanced MRI follow-up.. Forty-nine cirrhotic patients with 55 LR-3 and 19 LR-4 without APHE were evaluated. Observations were classified as decreased, stable or increased in category at follow-up. Observation size and LI-RADS major and ancillary features were evaluated.. Seventeen/fifty-five (31%) LR-3 and 8/19 (42%) LR-4 progressed to LR-5 at follow-up. Baseline LI-RADS major and ancillary features were not significantly different among LR-3 and LR-4. A diameter ≥ 10 mm significantly increased LR-5 progression risk of LR-3 (OR = 6.07; 95% CI: 0.12; 60.28]; P < .001). LR-4 with a diameter ≥ 10 mm more likely become LR-5 at follow-up (OR = 8.95; 95% CI: 0.73; 111.8; P = .083]).. LR-3 and LR-4 without APHE were often downgraded or remained stable in category on Gd-EOB-DTPA-enhanced MRI follow-up.

Topics: Carcinoma, Hepatocellular; Contrast Media; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

Background Accurate identification of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) before treatment is critical for selecting a proper treatment strategy. Purpose To evaluate the interobserver agreement and the diagnostic performance of the MRI assessment of MVI in HCC according to the level of radiologist experience. Materials and Methods This retrospective study included 100 patients with surgically confirmed HCCs smaller than 5 cm who underwent gadoxetic acid-enhanced MRI between 2013 and 2016. Eight postfellowship radiologists (four with 7-13 years of experience [more experienced] and four with 3-6 years of experience [less experienced]) evaluated four imaging features (nonsmooth tumor margin, irregular rim-like enhancement in the arterial phase, peritumoral arterial phase hyperenhancement, peritumoral hepatobiliary phase hypointensity) and assigned the possibility of MVI. Interobserver agreement was determined by using Fleiss κ statistics according to reviewer experience and tumor size (≤3 cm vs >3 cm). With reference standards of histopathologic specimens, the diagnostic performance in the identification of MVI was assessed by using receiver operating characteristic curve analysis. Results In 100 patients (mean age, 58 years ± 10 [standard deviation]; 70 men) with 100 HCCs (mean size, 2.8 cm ± 0.9), 39 (39%) HCCs had MVI. The overall interobserver agreement was fair to moderate for the imaging features and their combinations (κ = 0.38-0.47) and MVI probability (κ = 0.41; 95% confidence interval: 0.33, 0.45). More experienced reviewers demonstrated higher agreement in MVI probability than less experienced reviewers (κ = 0.55 vs 0.36, respectively;

Topics: Adult; Aged; Carcinoma, Hepatocellular; Clinical Competence; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Observer Variation; Predictive Value of Tests; Retrospective Studies

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Observer Variation

To investigate whether Liver Imaging Reporting and Data System (LI-RADS) imaging features at preoperative gadoxetic acid-enhanced MRI can predict microvascular invasion (MVI) and histologic grade of hepatocellular carcinoma (HCC) and to evaluate their associations with recurrence after curative resection of single HCC.. From July 2015 to September 2018, 111 consecutive patients with pathologically confirmed HCC who underwent gadoxetic acid-enhanced MRI within 1 month before surgery were included in this retrospective study. Significant MRI findings and clinical parameters for predicting MVI, high-grade HCCs and postoperative recurrence were identified by logistic regression model and Cox proportional hazards model.. Twenty-six of 111 (23.4 %) patients had MVI and 36 of 111 (32.4 %) patients had high-grade HCCs, whereas 44 of 95 (46.3 %) patients experienced recurrence. Tumor size > 5 cm (OR = 9.852; p < 0.001) and absence of nodule-in-nodule architecture (OR = 8.302; p = 0.001) were independent predictors of MVI. Enhancing capsule (OR = 4.396; p = 0.004) and corona enhancement (OR = 3.765; p = 0.021) were independent predictors of high-grade HCCs. Blood products in mass (HR = 2.275; p = 0.009), corona enhancement (HR = 4.332; p < 0.001), and serum AFP level > 400 ng/mL (HR = 2.071; p = 0.023) were independent predictors of recurrence.. LI-RADS imaging features can be used as potential biomarkers for predicting aggressive pathologic features and recurrence of HCC. The identification of prognostic LI-RADS imaging features may facilitate the selection of surgical candidates and optimize the management of HCC patients.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Retrospective Studies

This study was designed to preoperatively predict microvascular invasion (MVI) of solitary small hepatocellular carcinoma (sHCC) by quantitative analysis of Gd-EOB-DTPA enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI).. Sixty-one patients, 19 with and 42 without histologically confirmed MVI following hepatic resection for solitary sHCC (≤ 3 cm), were preoperatively examined with Gd-EOB-DTPA-enhanced MRI. The regions of interest (ROIs) of the hepatic lesions were manually delineated on the maximum cross-sectional area in the HBP images and used to calculate the lesion boundary index (LBI) and marginal gray changes (MGC). Histogram analysis was performed to measure standard deviations (STD) and coefficients of variation (CV). Correlations between quantitative parameters and MVI were evaluated and differences between MVI positive and negative groups were assessed.. The average LBI (0.85 ± 0.07) and MGC (0.48 ± 0.27) values of the negative group were significantly higher (p < 0.05) than the corresponding LBI (0.72 ± 0.07) and MGC (0.28 ± 0.18) values of the positive group. STDs and CVs in the negative group were significantly smaller (p < 0.05) than those of the positive group. Receiver operating characteristic (ROC) analysis revealed that LBI had the best predictive value with an AUC, sensitivity, and specificity of 0.91, 87 %, and 80 %, respectively.. Quantitative analysis of HBP images is useful for predicting MVI and beneficial to clinicians in making decisions before treatment.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The Liver Imaging Reporting and Data System (LI-RADS) is widely adopted for the noninvasive diagnosis of hepatocellular carcinoma (HCC). Herein, possible strategies to improve the diagnostic performance of LR-5 without reducing specificity for HCC were investigated. This retrospective study included 792 patients who underwent gadoxetate disodium-enhanced magnetic resonance imaging. Hepatic observations were categorized according to LI-RADS v2018 and categories were readjusted by upgrading LR4 to LR5 using ancillary features, arterial phase hyperenhancement (APHE) interpreted with subtraction images, indication of no washout when APHE was absent, extension of washout to the transitional phase, and subthreshold growth as a major feature. Based on LI-RADS v2018, LR-5 showed a sensitivity of 71.9% and a specificity of 97.9% for the diagnosis of HCC. Category-readjusted LR-5 after upgrading LR-4 to LR-5 using ancillary features favoring HCC in particular, subthreshold growth as a major feature, extending washout to transitional phase and APHE interpreted using subtraction images showed significantly increased sensitivity (P<0.001) without decreased specificity (Ps>0.05). The sensitivity of LR-5 can be improved without loss of specificity via category readjustment using AFs favoring HCC in particular, subthreshold growth as a major feature, extending washout to transitional phase and APHE interpreted with subtraction images.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Retrospective Studies; Sensitivity and Specificity

Hypervascular hyperplastic nodules (HHNs) occasionally develop in patients with alcoholic liver cirrhosis (ALC) and show arterial enhancement, thus mimicking hepatocellular carcinoma (HCC). Importantly, HHN as a benign lesion should be distinguished from HCC.. To evaluate the value of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) and diffusion-weighted imaging (DWI) in distinguishing HHN from small (<3 cm) hypervascular HCC (hHCC) in patients with ALC.. Retrospective case-control study.. 3.0T/in- and out-of-phase, T. Among 560 patients with ALC who underwent Gd-EOB-MRI and DWI, 12 patients with 28 HHNs and 22 patients with 29 hHCCs smaller than 3 cm were included.. Univariate and multivariate analyses were performed to determine the significant MRI findings, and their diagnostic performance for the prediction of HHN was analyzed.. Lesion size of ≤16 mm (odds ratio [OR], 24.41; P = 0.007), low-to-iso SI on DWI (OR, 26.92; P = 0.007), and absence of washout on PVP and/or TP (OR, 31.84; P = 0.009) were significant independent factors for predicting HHN. When all three criteria were satisfied, the specificity was 100%. Compared with hHCCs, HHNs showed significantly smaller size (mean, 13.8 mm vs. 19.9 mm; P < 0.001) and higher mean SI value (994.0 vs. 669.5) and lesion-to-liver SI ratio (1.045 vs. 0.806) on HBP (P < 0.001, respectively).. Gd-EOB-MRI and DWI may be helpful in differentiating HHN from small hHCC in patients with ALC.. 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:70-80.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Case-Control Studies; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis, Alcoholic; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

To determine the diagnostic accuracy and predictive value of gadoxetic acid liver MRI (Gd-EOB-DTPA MRI) alone or in combination with diffusion-weighted imaging (DWI) as a second-line tool for detecting early hepatocellular carcinoma (HCC) recurrence in cirrhotic patients with previous HCC treated with resection or ablation.. Between 2014 and 2017, we prospectively included 34 cirrhotic patients with complete response to resection and/or ablation of early HCC in whom a new focal lesion enhancing in the arterial phase without washout was detected during follow-up with EC-MRI. After signing the informed consent, all patients underwent DWI and Gd-EOB-DTPA MRI; two readers analyzed signal intensities on each phase of dynamic study and on DWI. The final diagnosis was established by histology or follow-up EC-MRI. We used cross-tabulation to calculate indices of diagnostic accuracy.. We evaluated 34 patients (7 women; 73.5% with hepatitis C virus) with a total of 53 new arterial-phase-enhancing foci (median size, 10 [IQR 9-14] mm). The final diagnosis, reached by histopathology in 15 (35.7%) lesions and EC-MR follow-up in 27 (64.3%), was HCC in 42 (79.2%) and benign conditions in 11 (21.8%). Hepatobiliary-phase hypointensity on Gd-EOB-DTPA MRI plus hyperintensity on DWI yielded 54.8% sensitivity, 90.9% specificity, 95.8% positive predictive value, and 34.5% negative predictive value for diagnosing HCC recurrence.. Among potential indices, combining hypointensity on hepatobiliary-phase Gd-EOB-DTPA MRI and hyperintensity on DWI has the highest specificity and positive predictive value to optimally detect HCC recurrence prior to confident diagnosis by conventional imaging criteria on EC-MRI in cirrhotic liver.. • In patients at risk of HCC recurrence, the use of gadoxetic acid liver MRI and DWI may improve the differentiation of unspecific new arterial-enhancing foci from early hypervascular HCC recurrence in patients with non-conclusive findings on extracellular liver MRI. • Combined findings on hepatobiliary-phase gadoxetic acid-enhanced liver MRI and DWI had high specificity (90.9%) and positive predictive value (95.8%) for detecting early hypervascular HCC recurrence, but limited sensitivity. • Combining hepatobiliary-phase hypointensity on gadoxetic acid MRI and hyperintensity on diffusion-weighted imaging allows early diagnosis of hypervascular hepatocellular carcinoma and may help select patients for salvage therapy.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Predictive Value of Tests; Sensitivity and Specificity

The 8th International Forum for Liver Magnetic Resonance Imaging (MRI), held in Basel, Switzerland, in October 2017, brought together clinical and academic radiologists from around the world to discuss developments in and reach consensus on key issues in the field of gadoxetic acid-enhanced liver MRI since the previous Forum held in 2013.. Two main themes in liver MRI were considered in detail at the Forum: the use of gadoxetic acid for contrast-enhanced MRI in patients with liver cirrhosis and the technical performance of gadoxetic acid-enhanced liver MRI, both opportunities and challenges. This article summarises the expert presentations and the delegate voting on consensus statements discussed at the Forum.. It was concluded that gadoxetic acid-enhanced MRI has higher sensitivity for the diagnosis of hepatocellular carcinoma (HCC), when compared with multidetector CT, by utilising features of hyperenhancement in the arterial phase and hypointensity in the hepatobiliary phase (HBP). Recent HCC management guidelines recognise an increasing role for gadoxetic acid-enhanced MRI in early diagnosis and monitoring post-resection. Additional research is needed to define the role of HBP in predicting microvascular invasion, to better define washout during the transitional phase in gadoxetic acid-enhanced MRI for HCC diagnosis, and to reduce the artefacts encountered in the arterial phase. Technical developments are being directed to shortening the MRI protocol for reducing time and patient discomfort and toward utilising faster imaging and non-Cartesian free-breathing approaches that have the potential to improve multiphasic dynamic imaging.. • Gadoxetic acid-enhanced MRI provides higher diagnostic sensitivity than CT for diagnosing HCC. • Gadoxetic acid-enhanced MRI has roles in early-HCC diagnosis and monitoring post-resection response. • Faster imaging and free-breathing approaches have potential to improve multiphasic dynamic imaging.

Topics: Artifacts; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Multidetector Computed Tomography; Switzerland

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Recurrence, Local

To investigate the clinical implications and natural history of observations showing a "nodule-in-nodule" architecture on hepatobiliary phase (HBP) in a cirrhotic population.. This is an IRB-approved retrospective study conducted in a single institution. We identified 20 patients (11 men and 9 women, mean age 71 years, range 51-83 years) who had a hyperintense nodule on HBP arising within a larger HBP-hypointense nodule without arterial phase hyperenhancement (APHE) at gadoxetate disodium-enhanced MRI. Size and signal intensity of the nodules were evaluated in all sequences, along with the evolution of the nodules at serial MRI studies.. Twenty-four nodules were analyzed in 20 patients. Mean diameter of the inner hyperintense nodule on HBP was 1.1 cm (range 0.6-1.8 cm) and that of the outer hypovascular hypointense nodule was 2.1 cm (range 1.2-4.1 cm). All intranodular foci were hyperintense on HBP and showed a typical pattern for hepatocellular carcinoma (HCC) with APHE and washout on portal venous phase (PVP) (n = 11, 46%), washout only (n = 7, 29%) or APHE with no washout (n = 6, 25%). The hyperintensity on 3-, 5- and 10-minute phases was seen in 21%, 58% and 83% of the nodules, respectively. In twelve out of sixteen (75%) nodules with subsequent imaging available the hyperintensity on HBP occurred before either the appearance of APHE or washout on PVP.. HBP-hypointense nodules without APHE may contain a hyperintense smaller nodule-in-nodule on HBP that can precede the appearance of either APHE or washout on PVP.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To describe the clinical characteristics and outcomes of patients with dual-phenotype hepatocellular carcinoma (DPHCC) and investigate the use of radiomics to establish an image-based signature for preoperative differential diagnosis.. This study included 50 patients with a postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7- and CK19-negative HCC (control group) who attended our hospital between January 2015 and December 2018. All patients underwent Gd-EOB-DTPA-enhanced MRI within 1 month before surgery. Arterial phase (AP), portal venous phase (PVP), delayed phase (DP) and hepatobiliary phase (HBP) images were transferred into a radiomics platform. Volumes of interest covered the whole tumor. The dimensionality of the radiomics features were reduced using LASSO. Four classifiers, including multi-layer perceptron (MLP), support vector machines (SVM), logistic regression (LR) and K-nearest neighbor (KNN) were used to distinguish DPHCC from CK7- and CK19-negative HCC. Kaplan-Meier survival analysis was used to assess 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups.. The best preoperative diagnostic power for DPHCC will likely be derived from a combination of different phases and classifiers. The sensitivity, specificity and accuracy of LR in PVP (0.740, 0.780, 0.766), DP (0.893, 0.700, 0.798), HBP (0.800, 0.720, 0.756) and MLP in PVP (0.880, 0.720, 0.798) were better performance. The 1-year DFS and OS of the patients in the observation group were 69% and 78%, respectively. The 1-year DFS and OS of the patients in the control group were 83% and 85%, respectively. Kaplan-Meier survival analysis showed no statistical difference in DFS and OS between groups (P = 0.231 and 0.326), but DFS and OS were numerically lower in patients with DPHCC.. The radiomics features extracted from Gd-EOB-DTPA-enhanced MR images can be used to diagnose preoperative DPHCC. DPHCC is more likely to recur and cause death than HCC, suggesting that active postoperative management of patients with DPHCC is required.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Phenotype; Portal Vein; Prognosis

To compare the diagnostic accuracy of dynamic computed tomography (CT) and gadoxetate-enhanced magnetic resonance imaging (MRI) for characterization of hepatic lesions by using the Liver Imaging Reporting and Data System (LI-RADS) in a multicenter, off-site evaluation.. In this retrospective multicenter study, we evaluated 231 hepatic lesions (114 hepatocellular carcinomas [HCCs], 58 non-HCC malignancies, and 59 benign lesions) confirmed histologically in 217 patients with chronic liver disease who underwent both gadoxetate-enhanced MRI and dynamic CT at one of five tertiary hospitals. Four radiologists at different institutes independently reviewed all MR images first and the CT images 4 weeks later. They evaluated the major and ancillary imaging features and categorized each hepatic lesion according to the LI-RADS v2014. Diagnostic performance was calculated and compared using generalized estimating equations.. MRI showed higher sensitivity and accuracy than CT for diagnosing hepatic malignancies; the pooled sensitivities, specificities, and accuracies for categorizing LR-5/5V/M were 59.0% vs. 72.4% (CT vs. MRI;. Gadoxetate-enhanced MRI showed superior accuracy for categorizing LR-5/5V/M in hepatic malignancies in comparison with dynamic CT. Both modalities had comparable accuracies for distinguishing other malignancies from HCC.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Heart Diseases; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed

To use Liver Imaging Reporting and Data System (LI-RADS) categorization and features of hepatocellular carcinomas (HCCs) to intraindividually compare gadopentetate dimeglumine-enhanced magnetic resonance imaging (Gd-DTPA-MRI) and gadoxetic acid-enhanced MRI (Gd-EOB-MRI), before and after applying modified major features.. Of 77 HCCs in 64 patients analysed, 17 HCCs were confirmed histopathologically and 46 patients had cirrhosis. Gd-EOB-MRI and Gd-DTPA-MRI were evaluated for the presence of major and ancillary features by two radiologists. LI-RADS categorization was done for Gd-DTPA-MRI (LI-RADS-DTPA) and for Gd-EOB-MRI before and after applying modified major features (hepatobiliary phase [HBP] hypointensity as an additional major feature, LI-RADS-EOBm1; HBP hypointense rim as capsule appearance, LI-RADS-EOBm2; and transitional phase [TP] hypointensity as washout appearance, LI-RADS-EOBm3). Sensitivities of LR-5 categorization for the diagnosis of HCC were compared.. Washout (p=0.012) and capsule appearance (p<0.001) were less frequently observed on Gd-EOB-MRI. Sensitivity for LR-5 categorization was significantly higher with LI-RADS-DTPA compared with LI-RADS-EOB (p=0.001) and LI-RADS-EOBm2 (p=0.004), while sensitivity for LR-5 categorization with LI-RADS-EOBm1 (p=0.210) and LI-RADS-EOBm3 (p=0.727) was comparable.. Modifying LI-RADS for use with Gd-EOB-MRI, such as applying HBP hypointensity as an additional major feature or using TP hypointensity as washout appearance, can improve the sensitivity for the detection of HCC.. • Adding HBP hypointensity as additional major feature improved sensitivity of LR-5 categorization. • Adding TP hypointensity as modified washout appearance improved sensitivity of LR-5 categorization. • Sensitivities for LR-5 classification were comparable between LI-RADS-DTPA, LI-RADS-EOBm1, and LI-RADS-EOBm3.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results

To investigate the performance of the Liver Imaging Reporting and Data System (LI-RADS) v2017 for combined hepatocellular cholangiocarcinoma (cHCC-CCA) in the differential diagnosis from hepatocellular carcinoma (HCC) and prediction of prognosis on gadoxetic acid-enhanced MRI (Gd-EOB-MRI).. Patients at high risk of HCC with pathologically confirmed cHCC-CCAs (n = 70) and a matched control of HCCs (n = 70) who had undergone Gd-EOB-MRI were included. LI-RADS category was assigned for each lesion by two radiologists. Imaging features and surgical outcomes were compared between cHCC-CCAs of LR-M and LR-5/4 using the χ. cHCC-CCAs and HCCs were categorised as LR-M, LR-5/4 and LR-TIV in 61.4% (43/70), 37.1% (26/70) and 1.4% (1/70) and 10.0% (7/70), 88.6% (62/70) and 1.4% (1/70), respectively. cHCC-CCAs of LR-5/4, in comparison to LR-M, showed significantly higher frequencies of major HCC features: arterial hyperenhancement (96.2% (25/26) vs. 58.1% (25/43), p = 0.001), washout appearance (80.8% (21/26) vs. 48.8% (21/43), p = 0.011) and enhancing capsule (34.6% (9/26) vs. 11.6% (5/43), p = 0.031). After curative surgery, patients with cHCC-CCAs of LR-M showed a higher early recurrence rate (≤ 6 months) than did those with LR-5/4 (27.8% (10/36) vs. 4.8% (1/21), p = 0.041), whereas no significant difference was observed in RFS (log-rank p = 0.084).. By using LI-RADS on Gd-EOB-MRI, a substantial proportion of cHCC-CCAs can be categorised as non-LR-M. In addition, cHCC-CCAs mimicking HCCs on imaging (LR-5/4) may indicate better surgical outcomes with regard to early recurrence than those of LR-M.. • cHCC-CCAs can be categorised as either LR-M or non-LR-M on Gd-EOB-MRI. • cHCC-CCAs of LR-5/4 frequently demonstrate major HCC imaging features. • LI-RADS categorisation may provide prognostic information after surgery in cHCC-CCAs.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis

Diffusion-weighted imaging (DWI) has been used for the detection and characterization of liver tumors because it has excellent contrast resolution. DWI using short tau inversion recovery (STIR) can improve tumor-to-liver contrast after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) administration that shortens the T. To quantitatively and qualitatively compare the conspicuity of malignant liver tumors on DWI after Gd-EOB-DTPA administration between STIR and chemical shift selective (CHESS) sequences.. Single-institution retrospective study.. Fifty-seven patients with histologically confirmed malignant liver tumors were evaluated.. Low b-value DWIs with STIR and CHESS sequences 18-20 minutes after Gd-EOB-DTPA administration were acquired at 1.5T.. Tumor contrast-to-noise ratio (CNR) and visual grade of tumor conspicuity on DWI between STIR and CHESS sequences were compared.. Paired Student's t-test and the Wilcoxon signed rank-test were applied. P < 0.05 was considered statistically significant.. The mean tumor CNR and visual grade of tumor conspicuity on DWI were significantly higher for STIR than for CHESS (both P < 0.001). Regardless of the presence of chronic liver disease, the mean CNR (normal liver 33.5 ± 19.8 vs. 15.7 ± 12.2, P < 0.001; chronic liver disease 19.6 ± 11.0 vs. 9.2 ± 7.8, P < 0.001) and the visual conspicuity grade (normal liver 3.36 ± 0.64 vs. 2.56 ± 0.77, P < 0.001; chronic liver disease 2.94 ± 0.80 vs. 2.25 ± 0.84, P = 0.001) were significantly higher for STIR than for CHESS. Mean CNR and the visual conspicuity grade were also significantly higher for STIR than for CHESS in patients with hepatocellular carcinomas (CNR 18.1 ± 10.5 vs. 8.8 ± 7.2, P < 0.001; visual grade 2.88 ± 0.83 vs. 2.22 ± 0.87, P = 0.001) or metastases (CNR 35.0 ± 19.3 vs. 16.2 ± 13.1, P < 0.001; visual grade 3.45 ± 0.51 vs. 2.59 ± 0.73, P < 0.001).. DWI using STIR may be more helpful for depicting malignant liver tumors after Gd-EOB-DTPA administration compared with DWI using CHESS.. 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:565-573.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Male; Middle Aged; Observer Variation; Reproducibility of Results; Retrospective Studies; Signal-To-Noise Ratio; Young Adult

Small hepatocellular carcinomas (HCCs) often show atypical features at cross-sectional imaging, yet there is no preferred recommendation for the diagnosis or characterization of small observations (10-19 mm) at present.. To determine the added value of sequentially performed gadoxetic acid-enhanced liver MRI for contrast-enhanced computed tomography (CECT)-detected small (10-19 mm) or atypical hepatic observations ≥20 mm in the diagnosis of HCC.. Prospective, cross-sectional, intraindividual comparison.. In all, 110 patients at high risk of developing HCC.. 1.5T and 3T/T. Hepatic observations were classified into HCCs or benign non-HCCs based on imaging features of arterial phase hyperenhancement (APHE) and portal or delayed washout at CT or APHE and portal washout at MRI. Final diagnoses were established using a composite algorithm and diagnostic performances of MRI and CT were compared in all observations. In addition, in a subgroup of histologically confirmed observations and stable benign observations during follow-up (n = 94), sensitivity and specificity of MRI were compared between the aforementioned criteria and LR-5 of Liver Imaging Reporting and Data System v2014.. χ. MRI provided higher sensitivity than CT (62.2% vs. 27.0%, P = 0.0001) while maintaining specificity (97.2%, each) at the per-patient level. Among 124 observations, 10-19 mm in size, MRI showed significantly higher sensitivity in diagnosing HCCs (62.5%, 50/80) than CT (25%, 20/80, P < 0.0001) with comparable specificity (97.7% [43/44], each). However, seven atypical observations (≥20 mm) at CT remained atypical at MRI. In the subgroup analysis, the diagnostic criteria of APHE and portal washout showed a significantly higher sensitivity (44.2%, 19/43) than LR-5 (23.2%, 10/43, P = 0.004), without compromising specificity (97.7% vs. 95.5%).. Sequentially performed gadoxetic acid-enhanced MRI provided added value to CECT for the diagnosis of HCCs in small observations by improving sensitivity while maintaining specificity.. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:574-587.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Cross-Sectional Studies; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

To compare the diagnostic accuracy of extracellular gadolinium-based contrast-enhanced MRI (Gd-MRI) and gadoxetic acid-enhanced MRI (EOB-MRI) for the assessment of hepatocellular carcinoma (HCC) response to locoregional therapy (LRT) using explant correlation as the reference standard.. Forty-nine subjects with cirrhosis and HCC treated with LRT who underwent liver MRI using either Gd-MRI (n = 26) or EOB-MRI (n = 23) within 90 days of liver transplantation were included. Four radiologists reviewed the MR images blinded to histology to determine the size and percentage of viable residual HCC using a per-lesion explant reference standard. Sensitivities, specificities, accuracies, and agreement with histology for the detection residual HCC were calculated.. Gd-MRI had greater agreement with histology (ICC: 0.98 [0.95-0.99] vs. 0.80 [0.63-0.90]) and greater sensitivity for viable HCC (76% [13/17 50-93%] vs. 58% [7/12; 28-85%]) than EOB-MRI; specificities were similar (84% [16/19; 60-97%] vs. 85% [23/27; 66-96%]). Areas under ROC curves for detecting residual viable tumor were 0.80 (0.64-0.92) for Gd-MRI and 0.72 (0.55-0.85) for EOB-MRI. Gd-MRI had greater inter-rater agreement than EOB-MRI for determining the size of residual viable HCC (ICC: 0.96 [0.92-0.98] vs. 0.85 [0.72-0.92]).. Gd-MRI may be more accurate and precise than EOB-MRI for the assessment of viable HCC following LRT.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

Hepatobiliary phase (HBP) Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) has increased the accuracy in differentiating focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). However, the ability of this technique to distinguish HCA subtypes remains controversial. The aim of this study was to investigate the expression of hepatocyte transporters (OATPB1/B3, MRP2, MRP3) in HCA subtypes, hence to understand their MRI signal intensity on HBP Gd-EOB-DTPA-enhanced MRI.. By means of immunohistochemistry (IHC), we scored the expression of OATPB1/B3, MRP2 and MRP3, in resected specimens of FNH (n = 40), subtyped HCA (n = 58) and HCA with focal malignant transformation (HCA-HCC, n = 4). Results were validated on a supplementary set of FNH (n = 6), subtyped HCA (n = 17) and HCA-HCC (n = 1) with Gd-EOB-DTPA MR images.. All FNH showed a preserved expression of hepatocytes transporters. Beta-catenin-activated HCA (at highest risk of malignant transformation) and HCA-HCC were characterized by preserved/increased OATPB1/B3 expression (predictor of hyperintensity on HBP), as opposed to other HCA subtypes (P < 0.01) that mostly showed OATPB1/B3 absence (predictor of hypointensity on HBP). HCA-HCC showed an additional MRP3 overexpressed profile (P < 0.01). On HBP Gd-EOB-DTPA-enhanced MRI, FNH and HCA signal intensity reflected the profile predicted by their specific OATPB1/B3 tissue expression. The hyperintense vs hypointense HBP signal criterion was able to distinguish all higher risk HCA and HCA-HCC (100% accuracy).. OATPB1/B3 and MRP3 IHC and signal intensity on HBP Gd-EOB-DTPA-enhanced MRI can help to stratify HCA according to their risk of malignant transformation.

Topics: Adenoma, Liver Cell; Adult; Biological Transport; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Immunohistochemistry; Liver; Liver Neoplasms; Liver-Specific Organic Anion Transporter 1; Magnetic Resonance Imaging; Male; Middle Aged; Multidrug Resistance-Associated Proteins; Sensitivity and Specificity; Solute Carrier Organic Anion Transporter Family Member 1B3

To investigate whether pre-operative gadoxetic acid-enhanced MRI can predict early recurrence after curative resection of single HCC using image features and texture analysis.. 179 patients with single HCC and who underwent pre-operative MRI were included. Two reviewers analyzed MR findings, including the tumor margin, peritumoral enhancement, peritumoral hypointensity on the hepatobiliary phase (HBP), diffusion restriction, capsule, tumoral fat, washout, portal-vein thrombus, signal intensity on HBP, and satellite nodule. Texture analysis on the HBP was also quantified. A multivariate analysis was used to identify predictive factors for early recurrence, microvascular invasion (MVI), and the tumor grade.. For early recurrence, satellite nodule, peritumoral hypointensity, absence of capsule, and GLCM ASM were predictors (P < 0.05). For MVI, satellite nodule, peritumoral hypointensity, washout, and sphericity were predictors (P < 0.05). Satellite nodules, peritumoral hypointensity, diffusion restriction, and iso to high signal intensity on HBP were predictor for higher tumor grade (P < 0.05). Satellite nodules and peritumoral hypointensity were important showed common predictors for early recurrence, MVI, and grade (P < 0.05). The sensitivity and specificity for satellite nodule were 47.36% and 96.25%. When added texture variables to MRI findings, the diagnostic performance for predicting early recurrence is improved from 0.7 (SD 0.604-0.790) to 0.83 (SD 0.787-0.894).. MR finding, including satellite nodule and peritumoral hypointensity on the HBP, as well as the texture parameters are useful to predict not only early recurrence, but also MVI and higher grade.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Preoperative Care; Retrospective Studies; Sensitivity and Specificity

To validate new diagnostic criteria for hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MR imaging (Gd-EOB-MRI) using hypointensity on the hepatobiliary phase (HBP) as an alternative to washout in combination with ancillary features.. This retrospective study included 288 patients at high risk for HCC with 387 nodules (HCCs, n=292; non-HCCs, n=95) showing arterial phase hyper-enhancement (APHE) ≥1 cm on Gd-EOB-MRI. Imaging diagnoses of HCCs were made using different criteria: APHE plus hypointensity on the portal venous phase (PVP) (criterion 1), APHE plus hypointensity on the PVP and/or transitional phase (TP) (criterion 2), APHE plus hypointensity on the PVP and/or TP and/or HBP (criterion 3), and criterion 3 plus non-LR-1/2/M according to the Liver Imaging Reporting and Data System (LI-RADS) v2017 considering ancillary features (criterion 4). Sensitivities and specificities of those criteria were compared using McNemar's test.. Among diagnostic criteria for HCCs, criteria 3 and 4 showed significantly higher sensitivities (93.8% and 92.5%, respectively) than criteria 1 and 2 (70.9% and 86.6%, respectively) (p values <0.001). The specificity of criterion 4 (87.4%) was shown to be significantly higher than that of criterion 3 (48.4%, p<0.001), albeit comparable to criterion 2 (86.3%, p>0.999) and significantly lower than criterion 1 (97.9%, p=0.002).. In the non-invasive diagnosis of HCCs on Gd-EOB-MRI, HBP hypointensity may be used as an alternative to washout enabling a highly sensitive diagnosis with little loss in specificity if it is used after excluding nodules considered to be benignities or non-HCC malignancies based on characteristic imaging features.. • Gd-EOB-MRI enhancement and ancillary features can be used to diagnose HCC. • Exclusion of LR-1/2/M improves specificity when HBP hypointensity is used.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Retrospective Studies; Sensitivity and Specificity

The Liver Imaging Reporting and Data System (LI-RADS) is being adapted by many clinical practices. To support continuation of its use, LI-RADS (LR) is in need of multicenter validation studies of recent LI-RADS iterations. Furthermore, while both gadoxetate and extracellular agents have been incorporated into LI-RADS, comparison of the diagnostic performance between the two has yet to be determined.. To evaluate the rate, diagnostic performance, and interreader reliability (IRR) of LI-RADS 2017 for hepatocellular carcinoma, including LR major and ancillary features, with both gadoxetate and extracellular agent-enhanced MRI against a reference standard of histopathology or imaging follow-up.. Retrospective.. In all, 114 patients with 144 observations were included who met LR 2017 criteria for at risk and had at least one hepatic observation on liver MRI performed with either gadoxetate (n = 52) or an extracellular agent (n = 92) between 2010-2016, with histopathology (n = 103) or follow-up imaging (n = 41).. 1.5 and 3.0T/T. Three radiologists independently assessed major/ancillary features and assigned overall LI-RADS category for every observation.. Diagnostic performance of LR5/TIV+LR5 for identifying hepatocellular carcinoma (HCC) was compared between contrast agents with a generalized estimating equation. Weighted kappa was performed for interrater reliability.. The frequency of HCCs among LR1, LR2, LR3, L4, LR5, LRTIV+LR5, and LRM observations were: 0% (all readers), 0-12.5%, 11.4-26.9%, 50-76%, 83.0-95.1%, 83.3-100.0%, and 45.0-65.0%, respectively. Sensitivity of LR5/LRTIV+LR5 for HCC was 59.7-71.4% and specificity 85.0-96.8%. LI-RADS specificity and positive predictive value for observations imaged with gadoxetate was higher than extracellular agent for the most inexperienced reader (R3) (P = 0.009-0.034). IRR for LI-RADS categorization was substantial (k = 0.661).. Increasing numerical LI-RADS 2017 categories demonstrate a greater percentage of HCCs. LR5/TIV+LR5 demonstrates excellent specificity and fair sensitivity for HCC. MRI with gadoxetate in liver transplant candidates may be beneficial for less experienced readers, although further large-scale prospective studies are needed.. 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:e205-e215.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Hepatocellular; Diagnosis, Computer-Assisted; Diagnostic Imaging; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Observer Variation; Reference Standards; Reproducibility of Results; Retrospective Studies; Young Adult

It remains controversial whether the eradication of hepatitis C virus (HCV) by interferon (IFN)-free anti-HCV therapy using direct-acting antivirals (DAAs) suppresses or promotes hepatocellular carcinoma (HCC) development. We investigated the influence of HCV eradication by DAA therapy on HCC development, by observing changes of non-hypervascular hypointense nodules (NHHNs) by gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI).. A total of 401 patients treated with DAA therapy who did not have a history of HCC were enrolled in this prospective cohort study. All patients underwent EOB-MRI prior to the start of DAA therapy and were followed up periodically after therapy. The progression of NHHNs detected at baseline to typical HCC, as indicated by hypervascularization and the incidence of newly emergent NHHNs, was analyzed.. In comparison of patients who achieved sustained virologic response (SVR) with propensity score-matched patients with persistent HCV infection, there was no difference in the incidence of hypervascularization of NHHNs to typical HCC among patients who had NHHNs at baseline. Among patients who did not have NHHNs at baseline, the incidence of the new emergence of NHHNs did not differ between study patients and propensity score-matched patients with persistent HCV infection.. During a 2-year observation period after SVR, the eradication of HCV by IFN-free DAA therapy did not suppress or enhance HCC development. (UMIN000017020).

Topics: Aged; Aged, 80 and over; Antiviral Agents; Carcinoma, Hepatocellular; Case-Control Studies; Cell Transformation, Viral; Contrast Media; Female; Gadolinium DTPA; Hepatitis C, Chronic; Humans; Incidence; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Precancerous Conditions; Prospective Studies; Risk Factors; Sustained Virologic Response; Time Factors; Treatment Outcome

To determine the usefulness of extracellular contrast agent (ECA)-enhanced multiphasic liver magnetic resonance imaging (MRI) using a pseudo-golden-angle radial acquisition scheme by intra-individual comparison with gadoxetic acid-MRI (EOB-MRI) with regard to image quality and the diagnosis of hepatocellular carcinoma (HCC).. This prospective study enrolled 15 patients with 18 HCCs who underwent EOB-MRI using a Cartesian approach and ECA-MRI using the pseudo-golden-angle radial acquisition scheme (free-breathing continuous data acquisition for 64 s following ECA injection, generating six images). Two reviewers evaluated the arterial and portal phases of each MRI for artifacts, organ sharpness, and conspicuity of intrahepatic vessels and the hepatic tumors. A Liver Imaging Reporting and Data System category was also assigned to each lesion.. There were no differences in the subjective image quality analysis between the arterial phases of two MRIs (p > 0.05). However, ghosting artifact was seen only in EOB-MRI (N = 3). Six HCCs showed different signal intensities in the arterial phase or portal phase between the two MRIs; five HCCs showed arterial hyperenhancement on ECA-MRI, but not on EOB-MRI. The capsule was observed in 15 HCCs on ECA-MRI and 6 HCCs on EOB-MRI. Five and one HCC were assigned as LR-5 and LR-4 with ECA-MRI and LR-4 and LR-3 with EOB-MRI, respectively.. Free-breathing ECA-enhanced multiphasic liver MRI using a pseudo-golden-angle radial acquisition was more sensitive in detecting arterial hyperenhancement of HCC than conventional EOB-MRI, and the image quality was acceptable.. • The pseudo-golden-angle radial acquisition scheme can be applied to perform free-breathing multiphasic dynamic liver MRI. • Adopting the pseudo-golden-angle radial acquisition scheme can improve the detection of arterial enhancement of HCC. • The pseudo-golden-angle radial acquisition scheme enables motion-free liver MRI.

Topics: Adult; Aged; Artifacts; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Prospective Studies; Reproducibility of Results; ROC Curve

The natural course and clinical implications of hypovascular lesions on dynamic computed tomography and/or gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging were investigated.. We followed the patients with hepatocellular carcinoma (HCC) who underwent hepatectomy between April 2009 and August 2012 to determine whether new classical HCCs developed from these unresected borderline lesions or emerged in different areas.. One hundred and eleven patients with HCC were identified to have undergone examinations using both imaging methods before hepatic resection. A total of 54 hypovascular lesions were detected. Gadolinium ethoxybenzyl-enhanced magnetic resonance imaging detected 51 lesions, while dynamic computed tomography identified 21 lesions. Eleven lesions were resected at the time of the hepatectomy together with the main HCCs. Classical HCCs had developed from 52.5% of the 43 unresected lesions at 3 years after hepatic resection. Subsequently, we conducted a patient-by-patient analysis to compare the development of classical HCC from these hypovascular lesions and the emergence of de novo classical HCC in other areas. The 3-year occurrence rate was 62.2% for the former group and 55.0% for the latter group (P = 0.83). Thus, although 52.2% of these hypovascular lesions had developed into classical HCCs at 3 years after the initial hepatectomy, de novo HCCs also occurred at other sites. Furthermore, new hypovascular lesions emerged after hepatectomy in 18-29% of patients irrespective of the presence or absence of hypovascular lesions at hepatectomy.. It remains uncertain whether these hypovascular lesions should be resected together with the main tumors at the time of hepatectomy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Neoplasm Recurrence, Local; Predictive Value of Tests; Retrospective Studies; Risk Factors; Treatment Outcome

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Prognosis

To investigate the feasibility of prediction for targeted therapy-related gene expression in hepatocellular carcinoma (HCC) using preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI).. Ninety-one patients (81 men, mean age 53.9 ± 12 years) with solitary HCC who underwent preoperative enhanced MRI were retrospectively analyzed. Features including tumor size, signal homogeneity, tumor capsule, tumor margin, intratumoral vessels, peritumor enhancement, peritumor hypointensity, signal intensity ratio on DWI, T1 relaxation times, and the reduction rate between pre- and post-contrast enhancement images were assessed. The operation and histopathological evaluation were performed within 2 weeks after MRI examination (mean time 7 days). The expression levels of BRAF, RAF1, VEGFR2, and VEGFR3 were evaluated. The associations between these imaging features and gene expression levels were investigated.. Tumor incomplete capsules or non-capsules (p = 0.001) and intratumoral vessels (p = 0.002) were significantly associated with BRAF expression, and tumor incomplete capsules or non-capsules (p = 0.001) and intratumoral vessels (p = 0.013) with RAF1 expression. There was no significant association between the expression of VEGFR2, VEGFR3, and all examined MRI features. Multivariate logistic regression showed that incomplete tumor capsule (p = 0.002) and non-capsule (p = 0.004) were independent risk factors of HCC with high BRAF expression; incomplete tumor capsule (p < 0.001) and non-capsule (p = 0.040) were independent risk factors of HCC with high RAF1 expression.. The presence of incomplete capsule or intratumoral vessels and the absence of capsule are potential indicators of high BRAF and RAF1 expression. Gadoxetic acid-enhanced MRI may facilitate the choice of gene therapy for patients with HCC.. • Incomplete tumor capsule and non-capsule were independent risk factors of HCC with high BRAF and RAF1 expression. • The presence of intratumoral vessels was a potential indicator of high BRAF and RAF1 expression. • Gadoxetic acid-enhanced MRI may be a predictor of efficacy of treatment with sorafenib.

Topics: Adult; Aged; Antineoplastic Agents; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Preoperative Period; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins c-raf; Retrospective Studies; Risk Factors; Sorafenib; Vascular Endothelial Growth Factor Receptor-2; Vascular Endothelial Growth Factor Receptor-3

To investigate the diagnostic accuracy of each LR-M feature defined in version 2017 of the Liver Imaging Reporting and Data System (LI-RADS) and determine the optimal LR-M feature for differentiating combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and hepatocellular carcinoma (HCC) on gadoxetate-enhanced magnetic resonance imaging (MRI).. Ninety-nine patients with pathologically proven cHCC-CCA (n = 33) or HCC (n = 66) after surgery were identified. Two radiologists retrospectively assessed preoperative gadoxetate-enhanced MRI for features favoring non-HCC malignancies (LR-M features) according to LI-RADS version 2017. Multivariate logistic regression analysis was performed to determine the independent differential features. The sensitivity and specificity for diagnosing cHCC-CCA were calculated for each LR-M feature.. Targetoid appearance showed the highest sensitivity (75.8%, 95% confidence interval [CI] 60.6%, 87.3%) to correctly identify cHCC-CCA as LR-M. At least one LR-M feature was observed in 31 (93.9%) patients with cHCC-CCA and 34 (51.5%) patients with HCC. The sensitivity and specificity for diagnosing cHCC-CCA using the presence of any one of the LR-M features were 93.9% (95% CI 80.7, 98.9) and 48.5% (95% CI 41.9, 51.0), respectively. The presence of three LR-M features yielded the highest diagnostic accuracy of 80.8% (95% CI 72.1, 86.1) with a reduced sensitivity of 54.5% (95% CI 41.4, 62.5).. The majority of cHCC-CCA cases can be properly categorized as LR-M when any one of the LR-M features defined in the LI-RADS version 2017 is used as a determiner. However, approximately half of HCC cases also show at least one LR-M feature.. • Targetoid appearance, including rim APHE, peripheral "washout" appearance, and delayed central enhancement, was the LR-M feature that identified cHCC-CCA as a non-HCC malignancy with the highest sensitivity. • Most cHCC-CCA cases can be properly categorized as LR-M when the presence of any one of the LR-M features was used as the determiner. • Approximately half of HCC cases also showed at least one LR-M feature.

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Data Systems; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Second shot arterial phase (SSAP) imaging is an additional arterial phase image obtained by re-injecting a small amount of contrast medium after routine dynamic imaging in gadoxetic acid-enhanced liver MRI. We aimed to evaluate the feasibility and additional value of a SSAP image in gadoxetic acid-enhanced liver MRI.. One hundred seventy-two patients who underwent SSAP imaging after re-injection of 4 mL of contrast material after routine dynamic imaging (original) in gadoxetic acid-enhanced liver MRIs were included. Motion artifacts on arterial phase (AP) images were rated using a 5-point scale and were compared between the original AP images and SSAP images. We evaluated visual detection rates of arterial hypervascularity on the original AP and SSAP images and their subtraction images in patients with hypervascular hepatocellular carcinoma (HCC).. The motion artifact of the SSAP images was significantly lower than that of the original AP images (mean score, 1.76 vs 2.06; p < 0.001). In particular, motion artifacts reduced significantly in the SSAP images of patients with substantial motion artifacts in their original AP images (2.28 vs 3.28; p < 0.001). Among the 30 HCC lesions showing hypervascularity on original AP images, only four (4/30, 13.3%) appeared hyperintense on SSAP images. However, subtraction images of SSAP clearly demonstrated arterial hypervascularity in all HCCs.. SSAP images showed significantly fewer motion artifacts than the original AP images. Subtraction images of SSAP maintained the detectability of arterial hypervascularity, although SSAP images showed poor visual detection of arterial hypervascularity of HCC.. • Arterial phase images obtained after a second injection of a small amount of contrast medium (second shot arterial phase [SSAP]) improved motion artifacts compared to the original AP images. • The motion artifacts improved significantly in the SSAP images of patients with substantial motion artifacts in their original AP images. • Subtraction images of SSAP demonstrated the arterial hypervascularity characteristic of HCC at a level comparable to that of the original AP image.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

The objective of our study was to assess the diagnostic performance of texture analysis (TA) on gadoxetic acid-enhanced MR images for differentiation of hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH).. This study included 40 patients (39 women and one man) with 51 HCAs and 28 patients (27 women and one man) with 32 FNH lesions. All lesions were histologically proven with preoperative MRI performed with gadoxetic acid. Two readers reviewed all the imaging sequences to assess the qualitative MRI characteristics. The T2-weighted fast spin-echo, hepatic arterial phase (HAP), and hepatobiliary phase (HBP) sequences were used for TA. Textural features were extracted using commercially available software (TexRAD). The differences in distributions of TA parameters of FNHs and HCAs were assessed using the Mann-Whitney U test. Area under the ROC curve (AUROC) values were calculated for statistically significant features. A logistic regression analysis was conducted to explore the added value of TA. A p value < 0.002 was considered statistically significant after Bonferroni correction for multiple comparisons.. Multiple TA parameters showed a statistically different distribution in HCA and FNH including skewness on T2-weighted imaging, skewness on HAP imaging, skewness on HBP imaging, and entropy on HBP imaging (p < 0.001). Skewness on HBP imaging showed the largest AUROC (0.869; 95% CI, 0.777-0.933). A skewness value on HBP imaging of greater than -0.06 had a sensitivity of 72.5% and a specificity of 90.6% for the diagnosis of HCA. Six of 51 (11.8%) HCAs lacked hypointensity on HBP imaging. A binary logistic regression analysis including hypointensity on HBP imaging and the statistically significant TA parameters yielded an AUROC of 0.979 for the diagnosis of HCA and correctly predicted 96.4% of the lesions.. TA may be of added value for the diagnosis of atypical HCA presenting without hypointensity on HBP imaging.

Topics: Adenoma, Liver Cell; Adolescent; Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

Contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) were compared with respect to diagnostic efficacy in the detection of small hepatocellular carcinoma. A new diagnostic strategy that combines the arterial phase of CEUS, the hepatobiliary phase of EOB-MRI and diffusion-weighted MR imaging (DWI) is described. One hundred sixteen nodules were enrolled to validate the performance of the strategy. For lesions ≤20 mm in size, the areas under the receiver operating characteristic curves (Az) of CEUS and EOB-MRI were 0.930 (95% confidence interval [CI]: 0.867-0.969) and 0.920 (95% CI: 0.855-0.962) (p = 0.796), respectively. The Az value of the new diagnostic strategy was 0.985 (95% CI: 0.942-0.999) (vs. CEUS, p = 0.026; vs. EOB-MRI, p = 0.014). The sensitivity, specificity and diagnostic accuracy of the new strategy were 95.5% (95% CI: 88.9%-98.8%), 96.3% (95% CI: 81.0%-99.9%) and 95.7% (95% CI: 91.9%-99.4%), respectively. The new diagnostic strategy based on the arterial phase of CEUS, hepatobiliary phase of EOB-MRI and DWI represents an appealing solution for distinguishing small hepatocellular carcinomas from benign lesions, especially when the nodules present atypical enhancement patterns.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Ultrasonography

This study was conducted in order to evaluate whether the presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules can help determine the treatment method for single nodular hepatocellular carcinoma (HCC) ≤ 3 cm.. This study was approved by the institutional review board. A total of 345 patients with single nodular HCC ≤ 3 cm underwent pretreatment gadoxetic acid-enhanced MR followed by hepatic resection (n = 123) or radiofrequency ablation (RFA) (n = 222). We retrospectively analyzed the results of tumor recurrence according to the presence of nonhypervascular HBP hypointense nodules at each treatment method.. Nonhypervascular HBP hypointense nodules were found in 18 of 123 patients treated by hepatic resection and in 63 of 222 patients who underwent RFA. The presence of nonhypervascular HBP hypointense nodules was a significant affecting factor for recurrence-free survival (RFS) after both hepatic resection (p = 0.004, hazard ratio [HR] = 2.75 [1.38-5.51]) and RFA (p = 0.004, HR = 1.78 [1.20-2.63]). In patients with nonhypervascular HBP hypointense nodules, 5-year RFS was 34.0% after hepatic resection, which was not significantly different from the 28.0% after RFA (p = 0.618). However, in patients without nonhypervascular HBP hypointense nodules, 5-year RFS was 65.0% after hepatic resection, which was significantly better than the 51.0% after RFA (p = 0.042), owing to significantly lower cumulative incidence of local tumor progression after hepatic resection (p < 0.001).. While the presence of nonhypervascular HBP hypointense nodules on gadoxetic acid-enhanced MR taken prior to treatment was a significant predictive factor of tumor recurrence after both hepatic resection and RFA, in patients without nonhypervascular HBP hypointense nodules, hepatic resection can provide significantly better RFS than RFA.. • The presence of nonhypervascular hepatobiliary phase (HBP) hypointense nodules was a significant risk factor for tumor recurrence after either hepatectomy or radiofrequency ablation (RFA). • Hepatectomy provided significantly better recurrence-free survival than RFA in patients without nonhypervascular HBP hypointense nodules. • In patients with nonhypervascular HBP hypointense nodules, recurrence-free survival after RFA was comparable to hepatectomy.

Topics: Aged; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors

Immunoscore evaluates the density of CD3+ and CD8+ T cells in both the tumor core and invasive margin. Pretreatment prediction of immunoscore in hepatocellular cancer (HCC) is important for precision immunotherapy. We aimed to develop a radiomics model based on gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI for pretreatment prediction of immunoscore (0-2 vs. 3-4) in HCC.. The study included 207 (training cohort: n = 150; validation cohort: n = 57) HCC patients with hepatectomy who underwent preoperative Gd-EOB-DTPA-enhanced MRI. The volumes of interest enclosing hepatic lesions including intratumoral and peritumoral regions were manually delineated in the hepatobiliary phase of MRI images, from which 1044 quantitative features were extracted and analyzed. Extremely randomized tree method was used to select radiomics features for building radiomics model. Predicting performance in immunoscore was compared among three models: (1) using only intratumoral radiomics features (intratumoral radiomics model); (2) using combined intratumoral and peritumoral radiomics features (combined radiomics model); (3) using clinical data and selected combined radiomics features (combined radiomics-based clinical model).. The combined radiomics model showed a better predicting performance in immunoscore than intratumoral radiomics model (AUC, 0.904 (95% CI 0.855-0.953) vs. 0.823 (95% CI 0.747-0.899)). The combined radiomics-based clinical model showed an improvement over the combined radiomics model in predicting immunoscore (AUC, 0·926 (95% CI 0·884-0·967) vs. 0·904 (95% CI 0·855-0·953)), although differences were not statistically significant. Results were confirmed in validation cohort and calibration curves showed good agreement.. The MRI-based combined radiomics nomogram is effective in predicting immunoscore in HCC and may help making treatment decisions.. • Radiomics obtained from Gd-EOB-DTPA-enhanced MRI help predicting immunoscore in hepatocellular carcinoma. • Combined intratumoral and peritumoral radiomics are superior to intratumoral radiomics only in predicting immunoscore. • We developed a combined clinical and radiomicsnomogram to predict immunoscore in hepatocellular carcinoma.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Health Status Indicators; Hepatectomy; Humans; Immunity; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nomograms; Retrospective Studies; Risk Factors

Dynamic magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) can be used not only to detect liver tumors but also to estimate liver function. The aim of this study was to establish a new EOB-MRI-based formula to determine the resection limit in patients undergoing hepatectomy.. Twenty-eight patients with a normal liver (NL group) and five with an unresectable cirrhotic liver (UL group) who underwent EOB-MRI were included. Standardized liver function (SLF) was calculated based on the signal intensity (SI), the volume of each subsegment (S1-S8), and body surface area. A formula defining the resection limit was devised based on the difference in the SLF values of patients in the NL and UL groups. The formula was validated in 50 patients who underwent EOB-MRI and hepatectomy.. The average SLF value in the NL and UL groups was 2038 and 962 FV/m2, respectively. The difference (1076 FV/m2) was consistent with a 70% in resection volume. Thus, the resection limit for hepatectomy was calculated as a proportion of 70%: 70×(SLF-962)/1076 (%). The one patient who underwent hepatectomy over the resection limit died due to liver failure. In other 49 patients, in whom the resection volume was less than the resection limit, procedures were safely performed.. Our formula for resection limit based on EOB-MRI can improve the safety of hepatectomy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results

Topics: Biliary Tract; Carcinoma, Hepatocellular; Consensus; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male

Microvascular invasion (MVI) is recognized as a risk factor for early recurrence of hepatocellular carcinoma (HCC) within the Milan criteria after curative treatment.. One hundred eleven consecutive patients with HCC within the Milan criteria who underwent hepatic resection were retrospectively reviewed. Independent preoperative predictors of MVI were identified, and a scoring system was developed using significant predictors.. MVI was identified in 51 of 111 patients (46%). Multivariate analysis identified the following independent predictors of MVI: alpha-fetoprotein (AFP) of > 95 ng/mL (odds ratio [OR], 9.87; 95% confidence interval [95% CI], 2.24-56.8; P = 0.002), des-γ-carboxy prothrombin (DCP) of > 55 mAU/mL (OR, 5.50; 95% CI, 2.09-15.4; P < 0.001), tumor size of > 2.8 cm (OR, 6.10; 95% CI, 2.07-20.0; P < 0.001), and non-smooth tumor margin in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (OR, 5.34; 95% CI, 1.84-16.9; P = 0.002). A clinical scoring system was developed using these four variables. Within a total possible score of 0 to 4, the prevalence of MVI with a score of 0, 1, 2, 3, and 4 was 4.5%, 24.0%, 45.5%, 91.7%, and 100%, respectively (P < 0.001). The area under the curve of the scoring system was 0.865 based on the receiver operating characteristic curve analysis of the prediction score.. Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.

Topics: Adult; Aged; Aged, 80 and over; alpha-Fetoproteins; Biomarkers; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neoplasm Invasiveness; Protein Precursors; Prothrombin; Retrospective Studies; ROC Curve; Tumor Burden

To evaluate the usefulness of the radiomic model in predicting early (≤2 years) and late (>2 years) recurrence after curative resection in cases involving a single hepatocellular carcinoma (HCC) 2-5 cm in diameter using preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI), in comparison with the clinicopathologic model.. This retrospective study included 167 patients with surgically resected and pathologically confirmed single HCC 2-5 cm in diameter (. The radiomic model showed a prognostic performance comparable with the clinicopathologic model only with 3-mm peritumoral border extension [c-index difference (radiomic-clinicopathologic), -0.021,. The prognostic value of the preoperative radiomic model with 3-mm border extension showed comparable performance with that of the postoperative clinicopathologic model for predicting DFS of early recurrence of HCC using gadoxetic acid-enhanced MRI. This suggests the importance of including peritumoral changes in the radiomic analysis of HCC.

Topics: Adult; Aged; Biomarkers; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Postoperative Period; Prognosis; Recurrence

To compare different imaging techniques (volume perfusion CT, cone-beam CT, and dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced dynamic contrast-enhanced MR imaging with golden-angle radial sparse parallel MR imaging) in evaluation of transarterial chemoembolization of hepatocellular carcinoma (HCC) using radiopaque drug-eluting embolics (DEE).. MR imaging and CT phantom investigation of radiopaque DEE was performed. In the clinical portion of the study, 13 patients (22 HCCs) were prospectively enrolled. All patients underwent cross-sectional imaging before and after transarterial chemoembolization using 100-300 μm radiopaque DEE. Qualitative assessment of images using a Likert scale was performed.. In the phantom study, CT-related beam-hardening artifacts were markedly visible at a concentration of 12% (v/v) radiopaque DEE; MR imaging demonstrated no significant detectable signal intensity changes. Imaging obtained before transarterial chemoembolization showed no significant difference regarding tumor depiction. Visualization of tumor feeding arteries was significantly improved with volume perfusion CT (P < .001) and cone-beam CT (P = .002) compared with MR imaging. Radiopaque DEE led to significant decrease in tumor depiction (P = .001) and significant increase of beam-hardening artifacts (P = .012) using volume perfusion CT before versus after transarterial chemoembolization. Greater residual arterial tumor enhancement was detected with MR imaging (10 HCCs) compared with volume perfusion CT (8 HCCs) and cone-beam CT (6 HCCs).. Using radiopaque DEE, the imaging modalities provided comparable early treatment assessment. In HCCs with dense accumulation of radiopaque DEE, treatment assessment using volume perfusion CT or cone-beam CT may be impaired owing to resulting beam-hardening artifacts and contrast stasis. Dynamic contrast-enhanced MR imaging may add value in detection of residual arterial tumor enhancement.

Topics: Aged; Aged, 80 and over; Antibiotics, Antineoplastic; Artifacts; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Cone-Beam Computed Tomography; Contrast Media; Doxorubicin; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microspheres; Middle Aged; Perfusion Imaging; Phantoms, Imaging; Polyvinyl Alcohol; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Treatment Outcome

To compare the efficacy of magnetic resonance imaging (MRI) with hepatobiliary agents (HBA-MRI) and MRI with extracellular contrast agents (ECA-MRI) for detection of recurrent hepatocellular carcinoma (HCC) after multiple treatments.. The institutional review board approved this retrospective study and waived the requirement for informed patient consent. A total of 135 patients with suspected HCC recurrence after 2-5 treatments (surgery, transarterial chemoembolization, and/or radiofrequency ablation) underwent both HBA-MRI and ECA-MRI within a 1 month interval. HBA-MRI and ECA-MRI were analyzed for HCC detection by two observers using a five-point scale. The diagnostic performances according to MRI modality were compared.. A total of 136 liver lesions (121 HCCs and 15 benign lesions; median size, 1.9 cm) were identified. ECA-MRI showed greater sensitivity (90.9% vs. 76.9% for observer 1; 91.7% vs. 78.5% for observer 2) and accuracy (91.2% vs. 78.7% for observer 1; 91.9% vs. 80.2% for observer 2) than HBA-MRI for both observers (P = 0.002, 0.003). Fifteen (12.4%) HCCs were correctly diagnosed with ECA-MRI but not with HBA-MRI by both observers. Interobserver agreement was excellent (0.885) for ECA-MRI and substantial (0.749) for HBA-MRI.. For detection of recurrent HCC, ECA-MRI was superior to HBA-MRI in terms of sensitivity and accuracy. Therefore, ECA-MRI could be the preferred imaging modality over HBA-MRI for assessing HCC recurrence following multiple treatments.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Cross-Over Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Background Current Liver Imaging Reporting and Data System guidelines define the washout appearance of gadoxetic acid-enhanced MRI only during the portal venous phase. Defining washout only during the portal venous phase may lead to lower sensitivity for diagnosis of hepatocellular carcinoma (HCC). Purpose To compare the diagnostic performances of three gadoxetic acid-enhanced MRI criteria for HCC according to the phases during which washout appearance was determined. Materials and Methods In this retrospective study, patients with a hepatic nodule detected at US surveillance for HCC from January to December 2012 underwent gadoxetic acid-enhanced MRI. Three diagnostic MRI criteria for HCC were defined according to the phases during which washout appearance was observed, with the presence of arterial phase hyperenhancement and hypointensity noted

Topics: Adult; Aged; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

We evaluated the detection rate and degree of motion artifact of the modified CAIPIRINHA-VIBE (mC-VIBE) without view-sharing and compare them with the CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) with view-sharing on multi-arterial gadoxetic acid-enhanced liver MRI in the assessment of hepatocellular carcinoma (HCC).. We retrospectively identified 114 pathological-proven hepatic tumors in 114 patients with risk of HCC who underwent multi-arterial gadoxetic acid-enhanced MRI between June 2016 and June 2018. All patients underwent triple arterial phase imaging using the mC-VIBE without view-sharing (54 patients; 49 HCCs and 5 non-HCCs) or the CDT-VIBE with view-sharing (60 patients; 55 HCCs and 5 non-HCCs). We compared the detection rate of two sequences for HCC, with reference to LI-RADS.V.2017. We also compared the mean motion scores and proportions of transient severe motion (TSM) in two sequences.. For the examination using the mC-VIBE, the HCC-detection rate was significantly higher, compared with that using CDT-VIBE (93.9% [46/49] vs 80.0% [44/55], respectively; p = 0.047). For the examination with the mC-VIBE, mean motion scores were significantly lower compared with those of CDT-VIBE for all multi-arterial phases (1.21, 1.19, and 1.15 vs. 1.82, 1.85, and 1.84, respectively; p < 0.001 for all three comparisons). The proportion of TSM in the CDT-VIBE was significantly higher than that in the mC-VIBE (15.0% [9/60] vs 0.0% [0/54], respectively; p = 0.003).. In multi-arterial phase gadoxetic acid-enhanced MRI, the mC-VIBE sequence without view-sharing has slightly higher HCC-detection rate and fewer motion artifacts compared with CDT-VIBE with view-sharing.. • Multi-arterial phase using the mC-VIBE without view-sharing can overcome motion artifacts, resulting in providing optimal arterial phase imaging. • The HCC-detection rate is slightly higher with the mC-VIBE vs. CAIPIRINHA-Dixon-TWIST-VIBE with view-sharing (CDT-VIBE). • View-sharing of CDT-VIBE in the multi-arterial phase is associated with increased frequency of TSM.

Topics: Artifacts; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies

Our aim of the study is to investigate the feasibility of preoperative prediction for hepatocellular carcinoma (HCC) histological grading using gadoxetic acid-enhanced magnetic resonance imaging (MRI).. This study included one hundred and fifty-six patients with solitary HCC. Preoperative gadoxetic acid-enhanced MRI findings were retrospectively analyzed. MRI qualitative features such as tumor size, margin, capsule status, signal homogeneity, intratumoral vessels, peritumoral enhancement during mid-arterial phase, peritumoral hypointensity during the hepatobiliary phase (HBP) were investigated. Apparent diffusion coefficients (ADCs), T1 reduction ratio of pre- and post-contrast enhanced images of the tumors were calculated. HCC histological grading in surgical specimens were confirmed by Edmonson's criteria. Correlations between these MRI features and HCC histological grading were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of the model.. Univariate analysis showed that maximum tumor diameter (p = 0.004), tumor margin (p = 0.006), intratumoral vessels (p = 0.001) and peritumoral hypointensity during HBP (p = 0.000), were significantly correlated with HCC histological grading. There was no relationship between capsule, tumor signal, venous thrombosis, peritumoral enhancement during mid-arterial phase, ADC value, T1 reduction ratio, and HCC histological grading. Multivariate logistic regression analysis demonstrated that the maximum tumor diameter (p = 0.012, odds ratio = 1.002, 95% confidence interval: 1.007-1.046)) was an independent risk factor for high grade HCC.. Greater tumor size, a more irregular margin, presence of intratumoral vessels, and peritumoral hypointensity during HBP were indicators for high grade HCC. The maximum tumor diameter was an independent risk factor for high grade HCC.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Preoperative Care; Prognosis; Retrospective Studies; ROC Curve

To identify independent confounding variables of gadoxetate-enhanced hepatobiliary-phase liver MRI using multiple regression analysis.. The institutional review board generally approved retrospective analyses and all patients provided written informed consent. One hundred ten patients who underwent a standardized 3.0-T gadoxetate-enhanced liver MRI between November 2008 and June 2013 were retrospectively reviewed. The gadoxetate liver enhancement normalized to enhancement in the erector spinae muscle (relative signal enhancement, SE) was related to biochemical laboratory parameters and descriptive patient characteristics (patient age, body mass index) using non-parametric univariate correlation analysis followed by a multiple linear regression model.. Using univariate statistics, relative SE was inversely correlated with patient age, ALP, AST, total bilirubin, gamma-glutamyltransferase, INR, model of end-stage liver disease score, and proportionally with albumin and hemoglobin (all p < 0.01). In a multiple regression analysis, total bilirubin (p = 0.001), serum albumin (p = 0.016), and patient age (p = 0.018) were independently correlated with relative liver SE (n = 110).. A multiple regression analysis showed that high total bilirubin, low serum albumin, or advanced age was associated with low hepatobiliary-phase gadoxetate parenchymal liver enhancement. In these patients, the lower contrast-to-noise ratio might impair diagnostic evaluation of non-enhancing liver lesions (e.g., HCC, liver metastasis).. • A multiple regression analysis identified independent confounding variables of hepatobiliary-phase gadoxetate liver enhancement. • High bilirubin, low albumin, or advanced age was associated with low enhancement. • Diagnostic evaluation might be hampered in these patients.

Topics: Adult; Aged; Bilirubin; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; gamma-Glutamyltransferase; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Serum Albumin

Most of the published studies about the diagnostic accuracy of gadoxetic acid-enhanced magnetic resonance (EOB-MR) for the non-invasive diagnosis of hepatocellular carcinoma (HCC) have had a retrospective design. Thus, we aimed to prospectively evaluate the diagnostic accuracy of EOB-MR for the non-invasive diagnosis of HCC in nodules ≤2 cm detected by screening ultrasound (US) in patients with cirrhosis.. Between July 2012 and October 2015, 62 consecutive asymptomatic Child-Pugh A-B cirrhotic patients with newly US-detected solitary nodules between 1 and 2 cm were prospectively included in the study. Hepatic extracellular contrast-enhanced MR (ECCE-MR) followed by EOB-MR were obtained in less than 1-month interval. Two independent radiologists blindly reviewed the EOB-MR studies, and the diagnosis of HCC was assigned when the lesion showed arterial enhancement followed by portal venous phase washout and/or hypointensity on the hepatobiliary phase (HBP). The final HCC diagnosis was made by ECCE-MR according to the accepted non-invasive criteria, or by biopsy in lesions with atypical vascular profile.. Final diagnoses were as follows: HCC (n = 41), intrahepatic cholangiocarcinoma (n = 2), colorectal metastases (n = 1) and benign conditions (n = 18). The sensitivity and specificity of EOB-MR for HCC diagnosis were 56.1% (95% CI: 39.7-71.5) and 90.5% (95% CI: 69.6-98.8), respectively, while sensitivity of ECCE-MR was 63.4% (95% CI: 46.9-77.9). The low rate of hypointense HCCs in the HBP and suboptimal liver uptake of contrast agent justify the low sensitivity of EOB-MR for HCC diagnosis.. EOB-MR does not surpass the diagnostic accuracy of ECCE-MR for non-invasive diagnosis of HCC in nodules ≤2 cm in cirrhotic patients.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity

This study was performed to prospectively develop and validate a radiomics nomogram for predicting postoperative early recurrence (≤1 year) of hepatocellular carcinoma (HCC) using whole-lesion radiomics features on preoperative gadoxetic acid-enhanced magnetic resonance (MR) images.. In total, 155 patients (training cohort: n = 108; validation cohort: n = 47) with surgically confirmed HCC were enrolled in this IRB-approved prospective study. Three-dimensional whole-lesion regions of interest were manually delineated along the tumour margins on multi-sequence MR images. Radiomics features were generated and selected to build a radiomics score using the least absolute shrinkage and selection operator (LASSO) method. Clinical characteristics and qualitative imaging features were identified by two independent radiologists and combined to establish a clinical-radiological nomogram. A radiomics nomogram comprising the radiomics score and clinical-radiological risk factors was constructed based on multivariable logistic regression analysis. Diagnostic performance and clinical usefulness were measured by receiver operation characteristic (ROC) and decision curves.. In total, 14 radiomics features were selected to construct the radiomics score. For the clinical-radiological nomogram, the alpha-fetoprotein (AFP) level, gross vascular invasion and non-smooth tumour margin were included. The radiomics nomogram integrating the radiomics score with clinical-radiological risk factors showed better discriminative performance (AUC = 0.844, 95%CI, 0.769 to 0.919) than the clinical-radiological nomogram (AUC = 0.796, 95%CI, 0.712 to 0.881; P = 0.045), with increased clinical usefulness confirmed using a decision curve analysis.. Incorporating multiple predictive factors, the radiomics nomogram demonstrated great potential in the preoperative prediction of early HCC recurrence after surgery.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nomograms

The aim of this study was to compare the major imaging features of hepatocellular carcinoma (HCC) on magnetic resonance imaging (MRI) scans with Gd-EOB-DTPA (EOB) and extracellular agent (ECA; Gd-DTPA) contrast media.. Among 184 surgically proven HCCs in 169 patients who underwent a liver MRI with either EOB (n = 120) or ECA (n = 49), 55 HCCs were matched according to tumor size, Edmonson grade (major and worst), and gross type for each of the 2 contrast media. For the qualitative analysis, 2 board-certified radiologists independently reviewed arterial phase hyperenhancement, hypointensity on portal venous phase, hypointensity on delayed or transitional phase (DP/TP, 120-150 seconds), and capsule appearance. For the quantitative analysis, a third radiologist measured the signal intensity at each phase by placing the region of interest for tumor and normal liver parenchyma. The lesion-to-liver contrast (LLC) and lesion-to-liver contrast enhancement ratio (LLCER) were calculated.. On qualitative analysis, hypointensity on DP/TP was seen more frequently with EOB (91% in reader 1, 89% in reader 2) than with ECA (73% in reader 1, 75% in reader 2; P = 0.026). Capsule appearance was seen less frequently with EOB (31% in reader 1, 44% in reader 2) than with ECA (73% in reader 1, 78% in reader 2; P < 0.001). On quantitative analysis, the LLC on arterial phase (AP) was better with ECA (P = 0.003), whereas LLC on DP was better with EOB (P < 0.001). The LLCER from precontrast to AP was higher with ECA (P = 0.022), whereas the LLCER from portal venous phase to DP was higher with EOB (P < 0.001).. ECA-MRI revealed better LLC on AP and detection rate of capsule appearance than EOB-MRI. EOB-MRI showed superior LLC on TP.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Evaluation Studies as Topic; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies

Although gadoxetate disodium-enhanced magnetic resonance imaging (MRI) shows higher sensitivity for diagnosing hepatocellular carcinoma (HCC), its arterial-phase images may be unsatisfactory because of weak arterial enhancement. We investigated the clinical effectiveness of arterial subtraction images from gadoxetate disodium-enhanced MRI for diagnosing early-stage HCC using the Liver Imaging Reporting and Data System (LI-RADS) v2018.. In 258 patients at risk of HCC who underwent gadoxetate disodium-enhanced MRI in 2016, a total of 372 hepatic nodules (273 HCCs, 18 other malignancies, and 81 benign nodules) of 3.0 cm or smaller were retrospectively analyzed. Final diagnosis was assessed histopathologically or clinically (marginal recurrence after treatment or change in lesion size on follow-up imaging). The detection rate for arterial hyperenhancement was compared between ordinary arterial-phase and arterial subtraction images, and the benefit of arterial subtraction images in diagnosing HCC using LI-RADS was assessed.. Arterial subtraction images had a significantly higher detection rate for arterial hyperenhancement than ordinary arterial-phase images, both for all hepatic nodules (72.3% vs. 62.4%, p <0.001) and HCCs (91.9% vs. 80.6%, p <0.001). Compared with ordinary arterial-phase images, arterial subtraction images significantly increased the sensitivity of LI-RADS category 5 for diagnosis of HCC (64.1% [173/270] vs. 55.9% [151/270], p <0.001), without significantly decreasing specificity (92.9% [91/98] vs. 94.9% [93/98], p = 0.155). For histopathologically confirmed lesions, arterial subtraction images significantly increased sensitivity to 68.8% (128/186) from the 61.3% (114/186) of ordinary arterial-phase images (p <0.001), with a minimal decrease in specificity to 84.8% (39/46) from 89.1% (41/46) (p = 0.151).. Arterial subtraction images of gadoxetate disodium-enhanced MRI can significantly improve the sensitivity of early-stage HCC diagnosis using LI-RADS, without a significant decrease in specificity.. Gadoxetate disodium-enhanced magnetic resonance imaging is an imaging technique with a high sensitivity for the diagnosis of hepatocellular carcinoma. However, arterial-phase images may be unsatisfactory because of weak arterial enhancement. We found that using arterial subtraction images led to clinically meaningful improvements in the diagnosis of early-stage hepatocellular carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Arteries; Carcinoma, Hepatocellular; Contrast Media; Data Accuracy; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Retrospective Studies; Sensitivity and Specificity; Subtraction Technique

To define the optimal lexicon of major imaging findings on gadoxetic acid-enhanced MRIs to diagnose HCC to improve diagnostic performance of the LI-RADS.. Two hundred forty-one hepatic lesions (149 HCC, six other malignancies, 86 benign lesions) in 177 treatment-naïve patients at risk of HCC who underwent gadoxetic acid-MRIs from January 2013 to December 2015 were retrospectively reviewed using either histopathological or follow-up imaging findings as a standard reference. Two board-certified radiologists independently evaluated the imaging features and categorized the nodules based on the original and the following modified definitions in LI-RADS: (1) washout appearance in the portal venous phase (PVP) only versus that in the PVP or transitional phase, and (2) enhancing capsule only versus enhancing or non-enhancing capsule. Diagnostic performance and inter-observer agreement of LR-5 were assessed and compared between the algorithms using generalized estimation equation.. The sensitivity [79.2% (95% confidence interval 71.9, 85.0)] and accuracy [84.6% (79.5, 88.7)] of LR-5 were significantly higher for modified lexicon compared with original LI-RADS [60.4% (52.3, 67.9) and 73.9% (67.9, 79.0); P < 0.001 in all cases]. There was no significant difference in specificity [93.5% (86.2, 97.0) and 95.7% (89.0, 98.4); P = 0.153]. Subgroups of lesions < or ≥ 2 cm showed similar tendencies. Inter-observer agreement for capsule appearance was fair to moderate, whereas that for other imaging findings was good to excellent.. Compared to original LI-RADS, LI-RADS with modified lexicon showed higher sensitivity for the diagnosis of HCC using gadoxetic acid-MRI, with similar specificity.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2.. To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1).. Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusion-weighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules.. There were 39 (34.2%; 39 of 114) and 75 (65.8%; 75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings,. Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Preoperative Period; Retrospective Studies; Sensitivity and Specificity

Background Few studies have reported on the diagnostic performance of Liver Imaging Reporting and Data System (LI-RADS) LR-5 or LR-5 V in the diagnosis of hepatocellular carcinoma (HCC) using MRI with gadoxetate disodium. Purpose To determine the diagnostic performance of LI-RADS version 2018 (hereafter, v2018) on gadoxetate disodium-enhanced MRI in comparison with LI-RADS version 2017 (hereafter, v2017) for the diagnosis of HCC in patients with cirrhosis or chronic hepatitis B viral infection or at high risk for HCC. Materials and Methods This retrospective study between January 2013 and October 2015 evaluated consecutive patients at high risk for HCC who had at least one observation of 10 mm or greater on gadoxetate disodium-enhanced MRI and no history of previous treatment for hepatic lesions. MRI features were reviewed by three radiologists. Observations were categorized according to LI-RADS v2018 and LI-RADS v2017. Per-observation sensitivity and specificity of LR-5 using LI-RADS v2017 and v2018 were compared using generalized estimating equation models. Results A total of 422 observations, including 234 HCCs confirmed by results of pathologic examination in 387 patients (305 men and 82 women; mean age ± standard deviation, 59 years ± 10), were included. In all observations, LI-RADS v2018 provided higher sensitivity than LI-RADS v2017 (81% [189 of 234] vs 68% [160 of 234], respectively;

Topics: Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To determine the consistency of major hepatocellular carcinoma (HCC) features between CT and MRI based on Liver Imaging Reporting and Data System (LI-RADS) v2018 and to investigate the additional value on gadoxetic acid-enhanced MRI.. Patients who underwent dynamic CT and gadoxetic acid-enhanced MRI within 1 month were investigated. Two radiologists evaluated the presence of major HCC features and categorized observations using LI-RADS v2018 algorithm. In addition, each observation was recorded as hyper-, iso-, or hypo-intensity on hepatobiliary-phase (HBP) images.. Sixty-one patients with 110 observations were identified. Among 88 observations classified as LR-3, 4 or 5, arterial phase hyper-enhancement and washout appearance showed higher frequencies on CT than on MRI (75.0% vs. 58.0%, P < 0.001, and 60.2% vs. 44.3%, P = 0.014, respectively). Of the 59 LR-3 observations categorized on MRI, 70.0% of observations with hypo-intensity on HBP images were HCCs, whereas 89.5% of observations with iso- or hyper-intensity on HBP images were non-HCCs (P < 0.001) CONCLUSION: The frequencies of arterial phase hyper-enhancement and washout appearances were higher on CT than on gadoxetic acid-enhanced MRI. For LR-3 observations, adding the hepatobiliary-phase hypo-intensity to major features improved the diagnostic performance of MRI in distinguishing HCCs from non-HCC lesions.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

In cirrhotic patients, the characterization of hypovascular nodules, hypointense on hepatobiliary phase gadoxetic acid disodium-enhanced magnetic resonance images (Gd-EOB-DTPA-enhanced MRI), is essential to look for the proper approach strategy. Our objective was to evaluate the imaging features and risk assessment of hypovascular nodules, hypointense on Gd-EOB-DTPA-enhanced MRI, focusing on the diagnostic value of diffusion-weighted imaging (DWI).. This prospective study includes 35 patients with 50 hypovascular hypointense nodules. Signal intensity on T2-weighted images and DWI, vascular pattern on dynamic contrast-enhanced MRI and on hepatobiliary phase, and volume doubling time were analyzed for each nodule as well as patient's clinical features. Univariate and multivariate analyses were made to determine the variables associated with the development of hypervascular pattern.. On 24 months follow-up period, 40% of the hypointense nodules (mean size 14 mm ± 6.1) became hypervascular hepatocellular carcinoma (HCC) with 6 and 12 months cumulative risk of 45 and 55%. Nine/12 (75%, mean size 15.50 mm ± 7.2) that appeared hyperintense in DWI at first exam show malignant transformation (p value = 0.007). Univariate and multivariate analyses identified hyperintensity at initial DWI (OR 6.49; 95% CI 1.28-32.80; p value = 0.009) and size ≥10 mm (OR 6.22; 95% CI 1.57-24.63; p value = 0.024) as independent factors with the development of HCC.. In conclusion, hypovascular lesions ≥10 mm and those hyperintense in DWI were associated with progression to hypervascular HCC. A close follow-up or histological characterization is recommended to improve patients outcome and to develop effective treatment.

Topics: Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Disease Progression; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Neovascularization, Pathologic; Prospective Studies; Risk Assessment

Background Central scars are rarely reported in conventional hepatocellular carcinoma (HCC). The presence of central scars on imaging might lead to erroneous diagnosis of hepatic tumors. Purpose To determine imaging features of HCC with central scars on magnetic resonance imaging (MRI) including gadoxetic acid-enhanced and diffusion-weighted imaging (DWI). Material and Methods Fifty-one patients with 51 surgically confirmed HCCs with central scars (fibrotic scar: n = 50; myxoid scar: n = 1; range = 1.2-15 cm; mean = 3.7 cm) underwent liver MRI that consisted of T1- and T2-weighted (T2W) imaging, gadoxetic acid-enhanced arterial, portal, 3-min late phase, and 20-min hepatobiliary phase (HBP), and DWI. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors and central scars for each image and reached consensus. Results Lobulated contour was seen for 30 tumors (58.8%); the rest were round or oval masses. Central scars (range = 0.2-6.0 cm; mean = 0.9 cm) were most commonly seen as defects within hyperenhancement on arterial phase images (n = 47, 92.2%), bright (n = 28, 54.9%) or dark areas (n = 15, 29.4%) on T2W imaging, areas of central darkness on high b-value DWI (b = 800) (n = 31, 60.8%), and/or central enhancement on HBP (n = 36, 70.6%), mimicking a target appearance. Tumor capsule was seen in 35 (39 pathology, 74.5%) and intratumoral septum in 35 (41 pathology, 78.4%) tumors on gadoxetic acid-enhanced MRI. Conclusion Non-fibrolamellar HCC may show central scar. HCC with central scar mimics cholangiocarcinoma by showing a target appearance on HBP and DWI. Tumor capsule and intratumoral septum might be useful for characterizing HCC with central scar.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cicatrix; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The annual risk of transformation of non-hypervascular magnetic resonance (MR) hepatobiliary phase imaging (HBPI) hypointense nodules into hypervascular hepatocellular carcinomas (HCCs) was evaluated.. Cirrhotic patients with non-hypervascular HBPI hypointense nodules were retrospectively analyzed if they were diagnosed as HCC and MR followed up longer than 1 year during the period from January 2010 to October 2016 with regular intervals of 3 to 6 months. Risk factors for transformation into hypervascular HCCs were analyzed using the Cox proportional hazard model.. Among the 103 non-hypervascular HBPI hypointense nodules meeting the inclusion criteria, transformation into hypervascular HCCs occurred in 44 tumors (42.7%). The median follow-up period was 24 months. Multivariate analysis revealed that hyperintensity on T2-weighted images (T2WI) and diffusion-weighted images (DWI) were the two independent predictors of transformation into hypervascular HCCs (p=0.036 and p=0.041, respectively). Most tumors with hyperintensity on T2WI or DWI on the initial or follow-up MR were transformed into hypervascular HCCs within the first year. Among the 22 nodules (21.3%) showing a new change in dynamic phases during follow-up, 14 nodules (13.6%) showed malignant transformations.. The transformation rates of HBPI hypointense nodules into hypervascular HCCs could be predicted according to the initial or serial MRI findings.

Topics: Aged; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver; Liver Neoplasms; Male; Neovascularization, Pathologic; Retrospective Studies

Background Gadoxetic acid is being widely used for detection and characterization of hepatic nodules. However, there are no data regarding intra-individual comparison of imaging features of hepatocellular carcinoma (HCC) on dynamic computed tomography (CT), gadopentetate dimeglumine-enhanced magnetic resonance imaging (Gd-DTPA-MRI), and gadoxetic acid-enhanced MRI (Gd-EOB-MRI). Purpose To evaluate typical imaging features of HCC and capsule appearance with dynamic CT, Gd-DTPA-MRI, and Gd-EOB-MRI. Material and Methods We retrospectively reviewed 56 HCCs in 49 patients. Lesion attenuation/signal intensity was graded using a five-point scale based on dynamic phase and hepatobiliary phase (HBP) imaging. Subjective washout and capsule appearance were evaluated on portal venous phase (PVP) or delayed/transitional phase (DP/TP) imaging. The tumor-to-liver contrast ratio (TLCR) was calculated. Results Gd-DTPA-MRI and Gd-EOB-MRI was graded higher than CT on arterial phase ( P < 0.001). Gd-EOB-MRI was graded lower than Gd-DTPA-MRI on PVP and DP/TP ( P < 0.05). The detection rate of subjective washout and capsule appearance did not differ among the three imaging studies on either PVP or DP/TP. TLCR of Gd-EOB-MRI was lower than CT on PVP ( P = 0.004) and was lower than Gd-DTPA-MRI on DP/TP ( P = 0.001). Conclusion Arterial phase hyperenhancement and washout appearance of HCC were well demonstrated in Gd-EOB-MRI. The detection of capsule appearance using Gd-EOB-MRI was not inferior to Gd-DTPA-MRI or CT.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed

To validate a free-breathing dynamic contrast-enhanced-MRI (DCE-MRI) in hepatocellular carcinoma (HCC) patients using gadoxetic acid, and to determine the relationship between DCE-MRI parameters and histological results.. Thirty-four HCC patients were included in this prospective study. Free-breathing DCE-MRI data was acquired preoperatively on a 3.0 Tesla scanner. Perfusion parameters (K. Significant relationship was found between DCE-MRI and CT results. The DCE-MRI derived K. The DCE-MRI derived parameters demonstrated weak but significant correlations with tumor proliferation status, histological grades or microvascular density, respectively. This free-breathing DCE-MRI is technically feasible and offers a potential avenue toward non-invasive evaluation of HCC malignancy.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Ki-67 Antigen; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Neovascularization, Pathologic; Prospective Studies

To compare the occurrence of transient severe motion (TSM) between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI and between gadoxetate disodium-enhanced MRI scans obtained with and without the application of a modified breath-holding technique.. We reviewed 80 patients who underwent two magnetic resonance examinations (gadoxetate disodium-enhanced MRI and gadopentetate dimeglumine-enhanced MRI) with the application of a modified breath-holding technique (dual group). This group was compared with 100 patients who underwent gadoxetate disodium-enhanced MRI without the application of the modified breath-holding technique (single group). Patient risk factors and motion scores (1 [none] to 5 [non-diagnostic]) for each dynamic-phase imaging were analysed.. In the dual group, mean motion scores did not differ significantly between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI (p=0.096-0.807) in any phase. However, in all phases except the late dynamic phase, mean motion scores of the dual group were significantly lower than those in the single group. TSM incidence did not differ significantly between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI in the dual group (3.8% vs. 1.3%, p=0.620).. With proper application of the modified breath-holding technique, TSM occurrence with gadoxetate disodium-enhanced MRI was comparable to that associated with gadopentetate dimeglumine-enhanced MRI.. • The modified breath-holding method significantly reduced the incidence of TSM. • Gadoxetate disodium and gadopentetate dimeglumine showed comparable motion scores. • TSM incidence was comparable between gadoxetate disodium- and gadopentetate dimeglumine-enhanced MRI.

Topics: Adult; Aged; Artifacts; Breath Holding; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Motion; Risk Factors

Objective We investigated the possible factors for predicting the future progression to hepatocellular carcinoma (HCC) from hypovascular nodules detected in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI). Methods A total of 91 hypovascular nodules detected by Gd-EOB-DTPA-MRI in 28 patients without any past history of treatment for HCC were retrospectively examined. The nodules were categorized into those with and without HCC progression, then comparisons were made to identify any factors possibly related to a progression to HCC in each case. In addition, we performed a receiver operating characteristics (ROC) analysis to determine the cut-off value for the initial nodule size for predicting HCC progression within 12 months. Results The observation period of the 28 patients was 1,172.6±95.6 (mean±standard error) days. The number of hypovascular nodules that changed to hypervascular ones was 15 (16.5%), and the cumulative incidence of hypervascular transformation was 7.1% at 12 months and 12.7% at 24 months. Of all 91 hypovascular nodules, 33 in 18 patients were diagnosed as HCC based on hypervascular transformation and/or size enlargement, while the remaining 58 did not progress to HCC. There was no significant difference regarding the background characteristics between the HCC progressed and non-progressed groups according to a multivariate analysis, or between the patients who had nodules that progressed to HCC and those with nodules that did not progress to HCC. Regarding HCC progression at 12 months, the area under the ROC (AUROC) had a level of 0.745 and showed that an initial nodule cut-off size of 9.5 mm (sensitivity, 57.9%; specificity, 87.3%) was predictive. Conclusion In patients without a past HCC treatment history, it is difficult to determine whether hypovascular nodules have a high risk of progression to HCC based on background factors alone.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Incidence; Liver Neoplasms; Magnetic Resonance Imaging; Male; Multivariate Analysis; Retrospective Studies; Risk Factors

To investigate the significance of subcentimetre (≤1 cm) arterially enhancing and hepatobiliary hypointense lesions (SAELs) observed on gadoxetic acid-enhanced magnetic resonance imaging (MRI) of patients at risk of hepatocellular carcinoma (HCC).. A SAEL was defined as a subcentimetre hypervascular nodule exhibiting a hepatobiliary phase defect on gadoxetic acid-enhanced MRI. We included 52 SAELs from 46 patients in a HCC surveillance population. The HCC reference standard was pathologic confirmation or a nodule >1 cm with typical imaging features of HCC at follow-up imaging. The malignancy rate and HCC-favourable imaging findings of SAELs were evaluated.. The malignancy rate among SAELs was 57.7% (30/52). At diagnosis, all SAELs that progressed to overt HCC were treatable with curative intention. Venous or late dynamic phase washout was more frequently observed with malignant SAELs than with benign SAELs (57.7% vs. 30.6%; P = 0.01). If SAELs exhibiting washout were considered as HCC, sensitivity, specificity, and positive predictive value was 83.3%, 50%, and 69.4%, respectively.. Among patients at risk of HCC, SAELs on gadoxetic acid-enhanced MRI exhibited high malignant potential. However, close observation may be an appropriate strategy for isolated SAELs. A washout appearance may be helpful for predicting malignancy.. • Gadoxetic acid-enhanced MRI provides hepatobiliary phase (HBP) images. • Screening frequently detects subcentimetre arterially enhancing and hepatobiliary hypointense lesions (SAELs). • A majority of SAELs progressed to overt HCC within 2 years. • A venous-phase washout appearance correlated significantly with malignancy in SAELs.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Injections, Intra-Arterial; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies

The aim of this study was to evaluate the efficacy of multiphasic hepatic arterial phase (HAP) imaging using DISCO (differential subsampling with Cartesian ordering) in increasing the confidence of diagnosis of hepatocellular carcinoma (HCC).. This retrospective study was approved by the institutional review board, and the requirement for informed patient consent was waived. Consecutive patients (from 2 study periods) with malignant liver nodules were examined by gadoxetic acid-enhanced magnetic resonance imaging using either multiphasic (6 phases; n = 135) or single (n = 230) HAP imaging, which revealed 519 liver nodules other than benign ones (HCC, 497; cholangiocarcinoma, 11; metastases, 10; and malignant lymphoma, 1). All nodules were scored in accordance with the Liver Imaging Reporting and Data System (LI-RADS v2014), with or without consideration of ring-like enhancement in multiphasic HAP images as a major feature.. In the multiphasic HAP group, 178 of 191 HCCs were scored as LR-3 to LR-5 (3 [1.69%], 85 [47.8%], and 90 [50.6%], respectively). Upon considering ring-like enhancement in multiphasic HAP images as a major feature, 5 more HCCs were scored as LR-5 (95 [53.4%]), which was a significantly more confident diagnosis than that with single HAP images (295 of 306 HCCs scored as LR-3 to LR-5: 13 [4.41%], 147 [49.8%], and 135 [45.8%], respectively; P = 0.0296). There was no significant difference in false-positive or false-negative diagnoses between the multiphasic and single HAP groups (P = 0.8400 and 0.1043, respectively).. Multiphasic HAP imaging can improve the confidence of diagnosis of HCCs in gadoxetic acid-enhanced magnetic resonance imaging.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies

We determined the cost-effectiveness of two different diagnostic imaging strategies in guiding curative treatment of early-stage hepatocellular carcinoma (HCC).. We developed a decision analytic model using as its starting point a cohort of patients aged 55 years with early-stage HCC detected at dynamic multiphasic CT and with Child-Pugh class A cirrhosis. The model compared two strategies on the initial workup: conventional CT strategy using dynamic multiphasic CT only and gadoxetic acid-enhanced MRI strategy using additional gadoxetic acid-enhanced MRI after initial CT. A Markov cohort model simulated a cohort of patients after curative or adjuvant treatment, with follow-up over the remaining life expectancy. We analyzed mean life-years gain, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratio (ICER). To evaluate results, we performed one-way, two-way, and probabilistic sensitivity analyses.. The life expectancies and QALY were 7.22 years and 5.08 for the conventional CT strategy and 7.79 years and 5.52 for the gadoxetic acid-enhanced MRI strategy, respectively. The expected costs were $99,770 for conventional CT and $105,025 for gadoxetic acid-enhanced MRI in the United States. The ICER with gadoxetic acid-enhanced MRI was $11,957, as opposed to that with conventional CT, which was lower than the cost-effectiveness threshold of $50,000/QALY. One-way, two-way, and probabilistic sensitivity analyses showed unchanged results over an acceptable range.. Gadoxetic acid-enhanced MRI after CT is cost-effective for detecting additional HCC in patients with early-stage HCC who can undergo curative treatment (besides liver transplantation). The cost-effectiveness of gadoxetic acid-enhanced MRI may be considered in the management of patients with early-stage HCC during staging.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Cost-Benefit Analysis; Decision Support Techniques; Female; Gadolinium DTPA; Humans; Life Expectancy; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Markov Chains; Middle Aged; Neoplasm Staging; Quality-Adjusted Life Years; Tomography, X-Ray Computed

The patient was a 43-year-old woman with obesity (body mass index: 29.1) and glucose intolerance who was not taking oral contraceptives. An ultrasound showed a hypoechoic hepatic mass. Dynamic contrast-enhanced computed tomography revealed a lesion in segment 6 that showed homogeneous and slight-to-moderate enhancement in the arterial phase with persistent enhancement during the portal and equilibrium phases. On magnetic resonance (MR) imaging, the lesion demonstrated hyperintensity on T2- and diffusion-weighted images and hypointensity in the hepatobiliary phase of gadoxetic-acid-enhanced MR imaging. In addition to the main lesion, approximately ten small hypointense lesions were seen in the hepatobiliary phase. The background liver was fatty without the deformity of chronic liver disease. Based on the pathological findings of the main lesion biopsy, it was initially suspected to be a non-neoplastic lesion with hematoxylin and eosin staining and initial immunohistochemical staining. However, the radiological findings indicated a neoplastic lesion. Additional immunohistochemical staining, including that for α-smooth muscle actin and organic anion transporter polypeptide 1B3, in combination with the radiological findings resulted in a diagnosis of unclassified hepatocellular adenoma. The other small lesions were presumed to be related to the main lesion.

Topics: Adult; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Glucose Intolerance; Humans; Immunohistochemistry; Liver Neoplasms; Obesity; Tomography, X-Ray Computed

Purpose To determine the preoperative magnetic resonance (MR) imaging findings potentially most useful for predicting cytokeratin 19 (CK19)-positive hepatocellular carcinoma (HCC) and to evaluate the prognosis after curative resection in patients with a single HCC lesion positive for CK19 compared with patients with HCC who are negative for CK19. Materials and Methods The institutional review board approved this study and waived the requirement for informed consent. Two hundred four patients with CK19-negative HCC and 38 with CK19-positive HCC who underwent curative resection after gadoxetic acid-enhanced and diffusion-weighted MR imaging were retrospectively evaluated in a single institution. Two radiologists evaluated preoperative findings at MR imaging. Significant findings for differentiating the two groups were identified at univariate and multivariate analyses. By using receiver operating characteristic analysis, the optimal cut-off values for quantitative variables were determined. Recurrence-free survival rates after surgery were also compared between groups. Results At multivariate analysis, irregular tumor margin (P = .024), arterial rim enhancement (P < .001), lower tumor-to-liver signal intensity (SI) ratio on hepatobiliary phase (HBP) images (≤0.522; P = .01), and lower tumor-to-liver apparent diffusion coefficient (ADC) ratio (≤0.820; P < .001) were independent significant factors to predict CK19-positive HCC. When three of these four criteria were combined, 63.2% (24 of 38; 95% confidence interval: 46.0%, 78.2%) of CK19-positive HCCs were identified with a specificity of 90.7% (185 of 204; 95% confidence interval: 46.0%, 78.2%). When all four criteria were satisfied, specificity was 99.5% (203 of 204; 95% confidence interval: 97.3%, 100%). Recurrence-free survival rates were significantly lower in patients with CK19-positive HCCs compared with those with CK19-negative HCCs after curative resection (63.9% vs 90.0% at 1 year, 63.9% vs 79.9% at 2 years, and 54.8% vs 70.2% at 3 years, P = .001 by log-rank test). Conclusion At gadoxetic acid-enhanced and diffusion-weighted MR imaging, irregular margin, arterial phase rim enhancement, lower tumor-to-liver ADC ratio, and lower tumor-to-liver SI ratio at HBP imaging may be helpful to predict CK19-positive HCC with early recurrence (<2 years) after curative resection.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Diffusion Magnetic Resonance Imaging; Gadolinium DTPA; Humans; Keratin-19; Liver Neoplasms; Middle Aged; Molecular Imaging; Retrospective Studies

To evaluate the diagnostic performance of the LI-RADS (v2014) on gadoxetate-enhanced MRI prospectively applied in actual practice.. We retrospectively reviewed the prospectively written radiology reports of 143 treatment-naïve at-risk patients who underwent gadoxetate-enhanced liver MRI from January to December 2014, and identified 202 hepatic observations categorized using the LI-RADS. The diagnostic performances of LI-RADS categories for hepatocellular carcinoma (HCC) and hepatic malignancy were calculated.. Twenty (69.0 %) of 29 LR-4, 73 (97.3 %) of 75 LR-5, and all of five (100 %) LR-5V observations were HCCs. The remaining two (2.7 %) LR-5 observations were combined hepatocellular-cholangiocarcinomas, while 10 (76.9 %) of 13 LR-M observations were HCCs. The sensitivity and specificity of LR-5/5V for HCC were 60.5 % and 97.3 %, respectively. Including LR-M in the diagnostic criteria for HCC increased sensitivity (68.2 %, p = 0.002) but decreased specificity without statistical significance (93.2 %, p = 0.154). LR-5/5V/M yielded sensitivity of 68.9 % and specificity of 100.0 % for hepatic malignancy.. LI-RADS v2014 was successfully applied on gadoxetate-enhanced MRI in clinical practice. LR-5/5V was the most specific diagnostic measure for HCC, but most LR-M observations were HCCs and a considerable portion of non-HCC malignancies were categorized as LR-4 or LR-5.. • LR-5/5V provided a highly specific diagnosis for HCC. • Half of non-HCC malignancies were categorized as LR-4 or LR-5. • The majority of LR-M observations were finally diagnosed as HCCs. • More sensitive diagnosis of HCC was feasible with LR-5/5V/M on gadoxetate-enhanced MRI. • Observations in either LR-5/5V or LR-M categories were definitely malignant.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radiology Information Systems; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To evaluate the diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI (AMRI) in cirrhotic and chronic hepatitis B (CHB) patients for hepatocellular carcinoma (HCC) screening.. Seventy-nine consecutive patients at risk for HCC due to cirrhosis and/or CHB were included in this retrospective study. For each patient, the first gadoxetate disodium-enhanced MRI between 2008 through 2014 was analysed. Two independent readers read an anonymised abbreviated image set comprising axial T1-weighted (W) images with fat saturation in the hepatobiliary phase, 20 minutes or more after gadoxetate injection, and axial T2W single-shot fast spin echo images. Each observation >10 mm was scored as negative or suspicious for HCC. Inter-reader agreement was assessed. A composite reference standard was used to determine the per-lesion diagnostic performance for each reader.. Inter-reader agreement was substantial (κ = 0.75). The final reference standard showed 27 HCCs in 13 patients (median 21 mm, range 11-100 mm). The two readers each correctly scored 23 as suspicious for HCC (sensitivity = 85.2%), scored a total of 27 and 32 observations as suspicious for HCC (positive predictive value [PPV] = 85.2% and 71.9%), and scored 83 and 78 observations or complete examinations as negative for HCC (negative predictive value [NPV] = 95.2% and 94.9%).. The AMRI protocol provides higher per-lesion sensitivity and NPV than reported values for ultrasound, the current recommended technique for screening, and similar per-lesion sensitivity and PPV to reported values for complete dynamic contrast-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Cross-Sectional Studies; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Peri-tumoral hyperintensity (P-hyperintensity) is occasionally seen in hepatocellular carcinoma (HCC) on the hepatobiliary (HB) phase of gadoxetic acid-enhanced MRI (EOB-MRI). A recent study reported peri-tumoral hyperplasia (P-hyperplasia) associated with over-expression of glutamine synthetase (GS) in HCC or metastatic carcinoma. The aim of this study was to analyze the correlation between P-hyperintensity on the HB phase and GS expression indicating P-hyperplasia and reveal its pathological features.. Seventy-seven surgically resected HCCs from 68 patients were analyzed. The grade of P-hyperintensity on HB phase was divided according to the degree of the peri-tumoral hyperintense signal: grade 0 (no P-hyperintensity), grade 1 (less than 50% of the tumor border), grade 2 (50%-80%), grade 3 (80%-100%). Immunohistochemical staining for GS and organic anion transporter polypeptides (OATP)1B3 was performed. The relationships among P-hyperplasia (peri-tumoral GS expression) and OATP1B3 expression, P-hyperintensity, and pathological features of the tumor were analyzed.. Thirty-four HCCs were classified as P-hyperintensity grade 0, 29 HCCs as grade 1,10 nodules as grade 2, and 4 HCCs as grade 3. P-hyperplasia was observed in 3/34 (8.8%) P-hyperintensity grade 0, 16/29 (55.2%) grade 1, 9/10 (90%) grade 2, and 4/4 (100%) grade 3. The incidence of P-hyperplasia was significantly increased in P-hyperintensity grades 1-3 compared with grade 0 (p < 0.0001). Hepatocytes in all P-hyperplasia sites demonstrated definite OATP1B3 expression. Microscopic hepatic venous invasion was significantly increased in P-hyperintensity-positive HCCs compared with negative HCCs (p = 0.0017).. P-hyperintensity on HB phase in HCC may indicate p-hyperplasia with GS and OATP1B3 expression and a higher incidence of microscopic hepatic venous invasion.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Hyperplasia; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

To determine ancillary features that help distinguish between scirrhous hepatocellular carcinoma (S-HCC) and intrahepatic cholangiocarcinoma (ICC) and investigate added value of ancillary features to enhancement pattern-based diagnosis on gadoxetic acid-enhanced MRI.. This retrospective study included 96 patients with S-HCCs and 120 patients with ICCs who underwent gadoxetic acid MRI before surgical resection. Two observers reviewed MRIs of the tumours. After determining ancillary features for differentiating tumour types, we measured the diagnostic performance of adding ancillary features to enhancement pattern-based diagnosis.. T2 central darkness, capsule and septum were significant and independent features differentiating S-HCC from ICC (p ≤ .06). Adding ancillary features to enhancement pattern led to increased accuracy (observer 1, 78.9 vs. 93.8 %; observer 2, 80.3 vs. 92.8 %; p < .001), sensitivity (observer 1, 74.5 vs. 96.4 %; observer 2, 77.1 vs. 93.2 %; p < .001 and .001), and specificity (observer 1, 82.5 vs. 91.7 %; observer 2, 82.9 vs. 92.5 %; p = .006 and .005) for diagnosis of S-HCC by differentiation from ICC.. Adding ancillary features capsule, septum and T2 central darkness to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy, sensitivity and specificity for S-HCC diagnosis with differentiation from ICC.. • Capsule, septum, and T2 central darkness were ancillary features for S-HCC. • A typical HCC enhancement was seen in 31.3% of S-HCCs. • Ancillary MRI features were useful in differentiation between S-HCC and ICC.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cell Differentiation; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

We evaluated the efficacy of fusion imaging combining contrast-enhanced ultrasonography (CEUS) images and arterial phase contrast-enhanced CT (CECT) or hepatobiliary phase magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (EOB-MRI) images for the early evaluation of the effectiveness of radiofrequency ablation (RFA) for small hypervascular hepatocellular carcinoma (HCC) with iso-echoic or unclear margins on conventional US.. Forty HCCs (22 iso-echoic and 18 unclear margin lesions) with mean diameters of 13.7 mm were treated using RFA under the guidance of fusion imaging with CEUS. The adequacy of RFA was evaluated using fusion imaging with CEUS 1 day after RFA. CECT or EOB-MRI was performed 1 month after RFA. We reviewed the images obtained using both modalities.. When the 1-month CECT or EOB-MRI scans were used as the reference standard, the sensitivity, specificity, and accuracy of the 1-day fusion imaging for the diagnosis of the adequate ablation of these HCCs were 97, 100, and 98%, respectively; the kappa value for the agreement between the findings using the two modalities was 0.655.. Fusion imaging with CEUS appears to be a useful method for the early evaluation of the efficacy of RFA for the treatment of HCCs with iso-echoic or unclear margins on conventional US.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Disease Progression; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Sensitivity and Specificity; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Ultrasonography

Hepatobiliary magnetic resonance imaging (MRI) provides additional information beyond the size and number of tumours, and may have prognostic implications. We examined whether pretransplant radiological features on MRI could be used to stratify the risk of tumour recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC).. A total of 100 patients who had received a liver transplant and who had undergone preoperative gadoxetic acid-enhanced MRI, including the hepatobiliary phase (HBP), were reviewed for tumour size, number, and morphological type (e.g. nodular, nodular with perinodular extension, or confluent multinodular), satellite nodules, non-smooth tumour margins, peritumoural enhancement in arterial phase, peritumoural hypointensity on HBP, and apparent diffusion coefficients. The primary endpoint was time to recurrence.. In a multivariable adjusted model, the presence of satellite nodules [hazard ratio (HR) 3.07; 95% confidence interval (CI) 1.14-8.24] and peritumoural hypointensity on HBP (HR 4.53; 95% CI 1.52-13.4) were identified as independent factors associated with tumour recurrence. Having either of these radiological findings was associated with a higher tumour recurrence rate (72.5% vs. 15.4% at three years, p <0.001). When patients were stratified according to the Milan criteria, the presence of these two high-risk radiological findings was associated with a higher tumour recurrence rate in both patients transplanted within the Milan criteria (66.7% vs. 11.6% at three years, p <0.001, n = 68) and those who were transplanted outside the Milan criteria (75.5% vs. 28.6% at three years, p <0.001, n = 32).. Radiological features on preoperative hepatobiliary MRI can stratify the risk of tumour recurrence in patients who were transplanted either within or outside the Milan criteria. Therefore, hepatobiliary MRI can be a useful way to select potential candidates for LT.. High-risk radiological findings on preoperative hepatobiliary magnetic resonance imaging (either one of the following features: satellite nodule and peritumoural hypointensity on hepatobiliary phase) were associated with a higher tumour recurrence rate in patients transplanted either within or outside the Milan criteria.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Neoplasm Recurrence, Local; Patient Selection; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors

Many improvements have been made in diagnosing hepatocellular carcinoma (HCC), but the radiological hallmarks of HCC have remained the same for many years. We prospectively evaluated the imaging criteria of HCC, early HCC and high-grade dysplastic nodules (HGDNs) in patients under surveillance for chronic liver disease, using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) MRI and diffusion-weighted imaging.. Our study population included 420 nodules >1 cm in 228 patients. The MRI findings of each nodule were collected in all sequences/phases. The diagnosis of HCC was made according to the American Association for the Study of Liver Diseases (AASLD) criteria; all atypical nodules were diagnosed using histology.. A classification and regression tree was developed using three MRI findings which were independently significant correlated variables for early HCC/HCC, and the best sequence of their application in a new diagnostic algorithm (hepatobiliary hypointensity, arterial hyperintensity and diffusion restriction) was suggested. This algorithm demonstrated, both in the entire study population and for nodules ≤2 cm, higher sensitivity (96% [95% CI 93.5% to 97.6%] and 96.6% [95% CI 93.9% to 98.5%], P<0.001, respectively) and slightly lower specificity (91.8% [95% CI 88.6% to 94.1%], P=0.063, and 92.7% [95% CI 88.9% to 95.4%], P=0.125, respectively) than those of the AASLD criteria. Our new diagnostic algorithm also showed a very high sensitivity (94.7%; 95% CI 92% to 96.6%) and specificity (99.3%; 95% CI 97.7% to 99.8%) in classifying HGDN.. Our new diagnostic algorithm demonstrated significantly higher sensitivity and comparable specificity than those of the AASLD imaging criteria for HCC in patients with cirrhosis evaluated using Gd-EOB-DTPA MRI, even for lesions ≤2 cm. Moreover, this diagnostic algorithm allowed evaluating other lesions which could arise in a cirrhotic liver, such as early HCC and HGDN.

Topics: Aged; Algorithms; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Contrast Media; Disease Progression; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity

Purpose To determine the outcomes after initial therapy in patients with chronic liver disease and retrospectively assigned Liver Imaging Reporting and Data System (LI-RADS; version 2014) category 4 (LR-4) and 5 (LR-5) nodules at gadoxetate disodium-enhanced MR imaging. Materials and Methods In this retrospective study, 260 patients with a single LR-4 (n = 132) or LR-5 (n = 128) nodule who were assigned a LI-RADS category were included. Patients were identified between January 2012 and December 2012, and were initially treated by resection, liver transplant, radiofrequency ablation (RFA), or transcatheter arterial chemoembolization (TACE) according to the Barcelona Clinic Liver Cancer staging system. Follow-up continued until August 31, 2016. The incidences of local tumor recurrence (ILRs) and distant tumor recurrence (IDRs) and recurrence-free survival (RFS) were compared between the LR-4 and LR-5 patients. For each category, ILRs, IDRs, and RFS were compared across the four treatments. Results LR-5 patients were more frequently treated by surgical resection than LR-4 patients (72.7% [93 of 128] vs 41.7% [55 of 132], respectively; P < .001), but less frequently treated by RFA (19.5% [25 of 128] vs 30.3% [40 of 132], respectively; P = .047) and TACE (6.3% [eight of 128] vs 22.0% [29 of 132], respectively; P < .001). ILRs and IDRs were not significantly different between LR-4 and LR-5 patients according to the type of treatment (0%-48.3% [14 of 29] vs 0%-25.0% [two of eight], P $ .423; 0%-55.2% [16 of 29] vs 0%-37.5% [three of eight], P $ .447, respectively). There was no difference in RFS between the two categories (36.3 months vs 41.7 months, respectively; P = .084). Liver transplant showed no local or distant tumor recurrence in either category. Resection showed higher RFS and lower ILR and IDR than RFA and TACE in both LR-4 and LR-5 patients. Conclusion Patients with LR-4 nodules had ILRs and IDRs similar to patients with LR-5 nodules when stratified by treatment type. RFS was also similar between patients with LR-4 and LR-5 nodules. Among the four initial treatments, liver transplant and resection showed better local tumor control, with longer RFS than RFA or TACE.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Patient Outcome Assessment; Radiology Information Systems; Reproducibility of Results; Retrospective Studies

To assess the added value of intratumoral ancillary features to conventional enhancement pattern-based diagnosis of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. A total of 773 consecutive patients with surgically resected 773 primary hepatic tumors (699 HCCs, 63 intrahepatic cholangiocarcinomas, and 11 benign nodules) who underwent gadoxetic acid-enhanced MRI were retrospectively identified. Enhancement patterns and three ancillary features of capsule, septum, and T2 spotty hyperintensity were assessed by two radiologists. Performance of enhancement pattern-based diagnosis of HCC was compared to diagnosis of HCC based on enhancement pattern plus ancillary features.. Enhancement patterns were positive (arterial diffuse hyperenhancement with washout) for 562 (72.7%) tumors, negative (no arterial hyperenhancement and no washout) for 75 (9.7%), and inconclusive (either no arterial hyperenhancement or no washout) for 136 (17.6%). Capsule was observed in 498 (64.4%) tumors, septum in 521 (67.3%), and T2 spotty hyperintensity in 107 (13.8%). The accuracy and sensitivity of HCC diagnosis was improved significantly after adding at least one ancillary feature compared with enhancement pattern-based diagnosis of HCCs (79.9% vs. 91.1% for accuracy, p < 0.0001 and 79.1% vs. 92.0% for sensitivity, p < 0.0001) with a minor tradeoff in specificity (87.8% vs. 82.4%, p = 0.125). Adding at least two ancillary features improved accuracy (88.1%, p < 0.0001) and sensitivity (88.1%, p < 0.0001) without changing specificity (87.8%, p = 1.0).. Adding intratumoral ancillary features of capsule, septum and T2 spotty hyperintensity to conventional enhancement patterns on gadoxetic acid-enhanced MRI improved accuracy and sensitivity, while maintaining specificity for HCC diagnosis.

Topics: Carcinoma, Hepatocellular; Contrast Media; Cross-Sectional Studies; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Fibrolamellar hepatocellular carcinoma (FLC) is a rare malignancy occurring in young patients without cirrhosis. Objectives of our study were to analyze contrast material uptake in hepatobiliary phase imaging (HBP) in gadoxetic acid-enhanced liver MRI in patients with FLC and to characterize imaging features in sequence techniques other than HBP.. In this retrospective study on histology-proven FLC, contrast material uptake in HBP was quantitatively assessed by calculating the corrected FLC enhancement index (CEI) using mean signal intensities of FLC and lumbar muscle on pre-contrast imaging and HBP, respectively. Moreover, enhancement patterns in dynamic contrast-enhanced MRI and relative signal intensities compared with background liver parenchyma were determined by two radiologists in consensus for HBP, diffusion-weighted imaging using high b-values (DWI), and T2 and T1 weighted pre-contrast imaging.. In 6 of 13 patients with FLC gadoxetic acid-enhanced liver MRI was available. The CEI suggested presence of HBP contrast material uptake in all FLCs. A mean CEI of 1.35 indicated FLC signal increase of 35% in HBP compared with pre-contrast imaging. All FLCs were hypointense in HBP compared with background liver parenchyma. Three of 6 FLCs had arterial hyperenhancement and venous wash-out. In DWI and T2 weighted imaging, 5 of 6 FLCs were hyperintense. In T1 weighted imaging, 5 of 6 FLCs were hypointense.. Hepatobiliary uptake of gadoxetic acid was quantitatively measurable in all FLCs investigated in our study. The observation of hypointensity of FLCs in HBP compared with background liver parenchyma emphasizes the role of gadoxetic acid-enhanced liver MRI for non-invasive diagnosis of FLC and its importance in the diagnostic work-up of indeterminate liver lesions.

Topics: Adolescent; Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged

To retrospectively analyze the evolution of indeterminate hepatocellular nodules in cirrhotic patients on serial Gd-EOB-DPTA-enhanced MRI, and to identify predictors of HCC development.. This IRB approved study included 33 cirrhotic patients with 69 indeterminate hepatocellular nodules (mean diameter 1.1 cm) at baseline Gd-EOB-DPTA-enhanced MRI and a Gd-EOB-DPTA-enhanced-MRI follow-up of at least 2 years. Two radiologists evaluated size and signal intensity of each nodule at baseline and follow-up. Age, cirrhosis etiology, and HCC history were recorded. Data were compared between nodules that became HCCs at follow-up (HCC) and those that did not (no-HCC).. On follow-up, 5/69 nodules became HCCs and 64/69 showed indeterminate characteristics. HCC history was more frequently found in HCCs than in no-HCCs. Age, sex, and cirrhosis etiology were not significantly different between HCCs and no-HCCs. HCCs had a significantly greater baseline diameter and increase in size than no-HCCs. Hepatobiliary phase hypointensity was significantly more common in HCCs than in no-HCCs. Multivariate regression analysis showed that increase in size (OR 10.48; sensitivity, 100%; specificity, 81.2%; p < 0.001) and hepatobiliary phase hypointensity (OR 1.02; sensitivity, 100%; specificity, 78.1%; p < 0.001) was associated with HCC development.. Indeterminate hepatocellular nodules at Gd-EOB-DPTA-enhanced MRI in cirrhotic patients rarely became HCCs. Hepatobiliary phase hypointensity had a weak association with HCC development.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies

The purpose of this study is to compare visualization rates of the major features covered by Liver Imaging Reporting and Data System (LI-RADS) version 2014 in patients at risk for hepatocellular carcinoma using either gadobenate dimeglumine or gadoxetate disodium IV contrast agent.. This retrospective study included liver MRI examinations performed with either gadobenate dimeglumine or gadoxetate disodium contrast enhancement. Using age, sex, underlying liver disease, and presence of cirrhosis, patients were placed into matched cohorts. All hepatic nodules 1 cm or larger (up to five per subject) were included, resulting in 63 subjects with 130 nodules (median nodule size, 1.9 cm) imaged with gadobenate and 64 subjects with 117 nodules (median nodule size, 2.0 cm) imaged with gadoxetate. Three radiologists reviewed the studies for LI-RADS major features independently. Bootstrap resampling with 10,000 repetitions was used to compare feature detection rates.. Arterial phase hyperenhancement was seen in a similar number of nodules with gadobenate dimeglumine (mean, 91.5% [119/130]) and gadoxetate disodium (mean, 88.0% [103/117]) (p = 0.173). Dynamic phase washout was more commonly seen with gadobenate dimeglumine (mean, 60.2% [78.3/130]) than with gadoxetate disodium (mean, 45.3% [53/117]) (p = 0.006). The capsule feature was more often visualized with gadobenate dimeglumine (mean, 50.2% [65.3/130]) than with gadoxetate disodium (mean, 33.3% [39/117]) (p < 0.001). Interreader agreement for arterial phase enhancement and dynamic phase washout was almost perfect for both contrast agents (κ > 0.83). Agreement for the capsule feature was moderate for gadobenate dimeglumine (κ = 0.52) and substantial for gadoxetate disodium (κ = 0.67).. The rates of visualization of arterial phase hyperenhancement are similar in studies performed with gadobenate dimeglumine and gadoxetate disodium, but dynamic phase washout and capsule appearance are more commonly visualized with gadobenate dimeglumine.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Retrospective Studies

To study whether the measurement of hepatic fibrosis on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) magnetic resonance (MR) imaging using the coefficient of variation (CV) might be correlated with the presence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).. This study included 104 patients with and without CHB, who were divided into 4 groups: control group, CHB without liver cirrhosis (LC; Group I), CHB with LC (Group II), and CHB with LC and HCC (Group III). MR images were analyzed to measure the inhomogeneity of signal intensities calculated using the CV map of the liver parenchyma. Intergroup comparisons of CV values were performed using ANOVA. The diagnostic performance of the CV map and alpha-fetoprotein (AFP) for diagnosing HCC was evaluated using the receiver operating characteristic (ROC) curve.. On the hepatobiliary phase of Gd-EOB-DTPA-enhanced T1-weighted imaging, the mean CV values of the control group and Groups I, II, and III were 3.9 ± 0.99, 3.97 ± 1.09, 5.58 ± 2.05, and 6.80 ± 2.34, respectively (P = 0.000). On ROC analysis of the CV value for predicting HCC, the value of the area under the curve (AUC) on Gd-EOB-DTPA MR imaging was 0.788 (95% CI: 0.697-0.862). The sensitivity and specificity were 84.2% and 63.6%, respectively, at a CV cutoff value >4.75. The value of AUC determined using AFP was 0.766.. The CV value for hepatic fibrosis on Gd-EOB-DTPA MR imaging may be correlated with the presence of HCC in patients with CHB, and shows comparable diagnostic performance to AFP analysis.

Topics: Adult; Aged; Area Under Curve; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatitis B, Chronic; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; ROC Curve; Sensitivity and Specificity

The purpose of this study is to identify points useful in the imaging differentiation of hepatocellular carcinoma (HCC) showing hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI and focal nodular hyperplasia (FNH) and FNH-like nodules.. We enrolled consecutive 51 pathologically diagnosed HCCs that were hyperintense on hepatobiliary phase imaging (47 patients, including 44 with cirrhosis) and 10 FNHs and eight FNH-like nodules (16 patients, including five with cirrhosis). Imaging findings of dynamic CT and gadoxetic acid-enhanced MRI were assessed by two radiologists and compared between HCC and FNH.. The apparent diffusion coefficient (ADC) was lower in hyperintense HCC than in FNH (p = 0.004). The enhancement patterns of hyperintense HCC and FNH at dynamic CT were significantly different (p < 0.0001), with 95.9% of HCCs and 22.2% of FNHs showing arterial phase enhancement with a washout pattern, and 4.1% of HCCs and 77.8% of FNHs showing arterial phase enhancement without a washout pattern. The frequency of coronalike enhancement was 84.3% in hyperintense HCCs versus 11.1% in FNHs (p < 0.0001). The signal distribution on the hepatobiliary phase was significantly different between hyperintense HCCs and FNHs (p = 0.0002). The frequency of a capsulelike rim was 88.2% versus 22.2%, that of a mosaic appearance was 72.5% versus 11.1%, and that of a central scar was 0% versus 55.6% in hyperintense HCCs versus FNHs (all p < 0.0001). Multivariate logistic regression analysis showed that ADC ratio (p = 0.03; odds ratio, 0.12) and enhancement pattern at dynamic CT (p = 0.04; odds ratio, 16.21) were the independent factors for differentiation between hyperintense HCC and FNH.. For the diagnosis of hyperintense HCC differentiated from FNH and FNH-like nodule, arterial phase enhancement and washout pattern at dynamic CT and decrease of ADC ratio would be important findings.

Topics: Adult; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To evaluate the feasibility of using radiomic features for differential diagnosis of hepatocellular carcinoma (HCC) and hepatic cavernous hemangioma (HHE).. Gadoxetate disodium-enhanced magnetic resonance imaging data were collected from a total of 135 HCC and HHE lesions. The radiomic texture features of each lesion were extracted on the hepatobiliary phase images, and the performance of each feature was assessed in differentiation and classification of HCC and HHE. In multivariate analysis, the performance of 3 feature selection algorithms (namely minimum redundancy-maximum relevance, mRmR; neighborhood component analysis, NCA; and sequence forward selection, SFS) was compared. The optimal feature subset was determined according to the optimal feature selection algorithm and used for testing the 3 classifier algorithms (namely the support vector machine, RBF-SVM; linear discriminant analysis, LDA; and logistic regression). All the tests were repeated 5 times with 10-fold cross validation experiments.. More than 50% of the radiomic features exhibited strong distinguishing ability, among which gray level co-occurrence matrix feature S (3, -3) SumEntrp showed a good classification performance with an AUC of 0.72 (P<0.01), a sensitivity of 0.83 and a specificity of 0.57. For the multivariate analysis, 15 features were selected based on the SFS algorithm, which produced better results than the other two algorithms. Testing of these 15 selected features for their average cross-validation performance with RBF-SVM classifier yielded a test accuracy of 0.82∓0.09, an AUC of 0.86∓0.12, a sensitivity of 0.88∓0.11, and a specificity of 0.76∓0.18.. The radiomic features based on gadoxetate disodium-enhanced magnetic resonance images allow efficient differential diagnosis of HCC and HHE, and can potentially provide important assistance in clinical diagnosis of the two diseases.

Topics: Carcinoma, Hepatocellular; Diagnosis, Differential; Gadolinium DTPA; Hemangioma; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Microvascular invasion (MVI) is regarded as one of the independent risk factors for recurrence and poor prognosis of hepatocellular carcinoma (HCC). The presence of MVI in HCCs was evaluated on the basis of pathological reports of surgical specimens and was defined as tumor within a vascular space lined by endothelium that was visible only on microscopy. The aim of the study was to investigate the usefulness of intravoxel incoherent motion (IVIM) diffusion weighted (DW) magnetic resonance (MR) imaging in predicting MVI of HCC. Preoperative IVIM DW imaging and Gd-EOB-DTPA-enhanced MRI (DCE-MRI) of 51 patients were analyzed. Standard apparent diffusion coefficient (ADC), D (the true diffusion coefficient), D* (the pseudodiffusion coefficient) and f (the perfusion fraction), relative enhancement (RE) and radiological features were evaluated and analyzed. Univariate analysis revealed that HCCs with MVI had a higher portion of an irregular tumor shape than HCCs without MVI (p = 0.009), the Standard ADC, D value were significantly lower in HCCs with MVI (p = 0.022, p = 0.007, respectively). Multivariate analysis revealed that an irregular shape (p = 0.012) and D value ≤ 1.16×10-3mm2/sec (p = 0.048) were independent predictors for MVI. Combining the two factors of an irregular shape and D value, a sensitivity of 94.4% and specificity of 63.6% for predicting MVI was obtained. In conclusion, we found that an irregular shape and D value ≤ 1.16×10-3mm2/sec may suggest the presence of MVI in HCCs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Young Adult

Our purpose was to demonstrate the prognostic significance of T. One hundred and seven patients with single nodular HCC (≤3 cm) who underwent preoperative gadoxetic acid-enhanced MRI were included in the study. T. Reduction rate of T

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Risk Factors; Young Adult

This study aimed to evaluate the capability of gadoxetic acid-enhanced MR (GAeMR) to detect presence of capsule appearance in hepatocellular carcinoma (HCC), and to correlate it with dynamic computed tomography (CT) and pathological features.Sixty-three patients (54: 9 = M: F, mean age 55.8) surgically confirmed HCCs with preoperative CT and GAeMR were included in this retrospective study. Two readers evaluated presence of capsule appearances on CT and GAeMR images in each phase including precontrast (Pre), portal phase (PP), delayed phase (DP), transitional phase (TP), and hepatobiliary phase (HBP). Histologic capsule was compared with CT and GAeMR. Diagnostic performance of CT and GAeMR of each phase for histologic capsule was evaluated and compared by receiver operating characteristic curve. Interobserver agreement was assessed with kappa statistics.Histologically the capsule was complete in 12.7% (8/63) and incomplete in 60.3% (38/63). Four cases (6.3%) were pseudocapsule. Interobserver agreement for capsule appearance on GAeMR was good in Pre (κ = 0.684), moderate in PP (κ = 0.434), poor in TP (κ = 0.187), fair in HBP (κ = 0.395), and moderate on CT in PP (κ = 0.476) and DP (κ = 0.485). Diagnostic performance and sensitivity for the histologic capsule in DP on CT was highest among PP on CT and other phases on GAeMR. DP on CT images showed a higher Az value than PP on CT images with statistical significance (P < .001). PP on MR images revealed higher Az value than PP on CT images.The capsule appearance was most frequently observed in the DP on CT with highest diagnostic performance, and so DP images should be obtained on CT study for liver mass categorization. GAeMR yielded comparable capsule appearance to CT with moderate interobserver agreement. Considering hypointense rim on the HBP as fibrous capsule on pathology should be refrained, and so further study is warranted to correlate HBP hypointense rim with pathologic findings.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

To compare the diagnostic performance of non-contrast liver MRI to whole MRI using gadoxetic acid for detection of recurrent hepatocellular carcinoma (HCC) after hepatectomy.. This retrospective study analyzed 483 patients who underwent surveillance with liver MRI after hepatectomy for HCC (median time interval, 7.7 months). Non-contrast MRI set (T. A total of 113 patients had 197 recurrent HCCs on first follow-up MRI. Although non-contrast MRI had fairly high sensitivity for recurrent HCC, there were significant differences in sensitivity (94.7% vs 99.1%, p = 0.025) and accuracy (97.5% vs 99.2%, p = 0.021) between the two image sets (per-patients base analysis). However, in patients followed for ≥1 year after surgery, the diagnostic performance of non-contrast MRI and whole MRI were not significantly different (p > 0.05).. Non-contrast MRI may serve as an alternative follow-up method which can potentially replace whole MRI at least in selected patients followed up ≥1 year after surgery who have relatively lower risk of HCC recurrence.. There is no consensus regarding the ideal imaging modality or follow-up interval after resection of HCC. Non-contrast MRI had comparable performance to that of gadoxetic acid-enhanced MRI in the detection of HCC recurrence during surveillance ≥1 year after surgery.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Cost Savings; Diffusion Magnetic Resonance Imaging; Female; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Sensitivity and Specificity

Stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) has emerged as an alternative treatment option when curative treatment modalities cannot be applied. Although excellent local tumor control has been achieved with SBRT, the targeting accuracy in real-life practice remains poorly understood. We proposed an in vivo assessment of targeting accuracy using hepatic parenchymal changes observed on gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) images and applied this method to investigate the "real-life" targeting accuracy of image-guided SBRT.. We selected 29 patients with available follow-up MR images acquired 2 to 4 months after completion of SBRT. All patients were administered 45 Gy in 3 fractions. The treated HCC and the region of hepatic parenchymal changes in the hepatobiliary phase of MR images were delineated. We evaluated the discrepancies between the center of the HCC and that of the parenchymal change area (intercenter discrepancy [ICD]). We also analyzed the difference in ICDs between those who underwent SBRT with intrahepatic marker guidance and those with diaphragm guidance.. The median ICD in the 3-dimensional direction was 6.81 mm (interquartile range [IQR], 4.27-9.61 mm). Those for the craniocaudal, left-right, and anteroposterior components were 2.70 mm (IQR, 1.83-4.06 mm), 1.63 mm (IQR, 0.76-3.49), and 4.12 mm (IQR, 1.20-6.96 mm), respectively. The median ICD for patients who underwent treatment with intrahepatic marker guidance and those with diaphragm guidance was 7.53 mm (IQR, 6.63-10.86 mm) and 5.60 mm (IQR, 4.28-8.18 mm), respectively. There was no significant difference in ICD between those who underwent treatment with intrahepatic marker guidance and those with diaphragm guidance (P = .296).. The hepatic parenchymal changes observed on Gd-EOB-DTPA-enhanced MR images can be used to assess the targeting accuracy after SBRT for HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiosurgery; Radiotherapy, Image-Guided

The objective of our study was to identify whether quantitative measurements from gadoxetic acid-enhanced MRI are useful for predicting posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) compared with and in combination with future remnant liver volume (FRLV) and an indocyanine green (ICG) clearance test.. Preoperative gadoxetic acid-enhanced MR images were retrospectively evaluated in 73 patients who underwent anatomic liver resection for HCC between 2011 and 2013. For quantitative measurement of hepatocyte function, relative liver enhancement (RLE) and remnant hepatocyte uptake index (rHUI) were measured using hepatobiliary phase MR images. FRLV was determined using measurements from preoperative CT scans. Univariate and multivariate analyses of measurements from gadoxetic acid-enhanced MRI, ICG clearance tests, and FRLV for finding predictors of PHLF were performed. To compare the diagnostic performance of predictors, ROC analyses were also performed.. Eighteen (25%) of 73 patients met the criteria for PHLF. Univariate analysis revealed that all measurements related to MRI including RLE, rHUI, ICG clearance, and FRLV were significantly associated with PHLF. Multivariate analysis showed that RLE, FRLV, ICG-plasma disappearance rate (ICG-PDR), rHUI, and rHUI corrected for body weight (rHUI-BW) were independent predictors of PHLF (p = 0.011, p = 0.034, p = 0.003, p < 0.001, and p = 0.001, respectively). In ROC analyses, AUCs of rHUI and rHUI-BW were larger than those of other independent predictors; the differences were statistically significant (for rHUI-BW vs RLE, ICG-PDR, and FRLV, p = 0.016, 0.007, and 0.046, respectively; for rHUI vs RLE and ICG-PDR, p = 0.045 and 0.016, respectively).. Measurements from gadoxetic acid-enhanced MRI predicted PHLF better than the ICG clearance test in patients with HCC who underwent hepatectomy.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Hepatocytes; Humans; Indocyanine Green; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Postoperative Complications; Retrospective Studies

The incidence of hepatocellular carcinoma (HCC) in patients with a history of curatively-treated HCC is higher than in patients with no history of HCC even after sustained virologic response (SVR).. To investigate differences in the patterns of HCC development after SVR in patients with a history of curatively-treated HCC and those with no history of HCC, based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings.. EOB-MRI was performed in 164 patients with HCV cirrhosis who achieved SVR by interferon-free direct-acting antiviral (DAA) therapy just before the start of therapy. Changes in EOB-MRI findings after SVR were compared prospectively between patients with (n = 62) and without (n = 102) a history of HCC.. The incidence of HCC after SVR was higher in patients with a history of HCC (P < 0.0001). The prevalence of nonhypervascular hypointense nodules (NHHNs) by EOB-MRI was significantly higher in patients with a history of HCC at baseline (P = 0.05). Although there was no difference in the incidence of the hypervascularisation of baseline NHHNs to typical hypervascular HCC between patients with and without a history of HCC, the incidence of direct emergence of hypervascular HCC despite the absence of NHHNs at baseline was significantly higher in patients with a history of HCC (P < 0.0001).. Direct emergence of hypervascular HCC and a higher prevalence of NHHNs before DD therapy contributed to the higher incidence of HCC after SVR. (UMIN000017020).

Topics: Aged; Antiviral Agents; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Hepatitis C; Humans; Incidence; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Remission Induction; Risk Factors; Sustained Virologic Response

We intraindividually compared the efficacy of magnetic resonance imaging (MRI) with extracellular contrast agents (ECA-MRI) and MRI with hepatobiliary agents (HBA-MRI) for the diagnosis of hepatocellular carcinoma (HCC) using the Liver Imaging Reporting and Data System (LI-RADS). Between November 2016 and November 2017, we enrolled 91 patients with chronic liver disease who underwent both ECA-MRI and HBA-MRI within a 1-month interval for a first detected hepatic nodule on ultrasound. In total, 117 observations (95 HCCs, 19 benign lesions, and 3 other malignancies; median size, 18 mm) were identified with surgical resection. Two observers assessed two MRIs based on LI-RADS v2017, with consensus by a third observer. We then compared the diagnostic performance of LR-5 according to LI-RADS and modified LI-RADS. ECA-MRI had higher sensitivity (77.9% versus 66.3%) and accuracy (82.1% versus 72.6%) than HBA-MRI in the LR-5 category (P < 0.001). When applying either modified washout on the portal venous phase (PVP)/transitional phase (TP) of HBA-MRI or isointensity with a capsule during the PVP/delayed phase of ECA-MRI (illusional washout), 13 HCCs on HBA-MRI and 11 HCCs on ECA-MRI were correctly classified as HCC, while achieving 100% specificity. One cholangiocarcinoma was accurately classified only with HBA-MRI due to its targetoid appearance in the TP and hepatobiliary phase. Conclusion: ECA-MRI showed better sensitivity and accuracy than HBA-MRI for the diagnosis of HCC with LI-RADS. We achieved better diagnostic performance when applying a modified washout on PVP/TP HBA-MRI and an illusional washout on ECA-MRI than we did with conventional criteria.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies

5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2018;47:1169-1171.

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Terminology as Topic

The goal of this study was to investigate the Liver Imaging Reporting and Data System (LI-RADS) v.2017 for the categorization of hepatocellular carcinomas (HCCs) with gadoxetic acid compared with gadopentetate dimeglumine-enhanced 1.5-T magnetic resonance imaging (MRI).. We included 141 high-risk patients with 145 pathologically-confirmed HCCs who first underwent gadopentetate dimeglumine-enhanced 1.5-T followed by gadoxetic acid-enhanced 1.5-T MRI. Two independent radiologists evaluated the presence or absence of major HCC features and assigned LI-RADS categories after considering ancillary features on both MRIs. Finally, the sensitivity of LI-RADS category 5 (LR-5) and the frequencies of major HCC features were compared between gadoxetic acid- and gadopentetate dimeglumine-enhanced 1.5-T MRI using the Wilcoxon test.. The sensitivity of LR-5 for diagnosing HCCs was significantly different between gadoxetic acid- and gadopentetate dimeglumine-enhanced MRI (73.8% [107/145] vs 26.2% [38/145], P < 0.001; 71% [103/145] vs 29% [42/145], P < 0.001 for reviewers 1 and 2, respectively). Among the major HCC LI-RADS features, capsule appearance was less frequently demonstrated on gadoxetic acid-enhanced MRI than on gadopentetate dimeglumine-enhanced MRI (3.4% [5/145] vs 5.5% [8/145], P = 0.793; 4.1% [6/145] vs 5.5% [8/145], P = 0.87 for reviewers 1 and 2, respectively), and the frequency of arterial hyperenhancement was not significantly different between gadoxetic acid and gadopentetate dimeglumine (89% [129/145] vs 89% [129/145], P = 1.000). In addition, the frequency of a washout appearance was less in the transitional phase (TP) than in the portal venous phase (PVP) on gadoxetic acid-enhanced MRI (43% [46/107] vs 57% [61/107], P = 0.367).. Gadoxetic acid-enhanced MRI showed a comparable sensitivity to gadopentetate dimeglumine-enhanced MRI for the diagnosis of HCCs, and LI-RADS category 4 (LR-4) hepatic nodules were upgraded to LR-5 when taking into account the major features according to LI-RADS v.2017.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

This study aimed to compare the sensitivity and accuracy for the detection of small lesions in patients with hepatocellular carcinoma (HCC) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 64-slice computed tomography (CT) enhanced scanning, and to evaluate the necessity to perform MRI in patients diagnosed with HCC by CT.The clinical data from 209 patients with HCC diagnosed prior to surgery in the Affiliated Hospital of Guilin Medical University, China were retrospectively analyzed. The 64-slice dynamic contrast-enhanced multi-detector CT (MDCT) and 3.0 T Gd-EOB-DTPA DCE MRI procedures were successively carried out on all patients who were enrolled in a self-controlled study including detection and diagnosis of HCC lesions by MRI and CT, respectively.A total of 243 lesions were detected and both imaging methods could accurately detect lesions of diameter >2 cm. For lesions <2 cm, MRI detected 47, while CT detected 25 lesions indicating that the detection rate of MRI was 88% higher than that of CT. In addition, MRI detected lesions in 15 cases (7.81% in the total of 209 cases) that were not diagnosed by CT. Among these cases, 2 patients were diagnosed to have no lesion by CT.Gd-EOB-DTPA DCE-MRI performed as a routine check prior to surgery in HCC patients can improve the detection of small HCC lesions.

Topics: Adult; Aged; Carcinoma, Hepatocellular; China; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, Spiral Computed

Hepatic schwannoma is a very rare hepatic tumor, usually appearing as a hypervascular solid mass with or without various degrees of cystic changes; however, to the best of our knowledge, only the two cases of hepatic schwannoma showing a multi-cystic appearance have previously been reported. We report herein a benign hepatic schwannoma presenting as an unusually large multi-cystic mass. The gadoxetic acid disodium-enhanced magnetic resonance imaging features are described with the histopathologic correlation and briefly review the literature. The solid-like areas showing the early/progressive enhancement, reflecting remnants of the Antoni A/B portion, during the dynamic phases may be helpful imaging features for the differentiation of other multi-cystic hepatic lesions, but pathological evaluation remains essential for diagnosis.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Neurilemmoma

Hepatic angiomyolipomas are a rare, benign group of mesenchymal tumors in the liver. Hepatic angiomyolipoma is sometimes misdiagnosed as hepatocellular carcinoma, and there is the possibility of a malignant transformation. Hence, the accurate diagnosis of this disorder is necessary.. A 64-year-old Japanese man was observed to have a space-occupying lesion of 15-mm diameter in the liver during a follow-up examination for a previously resected cecal carcinoma. He underwent lateral segmentectomy of the liver with a provisional diagnosis of hepatic metastatic recurrence of the carcinoma based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging.. We have explored the combination of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and histological examination to confirm our diagnosis of hepatic angiomyolipoma comprising an intimate mixture of numerous abnormal blood vessels, adipocytes, and epithelioid spindle cells of various sizes. Immunohistochemical examination revealed characteristic pathological findings associated with positive qualitative immunoreactions for human melanoma black 45 and desmin. Electron microscopic findings revealed the presence of melanosomes in the epithelioid cells. Diffusion-weighted imaging provides a more accurate diagnostic image with the characteristic macroscopic appearance of hepatic angiomyolipoma. Through immunohistochemistry and electron microscopy, we also show that this benign tumor comprises tissue elements.

Topics: Angiomyolipoma; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Immunohistochemistry; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microscopy, Electron, Transmission; Middle Aged; Treatment Outcome

To evaluate the utility of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in characterizing atypically enhanced cirrhotic nodules detected on conventional Gd-DTPA-enhanced MR images.. We enrolled 61 consecutive patients with 88 atypical nodules seen on conventional Gd-DTPA-enhanced MR images who underwent Gd-EOB-DTPA-enhanced MRI within a 3-month period. Using a reference standard, we determined that 58 of the nodules were hepatocellular carcinoma (HCC) and 30 were dysplastic nodules (DNs). Tumor size, signal intensity on precontrast T1-weighted images (T1WI), T2-weighted images (T2WI) and diffusion-weighted images (DWI), and the enhancement patterns seen on dynamic phase and hepatocyte phase images were determined.. There were significant differences between DNs and HCC in hyperintensity on T2WI, hypointensity on T1WI, hypervascularity on arterial phase images, typical HCC enhancement patterns on dynamic MR images, hypointensity on hepatocyte phase images, and hyperintensity on DWI. The sensitivity and specificity were 79.3% and 83.3% for T2WI, 50.0% and 80.0% for T1WI, 82.8% and 76.7% for DWI, 17.2% and 100% for dynamic MR imaging, 93.1% and 83.3% for hepatocyte phase imaging, and 46.8% and 100% when arterial hypervascularity was combined with hypointensity on hepatocyte-phase imaging.. Gd-EOB-DTPA-enhanced hepatocyte phase imaging is recommended for patients at high risk for HCC who present with atypical lesions on conventional Gd-DTPA-enhanced MR images.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The objective of the study was to evaluate the cost-effectiveness of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and treatment of hepatocellular carcinoma (HCC) in Japan compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and contrast media-enhanced computed tomography (CE-CT) scanning.. A 6-stage Markov model was developed to estimate lifetime direct costs and clinical outcomes associated with EOB-MRI. Diagnostic sensitivity and specificity, along with clinical data on HCC survival, recurrence, treatment patterns, costs, and health state utility values, were derived from predominantly Japanese publications. Parameters unavailable from publications were estimated in a Delphi panel of Japanese clinical experts who also confirmed the structure and overall approach of the model. Sensitivity analyses, including one-way, probabilistic, and scenario analyses, were conducted to account for uncertainty in the results.. Over a lifetime horizon, EOB-MRI was associated with lower direct costs (¥2,174,869) and generated a greater number of quality-adjusted life years (QALYs) (9.502) than either ECCM-MRI (¥2,365,421, 9.303 QALYs) or CE-CT (¥2,482,608, 9.215 QALYs). EOB-MRI was superior to the other diagnostic strategies considered, and this finding was robust over sensitivity and scenario analyses. A majority of the direct costs associated with HCC in Japan were found to be costs of treatment. The model results revealed the superior cost-effectiveness of the EOB-MRI diagnostic strategy compared with ECCM-MRI and CE-CT.. EOB-MRI could be the first-choice imaging modality for medical care of HCC among patients with hepatitis or liver cirrhosis in Japan. Widespread implementation of EOB-MRI could reduce health care expenditures, particularly downstream treatment costs, associated with HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Cost-Benefit Analysis; Gadolinium DTPA; Humans; Japan; Liver Neoplasms; Magnetic Resonance Imaging; Quality-Adjusted Life Years; Tomography, X-Ray Computed

To compare treatment outcomes of subcentimeter hypervascular nodules at high risk for developing into hepatocellular carcinomas (SHNHR) between early treatment and watchful waiting until progression to overt hepatocellular carcinoma (HCC) groups.. SHNHRs were defined as subcentimeter hypervascular nodules with the usual imaging features of HCC on gadoxetic acid-enhanced magnetic resonance imaging (MRI). Among 63 patients with 74 SHNHRs, 27 (37 SHNHRs) received early treatment (treatment of < 1 cm nodules), and 36 (37 SHNHRs) underwent watchful waiting until progression to overt HCC. Risk factor analysis was performed for recurrence-free and local recurrence-free survival.. Among the 36 patients who adopted watchful waiting, 33 eventually underwent treatment because their SHNHRs progressed to overt HCC. For recurrence-free survival, significant risk factors included number of previous treatments (HR, 1.181; p < 0.001), tumour number (HR, 1.943; p = 0.009), and α-feto protein level (HR, 1.005; p = 0.037) in the multivariate analyses. Treatment strategy was not a significant risk factor for recurrence-free survival. For local recurrence-free survival from the date of treatment, only treatment modality (transarterial chemoembolization) (HR, 6.879; p = 0.002) was a significant risk factor.. Recurrence-free survival was not significantly different between early treatment and watchful waiting for SHNHRs.. • Recurrence-free survival did not vary between the two treatment strategies. • Treatment modality was a significant factor for local recurrence-free survival. • Number of treatments, tumour number, and α-FP were risk factors for recurrence.

Topics: Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Disease-Free Survival; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Risk Factors; Watchful Waiting

Accurate gross classification through imaging is critical for determination of hepatocellular carcinoma (HCC) patient prognoses and treatment strategies. The present retrospective study evaluated the utility of contrast-enhanced computed tomography (CE-CT) combined with gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) for diagnosis and classification of HCCs prior to surgery. Ninety-four surgically resected HCC nodules were classified as simple nodular (SN), SN with extranodular growth (SN-EG), confluent multinodular (CMN), or infiltrative (IF) types. SN-EG, CMN and IF samples were grouped as non-SN. The abilities of the two imaging modalities to differentiate non-SN from SN HCCs were assessed using the EOB-MRI hepatobiliary phase and CE-CT arterial, portal, and equilibrium phases. Areas under the ROC curves for non-SN diagnoses were 0.765 (95% confidence interval [CI]: 0.666-0.846) for CE-CT, 0.877 (95% CI: 0.793-0.936) for EOB-MRI, and 0.908 (95% CI: 0.830-0.958) for CE-CT plus EOB-MRI. Sensitivities, specificities, and accuracies with respect to identification of non-SN tumors of all sizes were 71.4%, 81.6%, and 75.5% for CE-CT; 96.4%, 78.9%, and 89.3% for EOB-MRI; and 98.2%, 84.2%, and 92.5% for CE-CT plus EOB-MRI. These results show that CE-CT combined with EOB-MRI offers a more accurate imaging evaluation for HCC gross classification than either modality alone.

Topics: Adult; Aged; Area Under Curve; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Observer Variation; ROC Curve; Tomography, X-Ray Computed

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Ascites; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Germany; Humans; Infusions, Intravenous; Liver; Liver Cirrhosis; Liver Neoplasms; Lung Diseases; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Pleural Effusion; Risk Factors; Young Adult

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms

This study aimed to identify preoperative magnetic resonance (MR) imaging biomarkers for predicting microvascular invasion (MVI), to determine their diagnostic performance and to evaluate whether they are associated with early recurrence after surgery for single hepatocellular carcinoma (HCC).. The study included 197 patients with surgically resected HCC (≤5cm) who underwent preoperative gadoxetic acid-enhanced MR imaging. Significant MR imaging findings for predicting MVI were identified by univariate and multivariate analyses. Early recurrence rates (<2years) were analyzed with respect to significant imaging findings for predicting MVI.. Three MR imaging features were independently associated with MVI: arterial peritumoral enhancement (odds ratio [OR]=5.184; 95% confidence interval [CI]: 2.228, 12.063; p<0.001), non-smooth tumor margin (OR=3.555; 95% CI: 1.627, 7.769; p=0.001), and peritumoral hypointensity on hepatobiliary phase (HBP) (OR=4.705; 95% CI: 1.671, 13.246; p=0.003). When two of three findings were combined, the specificity was 92.5% (124/134). When all three findings were satisfied, the specificity was 99.3% (133/134). Early recurrence rates were significantly higher in patients with single HCC, with two or three significant MR imaging findings, compared to those with none (27.9% vs. 12.6%, respectively, p=0.030).. A combination of two or more of the following; arterial peritumoral enhancement, non-smooth tumor margin, and peritumoral hypointensity on HBP, can be used as a preoperative imaging biomarker for predicting MVI, with specificity >90%, and is associated with early recurrence after surgery of single HCC. Lay summary: A combination of two or more of the following; arterial peritumoral enhancement, non-smooth tumor margin, and peritumoral hypointensity on hepatobiliary phase, can be used as a preoperative imaging biomarker for predicting microvascular invasion, with specificity >90%, and is associated with early recurrence after curative resection of single HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Retrospective Studies

To determine the added value of capsule, septum, and T2 hyperintense foci for differentiating large hepatocellular carcinoma (HCC; ≥ 5 cm) from intrahepatic cholangiocarcinoma (ICC) using gadoxetic acid MRI.. The study included 116 patients (94 men, 22 women; mean age, 56.8 years) with surgically confirmed HCCs (n = 87, 5.0-18.0 cm) or ICCs (n = 29, 5.0-14.0 cm) who underwent gadoxetic acid MRI. Three observers independently reviewed MRIs in two sessions, examining enhancement patterns only and then adding capsule, septum, and T2 hyperintense foci. Reviewers used a five-point scale to score accuracy, sensitivity, and specificity.. A significant increase was observed in accuracy when ancillary features (96.1-98.3%) were added compared to enhancement pattern only (83.6-88.4%; p ≤ 0.02). Sensitivity was significantly increased with combined reading (97.1-98.3%) compared to enhancement features only (81.6-88.5%; p ≤ 0.006) for two observers, with no difference in specificity (84.5-89.7% vs. 86.2-98.3%; p > 0.05). We found substantial to excellent interobserver agreement for ancillary features (0.598-0.976).. Adding capsule, septum, and T2 hyperintense foci to enhancement patterns for gadoxetic acid MRI increased diagnostic performance for characterizing large HCC by differentiating it from ICC.. • Capsule, septum, and T2 hyperintense foci were useful for characterizing large HCC. • Adding ancillary features to enhancement pattern increased accuracy for diagnosing large HCC. • Interobserver agreement was substantial to excellent for ancillary features.

Topics: Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Retrospective Studies

To assess diagnostic accuracy of gadoxetic acid-enhanced MR for small hypervascular hepatocellular carcinoma (HCC) detected by C-arm CT and concordance rate of Liver Imaging Reporting and Data System (LI-RADS).. In this retrospective study, we recruited 4,544 patients suspected of having HCC underwent C-arm CT from November 2008 to May 2013. Among these patients, gadoxetic acid-enhanced MR was performed in 167 patients with HCC (n = 379; 257 > 1 cm, 122 ≤ 1 cm). HCC was confirmed by MR, CT, or follow-up images. Two radiologists graded likelihood of HCC and assessed MR features. Jackknife alternative free-response receiver operating characteristic (JAFROC) analysis was performed. All HCCs were evaluated concordance rate of LI-RADS.. Mean JAFROC figure of merit for large (>1-cm) HCC was 0.948, while that for small HCC was 0.787 with fair agreement (κ = 0.409). Mean sensitivity and positive predictive value (PPV) were 91% and 90% for large HCC versus 63.0% and 79% for small HCC, respectively. Seventeen of 122 small HCCs (13.9%) were not visible on MR. Among 379 HCCs, 99 met LR-5, and 259 met LR-4. Common features for small HCC included arterial enhancement (81.9%), hepatobiliary phase hypointensity (80.3%), and delayed washout (72.9%).. Diagnostic accuracy of gadoxetic acid-enhanced MR imaging for small, hypervascular HCCs (Mean figure of merit = 0.787) was still low compared with large HCC (Mean figure of merit = 0.948). LR-5 and LR-4 covered 94% (358/379) of the HCCs.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

The purpose of this study is to evaluate the effect of subtraction images of gadoxetic acid-enhanced MRI on the image interpretation of focal hepatic lesions in patients at risk for hepatocellular carcinoma (HCC).. We retrospectively analyzed 255 malignant nodules from 233 patients with chronic hepatitis or liver cirrhosis (187 men and 46 women; mean age, 55.2 years) who underwent preoperative gadoxetic acid-enhanced MRI and surgical resection. We compared the detection rate of arterial hypervascularity on visual assessment with that of subtraction images. Subgroup analysis was performed according to the pathologic profile of the lesion (HCC vs non-HCC), the lesion size (≤ 3 vs > 3 cm), and the MRI technique (1.5 vs 3 T). We assessed the effect of subtraction images in diagnosing HCC according to the American Association for the Study of Liver Diseases guidelines compared with that of visual assessment.. After excluding six patients whose images were not of nondiagnostic quality, 249 nodules (215 HCCs, 27 cholangiocarcinomas, and seven combined HCC and cholangiocarcinomas) from 227 patients were analyzed. Subtraction images more sensitively detected the arterial hypervascularity of all of the hepatic lesions than did visual assessment (sensitivity, 89.2% vs 72.4%; p < 0.001). In all of the subgroup analyses, the same tendency was observed (p = 0.001-0.145). Compared with visual assessment only, arterial hypervascularity determined by both subtraction images and the visual enhancement patterns increased sensitivity from 76.5% to 87.5% (p < 0.001) in diagnosing HCCs, with a minimal decrease in specificity from 80.9% to 78.1% (p = 0.332).. Adding subtraction images with consideration of visual enhancement patterns can enhance the sensitivity in diagnosing HCC by enhancing the detection of arterial hypervascularity.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Precancerous Conditions; Retrospective Studies; Subtraction Technique

To assess the usefulness of classification tree analysis (CTA) for discrimination of hepatocellular carcinoma (HCC) with target sign on hepatobiliary phase (HBP) and/or diffusion-weighted image (DWI) from intrahepatic cholangiocarcinoma (ICC).. This retrospective study was approved by the institutional review board. From among the 811 patients with histopathologically proven 79 ICCs and 732 HCCs, 69 patients with 69 (87.3%) ICCs and 115 patients with 115 HCCs (15.7%) including 25 scirrhous HCCs and 10 HCCs with central scar that showed the target sign either on HBP or on DWI were included. Two radiologists evaluated the presence of capsule, septum, and arterial enhancement pattern on MR imaging. Capsule, septum, arterial enhancement pattern, and target sign on HBP or DWI were used to classify the tumors using CTA.. On CTA, capsule was the initial predictor for assessing the probability of tumors being HCC. The CTA model demonstrated a sensitivity of 86.1%, specificity of 76.8%, and accuracy of 82.6% for discriminating between ICCs and HCCs. In 115 HCCs, only 16 (13.9%) tumors were misclassified as high probability of ICC, and 64.0% (16/25) scirrhous HCCs and 90.0% (9/10) HCCs with central scar were correctly classified as high probability of HCC.. Target sign either on HBP or on DWI was shown in 87.3% (69/79) of ICCs and 15.7% (115/732) of HCCs. The CTA applying capsule and septum may be useful for guiding correct diagnosis of atypical HCCs with the target sign from ICCs.

Topics: Arteries; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Capsules; Carcinoma, Hepatocellular; Cholangiocarcinoma; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity

To determine the utility of liver T1-mapping on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance (MR) imaging for the measurement of liver functional reserve compared with the signal intensity (SI) based parameters, technetium-99m-galactosyl serum albumin (. This retrospective study included 111 patients (Child-Pugh-A 90; -B 21) performed with both Gd-EOB-DTPA enhanced liver MR imaging and. A significant difference was obtained for Child-Pugh classification with T1hb, ΔT1, all SI based parameters and HH15. T1hb had the highest AUC followed by RE, LMR, LSR, ΔT1, HH15 and T1pre. The correlation coefficients with HH15 were T1pre 0.22, T1hb 0.53, ΔT1 -0.38 of T1 relaxation parameters; RE -0.44, LMR -0.45, LSR -0.43 of SI-based parameters. T1hb was highest for correlation with HH15. The correlation coefficients with ICG were T1pre 0.29, T1hb 0.64, ΔT1 -0.42 of T1 relaxation parameters; RE -0.50, LMR -0.61, LSR -0.58 of SI-based parameters; 0.64 of HH15. Both T1hb and HH15 were highest for correlation with ICG.. T1 relaxation time at post-contrast of Gd-EOB-DTPA (T1hb) was strongly correlated with ICG clearance and moderately correlated HH15 with

Topics: Aged, 80 and over; Bile Duct Neoplasms; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; ROC Curve; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Nervous System; Sensitivity and Specificity

The purpose of this study was to examine the associations between preoperative Liver Imaging Reporting and Data System (LI-RADS) categories and prognosis after curative resection of single hepatic malignancies in patients with chronic liver disease.. Between January 2008 and December 2010, 225 patients with chronic liver disease underwent resection of single hepatic malignant tumors (218 hepatocellular carcinomas, three cholangiocarcinomas, four biphenotypic carcinomas) after undergoing gadoxetic acid-enhanced MRI. Two radiologists retrospectively categorized the tumors into LI-RADS categories. Differences in disease-free survival duration between categories were analyzed by the Kaplan-Meier method with the log-rank test.. Reviewer 1 categorized two (0.9%) patients as having LR-3, 53 (23.6%) LR-4, 159 (70.7%) LR-5, and 11 (4.9%) LR-M lesions. The corresponding numbers for reviewer 2 were six (2.7%) LR-3, 30 (13.3%) LR-4, 178 (79.1%) LR-5, and 11 (4.9%) LR-M. The 2-year cumulative recurrence or death rates were 15.1% for lesions categorized LR-3 or LR-4 by reviewer 1, 31.7% for LR-5, and 60% for LR-M. For lesions categorized by reviewer 2 the corresponding rates were 20.6% for LR-3 or LR-4, 29% for LR-5, and 54.5% for LR-M. Disease-free survival was significantly worse among patients with lesions categorized as LR-M than for lesions categorized as LR-3 or LR-4 or as LR-5 (p < 0.01 for both reviewers). Disease-free survival did not significantly differ between patients with LR-3 or LR-4 and those with LR-5 lesions (reviewer 1, p = 0.301; reviewer 2, p = 0.291).. Patients with tumors preoperatively categorized as LR-M may have a worse prognosis than those with tumors categorized LR-3, LR-4, or LR-5 after curative resection of single hepatic malignancy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Survival Rate; Treatment Outcome

To evaluate the value of view-sharing multi-hepatic arterial-phase (mHAP) imaging for diagnosis of hypervascular hepatocellular carcinoma (HCC).. Forty-seven consecutive patients with HCC underwent gadoxetic acid-enhanced magnetic resonance (MR) imaging before angiographic and lipiodol CT. Hepatic arterial-phase images were obtained at 5 consecutive phases with shared central k-space of 25%, followed by portal venous, late (2 and 3min), and hepatobiliary phase imaging. One-hundred-eight HCC nodules (size: 5-88mm, mean size: 18.2mm) confirmed on angiographic CT and lipiodol CT were evaluated for LI-RADS category and compared with single arterial-phase and mHAP findings regarding wash out, capsule, corona enhancement, and image quality.. Twenty-four HCCs (22.2%) (size: 6-19mm, mean size: 12.3mm) were categorized as LR-3 based on the single arterial-phase. Capsule appearance (25.9%) and washout (57.4%) were most frequently observed in late phase (2min). Corona enhancement was observed in 73.1% of all HCCs on mHAP. For the 24 HCCs of LR-3, corona enhancement was observed in 75% on mHAP and contributed to upgrade category. No significant difference was found in the frequency of corona enhancement between mHAP and angiographic CT (P=0.11). Image quality was valued as good or excellent in all cases.. View-sharing mHAP was feasible without compromising image quality and contributed to the improvement in diagnostic confidence for hypervascular HCC in gadoxetic acid-enhance MR imaging.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Ethiodized Oil; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity

It is difficult to characterize the nodular lesions in cirrhotic liver if typical enhancement pattern is not present on dynamic contrast-enhanced imagings. Although the signal intensity of the hepatobiliary phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) is helpful for characterization of the lesions, some dysplastic nodules may also exhibit low signal intensity in the hepatobiliary phase. We aimed to assess the usefulness of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI including diffusion-weighted imaging (DWI) for differentiation between atypical small hepatocellular carcinomas (HCCs) and dysplastic nodules showing low signal intensity (SI) in the hepatobiliary phase, and to evaluate the MRI findings in determining the histological grade of atypical HCCs in patients with cirrhosis.A total of 43 cirrhotic patients with a small (≤3 cm) liver nodule (n = 25, HCC; n = 18, dysplastic nodule) who underwent Gd-EOB-DTPA-enhanced MRI and pathologic confirmation were retrospectively reviewed. Atypical HCC was defined as not showing arterial hyperenhancement and delayed washout on dynamic MRI.High SI on both T2WI and DWI (sensitivity 80.0%, specificity 100%, positive predictive value 100%, negative predictive value 78.3%) was the most specific feature to differentiate atypical HCCs from dysplastic nodules. High SI on both T2WI and DWI (100% vs 61.5%, P = .039) or low SI on pre-enhanced T1WI (83.3% vs 30.8%, P = .021) was more frequent observed in Edmonson grade II-III HCCs compared with those in grade I HCCs.The combination of DWI and T2WI is most useful for the differentiation of atypical small HCCs from dysplastic nodules showing low SI in the hepatobiliary phase. Combination of DWI and T2WI or pre-enhanced T1WI seems to be useful for predicting the histological grade of atypical HCCs.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Disease-Free Survival; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Kaplan-Meier Estimate; Liver; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Retrospective Studies; Sensitivity and Specificity; Tumor Burden

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Retrospective Studies; Risk Factors

We evaluated the association between histologic grade of hepatocellular carcinoma (HCC) and degree of HCC enhancement on Gd-EOB-DTPA (Gadoxetic acid, Primovist)-enhanced magnetic resonance images (MRI) in HCC patients.A total of 121 patients who underwent curative surgical resection for HCC at our institution between January 2012 and March 2015 were retrospectively analyzed. Gadoxetic acid enhanced MRI was performed in all patients before surgery. Signal intensities of HCC and peri-HCC areas were measured using regions of interest. Relative intensity ratios of HCC lesions versus the surrounding non-HCC areas on unenhanced images (precontrast ratio) and on hepatobiliary phase images (postcontrast ratio) were calculated. Relative liver enhancement (RLE) ratios (post-contrast ratio/pre-contrast ratio) were also calculated. The Edmondson-Steiner (E-S) grading system was used to histologically grade HCC.E-S grades I, II, III, and IV were observed in 2 (1.7%), 14 (11.6%), 54 (44.6%), and 51 (42.1%) of the patients, respectively. For E-S grades I/II (n = 16), III (n = 54), and IV (n = 51), mean RLE (%) were 85.5, 84.9, and 71.2, respectively (P = .01), and for E-S grades I-III (n = 70) and IV (n = 51), mean RLE (%) were 85.1 and 71.2, respectively (P < .01). Barcelona Clinic Liver Cancer (BCLC) stage A (vs 0) (odds ratio 4.38, P = .03) and mean RLE (odds ratio 0.05, P < .01) were found to predict E-S grade IV.E-S grade IV was associated with a low level mean RLE in the gadoxetic acid enhanced MR images of HCC patients.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Preoperative Care; Retrospective Studies

To evaluate detectability of hepatocellular carcinoma (HCC) using split-bolus cone-beam CT in intraindividual comparison between cone-beam CT and contrast-enhanced MR imaging.. In a retrospective, single-center study, 28 patients with 85 HCC tumors were treated with transarterial chemoembolization between May 2015 and June 2016. All patients underwent arterial and hepatobiliary phase (HBP) MR imaging within 1 month before transarterial chemoembolization. Cone-beam CT images were acquired using a split-bolus contrast injection with 2 contrast injections and 1 cone-beam CT acquisition. Statistical analyses included Friedman 2-way analysis, Kendall coefficient of concordance, and Wilcoxon test. Tumor detectability was scored using a 5-point system (1 = best; 5 = worst) by 2 independent readers resulting in 170 evaluated tumors. Quantitative analysis included signal-to-noise and contrast-to-noise ratio and contrast measurements. P values < .05 were considered significant.. Better tumor detection was provided with split-bolus cone-beam CT (2.91/2.73) and HBP MR imaging (2.93/2.21) compared with arterial MR imaging (3.72/3.05; P < .001) without statistical difference between cone-beam CT and HBP MR imaging in terms of detectability (P = .154) and sensitivity for hypervascularized tumors. More tumors were identified on cone-beam CT (n = 121/170) than on arterial MR imaging (n = 94/170). Average contrast-to-noise ratio values of arterial and HBP MR imaging were higher than for cone-beam CT (7.79, 8.58, 4.43), whereas contrast values were higher for cone-beam CT than for MR imaging (0.11, 0.13, 0.97).. Split-bolus cone-beam CT showed excellent detectability of HCC. Sensitivity is comparable to HBP MR imaging and better than arterial phase MR imaging.

Topics: Aged; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Cone-Beam Computed Tomography; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Retrospective Studies

Recently, it has been suggested that peritumoral decreased uptake area (PDUA) in the hepatobiliary phase (HBP) of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) was associated with vascular invasion in hepatocellular carcinoma (HCC). We aimed to investigate correlations between microvascular invasion and PDUA, and elucidate the predictability of PDUA for tumor recurrence after resection.We retrospectively analyzed clinicopathological and radiological data from 126 consecutive patients with single HCC ≤5 cm without macrovascular invasion who underwent preoperative Gd-EOB-DTPA-enhanced MRI and surgical resection. The presence of a faint and hypointense area around the tumor in the HBP was defined as PDUA.Among 126 patients with HCCs, microvascular invasion was observed in 29 (23.0%) patients and PDUA was observed in 15 (11.9%) patients. PDUA [odds ratio (OR) 20.06, confidence interval (CI) 4.74-84.96, P < .001] was an independent risk factor for microvascular invasion. In multivariate survival analysis using Cox regression, PDUA [hazard ratio (HR) 4.51, CI 2.17-9.38, P < .001], pathologically confirmed satellite nodules (HR 5.18, CI 1.50-17.88, P = .009), and AFP (≥100 ng/mL, HR 2.28, CI 1.04-5.01, P = .040) were independent risk factors for recurrence after resection. Recurrence-free survival in the group with PDUA was significantly lower than that in the group without PDUA according to analysis using the Kaplan-Meier method with the log-rank test (P < .001).PDUA in the HBP of Gd-EOB-DTPA-enhanced MRI could be a useful preoperative predictor of microvascular invasion and independent prognostic factor after surgical resection in patients with single HCC ≤5 cm without macrovascular invasion.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Disease-Free Survival; Gadolinium DTPA; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Magnetic Resonance Imaging; Microcirculation; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors

To assess the association between non-hypervascular hypointense nodules (NHHNs) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and liver stiffness (LS) in patients with chronic liver disease, and analyzed their progression to overt hepatocellular carcinoma (HCC).. Between August 2012 and March 2016, a total of 714 consecutive patients who had undergone transient elastography for LS measurement and gadoxetic acid-enhanced MRI were investigated. The association between the presence of NHHNs on the hepatobiliary phase and LS, and the patient's HCC status [none, presence of treatment-naïve HCC, or a history of previous HCC treatment] was assessed. In patients with these nodules, cumulative progression rates of nodules to overt HCC were compared with rates of new HCC development in other parts of the liver.. The prevalence of NHHNs was 16.8% (120/714). The presence of these nodules was significantly associated with the log LS (Odds ratio [OR], 1.48, p=0.002) and hepatitis B virus infection (OR, 3.14, p=0.017), regardless of the patient's HCC status. The two year cumulative progression rate of overt HCC from corresponding nodules and rate of progression to HCC in other parts of the liver were 34.1% and 18.3%, respectively (p=0.071).. The presence of NHHNs on gadoxetic acid-enhanced MRI was associated with higher LS and hepatitis B virus infection. Furthermore, these lesions frequently progressed to overt HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Cross-Sectional Studies; Disease Progression; Elasticity Imaging Techniques; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI have been reported to be associated with intrahepatic distant recurrence (IDR) after hepatectomy or radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). IDR is categorized into hypervascular transformation of non-hypervascular hypointense hepatic nodules and new intrahepatic recurrence. The aim of this study was to evaluate the relationship between non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI and IDR after RFA, focusing on new intrahepatic recurrence.. Ninety-one consecutive patients with 115 HCCs undergoing pretreatment Gd-EOB-DTPA-enhanced MRI and RFA for treatment of HCC were enrolled.. Of the 91 patients who underwent RFA for HCC, 24 had non-hypervascular hypointense hepatic nodules on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrences were observed in 15 and 19 patients with and without non-hypervascular hypointense hepatic nodules, respectively. Of the 15 recurrences in patients with non-hypervascular hypointense hepatic nodules, 10 patients had new intrahepatic recurrences. The cumulative incidence of new intrahepatic recurrence was significantly higher in patients with non-hypervascular hypointense hepatic nodules than in those without non-hypervascular hypointense hepatic nodules (p < 0.0001). Multivariate analysis revealed that the presence of non-hypervascular hypointense hepatic nodules and Child-Pugh score were independent risk factors for new intrahepatic recurrence.. Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were a useful predictive factor for IDR, particularly for new intrahepatic recurrence, after RFA.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Incidence; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Retrospective Studies; Risk Factors

To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images.. In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules.. The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule's initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p < 0.01).. Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination.. • Hypervascularization was rare on follow-up examination of hypovascular, hyperintense nodules • The risk of hypervascularization in a nodule increased with large size • Hypovascular, hyperintense nodules require neither treatment nor more intense follow-up.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver Cirrhosis; Liver Neoplasms; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Proportional Hazards Models; Retrospective Studies; Risk Factors

The purpose of this study was to evaluate the diagnostic performance of a "simulated" abbreviated MRI (AMRI) protocol using diffusion-weighted imaging (DWI) and T1-weighted (T1w) imaging obtained at the hepatobiliary phase (HBP) post gadoxetic acid injection alone and in combination, compared to dynamic contrast-enhanced (CE)-T1w imaging for the detection of hepatocellular carcinoma (HCC).. This was an IRB approved HIPAA compliant retrospective single institution study including patients with liver disease who underwent gadoxetic acid-enhanced MRI for HCC diagnosis. Three independent observers assessed 2 sets of images (full CE-set and AMRI including DWI+T1w-HBP). Diagnostic performance of T1w-HBP and DWI alone and in combination was compared to that of CE-set. All imaging sets included unenhanced T1w and T2w sequences. A preliminary analysis was performed to assess cost savings of AMRI protocol compared to a full MRI study.. 174 patients including 62 with 80 HCCs were assessed. Equivalent per-patient sensitivity and negative predictive value (NPV) were observed for DWI (85.5% and 92.2%, pooled data) and T1w-HBP (89.8% and 94.2%) (P = 0.1-0.7), while these were significantly lower for the full AMRI protocol (DWI+T1w-HBP, 80.6% and 80%, P = 0.02) when compared to CE-set (90.3% and 94.9%). Higher specificity and positive predictive value were observed for CE-set vs. AMRI (P = 0.02). The estimated cost reduction of AMRI versus full MRI ranged between 30.7 and 49.0%.. AMRI using DWI and T1w-HBP has a clinically acceptable sensitivity and NPV for HCC detection. This could serve as the basis for a future study assessing AMRI for HCC screening and surveillance.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

To investigate the Liver Imaging Reporting and Data System (LI-RADS) v2014 categorization of hepatocellular carcinomas (HCCs) on gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) in comparison with multiphasic multidetector computed tomography (MDCT).. Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. We included 182 high-risk patients with 216 pathologically confirmed HCCs who underwent both Gd-EOB-MRI at 1.5 or 3T and multiphasic MDCT. Two independent radiologists assessed the presence or absence of major HCC features and assigned LI-RADS categories before and after considering ancillary features on both MRI and MDCT. Finally, sensitivities of LR-5/5v and frequencies of major HCC features were compared between MRI and MDCT using the McNemar test.. Sensitivities of LR-5/5v were not significantly different between MRI and MDCT (63.4% [137/216] vs. 64.4% [139/216], P = 0.831; 60.6% [131/216] vs. 60.6% [131/216], P = 0.868, for reviewers 1 and 2, respectively). Among major HCC features seen on consensus review, washout and capsule appearance were less frequently observed on MRI than on MDCT (69.0% [149/216] vs. 87.0% [188/216], P < 0.001 and 17.1% [37/216] vs. 31.5% [68/216], P < 0.001), while no significant differences were found for arterial hyperenhancement (88.9% [192/216] vs. 84.7% [183/216], P = 0.081). Ancillary features led to category changes in 18.1% (39/216) of nodules on MRI (all, LR-3 to LR-4), while no changes were seen on MDCT.. Using LI-RADS, Gd-EOB-MRI showed comparable sensitivity to multiphasic MDCT for the diagnosis of HCCs, and ancillary features of MRI frequently led to the upgrade of nodules from LR-3 to LR-4.. 3 J. Magn. Reson. Imaging 2017;45:731-740.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Internationality; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Practice Guidelines as Topic

To examine the added value of considering smooth hypointense rim in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI as capsule appearance for diagnosing tumour capsules and hepatocellular carcinoma (HCC).. A total of 377 hepatic lesions (330 HCCs, 35 non-HCC malignancies and 12 benign) were included from 345 patients who underwent resection after MRI between January 2008 and December 2011. Two radiologists assessed the presence or absence of conventional capsule appearance and smooth hypointense rim in the HBP, and categorized each hepatic lesion according to the Liver Imaging Reporting and Data System. Difference in diagnostic performance was evaluated using the generalized estimating equation method.. For identifying capsule, the sensitivity and accuracy of HBP hypointense rim were significantly higher than those of conventional capsule appearance (81.5 % vs. 57.8 % and 76.1 % vs. 59.4 %, respectively; P < 0.001). For diagnosing HCC, the sensitivity and accuracy of LR-5 or LR-5 V were significantly higher when the HBP hypointense rim was also considered capsule appearance (83 % vs. 72.7 % and 84.1 % vs. 75.1 %, respectively; P < 0.001), with the same specificity (91.5 %).. Regarding smooth hypointense rim in the HBP as capsule appearance could improve the detection of tumour capsule and the diagnosis of HCC.. • Identifying tumour capsule is important for diagnosis of hepatocellular carcinoma (HCC). • Gadoxetic acid-enhanced MRI provides hepatobiliary phase (HBP) images. • Smooth hypointense rim seen in HBP may represent tumour capsule. • Regarding smooth hypointense rim as capsule appearance may improve HCC diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

We investigated the characteristic findings of regenerative nodules (RNs) for differentiating early hepatocellular carcinoma (HCC) from high-grade dysplastic nodules (HGDNs) using magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA; EOB-MRI) and contrast-enhanced ultrasonography (CEUS) in patients with chronic liver disease.. Pathologically confirmed lesions (100 early HCCs, 7 HGDNs, and 20 RNs with a maximum diameter of more than 1 cm and mean maximal diameters of 15.5, 15.1, and 14.8 mm, respectively) were enrolled in this retrospective study. The signal intensities of these lesions during the hepatobiliary phase of EOB-MRI were investigated, and findings characteristic of RNs using this modality were also evaluated using CEUS.. Ninety-eight of the 100 early HCCs that were hypo-intense (n = 95), iso-intense (n = 2), or hyper-intense (n = 1) and the seven HGDNs that were hypo-intense (n = 6) or hyper-intense (n = 1) during the hepatobiliary phase of EOB-MRI exhibited centripetal vessels during the arterial dominant phase of CEUS, although one early HCC that was hypo-intense exhibited both centrifugal and centripetal vessels. Eighteen of the 20 RNs and one early HCC that were hyper-intense with a small central hypo-intensity and the remaining two RNs that were hyper-intense on EOB-MRI exhibited centrifugal vessels during the arterial dominant phase of CEUS. The small central hypo-intense area corresponded to central vascular structures in the lesion, such as the hepatic artery and portal vein running from the center to the periphery, when viewed using CEUS.. Central vascular structures may be a characteristic finding of RNs when observed during the hepatobiliary phase of EOB-MRI and the arterial dominant phase of CEUS.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Early Diagnosis; Female; Gadolinium DTPA; Humans; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Ultrasonography

Purpose To determine the imaging features at gadoxetic acid-enhanced magnetic resonance (MR) imaging of intrahepatic cholangiocarcinoma (IHCC) in a cirrhotic liver, with an emphasis on the distinction between IHCC and hepatocellular carcinoma (HCC) and on the comparison of nodule enhancement patterns between MR imaging and computed tomography (CT). Materials and Methods The institutional review board approved this study and waived the requirement for informed consent. Gadoxetic acid-enhanced MR and CT images in 72 consecutive patients (61 men; mean age, 56.6 years) with 78 IHCCs and one-to-one matched control patients (56 men; mean age, 56.6 years) with 77 HCCs were evaluated retrospectively by two independent readers. Findings that could differentiate IHCC from HCC were evaluated with univariate and multivariate analyses. Using the enhancement criteria and the Liver Imaging Reporting and Data System with modifications (mLI-RADS), the sensitivity and specificity for diagnosing HCC were calculated with conventional washout and portal venous phase (PVP) washout. Results At MR imaging with conventional washout, the specificities for diagnosing HCC were 94.9% (74 of 78) with the enhancement criteria and 96.2% (75 of 78) with mLI-RADS, while the use of PVP washout achieved 100% (78 of 78) specificity for diagnosing HCC with both diagnostic criteria at the expense of decreased sensitivity (from 76.6% [59 of 77] to 63.6% [49 of 77] with the enhancement criteria and from 64.9% [50 of 77] to 55.8% [43 of 77] with mLI-RADS, P ≤ .016). At CT, the sensitivities and specificities with conventional washout were 72.7% (56 of 77) and 97.4% (76 of 78), respectively, with the enhancement criteria and 67.5% (52 of 77) and 97.4% (76 of 78), respectively, with mLI-RADS. Conclusion The use of PVP washout instead of conventional washout at gadoxetic acid-enhanced MR imaging prevents the misclassification of IHCC as HCC in a cirrhotic liver but leads to a decreased sensitivity for HCC.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiographic Image Enhancement; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To establish cut-off levels of the clinical parameters, which would predict suboptimal 30 minutes delayed hepatobiliary phase (HBP) with high specificity.. This retrospective study included patients with chronic liver disease who underwent hepatocellular carcinoma screening with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 30 November 2014. For each case, HBP was graded as adequate or suboptimal, based on Liver Image Reporting and Data System (LI-RADS) criteria. The following laboratory data obtained within 3 months of the MRI date was extracted: total bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, activated partial thromboplastin time (aPTT), and International normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver operating characteristic (ROC) curve analysis was used to establish cut-off values for predicting suboptimal HBP.. Of 284 patients, 242 (85.2%) patients (91; 57.6% male) had an adequate HBP and 42 (14.8%) patients (13; 61.9% male) had suboptimal HBP, with mean ages of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC curve for predicting suboptimal HBP were 0.85 (95%CI 0.79-0.91) for the MELD score, 0.88 (95%CI 0.82-0.93) for TB, and 0.91 (95%CI 0.86-0.95) for DB. Accuracy, positive likelihood ratios and cut-off values for predicting suboptimal HBP were, respectively: 86.7% and 11.2 for the MELD score ≥16.7, 88.2% and 28.7 for TB ≥4.3 mg/dl, and 91.1% and 36.4 for DB ≥1.3 mg/dl. SGOT, SGPT, and ALP were not statistically significantly different between the groups.. Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.

Topics: Bilirubin; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Reproducibility of Results; Sensitivity and Specificity

To evaluate gadoxetic acid-enhanced magnetic resonance imaging (MRI) findings of combined hepatocellular cholangiocarcinoma (cHCC-CC) with special emphasis on correlation of MRI findings with histopathologic tumor characteristics and survival outcomes after curative surgery.. Our Institutional Review Board approved this study, with a waiver of informed consent. For 82 patients (64 men, 18 women; mean age, 54.0 years; age range, 30-81) with surgically confirmed cHCC-CCs, we evaluated clinical features, histologic findings, and tumor morphologic and enhancement features on gadoxetic acid-enhanced liver MRI at 1.5T (n = 67) or 3.0T (n = 15). Imaging features of cHCC-CCs were correlated with pathologic findings according to the 2010 World Health Organization classification system. Tumors were categorized as hypervascular or nonhypervascular based on arterial phase enhancement and were compared with respect to overall and recurrence-free survival after curative-intent surgery.. Of the 82 lesions, 48 showing global arterial phase enhancement were categorized as the hypervascular group, while 34 lesions demonstrating rim, peripheral, or isoenhancement were categorized as the nonhypervascular group. There was no significant difference in MRI findings between pathologic tumor types (classical type versus stem cell feature type, P = 0.324-1.0). Compared with the nonhypervascular group, the hypervascular group had a larger HCC component (P = 0.014), smaller CC component (P = 0.001), and lesser amount of fibrotic stroma (P = 0.006) on pathologic analysis and was an independent factor associated with better overall survival after surgical resection (P = 0.033).. Gadoxetic acid-enhanced MRI findings of cHCC-CCs were diverse, reflecting heterogeneous histologic features. The hypervascular group on MRI is associated with a larger HCC component, smaller CC component, less fibrotic stroma, and better overall survival after curative surgery than the nonhypervascular group.. 4 J. MAGN. RESON. IMAGING 2017;46:267-280.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Prevalence; Prognosis; Republic of Korea; Risk Factors; Statistics as Topic; Survival Rate

Background Intrahepatic distant recurrence (IDR) after radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) is associated with poor overall survival outcome. Purpose To evaluate the incidence and findings on pre-procedural gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) of precursor nodules for IDR after RF ablation for HCC. Material and Methods This study was approved by our institutional review board. Among 343 patients treated with RF ablation for HCC between 2009 and 2011, 141 patients who underwent pre-procedural gadoxetic acid-enhanced liver MRI and experienced IDR were enrolled. The presence of precursor nodules for IDR on pre-procedural imaging was assessed. Nodules were categorized based on hypervascularity in the arterial phase and signal intensity on hepatobiliary phase images. Time to recurrence was compared between patients with and without precursor nodules. Results In 46 (32.7%) of 141 patients (50 HCCs), there were precursor nodules on pre-procedural MRIs (median follow-up period, 4.39 years; range, 0.08-6.08). In three patients, HCCs were missed on imaging. In the remaining 43 patients, the 47 precursor nodules identified were non-hypervascular hypointense (n = 26), non-hypervascular isointense (n = 6), non-hypervascular hyperintense (n = 2), hypervascular hypointense (n = 10), and hypervascular isointense (n = 3). The mean time-to-recurrence was significantly shorter for patients with precursor nodules than for those without (16.6 versus 24.0 months, P = 0.011). Conclusion About one-third of patients with IDR after RF ablation for HCC had precursor nodules on pre-procedural gadoxetic acid-enhanced MRI, most commonly non-hypervascular hypointense nodules in the hepatobiliary phase.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies

Characteristics of hepatocellular carcinoma (HCC) on magnetic resonance (MR) images were compared in patients who did or did not undergo liver transplantation (LT), and we evaluated the relationship of these findings with overall survival (OS) and time-to-tumour recurrence (TTR) after transplantation.. The enhancement pattern of gadoxetic acid-enhanced MR images of 25 patients with recurrent HCCs (LT group) and 25 surgically confirmed HCC patients in the non-transplanted (control) group were compared. Typical enhancement was defined as 1) arterial enhancement and delayed wash-out and 2) absence of typical features of cholangiocarcinoma consisting of arterial rim enhancement and target appearance on hepatobiliary phase images. OS and TTR were analyzed in the LT group according to these patterns using the log-rank test.. HCCs in the LT group significantly more often had an atypical enhancement pattern (16/25, 64.0%) than those in the control group (5/25, 20.0%; p = 0.004). However, OS and TTR did not differ significantly according to these enhancement patterns of recurrent HCC (p > 0.05).. Although enhancement patterns of recurrent HCC in transplanted liver did not affect OS and TTR, these HCCs that arise after LT frequently revealed atypical enhancement on gadoxetic acid-enhanced MR imaging.. • Recurrent HCCs after LT showed atypical enhancement on gadoxetic acid-enhanced MRI. •They showed absence of delayed wash-out or cholangiocarinoma-like features. • Enhancement patterns of recurrent HCCs did not affect OS and TTR.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Case-Control Studies; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies

To clarify the development of HCC, temporal change of steatosis and Gd-EOB-DTPA enhancement of non-alcoholic steatohepatitis (NASH) model mice by magnetic resonance imaging (MRI).. All animal experiments were approved by the institution's Animal Research Committee. MRI was performed on six NASH and six simple steatosis (SS) model mice every 2weeks from the ages of 8weeks to 16weeks. The sequential changes in the number and size of the focal liver lesions detected on Gd-EOB-DTPA-enhanced MRI were evaluated. Additionally, the hepatic fat fraction (HFF), contrast-to-noise ratio (CNR) and relative enhancement (RE) were calculated at each time point. The temporal changes and correlations in these parameters were evaluated.. All alive NASH model mice demonstrated focal liver lesions from week 10, at the latest. Number of the lesions increased with time, and all the lesion enlarged with time. All the lesions larger than 1mm were confirmed as hepatocellular carcinoma (HCC) pathologically. While the HFF remained constant in NASH model mice, HFF in SS model mice dramatically increased with time. CNR of the NASH model mice remained constant through the study period, while CNR in SS model mice decreased with time. Although no correlation was seen in NASH model mice, the HFF showed a negative correlation against CNR and RE in SS model mice.. Development of HCC was observed using Gd-EOB-DTPA-enhanced MRI only in NASH model mice. Degree of steatosis and hepatic enhancement by Gd-EOB-DTPA was both constant in NASH model mice, while steatosis increased and hepatic enhancement decreased with time in SS model mice.

Topics: Animals; Animals, Newborn; Carcinoma, Hepatocellular; Contrast Media; Disease Models, Animal; Female; Gadolinium DTPA; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mice; Mice, Inbred C57BL; Non-alcoholic Fatty Liver Disease; Streptozocin

To determine the imaging features of hepatic sarcomatous carcinoma including sarcomatous intrahepatic cholangiocarcinoma (S-ICC) and sarcomatous hepatocellular carcinoma (S-HCC) on computed tomography (CT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI).. Twenty-four patients with pathologically confirmed S-ICCs (n = 13), S-HCCs (n = 7), sarcomatous carcinoma (n = 2), carcinosarcoma (n = 1), and sarcomatous combined HCC-CC (n = 1) (size range 2.1-23 cm, mean 8.3 cm) underwent gadoxetic acid-enhanced MRI (n = 20) and/or dynamic CT (N = 24). Underlying chronic hepatitis or cirrhosis was found in 17 patients. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors based on a consensus.. Lobulated contour was observed in 15 tumors (62.5%); the rest were round or oval masses. During dynamic imaging, S-ICCs showed poor enhancement (n = 10 on CT; n = 7 on MRI) or initial thin-rim enhancement with/without progressive enhancement (n = 3 on CT; n = 6 on MRI). S-HCCs and the other four tumors showed a thin or thick enhancement pattern on both CT and MRI. T2 bright signal intensity similar to fluid was found in 10 tumors. Target appearance on hepatobiliary phase and diffusion-weighted imaging was seen in two S-ICCs and two S-HCCs. Of 18 surgically resected tumors, 17 showed vascular invasion and/or thrombosis in histology and 12 in CT and MRI. Ten tumors were accompanied by intrahepatic metastasis or tumor seeding and 19 patients had recurrence or progression of tumors during follow-up.. Hepatic sarcomatous carcinoma including S-HCC and S-ICC generally presents minimal rim-like arterial enhancement or extreme hypovascularity on CT and gadoxetic acid-enhanced MRI with a high frequency of T2 bright area due to extensive necrosis and vascular invasion.

Topics: Adult; Aged; Carcinoma; Carcinoma, Hepatocellular; Carcinosarcoma; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sarcoma; Tomography, X-Ray Computed

Focal liver reaction (FLR) appears in the hepatobiliary-phase images of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) following radiotherapy (RT). We investigated the threshold dose (TD) for FLR development in 13 patients with hepatocellular carcinoma (HCC) who underwent three-dimensional conformal radiotherapy (3D-CRT) with 45 Gy in 15 fractions. FLR volumes (FLRVs) were calculated based on planning CT images by referring to fused hepatobiliary- phase images. We also calculated the TD and the irradiated volumes (IVs) of the liver parenchyma at a given dose of every 5 Gy (IVdose) based on a dose-volume histogram (DVH). The median TD was 35.2 Gy. The median IV20, IV25, IV30, IV35, IV40, and IV45 values were 371.1, 274.8, 233.4, 188.6, 145.8, and 31.0 ml, respectively. The median FLRV was 144.9 ml. There was a significant difference between the FLRV and IV20, IV25, and IV45 (p<0.05), but no significant differences between the FLRV and IV30, IV35, or IV40. These results suggest that the threshold dose of the FLR is approx. 35 Gy in HCC patients who undergo 3D-CRT in 15 fractions. The percentage of the whole liver volume receiving a dose of more than 30-40 Gy (V30-40) is a potential candidate optimal DVH parameter for this fractionation schedule.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Dose-Response Relationship, Radiation; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiation Injuries; Radiotherapy, Conformal; Retrospective Studies

To compare the response to transcatheter arterial chemoembolization (TACE) between hepatocellular carcinoma (HCC) with paradoxical uptake on the hepatobiliary phase (HBP) (HCC. Ninety-three HCCs from 54 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) prior to TACE were included. HCCs were classified into two groups according to the signal intensity (SI) on the HBP: HCC. Despite larger size and lower AER, HCC

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Ethiodized Oil; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Tomography, X-Ray Computed

Liver-specific MRI is a fast-growing field, with technological and protocol advancements providing more robust imaging and allowing a greater depth of information per examination. This article reports the evidence for, and expert thinking on, current challenges in liver-specific MRI, as discussed at the 7th International Forum for Liver MRI, which was held in Shanghai, China, in October 2013.. Topics discussed included the role of gadoxetic acid-enhanced MRI in the differentiation of focal nodular hyperplasia from hepatocellular adenoma and small hepatocellular carcinoma (HCC) from small intrahepatic cholangiocarcinoma (in patients with chronic liver disease), the differentiation of low-grade dysplastic nodule (DN) from pre-malignant high-grade DN and early HCC, and treatment planning and assessment of treatment response for patients with HCC and colorectal liver metastasis. Optimization of the gadoxetic acid-enhanced MRI protocol to gain robust arterial and hepatobiliary phase images was also discussed.. Gadoxetic acid-enhanced MRI demonstrates added value for the detection and characterization of focal liver lesions and shows promise in a number of new indications, including regional liver functional assessment and patient monitoring after therapy; however, more data are needed in some areas, and further developments are needed to translate cutting-edge techniques into clinical practice.. Liver-specific MRI is a fast-growing field, with many technological and protocol advancements. Gadoxetic acid-enhanced MRI demonstrates value for detecting and characterizing focal liver lesions. Gadoxetic acid-enhanced MRI shows promise in regional functional assessment and patient monitoring. Further developments are needed to translate cutting-edge techniques into clinical practice.

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Precancerous Conditions

We investigated the added value of the hypointensity on hepatocyte-phase (HP) imaging of gadoxetic acid-enhanced MRI (EOB-MRI) in the 2014 version of the Liver Imaging Reporting and Data System (LI-RADS) for distinguishing hepatocellular carcinoma (HCC) from benign hepatic lesions in patients with chronic liver disease.. We retrospectively evaluated targeted lesions (111 HCCs, 28 benign hepatic lesions) of 139 patients (101 men, 38 women; aged 18 to 89 years, mean age, 68 ± 11 years) with chronic liver disease. EOB-MRI and dynamic contrast-enhanced computed tomography (CECT) were performed within 3 months. Two abdominal radiologists independently reviewed 3 imaging datasets: (1) EOB-MRI without an HP image using the LI-RADS system (MR imaging without HP); (2) EOB-MRI with an HP image using a modified version of the LI-RADS system in which hypointensity on the HP image was used as an additional major criterion of malignancy (MR imaging with HP); and (3) dynamic contrast-enhanced computed tomography (CECT) images using the LI-RADS system. We evaluated intra- and inter-reader agreement with kappa statistics along with 95% confidence intervals and compared diagnostic sensitivity and specificity of the 3 imaging datasets with McNemar's test.. The sensitivities of MR imaging were statistically higher with HP (Reader 1, 95% [107/111]; Reader 2, 95% [106/111]) than without HP (Reader 1, 84% [93/111], P = 0.002; Reader 2, 86% [96/111], P = 0.002). Specificity was comparably high between MR imaging with HP (Reader 1, 96% [27/28]; Reader 2, 96% [27/28]) and dynamic CECT (Reader 1, 100% [28/28], P = 0.317; Reader 2, 100% [28/28], P = 0.317) and MR imaging without HP (Reader 1, 96% [27/28], P = 1.00; Reader 2, 100% [28/28], P = 0.317).. The use of an HP image from EOB-MRI as an additional major criterion improved the sensitivity of LI-RADS to distinguish HCCs from benign hepatic lesions while retaining high specificity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; False Negative Reactions; False Positive Reactions; Female; Follow-Up Studies; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Radiographic Image Enhancement; Radiology Information Systems; Retrospective Studies; Sensitivity and Specificity; Young Adult

Irreversible electroporation (IRE) is a new ablation modality. Our purpose was to describe the effectiveness and the safety of the treatment and to evaluate the magnetic resonance imaging (MRI), computed tomography (CT) and contrast-enhanced ultrasound (CEUS) diagnostic accuracy in HCC patients treated with IRE at 1-, 3-, and 6-month follow-up.. In an 18-month period, we treated 24 HCC lesions in 20 patients unfit for surgery. MRI, CT and CEUS were performed before and one, 3 and 6 month after IRE. We employed the liver-specific contrast medium Primovist (gadolinium ethoxybenzyl dimeglumine) in MRI. After IRE the lesions were classified as responders or non-responders to the treatment according to the mRECIST and the complications were recorded. We evaluated the size, shape, signal intensity (T1-W, T2-W, and DWI) in MRI, dynamic contrast enhancement pattern for CEUS, CT and MRI and signal behavior during the liver-specific phase for MRI.. According to mRECIST, at 1 month MRI and CEUS showed a complete response (CR) in 91.7% of cases (22/24) tumors, while there was partial response (PR) in the remaining 2/24 (8.3%) treated nodules; in CT study all ablated zone appeared as necrotic (CR 100%). The residual viable tumor in MRI and in CEUS study had similar diameter (10 mm). No new HCC were identified from MRI, CT or CEUS. At 3 months MRI and CEUS showed the same results seen after 1 month from the treatment. Twenty-two necrotic lesions, and 2 residual tumors were found (CR = 91.7% and PD = 8.3%). In MRI study the two cases of residual tumor tissue had a diameter of 11 and 12 mm each. At CEUS the diameter of residual HCC was similar to the diameter at 1 month. CT showed 23 necrotic areas and one residual viable tissue in the treated zone, with a diameter of 10 mm (CR = 95.3% and PD = 4.7%). No new foci of HCC were identified from all imaging studies. At 6 months MRI, CEUS, and CT showed 22 necrotic lesions and 2 residual tumors in ablated zone (CR = 91.7% and PD = 8.3%). At MRI the diameters of the two residual viable HCCs were 12 and 14 mm, at CEUS the diameters were 11 and 12 mm, while at CT the diameters were 10 and 10 mm. No statistical difference was evaluated between CR, PR, PD percentage values for MRI, CT and CEUS (p value > 0.05 at Chi-square test). No major vascular complication was recorded after IRE. Six out of 20 patients (30%) showed a transient hepatic intensity difference (THID) area within the normal liver parenchyma adjacent to the treated lesions. Two of the 20 patients (10%) showed an absent concentration of liver-specific contrast medium around the ablation zone. Two patients developed complications, consisting in a peripheral arteriovenous shunt and a segmental dilation of the intrahepatic biliary ducts. We found no statistically significant difference in morphology, size (variation in the largest diameter), signal intensity in T1-weighted images, in T2-weighted images, in DWI and in the related map of the apparent diffusion coefficient (ADC), presence or absence of contrast enhanced during the arterial, portal, and late phase in MRI, CT, and CEUS, and signal characteristic during the liver-specific phase in MRI of the ablation zone at 1, 3, and 6 months.. IRE is a feasible, safe and efficient modality in the treatment of patients with non-resectable HCC. We had no major complication, even when the ablated lesion was adjacent to major branches of the portal vein. All images techniques showed similar accuracy during the follow-up at 1, 3, and 6 months in the assessment ablated zone.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Electrochemotherapy; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Tomography, X-Ray Computed; Ultrasonography

We attempted to clarify the relationship between the signal intensity (SI) in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (MR) imaging and the efficacy of hepatic arterial infusion chemotherapy (HAIC) in hepatocellular carcinomas (HCCs).. We enrolled 14 patients with HCCs who underwent gadoxetic acid-enhanced MR imaging prior to HAIC using cisplatin and 5-fluorouracil. In the hepatobiliary phase, we calculated the SI of the HCCs and the background liver. In cases with multiple HCCs, we calculated the SI of the largest lesion. Patients were classified into high (n = 7) and low intensity (n = 7) groups based on the median value of the SI ratio (SI of the tumor/SI of the background liver). We analyzed progression-free survival using the Kaplan-Meier method and the log-rank test. In the 5 patients with a history of HCC surgery, we compared the expression of immunohistochemical organic anion-transporting polypeptide (OATP) 8 between the high and low intensity groups by chi-square test.. The SI ratios were 0.568 ± 0.093 (mean ± standard deviation) in the high intensity group and 0.251 ± 0.086 in the low intensity group. Compared to the group with low signal intensity, the group with high signal intensity demonstrated significantly lower serum levels of alpha fetoprotein (AFP) (P = 0.0350), significantly higher progression-free survival (P = 0.0108), better differentiation of tumor grade at histologic examination (P = 0.0253), and significantly higher OATP8 expression (P = 0.0253).. Patients with HCCs of high SI ratio in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging can respond better to HAIC.

Topics: Adult; Aged; Aged, 80 and over; alpha-Fetoproteins; Antimetabolites, Antineoplastic; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Hepatocellular; Cisplatin; Contrast Media; Disease-Free Survival; Female; Fluorouracil; Forecasting; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Image Processing, Computer-Assisted; Infusion Pumps, Implantable; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Organic Anion Transporters, Sodium-Independent; Retrospective Studies; Solute Carrier Organic Anion Transporter Family Member 1B3; Treatment Outcome

To determine the different imaging features of intrahepatic mass-forming cholangiocarcinoma (IMCC) from hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. This retrospective study was institutional review board approved and the requirement for informed consent was waived. Patients who underwent gadoxetic acid-enhanced MRI with histologically confirmed IMCCs (n = 46) or HCCs (n = 58) were included. Imaging features of IMCCs and HCCs on gadoxetic acid-enhanced MRI including T2- and T1-weighted, diffusion weighted images, dynamic study and hepatobiliary phase (HBP) images were analyzed. Univariate and multivariate logistic regression analyses were performed to identify relevant differentiating features between IMCCs and HCCs.. Multivariate analysis revealed heterogeneous T2 signal intensity and a hypointense rim on the HBP as suggestive findings of IMCCs and the wash-in and "portal wash-out" enhancement pattern as well as focal T1 high signal intensity foci as indicative of HCCs (all, p < 0.05). When we combined any three of the above four imaging features, we were able to diagnose IMCCs with 94 % (43/46) sensitivity and 86 % (50/58) specificity.. Combined interpretation of enhancement characteristics including HBP images, morphologic features, and strict application of the "portal wash-out" pattern helped more accurate discrimination of IMCCs from HCCs.. • Analysis of enhancement characteristics helped accurate discrimination of IMCCs from HCCs. • Wash-out should be determined on the PVP of gadoxetic acid-enhanced MRI. • A hypointense rim on the HBP was a significant finding of IMCCs.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Observer Variation; Retrospective Studies; Sensitivity and Specificity

It remains unknown whether Kupffer-phase images in Sonazoid-enhanced ultrasonography (US) can be used to predict hypervascularization of borderline lesions. Therefore, we aimed to clarify whether Kupffer-phase images in Sonazoid-enhanced ultrasonography can predict subsequent hypervascularization in hypovascular borderline lesions detected on hepatobiliary-phase gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging.. From January 2008 to March 2012, 616 low-intensity hypovascular nodules were detected in hepatobiliary-phase images of Gd-EOB-DTPA-enhanced MRI at nine institutions. Among these, 167 nodules, which were confirmed as hypovascular by Gd-EOB-DTPA-enhanced MRI and Sonazoid-enhanced US, were evaluated in this study. Potential hypervascularization factors were selected based on their clinical significance and the results of previous reports. The Kaplan-Meier model and log-rank test were used for univariate analysis and the Cox regression model was used for multivariate analysis.. The cumulative incidence of hypervascularization of borderline lesions was 18, 37, and 43 % at 1, 2, and 3 years, respectively. Univariate analyses showed that tumor size (p = 0.0012) and hypoperfusion on Kupffer-phase images in Sonazoid-enhanced US (p = 0.004) were associated with hypervascularization of the tumor. Multivariate analysis showed that tumor size [HR: 1.086, 95 % confidence interval = 1.027-1.148, p = 0.004] and hypo perfusion on Kupffer-phase images [HR: 3.684, 95 % confidence interval = 1.798-7.546, p = 0.0004] were significantly different.. Kupffer-phase images in Sonazoid-enhanced US and tumor diameter can predict hypervascularization of hypointense borderline lesions detected on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Female; Ferric Compounds; Gadolinium DTPA; Humans; Iron; Kaplan-Meier Estimate; Kupffer Cells; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Oxides; Retrospective Studies; Ultrasonography

The present study evaluated the threshold dose for hepatic parenchymal changes on gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) images after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC).. Twenty patients with available data of follow-up MR images acquired 2-4 months after completion of SBRT were selected among the registered patients. SBRT was performed using multiple coplanar and non-coplanar beams with energies of 6 or 15 MV. All patients were treated with doses of 45 Gy administered in three fractions over 3 consecutive days. For image registration between planning computed tomography (CT) and MR images, landmark-based rigid body registration was performed using MIM software.. Seventeen patients were included in the analysis. The median discrepancies between planning CT and MR images in the left-right, anterior-posterior and superior-inferior directions were 1.38 mm, 1.24 mm and 1.72 mm, respectively. The median D50 value for the defect in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR images after SBRT was 19.8 Gy (range, 14.2-28.7 Gy), with R(2) values ranging from 0.76 to 0.99.. The threshold dose for parenchymal changes in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MR images performed 2-4 months after 45 Gy of SBRT in three fractions was approximately 20 Gy. Our results provide the basis for further research on the functional loss of liver parenchyma after SBRT.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiosurgery; Radiotherapy Dosage; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Treatment Outcome

To determine which clinical variables and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging features are associated with histologically proved hepatocellular adenoma (HCA) genotypic subtypes.. In this institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study, clinical information and MR images of 49 histologically proved HCAs from January 2002 to December 2013 (21 patients; mean age, 39 years; age range, 15-59 years) were retrospectively reviewed by two radiologists. Qualitative and quantitative imaging features, including the signal intensity ratio relative to liver in each phase, were studied. HCA tissues were stained with subtype-specific markers and subclassified by a pathologist. Clinical and imaging data were correlated with pathologic findings and compared by using Fisher exact or t test, with a Bonferroni correction for multiple comparisons.. Forty-nine HCAs were subclassified into 14 inflammatory, 20 hepatocyte nuclear factor (HNF)-1α-mutated, one β-catenin-activated, and 14 unclassified lesions. Intralesional steatosis was exclusively seen in HNF-1α-mutated lesions. Marked hyperintensity on T2-weighted images was seen in 12 of 14 (86%) inflammatory lesions compared with four of 21 (19%) HNF-1α-mutated, seven of 14 (50%) unclassified, and zero of one (0%) β-catenin-activated lesion. Two large lesions (one β-catenin-activated and one unclassified) transformed into hepatocellular carcinomas and were the only lesions to enhance with marked heterogeneity. In the hepatobiliary phase, all HCA subtypes were hypoenhancing compared with surrounding liver parenchyma, and they reached their nadir signal intensity by 10 minutes after the administration of contrast material before plateauing. HNF-1α-mutated lesions had the lowest lesion signal intensity ratio of 0.47 ± 0.09, compared with 0.73 ± 0.18 for inflammatory lesions (P = .0004), 0.82 for the β-catenin-activated lesion, and 0.73 ± 0.06 for the unclassified lesion (P = .00002).. In this study, all HCA subtypes were hypoenhancing at Gd-EOB-DTPA-enhanced MR imaging in the hepatobiliary phase and reached their nadir signal intensity at 10 minutes. HNF-1α-mutated lesions could be distinguished from other subtypes by having the lowest lesion signal intensity ratio.

Topics: Adenoma; Adult; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

Tumor biopsy is not essential for the diagnosis of hepatocellular carcinoma (HCC); however, grading remains important for the prognosis.. To investigate whether combined Gd-EOB-DTPA and gadobutrol liver magnetic resonance imaging (MRI) can predict HCC grading.. Thirty patients (66.6 ± 7.3 years) with histologically confirmed HCC (grade 1, n = 5; grade 1-2, n = 6; grade 2, n = 13; grade 2-3, n = 2; grade 3, n = 4) underwent two liver MRIs, one with gadobutrol and one with Gd-EOB-DTPA, on consecutive days. Blinded to grading, two radiologists reviewed the gadobutrol and Gd-EOB-DTPA images in consensus with respect to: (i) HCC hyper-/iso-/hypointensity in the arterial, portal-venous/delayed, and Gd-EOB-DTPA hepatocellular phase; and (ii) morphologic tumor features (encapsulated growth, vessel invasion, heterogeneity, liver capsule infiltration, satellite metastases).. A significant correlation with grading was not found for either the combined dynamic information of all gadobutrol phases (r = -0.187, P = 0.331) or all the Gd-EOB-DTPA phases (r = 0.052, P = 0.802). No correlation with grading was found for a combination of arterial and hepatocellular phase in Gd-EOB-DTPA MRI (r = 0.209, P = 0.305), a combination of both arterial phases (gadobutrol and Gd-EOB-DTPA) with the Gd-EOB-DTPA hepatocellular phase (r = 0.240, P = 0.248), or a combination of all available gadobutrol and Gd-EOB-DTPA phases (r = 0.086, P = 0.691). For all gadobutrol information (dynamic phases and morphology; r = 0.049, P = 0.801) and for all Gd-EOB-DTPA information (r = 0.040, P = 0.845), no correlation with grading was found. Hepatocellular Gd-EOB-DTPA phase iso-/hyperintensity never occurred in grade 3 HCCs.. Histological HCC grading cannot be predicted by combined Gd-EOB-DTPA/gadobutrol MRI. However, Gd-EOB-DTPA hepatocellular phase iso-/hyperintensity was never detected in grade 3 HCCs.

Topics: Aged; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Grading; Organometallic Compounds; Predictive Value of Tests

Topics: Biopsy; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Gadolinium DTPA; Hepatectomy; Hepatitis C; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Peliosis Hepatis; Predictive Value of Tests; Tomography, X-Ray Computed

To identify predictors for the discrimination of intrahepatic cholangiocarcinoma (IMCC) and combined hepatocellular-cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC) for primary liver cancers on gadoxetic acid-enhanced MRI among high-risk chronic liver disease (CLD) patients using classification tree analysis (CTA).. A total of 152 patients with histopathologically proven IMCC (n = 40), CHC (n = 24) and HCC (n = 91) were enrolled. Tumour marker and MRI variables including morphologic features, signal intensity, and enhancement pattern were used to identify tumours suspicious for IMCC and CHC using CTA.. On CTA, arterial rim enhancement (ARE) was the initial splitting predictor for assessing the probability of tumours being IMCC or CHC. Of 43 tumours that were classified in a subgroup on CTA based on the presence of ARE, non-intralesional fat, and non-globular shape, 41 (95.3 %) were IMCCs (n = 29) or CHCs (n = 12). All 24 tumours showing fat on MRI were HCCs. The CTA model demonstrated sensitivity of 84.4 %, specificity of 97.8 %, and accuracy of 92.3 % for discriminating IMCCs and CHCs from HCCs.. We established a simple CTA model for classifying a high-risk group of CLD patients with IMCC and CHC. This model may be useful for guiding diagnosis for primary liver cancers in patients with CLD.. • Arterial rim enhancement was the initial splitting predictor on CTA. • CTA model achieved high sensitivity, specificity, and accuracy for discrimination of tumours. • This model may be useful for guiding diagnosis of primary liver cancers.

Topics: Adult; Aged; Arteries; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biomarkers, Tumor; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

For patients with hepatocellular carcinoma (HCC), gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) improved the diagnosis, migrated Barcelona Clinic Liver Cancer (BCLC) stage, and changed therapeutic decision in retrospective analysis.. This prospective study was to evaluate the clinical impact of EOB-MRI on HCC management.. From September 2012 to February 2014, consecutive patients with suspicion of HCC in BCLC early stage by multidetector computed tomography or dynamic MRI with non-specific gadolinium, well liver function reserve, and admitted for resection evaluation were enrolled prospectively. Additional EOB-MRI was performed. The HCC diagnosis, BCLC staging, and treatment decision were obtained in a liver cancer conference. EOB-MRI impact on HCC management was analyzed.. One hundred and three patients including 68 with typical and 35 with atypical HCC nodules in dynamic imaging studies were enrolled. EOB-MRI characterized 3 (4.4 %) benign and 33 (94.3 %) HCC for patients with typical and atypical HCC nodules, respectively. For 90 HCC patients, additional EOB-MRI changed BCLC stage in 25 (27.8 %) and treatment decision in 17 (18.9 %) patients. There were 66 patients with 78 resected nodules including 65 HCCs, 4 intrahepatic cholangiocarcinomas, and 9 benign nodules. Dynamic study and EOB-MRI detected and characterized 69 and 77 nodules, respectively. The sensitivity and accuracy in HCC diagnosis were 98.5 and 85.7 % for EOB-MRI, which were better than those of dynamic study (p < 0.001).. Additional EOB-MRI improved HCC diagnosis in sensitivity, accuracy but not specificity. It changed BCLC staging and treatment decision in 27.8 and 18.9 % of early-stage HCC patients.

Topics: Aged; Carcinoma, Hepatocellular; Clinical Decision-Making; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Prospective Studies

To evaluate the long-term outcomes and imaging features associated with hypervascularization of hypovascular nodules that show T2 iso-/hypointensity and hypointensity on hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) images in patients with chronic liver disease.. Sixty patients and 114 nodules, which were hypovascular and iso-/hypointense on T2-weighted images and hypointense on HBP of gadoxetic acid-enhanced MRI, were included. We evaluated the effect of baseline clinical features, baseline MR features and growth rate on subsequent hypervascularization.. Twenty-seven nodules in 21 patients transformed to hypervascular hepatocellular carcinoma (HCC). Using multivariate Cox analysis, T1 hyperintensity (hazard ratio [HR] = 2.69, P = 0.021), previous history of HCC (HR = 2.64, P = 0.021), and initial nodule size (HR = 1.09, P = 0.046) were identified to be associated with hypervascularization. The growth rate of nodules was a more powerful determinant of subsequent hypervascularization than baseline clinical and MR features. At long-term follow-up after >3 years, only one nodule with T1 isointensity showed hypervascularization.. Careful follow-up or diagnostic procedures, such as biopsy, should be considered for up to 3 years after detection of hypointense nodules on HBP with T1 hyperintensity or a higher growth rate.. • T1 hyperintensity is a baseline MR predictive factor for subsequent hypervascularization. • A higher growth rate is a more powerful determinant of subsequent hypervascularization. • Management of patients with these predictive factors requires more attention.

Topics: Adult; Aged; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Precancerous Conditions; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors

To develop and validate a prediction model using magnetic resonance imaging (MRI) for local tumour progression (LTP) after radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients.. Two hundred and eleven patients who had received RFA as first-line treatment for HCC were retrospectively analyzed. They had undergone gadoxetic acid-enhanced MRI before treatment, and parameters including tumour size; margins; signal intensities on T1-, T2-, and diffusion-weighted images, and hepatobiliary phase images (HBPI); intratumoral fat or tumoral capsules; and peritumoural hypointensity in the HBPI were used to develop a prediction model for LTP after treatment. This model to discriminate low-risk from high-risk LTP groups was constructed based on Cox regression analysis.. Our analyses produced the following model: 'risk score = 0.617 × tumour size + 0.965 × tumour margin + 0.867 × peritumoural hypointensity on HBPI'. This was able to predict which patients were at high risk for LTP after RFA (p < 0.001). Patients in the low-risk group had a significantly better 5-year LTP-free survival rate compared to the high-risk group (89.6 % vs. 65.1 %; hazard ratio, 3.60; p < 0.001).. A predictive model based on MRI before RFA could robustly identify HCC patients at high risk for LTP after treatment.. • Tumour size, margin, and peritumoural hypointensity on HBPI were risk factors for LTP. • The risk score model can predict which patients are at high risk for LTP. • This prediction model could be helpful for risk stratification of HCC patients.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Disease-Free Survival; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Treatment Outcome

Purpose To assess the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the evaluation of portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC). Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. A total of 366 patients with HCC who underwent gadoxetic acid-enhanced MR imaging between January 2007 and May 2013, including 134 with malignant PVT, 49 with benign PVT, and 183 without PVT matched for age and sex, comprised our study population. PVTs were complete in 125 patients and partial in 58 and were located in a major portal vein (n = 159) or segmental portal vein (n = 24). Two radiologists independently reviewed the MR images and assessed the sensitivity, specificity, and accuracy in the detection and characterization of PVT according to location (major vs segmental) and type (complete vs partial). The Fisher exact or χ(2) test was used to evaluate sensitivity difference between the subsets. Results Gadoxetic acid-enhanced MR imaging showed good sensitivity (reviewer 1, 84% [154 of 183 patients]; reviewer 2, 70% [129 of 183 patients]) and high specificity (reviewer 1, 89% [163 of 183 patients]; reviewer 2, 96% [176 of 183 patients]) in the detection of PVT. Diagnostic accuracy for differentiating malignant PVT from benign PVT was high (reviewer 1, 92% [141 of 154 patients]; reviewer 2, 95% [122 of 129 patients]). However, there was slightly lower sensitivity for detecting segmental PVT compared with that of major PVT in the malignant PVT group (reviewer 1, 95% [104 of 110 patients] vs 88% [21 of 24 patients]; reviewer 2, 82% [90 of 110 patients] vs 79% [19 of 24 patients]; P = .203 and .775 for reviewers 1 and 2, respectively). Conclusion Gadoxetic acid-enhanced MR imaging provided good diagnostic performance in the detection of PVT and the differentiation of malignant from benign PVT in patients with HCC. However, caution is needed when evaluating potential candidates for curative treatment because of the low sensitivity for segmental PVT in the malignant PVT group. (©) RSNA, 2016 Online supplemental material is available for this article.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Retrospective Studies; Sensitivity and Specificity; Venous Thrombosis

The Milan criteria for the selection of patients with hepatocellular carcinoma (HCC) for liver transplantation were originally based on the findings of contrast-enhanced CT examinations. Studies have shown improvement in HCC detection of using contrast-enhanced MRI instead of CT, but they have provided little information on the potential downstream effect on patient management that might result from discrepant imaging findings. We sought to assess the effect of discrepant imaging findings on patient eligibility to undergo liver transplantation.. From 2006 to 2013, patients with a diagnosis of HCC who underwent both MDCT and MRI examinations within a 40-day period were studied retrospectively. All examinations were independently reviewed by two abdominal radiologists who recorded the number, diameter, and location of each lesion. Secondary confirmation of the lesions was made on the basis of histopathologic findings, diffusion restriction on DWI, increased T2 signal intensity, lesion growth, presence of fat, uptake of ethiodized oil, or a combination of these findings.. Sixty-four patients (48 men and 16 women; mean age, 62 years) met the criteria for inclusion in the study. Of the 129 lesions identified by MRI, only 102 of these lesions (79%) were identified by MDCT. This discrepancy led to a difference in the Milan criteria scoring for nine patients (14%). There was no statistically significant difference in the mean (± SD) greatest lesion diameter measured using the two modalities, with measurements of 3.52 ± 2.8 cm and 3.46 ± 2.8 cm noted on MDCT and MRI, respectively (p = 0.8). Lesions missed on MDCT studies tended to be smaller, with a mean diameter of 2.7 cm. Of the 129 lesions identified by MRI, 112 (87%) had available histopathologic findings or other confirmatory diagnostic evidence.. MDCT missed one-fifth of the HCC lesions detected by MRI. Had MDCT been the only imaging examination performed, failure to identify these lesions would have led to a different management plan for 14% of patients.

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Iopamidol; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Patient Selection; Retrospective Studies; Tomography, X-Ray Computed

To determine added value of hepatobiliary phase (HBP) using gadoxetate disodium compared to MRI with extracellular gadolinium-based contrast agent (GBCA) for detection of primary hepatic malignancies in a single imaging session.. IRB approved this HIPAA compliant retrospective study. Within 90 days of resection or liver transplant, thirty patients underwent MRI with extracellular GBCA followed by separate injection of gadoxetate for HBP. Two sets of images were reviewed: Set #1-unenhanced and enhanced images with an extracellular GBCA and set #2-with addition of HBP. Data were analyzed in two groups, cases with hepatocellular carcinoma (HCC) only and cases with either HCC and/or cholangiocarcinoma. Observer diagnostic accuracy (Az), sensitivity, and specificity were calculated.. 14/30 subjects had HCC (46%, CI 28-66%), 2/30 (2%, CI 1-22%) cholangiocarcinoma, and 14/30 (46%, CI 28-66%) no malignancy. There was no significant change in A z value with addition of gadoxetate in the detection of HCC (range 0.84-0.97 set #1 and 0.85-0.97 set #2, p > 0.05). Sensitivity and specificity showed no significant differences (p > 0.05) between the image sets for all readers. When stratified by lesion size, there was no significant difference in accuracy, sensitivity, or specificity for any reader (p > 0.05).. When compared to extracellular GBCA, gadoxetate HBP imaging does not result in a significant difference in accuracy or sensitivity in diagnosis of HCC or cholangiocarcinoma and may result in a decrease in specificity.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Current diagnostic imaging criteria for hepatocellular carcinoma (HCC) are dedicated to imaging with nonspecific extracellular contrast agents. This study aimed to evaluate diagnostic criteria for HCC ⩽3 cm on magnetic resonance imaging (MRI) with a hepatocyte-specific contrast agent through an inception cohort study.. Of 291 patients with chronic liver disease and new nodules of 1-3 cm in diameter at surveillance ultrasonography, 295 solid nodules (194 HCCs, 98 benign nodules, and three other malignancies) in 198 patients with a confirmed final diagnosis or ⩾24 months follow-up were evaluated on gadoxetic acid-enhanced MRI. Through univariate and multivariate logistic regression analyses, various diagnostic criteria were developed by combining significant MRI findings for diagnosing HCC. The diagnostic performance of each criterion was compared with that of the European Association for the Study of the Liver (EASL) criteria.. Four MRI findings (arterial-phase hyperintensity, transitional-phase hypointensity, hepatobiliary-phase hypointensity, and rim enhancement) were independently significant for diagnosis of HCC ⩽3 cm. For whole nodules, EASL criteria showed the best performance for diagnosing HCC (sensitivity, 83.5%; specificity, 81.2%). For nodules ⩽2 cm in diameter, a new criterion (arterial-phase hyperintensity and hepatobiliary-phase hypointensity) showed a significantly higher sensitivity than that of the EASL criteria (83.0% vs. 74.5%, p=0.008), without a significantly different specificity (76.7% vs. 81.1%, p=0.125).. EASL criteria exhibit the best diagnostic performance for HCC ⩽3 cm on hepatocyte-specific contrast-enhanced MRI. A newly identified criterion (arterial-phase hyperintensity and hepatobiliary-phase hypointensity) may increase the diagnostic sensitivity of small (⩽2 cm) HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Follow-Up Studies; Gadolinium DTPA; Hepatocytes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Reproducibility of Results; Retrospective Studies

To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC).. Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12° and 25° flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences.. 40% of lesions progressed to arterial-enhancing HCC; 60% were stable at ≥6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10-25th, and 25-50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25° (range 0.619-0.657) than at 12° (range 0.512-0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655-0.750 at 12° and 0.686-0.800 at 25. The metric with highest AUC at 12° was SD (AUC = 0.750) and at 25° was CV (AUC = 0.800).. Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.

Topics: Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Pilot Projects; Precancerous Conditions; Reproducibility of Results; Retrospective Studies

The aim of this study was to validate the Liver Imaging Reporting and Data System (LI-RADS) v2014 category 4 (LR-4) and 5 (LR-5) criteria on gadoxetate disodium-enhanced magnetic resonance imaging (MRI) in patients with chronic liver disease.. Between January and December 2012, 300 patients with chronic liver disease who had hepatic nodules 3.0 cm or smaller at surveillance ultrasonography and gadoxetate disodium-enhanced MRI were included. LI-RADS category was retrospectively assigned to each nodule on MRI. Final diagnosis was assessed using pathologic diagnosis only (operation or core-needle biopsy) or pathologic and clinical diagnosis (marginal recurrence after treatment or a change in lesion size on follow-up imaging). To validate the LR-4 and LR-5 criteria, the sensitivity, positive predictive value (PPV), and false referral rate for diagnosing hepatocellular carcinoma were examined.. Based on major imaging features only, 137 nodules were initially assigned as LR-3, but 133 (97.1%) were upgraded into LR-4 by the presence of ancillary features. Excluding the remaining 4 LR-3 and 3 LR-M nodules, we analyzed 379 nodules in 294 patients, consisting of 211 LR-4 and 168 LR-5 nodules. Using pathologic diagnosis only, the sensitivity and PPV with 95% confidence intervals (CIs) for LR-5 were higher than those for LR-4 (57.3% [50.6-63.7] vs 42.7% [36.3-49.4]; 94.6% [89.0-97.5] vs 82.0% [73.7-88.1]), with a lower false referral rate (5.4% [2.5-11.0] vs 18.0% [11.9-26.3]). Using pathologic and clinical diagnosis, PPV and 95% CI for LR-5 were higher than that for LR-4 (95.2% [90.7-97.7] vs 79.1% [73.1-84.1]), whereas sensitivity and 95% CI for LR-5 was similar to that for LR-4 (48.9% [43.6-54.3] vs 51.1% [45.7-56.4]).. In patients with chronic liver disease, LR-5 criteria on gadoxetate disodium-enhanced MRI had excellent PPV for diagnosing hepatocellular carcinoma, whereas LR-4 criteria showed good PPV, but are only of limited use.

Topics: Carcinoma, Hepatocellular; Chronic Disease; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

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).. 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).. 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.. 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.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Failure; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Retrospective Studies; Risk

To clarify whether the heterogeneity of non-cancerous liver parenchyma (NLP) in the hepatobiliary phase on gadoxetic acid enhanced magnetic resonance imaging (MRI) is correlated with hepatocellular carcinoma (HCC) development.. Institutional review board approval was obtained, and the requirements for informed consent were waived for this retrospective study. The imaging characteristics of 84 patients with chronic liver disease who underwent gadoxetic acid-enhanced 3T MRI between January 2013 and October 2014 were examined retrospectively. For the evaluation of the heterogeneity of the intensity in the hepatobiliary phase, the largest possible region of interest was placed on the NLP, and the skewness and kurtosis were calculated using ImageJ software. Skewness is the degree of asymmetry of a histogram, and kurtosis is a measure of the peak. Based on the median values of kurtosis and skewness, the patients were classified into four categories and the categories were compared between the 49 patients with HCC (HCC group) and the 35 patients without HCC (non-HCC group).. Kurtosis was significantly higher in the HCC group compared to the non-HCC group (1.19±1.15 versus 0.43±0.83; p=0.0006). Skewness was significantly lower in the HCC group than in the non-HCC group (1.19±1.15 versus 0.43±0.83; p=0.0152). In a multivariate logistic analysis, the category showing lower-than-the-median (-0.1185) skewness and higher-than-the-median (0.547) kurtosis was significantly and independently associated with HCC development (p=0.0031).. The heterogeneity of NLP in the hepatobiliary phase on gadoxetic acid enhanced MRI may reflect the development of HCC.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Carcinoma, Hepatocellular; Chronic Disease; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

To compare the conspicuity of hepatocellular carcinoma (HCC) on hepatobiliary phase of gadoxetate disodium-enhanced vs. delayed phase of gadodiamide-enhanced MR images, relative to liver function.. We retrospectively identified 86 patients with newly diagnosed HCC between 2010 and 2013 and recorded the severity of liver disease by Child-Pugh class (CPC). 38 patients had gadodiamide-enhanced 5-min delayed and 48 had gadoxetate disodium-enhanced 20-min delayed hepatobiliary MR images. The conspicuity of 86 HCCs (mean size, 2.7 cm) was graded visually on a 3-point scale and quantified by liver-to-tumor contrast ratios (LTC). The relative liver parenchymal enhancement (RPE) was measured. For different CPCs, we compared the conspicuity of HCC and RPE between gadodiamide and gadoxetate.. In patients with CPC A, the visual conspicuity and LTC of the 27 HCCs imaged with gadodiamide were significantly lower than those of the 38 HCCs with gadoxetate (P < 0.01, <0.01, respectively). RPE was lower in gadodiamide scans than gadoxetate scans (P < 0.01). Conversely, in patients with CPC B and C, HCCs appeared more frequently as definite hypointensity when imaged with gadodiamide (72.7%, 8/11) than gadoxetate (20%, 2/10, P = 0.03). LTC (mean 18.1 vs. 7.5, P = 0.04) and RPE (mean 75.5 vs. 45.4, P = 0.04) was significantly higher in the gadodiamide than gadoxetate scans.. In patients with compromised liver function, hypointensity of HCC is more conspicuous in the gadodiamide delayed phase than the gadoxetate hepatobiliary phase. This likely reflects the high extracellular accumulation of gadodiamide and poor hepatocyte uptake of gadoxetate in patients with compromised liver function.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

The effectiveness of treatment decisions and economic outcomes of using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) were compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and multi-detector computed tomography (MDCT) as initial procedures in patients with suspected hepatocellular carcinoma (HCC) in South Korea and Thailand.. A decision-tree model simulated the clinical pathway for patients with suspected HCC from the first imaging procedure to a confirmed treatment decision. Input data (probabilities and resource consumptions) were estimated and validated by clinical experts. Costs for diagnostic alternatives and related treatment options were derived from published sources, taking into account both payer's and hospital's perspectives.. All experts from Korea and Thailand agreed that Gd-EOB-DTPA-MRI yields the highest diagnostic certainty and minimizes the need for additional confirmatory diagnostic procedures in HCC. In Korea, from the payer's perspective, total cost was USD $3087/patient to reach a confirmed treatment decision using Gd-EOB-DTPA-MRI (vs $3205/patient for MDCT and $3403/patient for ECCM-MRI). From the hospital's perspective, Gd-EOB-DTPA-MRI incurred the lowest cost ($2289/patient vs $2320/patient and $2528/patient, respectively). In Thailand, Gd-EOB-DTPA-MRI was the least costly alternative for the payer ($702/patient vs $931/patient for MDCT and $873/patient for ECCM-MRI). From the hospital's perspective, costs were $1106/patient, $1178/patient, and $1087/patient for Gd-EOB-DTPA-MRI, MDCT, and ECCM-MRI, respectively.. Gd-EOB-DTPA-MRI as an initial imaging procedure in patients with suspected HCC provides better diagnostic certainty and relevant statutory health insurance cost savings in Thailand and Korea, compared with ECCM-MRI and MDCT.

Topics: Carcinoma, Hepatocellular; Computer Simulation; Contrast Media; Cost-Benefit Analysis; Decision Support Techniques; Delphi Technique; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Models, Econometric; Republic of Korea; Sensitivity and Specificity; Thailand; Tomography, X-Ray Computed

The purpose of the study is to compare the MR-imaging features of hepatocellular carcinoma (HCC) capsule appearance on gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging, using imaging-based presumptive diagnosis of HCC as the reference standard.. Gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging of 51 patients with 71 HCCs were retrospectively reviewed. Three readers graded in consensus, using a five-point scale, the presence (score 4-5) of capsule appearance on images obtained during T1-weighted GRE portal venous phase (PVP), 3-min phase, and hepatobiliary phase (HBP). The Fisher's exact test and the t student unpaired test were performed.. A hyperintense capsule appearance was present either on PVP or 3-min phase in 11/46 and in 24/25 HCCs imaged with gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging, respectively (24% vs. 96% p < 0.001). A hypointense capsule appearance was present on HBP in 8/46 and 0/22 HCCs evaluated with gadoxetic acid and gadobenate dimeglumine-enhanced MR imaging, respectively (17% vs. 0% p = 0.046). A capsule appearance was detected either on PVP, 3-min phase, or HBP in 17/46 (37%) HCCs after gadoxetic acid injection and in 24/25 (96%) HCCs after gadobenate dimeglumine injection (p < 0.001).. A capsule appearance was more frequently seen on gadobenate dimeglumine-enhanced MR imaging when compared to gadoxetic acid-enhanced MR imaging.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To assess the diagnostic performance of magnetic resonance imaging (MRI) with gadoxetic acid in the identification of hepatocellular carcinoma (HCC) nodules by comparison with histological findings.. In a cohort of patients suffering from cirrhosis of various etiologies (chronic hepatitis C virus (HCV) or hepatitis B virus (HBV), alcohol abuse, cryptogenic forms), we selected 17 patients affected by HCC who were eligible for liver transplantation on the basis of a computed-tomography (CT) total-body examination. Such patients also underwent an MRI examination under basal conditions, and with four dynamic phases, as well as a hepatobiliary phase acquired after at least 20 min and recognized by the excretion of contrast agent into the bile duct, following intravenous administration of 0.05 mol/kg of gadoxetic acid (gadoxetate disodium, Primovist(®); Bayer, Osaka, Japan). The MRI images were then evaluated in a double-blinded experimental setup by two radiologists experienced in imaging of the liver. The diagnosis of HCC was made in the presence of nodular lesions that showed typical or atypical enhancement patterns. The liver was subsequently explanted (on average 47.4 days after MRI evaluation), dissected into 1-cm samples, and histologically evaluated according to the classification of Edmondson-Steiner.. At the histopathological examination, 46 nodules were identified, on average 2.7 nodules for each patient. Of these, 37 were hepatocellular carcinomas, 3 were characterized by histologically unrecognizable complete necrosis, and 6 showed high-grade dysplasia. MRI with hepatospecific contrast medium showed inter-observer average values of sensitivity, specificity, and diagnostic accuracy of 94.6, 90, and 93.6 %, respectively. In one case, a nodule was not identified by MRI with gadoxetic acid, even in the hepatospecific phase (false negative (FN)). This result could be implicated to the long time interval between the analysis and the explant (88 days). In another case, there was an overdiagnosis of a HCC with a typical nodular pattern (false positive (FP)), but which most likely should have been attributed to a previous echinococcus cyst. MRI analysis, in combination with the study of the hepatobiliary phase, also showed a greater sensitivity, the same specificity, and a greater diagnostic accuracy compared to MRI evaluated only in the dynamic phases (with an average percentage between the two operators, respectively, of 75.7, 90, and 78 %).. MRI with gadoxetic acid shows a diagnostic accuracy superior to contrast-enhanced MRI, allowing for the diagnosis of additional lesions, and it could be considered as an imaging method to carry out a more appropriate management of waiting lists for liver transplants.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Preoperative Care; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Waiting Lists

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

The purpose of this study is to describe the imaging characteristics of hepatic angiomyolipoma (AML) on gadoxetic acid-enhanced MRI and to identify imaging features that are helpful for differentiating it from hepatocellular carcinoma (HCC) in a noncirrhotic liver.. We retrospectively identified 18 patients with pathologically proven hepatic AMLs who had undergone gadoxetic acid-enhanced MRI between 2008 and 2012. We randomly chose 36 patients with noncirrhotic liver who had a single HCC diagnosed radiologically during the same period. None of the HCCs was of the fibrolamellar variant. Two readers reviewed images in consensus to assess the lesion size, the presence of fat, signal intensity characteristics, enhancement profile, early draining veins, intratumoral vessels, and tumor capsules. The tumor-to-liver contrast ratios were measured. These features and the measurements were compared between the two groups.. AMLs are more commonly found in women (83.3%), whereas HCCs are more common in men (75%) (p < 0.01). The size of AMLs (3.4 cm) and HCCs (4.3 cm) did not differ significantly. Intratumoral fat was identified in both AMLs (50.0%) and HCCs (30.6%). The dynamic enhancement profile (arterial hypervascularity and hypointensity during the delayed phase) was similar qualitatively and quantitatively except for the portal phase. AMLs and HCCs differed significantly with regard to isointensity on DWI (16.7% vs 0.0%; p = 0.03), washout in the portal phase (61.1% vs 88.9%; p = 0.03), early draining veins (27.8% vs 2.8%; p = 0.01), intratumoral vessels (55.6% vs 22.2%; p = 0.03), and presence of capsule (11.1% vs 50.0%; p = 0.01).. On gadoxetic acid-enhanced MRI of noncirrhotic liver, AML is often indistinguishable from HCC on the basis of the enhancement profiles. Female sex and some imaging features including DWI could facilitate the differentiation.

Topics: Adult; Aged; Angiomyolipoma; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

Incidental detection of nonenhancing tumors during imaging studies for patients with classical hepatocellular carcinoma is not unusual. These tumors are considered to have a high potential of malignant transformation. The aim of this study was to clarify the natural history of such tumors.. In 93 patients who underwent liver resection for hepatocellular carcinoma, 138 nonenhancing or enhancing nodules without washout were detected during dynamic computed tomography and observed without further treatments. We subsequently compared the cumulative occurrence of new hepatocellular carcinomas to that of the malignant transformation of these lesions. We additionally compared the appearance of new hepatocellular carcinomas between the patients with (n = 93) and without (n = 782) nonenhancing lesions or enhancing lesions without washout.. After a median follow-up period of 0.7 years (range, 0.2-6.8), the median intervals from resection to the appearance of new classical hepatocellular carcinoma and malignant transformation of nonenhancing lesions or enhancing lesions without washout were 1.6 years (95% confidence interval, 1.2-1.9) and 2.3 years (1.9-6.8 years; P = .002), respectively. On the other hand, the median intervals from resection to the appearance of new lesions in patients with and without nonenhancing lesions or enhancing lesions without washout were 1.6 years (95% confidence interval, 1.2-1.9) and 2.1 years (1.9-2.1 years; P = .031), respectively.. During the natural history of nonenhancing lesions and enhancing lesions without washout that coexist with hepatocellular carcinoma, new lesions often develop prior to the malignant transformation of these lesions. This should be considered a risk factor for the appearance of new hepatocellular carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Incidental Findings; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Multimodal Imaging

We analyzed the incidence of change of Barcelona Clinic Liver Cancer (BCLC) stage after add-on Primovist-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) patients with Barcelona Clinic Liver Cancer stage 0 or A as determined by liver dynamic computed tomography (LDCT).. A total of 166 patients enrolled prospectively between August 2012 and December 2014 were retrospectively analyzed. The rates of stage change after Primovist-enhanced MRI and the treatment finally adopted in patients with stage change were evaluated.. Of the 166 patients, 24 (18.6%) had truly new HCCs. Forty-six (27.7%) and 120 (72.3%) patients had BCLC stages 0 and A, respectively, before Primovist-enhanced MRI, but after Primovist-enhanced MRI, 28 (16.9%), 134 (80.7%), and 4 (2.4%) patients had BCLC stages 0, A, and B, respectively. Tumor stage changed in 22 (13.3%) patients, from 0 to A (18, 39.1%) or A to B (4, 3.3%).. Add-on Primovist-enhanced magnetic resonance imaging can change BCLC stage with 13.3% in patients with BCLC 0 or A staged HCC, as determined by LDCT. J. Surg. Oncol. 2016;114:106-111. © 2016 Wiley Periodicals, Inc.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Clinical Decision-Making; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Humans; Intraoperative Care; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; Tomography, X-Ray Computed; Young Adult

Poor differentiation and microvascular invasion are indicators of poor outcome after hepatectomy for patients with small hepatocellular carcinoma (HCC).. We investigated whether gadoxetic acid-enhanced and diffusion-weighted magnetic resonance imaging (MRI) could predict these factors before hepatectomy.. Between July 2008 and April 2012, 75 patients who underwent hepatectomy for small HCCs (diameter: ≤3cm, tumor number: ≤3) were consecutively enrolled. In gadoxetic acid-enhanced MRI, the signal intensity in the tumor was corrected to that in the paraspinous muscles, and the relative enhancement was calculated. In diffusion-weighted imaging, we measured the apparent diffusion coefficient (ADC). We then investigated the correlations between relative enhancement or ADC and histological grade, microvascular invasion and recurrence-free survival.. Poorly differentiated HCCs showed significantly lower ADC than well-differentiated and moderately differentiated HCCs. There was no significant difference in the hepatobiliary phase. Only ADC was an independent predictor of microvascular invasion, and the best cut-off point of its prediction was 1.175×10(-3)mm(2)/s. Additionally, the recurrence-free survival was significantly shorter in low-ADC group than in high-ADC group.. ADC is useful for predicting poorly differentiated HCCs and microvascular invasion, and low ADC is associated with increased recurrence risk for small HCCs after hepatectomy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hepatectomy; Humans; Japan; Kaplan-Meier Estimate; Liver Neoplasms; Logistic Models; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; ROC Curve

This study aimed to determine whether the predicted remnant liver function on dynamic hepatocyte-specific contrast media-enhanced magnetic resonance (DHCE-MR) imaging correlates with the results of the indocyanin green retention test (ICG R. This prospective multicenter study was approved by the Institutional Review Boards of each hospital. Informed consents were obtained from all. DHCE-MRI and ICG R. Predicted remnant HEFml showed a negative correlation with post-treatment ICG R. DHCE-MRI using Gd-EOB-DTPA was able to provide both global and segmental liver function information, and post-treatment remnant liver function predicted on pre-treatment DHCE-MRI showed a significant negative correlation with post-treatment ICG R. Post-treatment liver function could be predicted at pre-treatment DHCE-MRI. Liver function was heterogeneous among the liver segments. Liver anatomy, disease extent, and underlying liver function can be assessed in one DHCE-MRI examination.. ClinicalTrials.gov number, NCT01490203.

Topics: Carcinoma, Hepatocellular; Gadolinium DTPA; Humans; Liver; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Prospective Studies

Variable degrees of differentiation in hepatocellular carcinoma(HCC)under Edmondson-Steiner grading system has been proven to be an independent prognostic indicator for HCC. Up till now, there has been no effective radiological method that can reveal the degree of differentiation in HCC before surgery. This paper aims to evaluate the use of Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging combined with T1 mapping for the diagnosis of HCC and assessing its degree of differentiation.. Forty-four patients with 53 pathologically proven HCC had undergone Gd-EOB-DTPA enhanced MRI with T1 mapping before surgery. Out of the 53 lesions,13 were grade I, 27 were gradeII, and 13 were grade III. The T1 values of each lesion were measured before and at 20 min after Gd-EOB-DTPA administration (T1p and T1e). The absolute reduction in T1 value (T1d) and the percentage reduction (T1d %) were calculated. The one-way ANOVA and Pearson correlation were used for comparisons between the T1 mapping values.. The T1d and T1d % of grade I, II and III of HCC was 660.5 ± 422.8ms、295.0 ± 99.6ms、276.2 ± 95.0ms and 54.0 ± 12.2 %、31.5 ± 6.9 %、27.7 ± 6.7 % respectively. The differences between grade Iand II, grade Iand III were statistically significant (p < 0.05), but there was no statically significant difference between grade II and III. The T1d % was the best marker for grading of HCC, with a Spearman correlation coefficient of -0.676.. T1 mapping before and after Gd-EOB-DTPA administration can predict degree of differentiation in HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cell Differentiation; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Retrospective Studies

Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Hepatocellular carcinoma is the most common primary hepatic tumor in dogs and is amenable to surgical resection in many cases. Unfortunately, overlap of sonographic findings between benign and malignant hepatic lesions typically requires more invasive diagnostic tests to be performed (e.g., biopsy for histopathology). The availability of a noninvasive diagnostic test to identify hepatocellular carcinoma would be beneficial. The use of a liver-specific magnetic resonance imaging (MRI) contrast agent such as gadoxetate disodium (Gd-EOB-DTPA; Eovist® or Primovist®) has improved lesion detection in human patients. In this descriptive study, gadoxetate disodium contrast-enhanced MRI characteristics in dogs were evaluated in seven dogs (total of eight lesions). The imaging characteristics were variable with the exception of all lesions being hypointense to surrounding normal hepatic parenchyma on 3D T1-weighted gradient recalled echo images at all postcontrast time points. All lesions displayed signal intensity ratios less than 1, consistent with retained but impaired hepatocyte function. Hepatic lesions not identified on previous imaging were found in 3/7 patients which may affect surgical planning. In two patients, several hepatic nodules were identified during surgery which had not been visualized on MRI and were found to be benign on histopathology. This descriptive study reports the MRI characteristics of hepatocellular carcinoma in dogs using the liver-specific contrast agent gadoxetate disodium.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Dog Diseases; Dogs; Female; Gadolinium DTPA; Imaging, Three-Dimensional; Liver Neoplasms; Magnetic Resonance Imaging; Male

To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with that of computed tomography (CT) during hepatic arteriography and arterial portography (CT HA/AP) for detecting hepatocellular carcinoma (HCC) from small hypervascular nodules.This retrospective study included 38 patients with 131 hypervascular nodules (≤2 cm) who had underwent MRI and CT HA/AP within a 2-week interval. Two observers analyzed MRI while other 2 observers analyzed CT HA/AP. Thereafter, MRI observers reviewed the CT HA/AP and magnetic resonance (MR) images again using both modalities. HCC was diagnosed by pathologic or imaging studies according to American Association for the Study of Liver Diseases (AASLD) criteria. Alternative free-response receiver operating characteristic (ROC) analysis was performed on a lesion-by-lesion basis. Diagnostic accuracy (area under the ROC curve [Az]), sensitivity, specificity, and positive and negative predictive values were calculated.The pooled Az was significantly higher for the combined modalities (0.946) than for MRI alone (0.9, P = 0.004), and for MRI than for CT HA/AP alone (0.827, P = 0.0154). Subgroup analysis for HCC ≤1 cm showed the sensitivity of the combined modalities (79.4%) was significantly higher than for MRI (52.9%) and CT HA/AP alone (50%) (both, P < 0.005). The specificity of the combined modalities was not different from MRI alone (98.8% vs. 97.3%, P = 0.5), but was significantly higher than for CT HA/AP alone (98.8% vs. 92.5%, P = 0.022).Hypervascular HCCs >1 to 2 cm can be diagnosed sufficiently by MRI. The combined modalities increased the diagnostic accuracy of HCCs ≤1 cm, compared with MRI or CT HA/AP alone.

Topics: Aged; Aged, 80 and over; Angiography; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Veins; Humans; Liver Circulation; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portography; Predictive Value of Tests; Retrospective Studies; ROC Curve; Sensitivity and Specificity

The characterization of small lesions in cirrhotic patients is extremely difficult due to the overlap of imaging features among different entities in the step-way of the hepatocarcinogenesis. The aim of our study was to evaluate the role of gadoxetic-acid MRI in the differentiation of small (≤2 cm) well-differentiated hepatocellular carcinomas from regenerative and dysplastic nodules.. Seventy-three cirrhotic patients, with 118 focal liver lesions (≤2 cm) were prospectively recruited. MRI examination was performed with a 3T magnet and the study protocol included T1 - and T2-weighted pre-contrast sequences and T1 -weighted gadoxetic-acid enhanced post-contrast sequences obtained during the arterial, venous, late dynamic and hepatobiliary phases. All lesions were pathologically confirmed. Two radiologists blinded to clinical and pathological information evaluated two imaging datasets; another radiologist analysed the signal intensity characteristics of each lesion. Sensitivity, specificity and diagnostic accuracy were considered for statistical analysis.. Good agreement was reported between the two readers (κ 0.70). Both readers reported a significantly improved sensitivity (57.7 and 66.2 vs 74.6 and 83.1) and diagnostic accuracy (0.717 and 0.778 vs 0.843 and 0.901) with the adjunction of the hepatobiliary phase 57.7 vs 74.6 and 66.2 vs 83.1 (p ≤ 0.04).. Gadoxetic-acid MRI is a reliable tool for the characterization of HCC and lesions at high risk to further develop.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Observer Variation; Prospective Studies; Sensitivity and Specificity; Tumor Burden; Young Adult

Proton beam therapy (PBT) achieves good local control for hepatocellular carcinoma (HCC), and toxicity tends to be lower than for photon radiotherapy. Focal liver parenchymal damage in radiotherapy is described as the focal liver reaction (FLR); the threshold doses (TDs) for FLR in the background liver have been analyzed in stereotactic ablative body radiotherapy and brachytherapy. To develop a safer approach for PBT, both TD and liver volume changes are considered clinically important in predicting the extent of damage before treatment, and subsequently in reducing background liver damage. We investigated appearance time, TDs and volume changes regarding FLR after PBT for HCC.. Patients who were treated using PBT and were followed up using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) after PBT were enrolled. Sixty-eight lesions in 58 patients were eligible for analysis. MRI was acquired at the end of treatment, and at 1, 2, 3 and 6 months after PBT. We defined the FLR as a clearly depicted hypointense area on the hepatobiliary phase of Gd-EOB-DTPA MRI, and we monitored TDs and volume changes in the FLR area and the residual liver outside of the FLR area.. FLR was depicted in all lesions at 3 months after PBT. In FLR expressed as the 2-Gy equivalent dose (α/β = 3 Gy), TDs did not differ significantly (27.0±6.4 CGE [10 fractions [Fr] vs. 30.5±7.3 CGE [20 Fr]). There were also no correlations between the TDs and clinical factors, and no significant differences between Child-Pugh A and B scores. The volume of the FLR area decreased and the residual liver volume increased, particularly during the initial 3 months.. This study established the FLR dose for liver with HCC, which might be useful in the prediction of remnant liver volume for PBT.

Topics: Carcinoma, Hepatocellular; Follow-Up Studies; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Proton Therapy; Retrospective Studies

To compare 10-minute (min) delayed hepatocyte phase imaging (HPI) using a 30° flip angle (FA) (10m-FA30) and 20-min delayed HPI using a 10° FA (20m-FA10) or 30° FA (20m-FA30) in Gd-EOB-DTPA-enhanced MRI in patients with chronic hepatitis or cirrhosis, in terms of lesion-to-liver contrast-to-noise ratio (CNR) for hepatocellular carcinoma (HCC) and detection sensitivity for focal hepatic lesions (FHLs).. One hundred and four patients with 168 HCCs and 55 benign FHLs who underwent Gd-EOB-DTPA-enhanced MRI with 10m-FA30, 20m-FA10, and 20m-FA30 were enrolled. Patients were divided into two groups according to the Child-Pugh classification: group A with chronic hepatitis or Child-Pugh A cirrhosis and group B with Child-Pugh B or C cirrhosis. Lesion-to-liver CNR for HCCs was compared between 10m-FA30 and 20m-FA10 or 20m-FA30 for each group. The presence of FHLs was evaluated using a four-point scale by two independent reviewers, and the detection sensitivity was analyzed.. In group A, the CNR for HCCs (n = 86) on 10m-FA30 (165.8 ± 99.7) was significantly higher than that on 20m-FA10 (113.4 ± 71.4) and lower than that of 20m-FA30 (210.2 ± 129.3). However, there was no significant difference in the sensitivity of FHL detection between 10m-FA30 (mean 95.0% for two reviewers) and 20m-FA10 (94.7%) or 20m-FA30 (94.7%). In group B, the CNR (54.0 ± 36.4) for HCCs (n = 57) and the sensitivity (94.2%) of FHL detection for 10m-FA30 were significantly higher than those for 20m-FA10 (41.8 ± 36.4 and 80.8%, respectively) and were not different from those for 20m-FA30 (62.7 ± 44.4 and 93.3%, respectively).. The diagnostic performance of 10m-FA30 was similar to or higher than 20m-FA10 or 20m-FA30 in both groups A and B. This finding indicates that 10m-FA30 could replace 20-min delayed HPI regardless of patient liver function and reduce the delay time by 10 minutes.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatitis, Chronic; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

This study aimed to investigate the utility of gadoxetic acid-enhanced magnetic resonance imaging (Gd-MRI) in surveillance for recurrent hepatocellular carcinoma (HCC) after hepatectomy.This retrospective study analyzed 147 patients who underwent surveillance with alternating multidetector computed tomography (MDCT) and Gd-MRI after hepatectomy for HCC. The patients were followed-up every 3 months during the first 2 years, and every 6 months thereafter. At each visit, MDCT was performed but once a year (every 12 months), Gd-MRI was performed instead of MDCT. Each HCC recurrence detection rate of MDCT and Gd-MRI was evaluated, and recurrent HCC characteristics were compared according to the detection test.A total of 63 patients had recurrent HCC. Among them, 9 were detected with Gd-MRI and 29 with MDCT. The baseline characteristics of patients with recurrent HCC showed no significant differences according to the detection test. The HCC recurrence detection rate of Gd-MRI and MDCT was 4.8% (9/180) and 4.3% (29/580), respectively, on the per test basis (P = 0.764). However, in the population with a follow-up period of ≥12 months, the detection rate of Gd-MRI and MDCT was 4.3% (7/150) and 1.5% (19/400), respectively (P = 0.035). Recurrent HCCs detected with Gd-MRI were smaller than those detected with MDCT (tumor size < 2 cm, 100% vs 65.5%, P = 0.040).Our data suggest that Gd-MRI has advantages in detecting recurrent HCC after hepatectomy. Surveillance with alternating MDCT and Gd-MRI may identify more recurrent HCC in an early stage than with MDCT alone in patients who received hepatectomy for HCC.

Topics: Carcinoma, Hepatocellular; Early Detection of Cancer; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Time Factors

To evaluate short-term test-retest and interobserver reproducibility of IVIM (intravoxel incoherent motion) diffusion parameters and ADC (apparent diffusion coefficient) of hepatocellular carcinoma (HCC) and liver parenchyma at 3.0T.. In this prospective Institutional Review Board (IRB)-approved study, 11 patients were scanned twice using a free-breathing single-shot echo-planar-imaging, diffusion-weighted imaging (DWI) sequence using 4 b values (b = 0, 50, 500, 1000 s/mm(2)) and IVIM DWI using 16 b values (0-800 s/mm(2)) at 3.0T. IVIM parameters (D: true diffusion coefficient, D*: pseudodiffusion coefficient, PF: perfusion fraction) and ADC (using 4 b and 16 b) were calculated. Short-term test-retest and interobserver reproducibility of IVIM parameters and ADC were assessed by measuring correlation coefficient, coefficient of variation (CV), and Bland-Altman limits of agreements (BA-LA).. Fifteen HCCs were assessed in 10 patients. Reproducibility of IVIM metrics in HCC was poor for D* and PF (mean CV 60.6% and 37.3%, BA-LA: -161.6% to 135.3% and -66.2% to 101.0%, for D* and PF, respectively), good for D and ADC (CV 19.7% and <16%, BA-LA -57.4% to 36.3% and -38.2 to 34.1%, for D and ADC, respectively). Interobserver reproducibility was on the same order of test-retest reproducibility except for PF in HCC. Reproducibility of diffusion parameters was better in liver parenchyma compared to HCC.. Poor reproducibility of D*/PF and good reproducibility for D/ADC were observed in HCC and liver parenchyma. These findings may have implications for trials using DWI in HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Echo-Planar Imaging; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Male; Meglumine; Middle Aged; Motion; Observer Variation; Organometallic Compounds; Prospective Studies; Reproducibility of Results

The macroscopic type of hepatocellular carcinoma (HCC) is a predictor of prognosis. We clarified the diagnostic value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in the macroscopic classification of nodular hepatocellular carcinoma (HCC) as compared to angiography-assisted computed tomography (CT).. A total of 71 surgically resected nodular HCCs with a maximum diameter of ≤5 cm were investigated. HCCs were evaluated preoperatively using Gd-EOB-DTPA-enhanced MRI and angiography-assisted CT. HCCs were pathologically classified as simple nodular (SN), SN with extranodular growth (SN-EG), or confluent multinodular (CMN). SN-EG and CMN were grouped as non-SN. Five readers independently reviewed the images using a five-point scale. We examined the accuracy of both imaging modalities in differentiating between SN and non-SN HCC.. Overall, the area under the receiver operating characteristic curve (A z ) for the diagnosis of non-SN did not differ between Gd-EOB-DTPA-enhanced MRI and angiography-assisted CT [0.879 (95% confidence interval (CI), 0.779-0.937) and 0.845 (95% CI, 0.723-0.919), respectively]. For HCCs >2 cm, the A z for Gd-EOB-DTPA-enhanced MRI was greater than 0.9. The sensitivity, specificity, and accuracy of Gd-EOB-DTPA-enhanced MRI for identifying non-SN were equal to or higher than values with angiography-assisted CT in all three categories (all tumors, ≤2 cm, and >2 cm), but the differences were not statistically significant.. Using Gd-EOB-DTPA-enhanced MRI to assess the macroscopic findings in nodular HCC was equal or superior to using angiography-assisted CT.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

This study was designed to assess feasibility of US-CT/MRI fusion-guided ablation in liver tumors undetectable with US.. From 2002 to 2012, 295 tumors (162 HCCs and 133 metastases; mean diameter 1.3 ± 0.6 cm, range 0.5-2.5 cm) detectable on contrast-enhanced CT/MRI, but completely undetectable with unenhanced US and either totally undetectable or incompletely conspicuous with contrast-enhanced US (CEUS), were treated in 215 sessions using either internally cooled radiofrequency or microwave with standard ablation protocols, guided by an image fusion system (Virtual Navigation System, Esaote S.p.A., Genova, Italy) that combines US with CT/ MRI images. Correct targeting and successful ablation of tumor were verified after 24 hours with CT or MRI.. A total of 282 of 295 (95.6 %) tumors were correctly targeted with successful ablation achieved in 266 of 295 (90.2 %). Sixteen of 295 (5.4 %) tumors were correctly targeted, but unsuccessfully ablated, and 13 of 295 (4.4 %) tumors were unsuccessfully ablated due to inaccurate targeting. There were no perioperative deaths. Major complications were observed in 2 of the 215 treatments sessions (0.9 %).. Real-time virtual navigation system with US-CT/MRI fusion imaging is precise for targeting and achieving successful ablation of target tumors undetectable with US alone. Therefore, a larger population could benefit from ultrasound guided ablation procedures.

Topics: Aged; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging, Interventional; Male; Radiography, Interventional; Treatment Outcome; Ultrasonography, Interventional

With the advent of 3-T magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI), many subcentimeter hepatic nodules have been frequently detected in patients with chronic liver disease, and the prediction of subcentimeter nodules that progress to hypervascular hepatocellular carcinoma (HCC) is important.. To reveal the imaging features of subcentimeter hypointense nodules on gadoxetic acid-enhanced hepatobiliary phase MR images in patients with chronic liver disease that may be related with progression to hypervascular HCC.. This study included 109 patients with 135 subcentimeter hypointense nodules (103 hepatocellular carcinomas [HCCs] and 32 benign nodules) on gadoxetic acid-enhanced hepatobiliary phase. For each subcentimeter nodule, the following imaging features were analyzed: (i) hyperintensity on T2-weighted (T2W) image or DWI; (ii) arterial hypervascularization; and (iii) hypointensity on a portal or late phase. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of those imaging features for predicting subcentimeter nodules that progressed to hypervascular HCC were evaluated. Volume doubling time (VDT) of subcentimeter nodules that progressed to hypervascular HCC was compared to that of growing benign nodules.. Arterial hypervascularization with washout yielded the highest specificity (90.6%) and PPV (95.4%) for prediction of subcentimeter nodules that progressed to hypervascular HCC. Combining hyperintensity on T2W image or DWI and arterial hypervascularization with washout did not raise the specificity (90.6%) for prediction of subcentimeter nodules that progressed to hypervascular HCC. Mean VDT (112.2 ± 106.3 days) of subcentimeter nodules that progressed to hypervascular HCC during follow-up was significantly shorter than those of benign subcentimeter nodules (1258 ± 766.5 days, P < 0.001).. Arterial hypervascularization with washout in subcentimeter hypointense nodules on gadoxetic acid-enhanced hepatobiliary phase in patients with chronic liver disease is strongly related with progression to hypervascular HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Risk Factors; Sensitivity and Specificity

To assess the impact of preoperative evaluation by gadoxetic acid-enhanced magnetic resonance imaging (MRI) on early recurrence outcomes after hepatocellular carcinoma (HCC) resection.. The retrospective study included two groups of Child-Pugh class A patients who underwent curative liver resection for a single HCC; in one group the HCC was identified by dynamic computed tomography (CT) and gadoxetic acid-enhanced MRI (n = 174; MRI group); in the other by dynamic CT only (n = 416; non-MRI group). We compared the two groups with respect to recurrence-free survival after propensity score matching (162 pairs).. In the matched cohorts, disease-free survival rates for overall and intrahepatic recurrence were 92.6% and 91.9% at 1 year and 78.3% and 79.4% at 2 years, respectively, for the MRI group versus 82.7% and 82.7% at 1 year and 67.2% and 70.4% at 2 years, respectively, for the non-MRI group (P < 0.05). Multivariate Cox analyses revealed that the MRI group was independently superior to the non-MRI group in terms of risk of overall and intrahepatic recurrence at 1 and 2 years in the pooled cohort (P < 0.05).. Gadoxetic acid-enhanced MRI evaluation is more useful than dynamic CT for identifying good surgical candidates at low risk of early recurrence following hepatic resection for HCC. J. Magn. Reson. Imaging 2015;41:1115-1123. © 2014 Wiley Periodicals, Inc.

Topics: Carcinoma, Hepatocellular; Contrast Media; Disease-Free Survival; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Preoperative Care; Prevalence; Prognosis; Reproducibility of Results; Republic of Korea; Retrospective Studies; Risk Factors; Sensitivity and Specificity

To evaluate Gd-EOB-DTPA-enhanced magnetic resonance (MR) performance during dynamic (DYN) phases, hepatobiliary (HB) phase and diffusion-weighted imaging (DWI) compared with pathological findings in patients undergoing orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) associated with different conditions, such as stage of chronic liver disease, histological grading, nodule size, and occurrence of previous treatments.. Retrospective analysis of 64 nodules reported as HCC at pathological analysis on 28 explanted livers, examined about 3 months before OLT using a 1.5 T device and 16 channels array after intravenous GD-EOB-DTPA injection. Lesions features and hepatic functional values were recorded for each patient. Two radiologists performed in consensus the analysis of nodules on DYN, HB, and DWI. MR findings were compared with those of pathological anatomy. Diagnostic indicators were calculated for each technique.. DYN and HB showed no statistically significant difference in sensitivity (88% and 98%, respectively), diagnostic accuracy (90.6% and 99.9%), and specificity (both 100%), for all Child-Pugh scores, gradings, sizes, and presence or absence of previous treatments. DWI had a statistically significant lower sensitivity compared to DYN (p = 0.001) and HB (p < 0.0001); its sensitivity was significantly inferior for Child-Pugh Class B nodules than for Child-Pugh Class A ones (p = 0.00005). DWI sensitivity presented a significant increase (p = 0.03) with grading and presence of previous treatments (p = 0.0006). ADC values showed no statistically significant changes with Child-Pugh score, grading and nodules size; statistically significant increase was instead found for treated vs. untreated nodules (p = 0.016).. In a multiparametric HCC MRI assessment, DYN and HB play the leading role, with DWI faring acceptably well for Child-Pugh Class A nodules and treated ones.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Postoperative Period; Preoperative Period; Retrospective Studies; Sensitivity and Specificity

To identify imaging characteristics that differentiate small (≤2 cm) HCCs from small (≤2 cm) benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted (DW) magnetic resonance (MR) images.. On gadoxetic acid-enhanced and DW MR images, we analysed signal intensity of 222 small HCCs and 61 benign nodules (diameter, 0.5-2 cm) at each sequence and rim enhancement during portal or equilibrium phases. Univariate and multivariate logistic regression analyses identified predictors of HCC. Combinations of significant MR findings in multivariate analysis were compared with American Association for the Study of Liver Disease (AASLD) practice guidelines.. In multivariate analysis, arterial enhancement (adjusted odds ratio [aOR], 8.6), T2 hyperintensity (aOR, 5.8), and hyperintensity on DW images (aOR, 3.8) were significant for differentiating small HCCs from benign nodules (p ≤ 0.004). When two or all three findings were applied as diagnostic criteria for differentiating small HCCs from benign nodules, sensitivity and accuracy were significantly higher compared with AASLD practice guidelines (91% vs. 78% and 89% vs. 81%, respectively; each p < 0.0001).. On gadoxetic acid-enhanced MR imaging, arterial enhancement and hyperintensity on T2-weighted and DW MR images are helpful for differentiating small HCCs from benign nodules in liver cirrhosis.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Sensitivity and Specificity

To assess the feasibility of fusion of pre- and post-ablation gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) to evaluate the effects of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), compared with similarly fused CT images. This retrospective study included 67 patients with 92 HCCs treated with RFA. Fusion images of pre- and post-RFA dynamic CT, and pre- and post-RFA Gd-EOB-DTPA-MRI were created, using a rigid registration method. The minimal ablative margin measured on fusion imaging was categorized into three groups: (1) tumor protruding outside the ablation zone boundary, (2) ablative margin 0-<5.0 mm beyond the tumor boundary, and (3) ablative margin ≥5.0 mm beyond the tumor boundary. The categorization of minimal ablative margins was compared between CT and MR fusion images.. In 57 (62.0%) HCCs, treatment evaluation was possible both on CT and MR fusion images, and the overall agreement between them for the categorization of minimal ablative margin was good (κ coefficient = 0.676, P < 0.01). MR fusion imaging enabled treatment evaluation in a significantly larger number of HCCs than CT fusion imaging (86/92 [93.5%] vs. 62/92 [67.4%], P < 0.05).. Fusion of pre- and post-ablation Gd-EOB-DTPA-MRI is feasible for treatment evaluation after RFA. It may enable accurate treatment evaluation in cases where CT fusion imaging is not helpful.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome

To clarify the relationship between the biological behaviour of hepatocellular carcinomas (HCCs) and their signal intensity in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging with a special focus on the signal heterogeneity.. A total of 68 patients with 70 pathologically proven HCCs were enrolled. On the basis of the signal intensity in the hepatobiliary phase, the lesions were classified into three groups: group 1, homogeneous hypointensity (n = 44); group 2, heterogeneous hyperintensity (n = 20); and group 3, homogeneous hyperintensity (n = 6). The clinicopathological findings were compared among the three groups.. The tumour size and the serum level of protein induced by vitamin K absence or antagonist-II (PIVKA-II) were significantly higher in group 2 compared to group 1 (p = 0.0155, p = 0.0215, respectively) and compared to group 3 (p = 0.0330, p = 0.0220, respectively). The organic anion transporting polypeptide 8 (OATP8) expression in group 2 and group 3 was significantly higher than in group 1 (p < 0.0001, p < 0.0001, respectively). Group 2 showed a significantly lower disease-free survival rate compared to group 1 (p = 0.0125), and group 2 was an independent prognostic factor for disease-free survival (p = 0.0308).. HCCs in the hepatobiliary phase that are heterogeneously hyperintense on gadoxetic acid-enhanced MR imaging have more malignant potential than other types of HCCs.. • Heterogeneous uptake of gadoxetic acid suggests more malignant potential in HCC • Uptake of gadoxetic acid does not suggest less malignancy in HCC • Evaluation of signal heterogeneity on gadoxetic acid-enhanced MR imaging is useful.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

This study was designed to evaluate the usefulness of gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) in staging hepatocellular carcinoma (HCC).. This study was approved by the institutional review board of our institution. Two investigators independently and retrospectively reviewed dynamic computed tomography (CT) and gadoxetic acid-enhanced dynamic MRI obtained from July to September 2011 in 195 patients with HCC (158 men, 37 women; mean age, 57.1 years). The diagnostic performances of dynamic CT and MRI were evaluated. Barcelona Clinic Liver Cancer (BCLC) stages were determined before and after gadoxetic acid-enhanced dynamic MRI and according to final diagnosis. Change in BCLC stage was evaluated after adding gadoxetic acid-enhanced dynamic MRI to dynamic CT. Diagnostic performance and BCLC staging between the two modalities were compared using the McNemar test.. Final BCLC stage was classified as stage 0 in 25 patients (12.8%), A in 118 (60.5%), B in 33 (16.9%), C in 17 (8.7%), and D in 2 (1.0%). Compared with dynamic CT, gadoxetic acid-enhanced dynamic MRI showed significantly greater sensitivity (90.6% [203/224] vs. 79.5 % [178/224]; P < 0.0001) and significantly more accurate BCLC staging (92.8% [181/195] vs. 80.5% [157/195]; P < 0.0001). BCLC stage was changed correctly after gadoxetic acid-enhanced dynamic MRI in 13.8% (27/195) patients showing differences between CT and final BCLC stages.. Gadoxetic acid-enhanced dynamic MRI provided important additional information compared with dynamic CT during initial staging workups in patients with HCC. Gadoxetic acid-enhanced dynamic MRI showed higher diagnostic performance and more accurate BCLC staging than dynamic CT.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Prognosis; Retrospective Studies

To determine whether hepatobiliary phase ( HBP hepatobiliary phase ) imaging can improve the diagnostic performance of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging in the detection of hepatocellular carcinomas ( HCC hepatocellular carcinoma s) and to investigate the accuracy of gadoxetic acid-enhanced MR imaging in the allocation of transplant recipients on the basis of the Milan criteria and United Network for Organ Sharing ( UNOS United Network for Organ Sharing ) guidelines.. This retrospective study had institutional review board approval; the requirement for informed consent was waived. Between June 2008 and June 2011, 63 patients who underwent liver transplantation (LT) were included. All patients underwent a gadoxetic acid-enhanced 3.0-T MR imaging examination of the liver that included HBP hepatobiliary phase images obtained 20 minutes after contrast material administration. Two abdominal radiologists independently assessed two MR imaging data sets to detect HCC hepatocellular carcinoma s: Set 1 included unenhanced and gadoxetic acid-enhanced dynamic images, and set 2 also included HBP hepatobiliary phase images. Patients were allocated into three groups: Those who did not meet the Milan criteria, those who did meet the Milan criteria with additional priority according to UNOS United Network for Organ Sharing guidelines, and those who did meet the Milan criteria without additional priority. Diagnostic performance of each data set in depicting HCC hepatocellular carcinoma s was compared by using jackknife alternative free-response receiver operating characteristics ( JAFROC jackknife alternative free-response receiver operating characteristic s). Sensitivity and accuracy of patient allocation were compared by using generalized estimating equations.. Sixty-three HCC hepatocellular carcinoma s were found in 36 of 63 patients. Eight patients were classified as not meeting Milan criteria, 12 as meeting Milan criteria with additional priority, and 43 as meeting Milan criteria without additional priority. For the detection of HCC hepatocellular carcinoma s, reader-averaged figures of merit estimated with JAFROC jackknife alternative free-response receiver operating characteristic s were 0.761 for set 1 and 0.791 for set 2 (P < .001). Addition of HBP hepatobiliary phase images significantly improved sensitivity for the detection of HCC hepatocellular carcinoma s, particularly 1-2-cm HCC hepatocellular carcinoma s (six [20.7%] vs 13 [44.8%] of 29 [P = .008] for reader 1 and eight [27.6%] vs 12 [41.4%] of 29 [P = .041] for reader 2). Accuracy of patient allocation was 88.9% for set 1 and 92.1% for set 2 (P = .151).. Addition of HBP hepatobiliary phase images can significantly improve the diagnostic performance of gadoxetic acid-enhanced liver MR imaging in the detection of 1-2-cm HCC hepatocellular carcinoma s in liver transplantation candidates. In addition, gadoxetic acid-enhanced MR imaging showed 92.1% accuracy in patient allocation on the basis of the Milan criteria and UNOS United Network for Organ Sharing guidelines.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Practice Guidelines as Topic; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Transplant Recipients

To identify the gadoxetic acid-enhanced MR and the (18)F-fludeoxyglucose (FDG) PET/CT findings associated with microvascular invasion (MVI) of hepatocellular carcinoma (HCC) in patients who are undergoing liver transplantation (LT).. Fifty-one patients with 78 HCCs underwent LT. Preoperative MRI and (18)F-FDG PET/CT findings were retrospectively analyzed and the association of the imaging findings with MVI was assessed.. Univariate analysis revealed that hypointensity seen on T1WI (OR = 4.329, p = 0.011), peritumoral enhancement (OR = 7.000, p = 0.008), inhomogeneity on arterial phase (OR = 4.321, p = 0.011), delayed phase (OR = 4.519, p = 0.009) or hepatobiliary phase (OR = 3.564, p = 0.032), and the large tumor size (>5 cm) (OR = 12.091, p = 0.001) showed statistically significant associations with MVI. The ratio of tumor maximum standardized uptake value (SUV) to normal liver mean SUV (TSUVmax/LSUVmean) (2.05 ± 1.43 vs. 1.08 ± 0.37) revealed significantly higher value in the MVI-positive group. Multivariate analysis revealed that peritumoral enhancement and a TSUVmax/LSUVmean of 1.2 or greater had a statistically significant association with MVI, with odds ratios of 10.648 (p = 0.016) and 14.218 (p = 0.001), respectively.. Preoperative imaging findings such as peritumoral enhancement seen on gadoxetic acid-enhanced MR and a TSUVmax/LSUVmean of 1.2 or more on (18)F-FDG PET/CT, may suggest the presence of MVI in HCC patients.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Fluorodeoxyglucose F18; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Multimodal Imaging; Neoplasm Invasiveness; Neovascularization, Pathologic; Positron-Emission Tomography; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To investigate whether additional diffusion-weighted imaging (DWI) improves therapy response evaluation by Gd-EOB magnetic resonance imaging (MRI) in hepatocellular carcinoma (HCC) after radioembolization.. Fifty patients with radioembolization for HCC underwent gadobutrol and Gd-EOB MRI with DWI prior to and 30, 90, and 180 days after radioembolization. A combination of gadobutrol MRI, alpha-fetoprotein, and imaging follow-up served as the reference standard. Two radiologists reviewed Gd-EOB alone (Gd-EOB), DWI alone (DWI), and the combination of both (Gd-EOB+DWI) separately and in consensus using a 4-point-scale: 1 = definitely no tumor progression (TP), 2 = probably no TP, 3 = probably TP, 4 = definitely TP. Receiver operating characteristic (ROC) and kappa analysis were performed.. Kappa values for Gd-EOB, DWI, and Gd-EOB+DWI ranged between 0.712 and 0.892 (P < 0.001). 30 days after radioembolization three out of 38 patients showed TP, which was missed by DWI in one case. No significant area under the curve (AUC) difference between Gd-EOB (1.0, P = 0.004), DWI (0.881, P = 0.030), and Gd-EOB+DWI (1.0, P = 0.004) was found (P = 0.320). 90 days after radioembolization six out of 28 patients showed TP, which was detected in one patient only by DWI and Gd-EOB+DWI. The AUC did not differ significantly (P = 0.319) between Gd-EOB (0.890, P = 0.004), DWI (1.0, P < 0.001), and Gd-EOB+DWI (1.0, P < 0.001). 180 days after radioembolization five patients showed TP, which in one case was missed by DWI. The AUC did not differ significantly (P1 = 0.322, P2 = 0.369, P3 = 0.350) between Gd-EOB (1.0, P = 0.003), DWI (0.913, P = 0.016), and Gd-EOB+DWI (0.963, P = 0.007).. Additional DWI does not substantially improve therapy response evaluation by Gd-EOB MRI in HCC after radioembolization but proved helpful in single cases.

Topics: Aged; Aged, 80 and over; alpha-Fetoproteins; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Diffusion Magnetic Resonance Imaging; Disease Progression; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; ROC Curve; Treatment Outcome

To compare the potential of T1 mapping on gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) for assessing liver function in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).. One hundred consecutive patients with known HBV-related HCCs were included. T1 relaxation time and apparent diffusion coefficient (ADC) of the liver were measured, and the reduction rate of T1 relaxation time (∆%) was calculated. T1 relaxation time measurements were compared with ADC values according to the Model for End-Stage Liver Disease (MELD) score.. Hepatobiliary phase (HBP) and ∆% of T1 relaxation time measurements showed significant correlations with MELD score (rho = 0.571, p < 0.0001; rho = -0.573, p < 0.0001, respectively). HBP and ∆% of T1 relaxation time were significantly different between good (MELD ≤8) and poor liver function (MELD ≥9) (p < 0.0001 for both). Areas under the receiver operating characteristic curves (AUCs) of T1 relaxation time for HBP (AUC 0.84) and ∆% (AUC 0.82) were significantly better than for ADC (AUC 0.53; p < 0.0001).. T1 mapping on Gd-EOB-DTPA-enhanced MRI showed promise for evaluating liver function in patients with HBV-related HCC, while DWI was not reliable. HBP T1 relaxation time measurement was equally accurate as ∆% measurement.. • T 1 mapping on Gd-EOB-DTPA MRI was accurate for assessing liver function. • HBP T 1 relaxation time measurement was as accurate as ∆% T 1 • T 1 mapping on Gd-EOB-DTPA MRI was more accurate than DWI-ADC measurement.

Topics: Adult; Aged; Area Under Curve; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hepatitis B; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; ROC Curve

Hepatobiliary phase images (HBPI) of gadoxetic acid-enhanced MRI can depict borderline hepatocellular nodules that have the potential to progress into hypervascular hepatocellular carcinomas (HCCs), as non-hypervascular hypointense nodules. We retrospectively evaluated the impact of the presence of non-hypervascular hypointense nodules at HBPI of gadoxetic acid-enhanced MRI on the patient's prognosis after radiofrequency ablation (RFA) for early stage HCCs.. A total of 139 patients who underwent pre-procedural gadoxetic acid-enhanced MRI followed by RFA were included. After a mean follow-up of 44.6±13.2 months, we compared the results of tumor recurrence as well as overall and recurrence-free survival (RFS) with the presence of non-hypervascular hypointense nodules on HBPI.. The presence of non-hypervascular hypointense nodules on HBPI did not affect overall survival (p=0.136). However, the estimated 5-year RFS rate was 71.3% in 29 patients without non-hypervascular hypointense nodules on HBPI compared to 27.9% in 110 patients with non-hypervascular hypointense nodules on HBPI, indicating a significant difference (hazard ratio=2.84 [1.39-5.98], p=0.006). When we classified recurrence into local tumor progression [LTP], intrahepatic distant recurrence [IDR], and extra-hepatic metastasis [EM], five-year cumulative incidences (CI) of IDR in patients with non-hypervascular hypointense nodules on HBPI were significantly higher than those in patients without non-hypervascular hypointense nodules on HBPI (17.9% vs. 67.5%, p<0.001). Five-year CIs of LTP and EM showed no significant difference (p>0.05).. The presence of non-hypervascular hypointense hepatocellular nodules on HBPI of gadoxetic acid-enhanced MRI taken prior to RFA is a significant predictive factor of recurrence after RFA of early stage HCCs, particularly IDR.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Predictive Value of Tests; Prognosis

To evaluate the feasibility of half-dose gadoxetic acid (0.0125mmol/kg) for liver MRI at 3-T compared to standard-dose (0.025mmol/kg) in patients at risk for nephrogenic systemic fibrosis (NSF).. Forty patients who underwent both half-dose and standard-dose gadoxetic acid-enhanced MRIs were included. Contrast enhancement index (CEI) was calculated for liver, aorta, pancreas and kidney. Two observers independently rated and performed a one-to-one direct comparison of enhancement quality for both groups.. Liver CEIs were not significantly different on arterial phase between the two groups but CEIs of standard-dose MRIs were greater than half-dose MRIs on other phases (P<0.001). CEIs were not significantly different on arterial phase for the aorta or on any phases for the pancreas. Kidney CEIs of standard-dose MRIs were greater than half-dose MRIs on all phases (P<0.05). Enhancement quality of both groups was diagnostic and did not significantly differ for any organs. In one-to-one direct comparisons of enhancement quality, equal ratings were given in 87.5% (35/40) of cases by observer 1 and 85.0% (34/40) by observer 2.. Liver MRI using half-dose gadoxetic acid at 3-T can be a feasible alternative for standard-dose MRI in patients at risk for NSF.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Nephrogenic Fibrosing Dermopathy; Pancreas; Retrospective Studies; Risk Factors; Sensitivity and Specificity

The purpose of this study was to investigate the value of enhancement kinetics and ancillary imaging findings on gadoxetic acid-enhanced and diffusion-weighted (DW) MR imaging for diagnosing hepatocellular carcinomas (HCCs) without the typical enhancement pattern on contrast-enhanced multiphasic MDCT in patients with chronic liver disease.. Eighty-two surgically confirmed HCCs without the typical enhancement pattern (hypervascular in the arterial phase, followed by washout on the portal or equilibrium phases) on triple-phase MDCT were enrolled in this study. The patients were classified into four categories based on the CT density pattern of arterial and equilibrium phases (isodense-isodense, hypodense-hypodense, isodense-hypodense, and hyperdense-isodense) compared to liver parenchyma. Signal intensity of HCCs on T2-weighted images (T2WI), arterial phase, 3 min late-phase, hepatobiliary phase (HBP) and DW images with a b value of 800 s/mm2 were qualitatively evaluated, and ADC values were measured. Fisher's exact test and Chi-square test were used to compare the frequency and trend of hyperintensity on T2WI, hypointensity on HBP images, hyperintensity on DW images, and histopathologic grades between groups with different CT density patterns. Kruskal-Wallis test was used to compare the ADC value between groups.. Thirty and 52 HCCs were categorized as hypervascular (hyperdense-isodense) and non-hypervascular HCCs (3, isodense-isodense; 37, hypodense-hypodense; 12, isodense-hypodense), respectively. Most HCCs showed hyperintensity on T2WI (77/82, 93.9%) and DW images (81/82, 98.8%) and hypointensity on HBP images (80/82, 97.6%). Thirty-eight HCCs (38/82, 46.3%) showed typical HCC enhancement pattern on dynamic MR images. There were no significant differences in the frequency and trend of signal intensity on T2WI, HBP images, DW images, and histopathologic grades with regard to the four CT density patterns (p<0.05). No significant difference in mean ADC values between groups was identified (p<0.05).. Gadoxetic acid-enhanced and DW MR imaging can help diagnose HCCs with atypical enhancement patterns on multiphasic CT in patients with chronic liver disease.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Diffusion Magnetic Resonance Imaging; End Stage Liver Disease; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Multidetector Computed Tomography; Sensitivity and Specificity

OBJECTIVE. The purpose of this study is to evaluate the per-patient diagnostic performance of an abbreviated gadoxetic acid-enhanced MRI protocol for hepatocellular carcinoma (HCC) surveillance. MATERIALS AND METHODS. A retrospective review identified 298 consecutive patients at risk for HCC enrolled in a gadoxetic acid-enhanced MRI-based HCC surveillance program. For each patient, the first gadoxetic acid-enhanced MRI was analyzed. To simulate an abbreviated protocol, two readers independently read two image sets per patient: set 1 consisted of T1-weighted 20-minute hepatobiliary phase and T2-weighted single-shot fast spin-echo (SSFSE) images; set 2 included diffusion-weighted imaging (DWI) and images from set 1. Image sets were scored as positive or negative according to the presence of at least one nodule 10 mm or larger that met the predetermined criteria. Agreement was assessed using Cohen kappa statistics. A composite reference standard was used to determine the diagnostic performance of each image set for each reader. RESULTS. Interreader agreement was substantial for both image sets (κ = 0.72 for both) and intrareader agreement was excellent (κ = 0.97-0.99). Reader performance for image set 1 was sensitivity of 85.7% for reader A and 79.6% for reader B, specificity of 91.2% for reader A and 95.2% for reader B, and negative predictive value of 97.0% for reader A and 96.0% for reader B. Reader performance for image set 2 was nearly identical, with only one of 298 examinations scored differently on image set 2 compared with set 1. CONCLUSION. An abbreviated MRI protocol consisting of T2-weighted SSFSE and gadoxetic acid-enhanced hepatobiliary phase has high negative predictive value and may be an acceptable method for HCC surveillance. The inclusion of a DWI sequence did not significantly alter the diagnostic performance of the abbreviated protocol.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Cross-Sectional Studies; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Population Surveillance; Reproducibility of Results; Retrospective Studies

Hepatocellular carcinoma (HCC) has a high rate of intrahepatic recurrence after curative treatment, possibly because metastases are not always identified before treatment. Magnetic resonance (MR) imaging with a liver-specific contrast agent, gadoxetic acid, can detect small HCCs with high levels of sensitivity. We investigated whether MR imaging with gadoxetic acid increases overall and recurrence-free survival of patients initially assessed by computed tomography (CT).. We performed a retrospective study of data from 700 patients diagnosed with a single-nodular HCC by dynamic 4-phase CT in Seoul, Korea, from January 2009 through December 2010. Of these patients, 323 underwent additional evaluation with gadoxetic acid-enhanced MR imaging (CT+MR group). The 377 patients who did not undergo MR imaging analysis are referred to as the CT group.. The CT and CT+MR groups were comparable in most baseline characteristics (Child-Pugh class A, 93.1% vs 94.7%; and median size of the primary HCCs, 2.8 vs 2.6 cm, respectively). Seventy-four additional HCC nodules were detected in 53 (16.4%) of the patients who underwent MR evaluation after CT (CT+MR group). These detections increased the Barcelona Clinic Liver Cancer stages for 43 patients (13.3%) and modified their treatment plans. On multivariable analyses, the CT+MR group had a significantly lower rate of HCC recurrence (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.54-0.96) and lower overall mortality (HR, 0.65; 95% CI, 0.44-0.96) than the CT group. In an analysis of 285 pairs of patients matched on the basis of the propensity score, the CT+MR group had significantly lower overall mortality (HR, 0.66; 95% CI, 0.44-0.99).. Among patients who underwent dynamic CT analysis of a single-nodular HCC, additional evaluation by MR imaging with gadoxetic acid led to the detection of additional HCC nodules in 16% of patients, reduced the risk of disease recurrence, and decreased overall mortality.

Topics: Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Disease-Free Survival; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Multiple Primary; Predictive Value of Tests; Propensity Score; Proportional Hazards Models; Republic of Korea; Retrospective Studies; Risk Factors; Time Factors; Tomography, X-Ray Computed; Tumor Burden

To compare the diagnostic performance of magnetic resonance (MR) imaging features, including those on diffusion-weighted (DW) and T2-weighted images, in differentiating between hypovascular hepatocellular carcinoma (HCC) and dysplastic nodules seen as hypointense nodules at hepatobiliary phase gadoxetic acid-enhanced MR imaging.. The institutional review board approved this retrospective study and waived the need to obtain informed patient consent. There were 53 patients (39 men and 14 women; age range, 32-75 years) with histologically proven hypovascular HCCs (n = 25) and/or dysplastic nodules (n = 31) who underwent gadoxetic acid-enhanced MR imaging at 3.0-T between March 2011 and January 2014. Images of 25 HCCs and 31 dysplastic nodules were analyzed for nodule size; signal intensity on T1- and T2-weighted, portal venous phase, and DW (b value = 800 sec/mm(2)) images; and intralesional fat. Correlations between the hyperintensity grade of lesions and the liver-to-lesion signal intensity ratio at T2-weighted and DW imaging were determined by means of analysis with generalized estimating equations.. Hyperintensity at T2-weighted and DW imaging and hypointensity in the portal venous phase were significant features for differentiating hypovascular HCCs from dysplastic nodules (P < .05). The sensitivity of DW imaging tended to be higher than that of T2-weighted imaging (72.0% [18 of 25] vs 40.0% [10 of 25]; P = .008 for grade 2 and 3 hyperintensity). Use of the parameter of hyperintensity similar to or slightly lower than the signal intensity of the spleen on DW images (b value = 800 sec/mm(2)) yielded a specificity of 100% (31 of 31) for the diagnosis of hypovascular HCC by differentiating it from a dysplastic nodule.. Hyperintensity at DW imaging could be a useful MR imaging feature for differentiating hypovascular HCCs from dysplastic nodules seen as hypointense nodules at gadoxetic acid-enhanced MR imaging.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To evaluate the natural course of subcentimeter hypervascular nodules at high risk for developing into hepatocellular carcinomas (SHNHR) using serial magnetic resonance imaging (MRI) in patients with a history of hepatocellular carcinoma (HCC).. An SHNHR was defined as a subcentimeter hypervascular nodule having typical imaging findings of HCC on gadoxetic acid-enhanced MRI and diffusion-weighted imaging. We included 39 patients with 46 SHNHRs (mean size ± standard deviation, 6.1 ± 1.6 mm; range, 3.2 - 9.0 mm). Overt HCC was defined as pathology proven HCC or a nodule larger than 1 cm with typical imaging findings of HCC. The cumulative rate and the independent predictive factors for progression to overt HCC were evaluated.. The median follow-up period was 139 days (range, 64 - 392 days). The cumulative progression rate to overt HCC at 3, 6, 9, and 12 months was 13.9%, 61.7%, 83.2%, and 89.9%. The initial size of SHNHR was a significant predictor of progression to overt HCC, with an optimal cut-off value of 5.5 mm.. The progression rate of SHNHR to overt HCC within 12 months was high (89.9%) in patients with history of HCC. The initial size of SHNHR was an important predictor for progression to overt HCC.. • Most SHNHRs (89.9%) progressed to overt HCCs within 12 months. • Initial size was an important predictor for progression to overt HCCs. • The optimal cut-off value for initial nodule size was 5.5 mm.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To determine which dynamic phase(s) of gadoxetic acid-enhanced MRI is most appropriate to assess "washout" in the noninvasive diagnosis of hepatocellular carcinoma (HCC) based on hemodynamic pattern.. In this retrospective cohort study, 288 consecutive patients with chronic liver disease presented with 387 arterially enhancing nodules (292 HCCs, 95 non-HCCs) (≥1 cm) on gadoxetic acid-enhanced MRI. All HCCs were confirmed by histopathology or by their typical enhancement pattern on dynamic liver CT. MR imaging diagnosis of HCC was made using criteria of arterial enhancement and hypointensity relative to the surrounding parenchyma (1) on the portal-venous phase (PVP), (2) on the PVP and/or transitional phase (TP), or (3) on the PVP and/or TP, and/or hepatobiliary phase (HBP).. For the noninvasive diagnosis of HCC, criterion 1 provided significantly higher specificity (97.9%; 95% confidence interval, 92.6 - 99.7%) than criteria 2 (86.3%; 77.7 - 92.5%), or 3 (48.4%; 38.0 - 58.9%). Conversely, higher sensitivity was obtained with criterion 3 (93.8%; 90.4 - 96.3%) than with criterion 2 (86.6%; 82.2 - 90.3%) or 1 (70.9%; 65.3 - 76.0%).. To make a sufficiently specific diagnosis of HCC using gadoxetic acid-enhanced MRI based on typical enhancement features, washout should be determined on the PVP alone rather than combined with hypointensity on the TP or HBP.. • Gadoxetic acid-enhanced MRI enhancement features can be used to diagnose HCC. • Washout should be determined on the PVP alone for high specificity. • Hypointensity on the TP or HBP increases sensitivity but lowers specificity.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult

In patients with hepatocellular carcinoma (HCC), gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) often identifies non-hypervascular hypointense hepatic nodules during the hepatobiliary phase, but their prognostic significance is unclear. We conducted a prospective observational study to investigate the impact of non-hypervascular hypointense hepatic nodules detected by Gd-EOB-DTPA-enhanced MRI on the outcome of patients with early-stage HCC.. Post-treatment recurrence and survival rates were analyzed in 138 patients with non-recurrent, early-stage HCC [Barcelona Clinic Liver Cancer (BCLC) stage 0 or A] and Child-Pugh A liver function according to the presence of non-hypervascular hypointense nodules on pretreatment Gd-EOB-DTPA-enhanced MRI.. Non-hypervascular hypointense hepatic nodules were detected in 51 (37.0%) patients with early-stage HCC on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrence rates were significantly higher in patients with non-hypervascular hypointense nodules (p < 0.0001). Based on a multivariate analysis, the presence of non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI was independently associated with an increased recurrence rate, independent of tumor progression or treatment (p = 0.0005). The survival rate was significantly lower in patients with non-hypervascular hypointense nodules on Gd-EOB-DTPA-enhanced MRI (p = 0.0108).. In patients with early-stage typical HCC (BCLC 0 or A), the presence of concurrent non-hypervascular hypointense hepatic nodules in the hepatobiliary phase of pretreatment Gd-EOB-DTPA-enhanced MRI is an indicator of higher likelihood of recurrence after treatment and may be a marker for unfavorable outcome.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Prospective Studies; Risk Factors; Survival Rate

To investigate the impact of intra-tumoral fat detected by chemical-shift MR imaging in predicting the MVI of HCC.. Gadoxetic acid-enhanced MR imaging of 365 surgically proven HCCs from 365 patients (306 men, 59 women; mean age, 55.6 years) were evaluated. HCCs were classified into two groups, fat-containing and non-fat-containing, based on the presence of fat on chemical-shift images. Fat-containing HCCs were subdivided into diffuse or focal fatty change groups. Logistic regression analyses were used to identify clinical and MR findings associated with MVI.. Based on MR imaging, 66 tumors were classified as fat-containing HCCs and 299 as non-fat-containing HCCs. Among the 66 fat-containing HCCs, 38 (57.6%) showed diffuse fatty changes and 28 (42.4%) showed focal fatty changes. MVI was present in 18 (27.3%) fat-containing HCCs and in 117 (39.1%) non-fat-containing HCCs (P=0.07). Univariate analysis revealed that serum alpha-fetoprotein (AFP) and tumor size were significantly associated with MVI (P<0.001). A multiple logistic regression analysis showed that log AFP (odds ratio 1.178, P=0.0016), tumor size (odds ratio 1.809, P<0.001), and intra-tumoral fat (odds ratio 0.515, P=0.0387) were independent variables associated with MVI.. Intra-tumoral fat detected with MR imaging may suggest lower risk for MVI of HCC and, therefore, a possibly more favorable prognosis, but the clinical value of this finding is uncertain.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnostic Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neoplasm Invasiveness; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The use of three-dimensional T1 weighted gradient echo sequences such as the Dixon technique and the frequency-selective fat suppression (FS) technique is currently widely accepted method in MRI examinations of the liver. To assess the image qualities of the Dixon technique and the frequency-selective FS technique, the contrast-to-noise ratios (CNRs) of hepatocellular carcinoma (HCC)-to-liver and fat-to-liver were compared between the two techniques in the hepatobiliary phase (HBP) following administration of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid.. MR images of 59 patients with a total of 86 HCCs were retrospectively evaluated. Images were consecutively obtained with the Dixon and frequency-selective FS methods in the HBP and their CNRs of HCC-to-liver and fat-to-liver were compared. CNRs and contrast ratios were calculated by the mean value of the liver parenchyma, HCC, fat and standard deviation of the liver parenchyma. The Wilcoxon signed-ranks test was used for statistical analysis.. The median CNRs for the frequency-selective FS and Dixon techniques of HCC-to-liver were 4.3 and 5.4 (p < 0.01), mesenteric fat-to-liver were 9.9 and 12.8 (p < 0.01) and subcutaneous fat-to-liver were 9.9 and 13.2 (p < 0.01), respectively.. The Dixon technique yielded higher CNRs of HCC-to-liver than that of the frequency-selective FS technique.. There are a limited number of reports on quantitative analysis of the image qualities of the Dixon technique and the frequency-selective FS technique, particularly within the same patient and examination.

Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Irreversible electroporation is a new ablation modality. Our purpose was to describe the MRI findings after irreversible electroporation treatment of hepatocellular carcinoma (HCC).. In an 18-month period, we treated 24 HCC lesions in 20 patients who were not candidates for surgery. MRI was performed before and 1 month after irreversible electroporation. We used the liver-specific contrast medium gadoxetic acid. We evaluated the size, shape, signal intensity (T1-weighted, T2-weighted, and diffusion-weighted imaging), dynamic contrast enhancement pattern, and signal behavior during the liver-specific phase. Changes in the perilesional parenchyma, perfusion abnormalities, and complications were also recorded.. According to the modified Response Evaluation Criteria in Solid Tumors system, 22 of 24 lesions had a complete response, and two lesions showed a partial response and were retreated. The lesions showed a mean size increase of 10%, with a round or oval shape. On the T1-weighted images, we observed a hyperintense core and a hypointense rim. On the T2-weighted sequences, the signal was heterogeneously hypointense. On diffusion-weighted images, 83% of lesions showed restricted diffusion, with b values of 0-800 s/mm(2), whereas in 17% of the lesions, the signal was not clearly discernible for different b values. The apparent diffusion coefficient values did not show statistically significant differences between the baseline (800-1020 × 10(-3) mm(2)/s) and the reassessment after 1 month (900-1100 × 10(-3) mm(2)/s). The necrotic area did not show a signal increase after contrast material injection. Perfusion abnormalities, such as areas of transient hepatic intensity difference, were present in the tissue adjacent to six treated lesions. In two patients, a reduced or absent concentration of the contrast medium was observed during the liver-specific phase around the ablation zone. One patient had an arteriovenous shunt and another had biliary duct dilatation.. MRI detects characteristic morphologic and functional changes after irreversible electroporation treatment.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Electroporation; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Treatment Outcome; Ultrasonography, Interventional

To establish a prognostic formula that distinguishes non-hypervascular hepatic nodules (NHNs) with higher aggressiveness from less hazardous one.. Seventy-three NHNs were detected in gadolinium ethoxybenzyl diethylene-triamine-pentaacetic-acid magnetic resonance imaging (Gd-EOB-DTPA-MRI) study and confirmed to change 2 mm or more in size and/or to gain hypervascularity. All images were interpreted independently by an experienced, board-certified abdominal radiologist and hepatologist; both knew that the patients were at risk for hepatocellular carcinoma development but were blinded to the clinical information. A formula predicting NHN destiny was developed using a generalized estimating equation model with thirteen explanatory variables: age, gender, background liver diseases, Child-Pugh class, NHN diameter, T1-weighted imaging/T2-weighted imaging detectability, fat deposition, lower signal intensity in arterial phase, lower signal intensity in equilibrium phase, α-fetoprotein, des-γ-carboxy prothrombin, α-fetoprotein-L3, and coexistence of classical hepatocellular carcinoma. The accuracy of the formula was validated in bootstrap samples that were created by resampling of 1000 iterations.. During a median follow-up period of 504 d, 73 NHNs with a median diameter of 9 mm (interquartile range: 8-12 mm) grew or shrank by 68.5% (fifty nodules) or 20.5% (fifteen nodules), respectively, whereas hypervascularity developed in 38.4% (twenty eight nodules). In the fifteen shrank nodules, twelve nodules disappeared, while 11.0% (eight nodules) were stable in size but acquired vascularity. A generalized estimating equation analysis selected five explanatories from the thirteen variables as significant factors to predict NHN progression. The estimated regression coefficients were 0.36 for age, 6.51 for lower signal intensity in arterial phase, 8.70 or 6.03 for positivity of hepatitis B virus or hepatitis C virus, 9.37 for des-γ-carboxy prothrombin, and -4.05 for fat deposition. A formula incorporating the five coefficients revealed sensitivity, specificity, and accuracy of 88.0%, 86.7%, and 87.7% in the formulating cohort, whereas these of 87.2% ± 5.7%, 83.8% ± 13.6%, and 87.3% ± 4.5% in the bootstrap samples.. These data suggest that the formula helps Gd-EOB-DTPA-MRI detect a trend toward hepatocyte transformation by predicting NHN destiny.

Topics: Aged; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Chi-Square Distribution; Contrast Media; Decision Support Techniques; Diagnosis, Differential; Disease Progression; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Time Factors; Tumor Burden

Non-simple nodules in hepatocellular carcinoma (HCC) correlate with poor prognosis. Therefore, we examined the diagnostic ability of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) and contrast-enhanced ultrasound (CEUS) for diagnosing the macroscopic classification of small HCCs.. A total of 85 surgically resected nodules (≤30 mm) were analyzed. HCCs were pathologically classified as simple nodular (SN) and non-SN. By evaluating hepatobiliary phase (HBP) of EOB-MRI and Kupffer phase of CEUS, the diagnostic abilities of both modalities to correctly distinguish between SN and non-SN were compared.. Forty-six nodules were diagnosed as SN and the remaining 39 nodules as non-SN. The area under the ROC curve (AUROCs, 95% confidence interval) for the diagnosis of non-SN were EOB-MRI, 0.786 (0.682-0.890): CEUS, 0.784 (0.679-0.889), in combination, 0.876 (0.792-0.959). The sensitivity, specificity, and accuracy were 64.1%, 95.7%, and 81.2% in EOB-MRI, 56.4%, 97.8%, and 78.8% in CEUS, and 84.6%, 95.7%, and 90.6% in combination, respectively. High diagnostic ability was obtained when diagnosed in both modalities combined. The sensitivity was especially statistically significant compared to CEUS.. Combined diagnosis by EOB-MRI and CEUS can provide high-quality imaging assessment for determining non-SN in small HCCs.. • Non-SN has a higher frequency of MVI and intrahepatic metastasis than SN. • Macroscopic classification is useful to choose the treatment strategy for small HCCs. • Diagnostic ability for macroscopic findings of EOB-MRI and CEUS were statistically equal. • The diagnosis of macroscopic findings by individual modality has limitations. • Combined diagnosis of EOB-MRI and CEUS provides high diagnostic ability.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Epidemiologic Methods; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Ultrasonography

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia (RLH) of the liver. She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however, histopathological analysis revealed RLH. The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging, which could be a useful clue for identifying RLH in the liver. Histologically, the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diagnostic Errors; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Multimodal Imaging; Predictive Value of Tests; Pseudolymphoma; Tomography, X-Ray Computed

Although hepatocellular carcinoma (HCC) is mostly a lower intensity lesion in the hepatobiliary phase on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, some HCCs were shown as a higher intensity lesion (high HCC). This study aimed to reveal the clinicopathological and biological properties of high HCC.. Patients who underwent curative hepatectomy as the first treatment for HCC were included. HCC was defined as high HCC if the ratio between the signal intensity of the HCC and the background liver was greater than or equal to 1.0. We retrospectively performed clinicopathological and global gene expression analyses.. Of the 77 patients, 14 had high HCC. Serum protein induced by vitamin K absence or antagonist II levels in high HCC were lower, and the high HCCs were well differentiated. The 3-year disease-free survival rates in high HCC and low HCC patients were 90% and 54%, respectively (P = .035). Overall survival did not differ significantly. Global gene expression analysis revealed that SLCO1B3 was upregulated in high HCC.. Clinicopathological analysis revealed low-grade malignancy in high HCCs compared with low HCCs. The expression of SLCO1B3 was key to the hyperintensity in the hepatobiliary phase of ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging.

Topics: Aged; Biomarkers; Carcinoma, Hepatocellular; Contrast Media; Disease-Free Survival; Female; Gadolinium DTPA; Gene Expression; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Invasiveness; Organic Anion Transporters, Sodium-Independent; Protein Precursors; Prothrombin; Retrospective Studies; Solute Carrier Organic Anion Transporter Family Member 1B3; Up-Regulation

The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT.. Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks.. Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (κ=1.00) and substantial agreement between MDCT and MRI (κ=0.67).. In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pilot Projects; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Topics: Adenoma, Bile Duct; Adult; Aged; Angiomyolipoma; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pseudolymphoma; Tomography, X-Ray Computed

To investigate the utility of gadoxetate disodium-enhanced hepatic MRI (EOB-MRI) for stereotactic body radiotherapy (SBRT) to treat hepatocellular carcinoma (HCC).. We divided 30 HCC patients who underwent SBRT into group A (no change in their Child-Pugh score 6 months post-SBRT) and group B (increased score 6 months post-SBRT). EOB-MRI was performed before and 6 months after SBRT. We calculated the liver-spleen contrast (LSC) ratio for each radiation dose area on hepatobiliary phase scans (LSCbefore using images obtained before SBRT and LSCafter using images acquired after SBRT) and the weighted LSC (W-LSC) as: [(mean LSCbefore (0-30 Gy) × liver volume (0-30 Gy) + mean LSCbefore (30 Gy-) × liver volume (30 Gy-))/total liver volume]. Then we compared the W-LSC, percentage of the liver volume exposed to >20 Gy (V20), and mean liver dose in the two groups.. The LSCafter at 48, 40, and 30 Gy to the liver was statistically lower than the unirradiated area of the liver (p < 0.01). Univariate analysis showed that only W-LSC was significantly associated with group B (p = 0.02).. W-LSC was a useful parameter for predicting changes in hepatic function after SBRT.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging, Interventional; Male; Middle Aged; Radiosurgery; Radiotherapy Dosage; Retrospective Studies; Treatment Outcome

The aim of this study was to investigate the feasibility of ablative margin (AM) grading by magnetic resonance imaging (MRI) with Gd-EOB-DTPA administered prior to radiofrequency ablation (RFA), and to identify factors for achieving a sufficient AM and predictors for local tumor progression.. A total of 124 hepatocellular carcinomas (HCCs) were treated by RFA after Gd-EOB-DTPA administration. MRI and enhanced CT were performed within seven hours and one month after RFA. The AM assessment was categorized using three grades: AM (+), low-intensity area with continuous high-intensity rim; AM zero, low-intensity area with discontinuous high-intensity rim; and AM (-), low-intensity area extends beyond the high-intensity rim. Patients were followed and local tumor progression was observed.. AM (+), AM zero, AM (-), and indeterminate were found in 34, 33, 26, and 31 nodules, respectively. The overall agreement rate between MRI and enhanced CT for the diagnosis of AM was 56.8%. The κ coefficient was 0.326 (p<0.001), indicating moderate agreement. Multivariate logistic regression analysis showed that a significant factor for the achievement of AM (+) on MRI was no contiguous vessels. The cumulative local tumor progression rates (0% at 1, 2, and 3 years) in 33 AM (+) nodules were significantly lower than those (3.6%, 11.5%, and 18.3% at 1, 2, and 3 years respectively) in 32 AM zero nodules. A multivariate Cox proportional hazards model identified tumor size as an independent predictor for local tumor progression.. Gd-EOB-DTPA-MRI enabled an early assessment of RFA effectiveness in the majority ofHCC nodules. Local tumor progression was not detected in AM (+) nodules during the follow-up.

Topics: Aged; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed

The objective of our study was to determine quantitative differences to differentiate low-grade from high-grade dysplastic nodules (DNs) and low-grade from high-grade hepatocellular carcinomas (HCCs) using gadoxetate disodium-enhanced MRI.. A retrospective study of 149 hepatic nodules in 127 consecutive patients who underwent gadoxetic acid-enhanced MRI was performed. MRI signal intensities (SIs) of the representative lesion ROI and of ROIs in liver parenchyma adjacent to the lesion were measured on unenhanced T1-weighted imaging and on dynamic contrast-enhanced MRI in the arterial, portal venous, delayed, and hepatobiliary phases. The relative SI of the lesion was calculated for each phase as the relative intensity ratio as follows: [mass SI / liver SI].. Of the 149 liver lesions, nine (6.0%) were low-grade DNs, 21 (14.1%) were high-grade DNs, 83 (55.7%) were low-grade HCCs, and 36 (24.2%) were high-grade HCCs. The optimal cutoffs for differentiating low-grade DNs from high-grade DNs and HCCs were an unenhanced to arterial SI of ≥ 0 or a relative SI on T2-weighted imaging of ≤ 1.5, with a positive predictive value (PPV) of 99.2% and accuracy of 88.6%. The optimal cutoffs for differentiating low-grade HCCs from high-grade HCCs were a relative hepatobiliary SI of ≤ 0.5 or a relative T2 SI of ≥ 1.5, with a PPV of 81.0% and an accuracy of 60.5%.. Gadoxetate disodium-enhanced MRI allows quantitative differentiation of low-grade DNs from high-grade DNs and HCCs, but significant overlap was seen between low-grade HCCs and high-grade HCCs.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Precancerous Conditions; Retrospective Studies

The characteristics of hypovascular and hypervascular well-differentiated hepatocellular carcinomas (HCCs) were compared in terms of tumor size, tumor markers and detectability by imaging modalities.. Well-differentiated HCC nodules that are smaller than 2 cm (n = 27) were evaluated in 27 patients using histopathology and divided into 2 groups: hypovascular (n = 10) and hypervascular (n = 17). The diagnostic sensitivity of imaging modalities was then evaluated for efficiency in disclosing tumor size and tumor markers in the 2 types.. No difference was observed in tumor size and tumor markers between the 2 types; however, the sensitivity of contrast-enhanced CT, contrast-enhanced ultrasonography and arterioportal angiography was significantly different between the 2 types, whereas that by Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) demonstrated no difference.. Hypovascular HCC could be diagnosed by Gd-EOB-DTPA MRI in the hepatobiliary phase.

Topics: Aged; Aged, 80 and over; alpha-Fetoproteins; Angiography; Biomarkers; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Protein Precursors; Prothrombin; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography

The diagnosis of intrahepatic cholangiocellular carcinoma (ICC) remains elusive at imaging, which is a critical issue in cirrhotic patients in whom a diagnosis of hepatocellular carcinoma (HCC) can be established only by imaging.. The aim of the study was to evaluate the potential of MRI in the diagnosis of ICC in cirrhosis using 'hepatocyte-specific' Gadolinium (Gd)-based contrast agents.. Sixteen histologically proven and retrospectively identified ICCs on cirrhosis were investigated with hepatocyte-specific magnetic resonance contrast agents (6 in Bologna with Gd-EOB-DTPA and 10 in Milan with Gd-BOPTA). The control group consisted of 41 consecutively and prospectively collected nodules (31 HCCs) imaged with Gd-EOB-DTPA.. Fifteen ICC nodules (94%) displayed hypointensity in the hepatobiliary phase, suggesting malignancy. Thirteen cholangiocarcinomas (81%) showed hyperenhancement in the venous phase. Only 2 cholangiocarcinoma nodules showed hypoenhancement in the venous phase, corresponding to washout, in both cases preceded by rim enhancement in arterial phase. All the hepatocarcinomas showed hypointensity in hepatobiliary phase, but was always preceded by hypointensity in the venous phase; arterial rim enhancement was never observed in any hepatocarcinoma or regenerative nodule.. MRI with hepatocyte-specific Gd-based contrast agents showed a pattern of malignancy in almost all the ICCs, concurrently avoiding misdiagnosis with hepatocarcinoma. These findings suggest a greater diagnostic capacity for this technique compared with the results of MRI with conventional contrast agents reported in the literature in this setting.

Topics: Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Retrospective Studies

To determine whether the presence of a hypovascular nodule in the liver showing hypointensity on hepatocyte-phase of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) is a risk factor for hypervascular hepatocellular carcinoma (HCC) in patients with chronic liver disease.. Forty-one patients with pathologically confirmed hypervascular HCC and 41 age- and gender-matched controls were retrospectively selected. These patients had undergone EOB-MRI at least twice: the latest EOB-MRI and EOB-MRI performed more than 6 months earlier. History of hypervascular HCC, presence of a hypointense hypovascular nodule in previous hepatocyte-phase MR images, percent prothrombin time, platelet count, serum levels of albumin, total bilirubin, aspartate aminotransferase, alanine aminotransferase, α-fetoprotein, and protein induced by vitamin K absence-II (PIVKA-II) were variables evaluated by multivariate logistic regression analysis.. Multivariate analysis revealed that serum albumin level (odds ratio [95% confidence interval], 0.19 [0.06-0.57]; P = 0.0024), history of hypervascular HCC (8.62 [2.71-32.8]; P = 0.0001), and presence of a hypointense hypovascular nodule (4.18 [1.18-17.2]; P = 0.0256) were significant risk factors for hypervascular HCC.. Patients with chronic liver disease showing a hypointense hypovascular nodule in the liver on hepatocyte-phase EOB-MRI have a high risk of HCC development.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Case-Control Studies; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Prognosis; Reproducibility of Results; Retrospective Studies; Risk Factors; Sensitivity and Specificity

Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC.. Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively.. On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P < 0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P < 0.001).. In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Ferric Compounds; Gadolinium DTPA; Humans; Image Enhancement; Immunohistochemistry; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Oxides; Retrospective Studies; Ultrasonography

To determine whether the diagnostic performance of combined gadoxetic acid-enhanced dynamic phases and diffusion-weighted imaging (DWI) is comparable to the standard protocol with hepatobiliary phase (HBP) and DWI for detection and characterization of focal liver lesions in chronic liver disease.. A total of 176 patients with 181 HCCs, 15 cholangiocarcinomas, and 32 benign lesions were included. Three combined gadoxetic acid-enhanced and DWI sets (dynamic phases [arterial, portal, and 3-min delay {3-min set} and dynamic phases with 10-min HBP [10-min set] or 20-min HBP [20-min set]) were analyzed by two observers to determine the diagnostic accuracy and sensitivity in detection of malignancy, and ability for lesion characterization.. There was a trend, although not statistically significant, toward highest diagnostic accuracy and sensitivity for detecting malignancies in the 20-min set (mean, 0.945, 96.2), followed by the 10-min set (0.937, 95.9), and the 3-min set (0.923, 94.1) (P > 0.05). For lesion characterization, three image sets were equivalent (P > 0.05).. For lesion detection and characterization in chronic liver diseases, 3-min set with DWI showed comparable efficacy to 10-min or 20-min set. However, the best diagnostic performance could be achieved by combination of all image sets.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; End Stage Liver Disease; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Observer Variation; Reference Standards; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Time Factors

To determine the added value of 3 Tesla liver MR in patients with hepatocellular carcinoma (HCC) within the liver computed tomography (CT) -based Milan criteria.. Liver CT and MR images of 130 patients with HCC within the Milan criteria based on liver CT were retrospectively reviewed. The number of MR-diagnosed HCCs and that of high risk hypervascular nodules (HRHNs), the effect of obtaining MR on patient management and CT appearances of MR-diagnosed HCCs and those of HRHNs were evaluated. Independent predictor for diagnosing additional HCCs on liver MR was analyzed.. A total of 18.5% (24/130) of patients had additional 39 HCCs on MR, with a 5.4% (7/130) dropout rate from the Milan criteria. 28.5% (37/130) of patients had additional 78 HRHNs. Overall, 39.2% (51/130) of patients required changes in management. The common CT appearances of MR-diagnosed HCCs were arterial enhancing lesions ≥ 0.5cm (38.4%, 15/39), low density nodules < 1.5 cm (30.8%, 12/39) and invisibility (28.2%, 11/39). For MR-diagnosed HRHNs, 55.1% (43/78) were invisible on CT. The presence of inconclusive lesions on CT was an independent predictor for diagnosing additional HCCs on MR.. For patients with HCCs within the Milan criteria on liver CT, liver MR may be necessary to detect additional HCCs and HRHNs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Europe; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neovascularization, Pathologic; Observer Variation; Practice Guidelines as Topic; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; United States

To determine imaging features of infiltrative hepatocellular carcinoma (HCC) on 3T magnetic resonance imaging (MRI) including gadoxetic acid-enhanced and diffusion-weighted imaging (DWI).. Eighteen patients with infiltrative HCC underwent liver MRI that consisted of T1- and T2-weighted image (T2WI), gadoxetic acid-enhanced arterial, portal, 3-min late and 20-min hepatobiliary phase (HBP), and DWI. Two reviewers evaluated in consensus tumor characteristics and lesion conspicuity using a 4-point scale. The tumor-to-liver contrast ratio was also measured.. Most of the tumors (n = 16, 88.9%) were seen as irregular permeative masses (4.0-23.0 cm, mean 10.5 cm in diameter) and the remaining two as poorly defined amorphous infiltration among thrombosed portal veins. Internal reticulation within the tumor was characteristic and was most frequently observed on 3-min late phase (n = 18), followed by HBP (n = 15). Tumor conspicuity and tumor-to-liver contrast ratio was highest with b-800 DWI, which was significantly higher than those of other images (P < 0.05).. DWI provides the highest conspicuity for infiltrative HCC compared to unenhanced T1- and T2WI and gadoxetic acid-enhanced MRI. The gadoxetic acid-enhanced 3-min late image is useful in characterizing infiltrative HCC, as it clearly depicts internal reticulation in all tumors.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Observer Variation; Reproducibility of Results; Sensitivity and Specificity

We evaluated the contrast-enhanced ultrasonography (US) imaging features of early hepatocellular carcinomas (HCCs) and compared these findings with those obtained using contrast-enhanced computed tomography (CT).. Forty-three patients with 52 early HCCs with a mean maximal diameter of 15.6mm were enrolled in this retrospective study. After confirming the location of the target lesion using fusion imaging combining conventional US and hepatobiliary phase of contrast-enhanced magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid, we evaluated findings of contrast-enhanced US using a perflubutane-based contrast agent. The contrast-enhanced US detection rates for hyper-vascularity in early HCCs were compared with those obtained for contrast-enhanced CT.. Transient hypo-vascularity subsequent to iso-vascularity during arterial phase and iso-vascularity during portal and post-vascular phases were the predominant contrast-enhanced US findings seen for 25 (48.1%) of the 52 early HCCs. Nine (17.3%) showed iso-vascularity during all three phases, while 1 (1.9%) showed hypo-vascularity during all three phases. The remaining 17 (32.7%) showed partial or whole hyper-vascularity during arterial phase, iso-vascularity during portal phase, and iso- or hypo-vascularity during post-vascular phase. The detection rate for the hyper-vascularity of early HCCs using contrast-enhanced US (32.7%, 17/52) was significantly higher than that obtained using contrast-enhanced CT (21.2%, 11/52) (P<0.05 by McNemar test).. Hypo-vascularity, iso-vascularity, and hyper-vascularity were observed during the arterial phase of contrast-enhanced US in 50.0%, 17.3%, and 32.7% of the early HCCs, respectively. Contrast-enhanced US was more sensitive than contrast-enhanced CT for the detection of hyper-vascularity in early HCCs. Of note, early HCCs might not exhibit the early arterial enhancement that is generally considered to be a typical finding for HCCs.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Early Detection of Cancer; Female; Ferric Compounds; Gadolinium DTPA; Humans; Image Enhancement; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neovascularization, Pathologic; Oxides; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography

A faint hypointensity in the noncancerous tissue around hepatocellular carcinoma (HCC) in the hepatobiliary phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) is encountered. The goal is to elucidate the significance of this type of pseudolesion designated as the peritumoral decreased uptake area of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) (PDUAE).. This study group consisted of 61 patients with 61 surgically resected HCCs who underwent preoperative Gd-EOB-DTPA-enhanced MRI. The presence of a faint and hypointense area around the tumor in the hepatobiliary phase was defined as PDUAE. The frequency with which PDUAE was seen was compared between pairs of groups determined by clinical and pathological parameters using a Fisher's exact probability test. The parameters showing significant differences in this test were further tested by multiple logistic regression analysis.. PDUAE was observed in 25 cases. In univariate analysis, the values of alpha-fetoprotein and protein-induced by vitamin K absence or antagonist-II, maximal diameter, the presence of a capsule, and vascular invasion were significantly correlated with the frequency with which PDUAE was seen. In multivariate analysis, only maximal diameter and vascular invasion were significantly correlated. When the presence of PDUAE was used as an indicator of vascular invasion, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 72%, 80.6%, 77%, 72%, and 80.6%, respectively.. By using this indicator, "microscopic" vascular invasion of HCC can be easily predicted with Gd-EOB-DTPA-enhanced MRI.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Predictive Value of Tests; Sensitivity and Specificity

To clarify the diagnostic performance of gadoxetic acid-enhanced MRI for the detection of hepatocellular carcinoma (HCC) in recipients of living related-liver transplantation (LRLT).. This retrospective study group consisted of 15 patients with 61 HCCs who each underwent multidetector row computed tomography (MDCT), gadoxetic acid-enhanced MRI, and angiography-assisted computed tomography (CT) before LRLT. The three modalities were compared for their ability to detect HCC. Two blinded readers independently reviewed the images obtained by each modality for the presence of HCC on a segment-by-segment basis using a 5-point confidence scale. The diagnostic performance of the modalities was evaluated in a receiver operating characteristic (ROC) analysis. The area under the ROC curve (Az), sensitivity, specificity, and accuracy were compared for the three modalities.. No significant difference in Az, sensitivity, specificity, or accuracy was obtained among gadoxetic acid-enhanced MRI, MDCT, and angiography-assisted CT for both readers. For reader 1, the sensitivity (55.6%) and the accuracy (84.7%) of angiography-assisted CT were significantly higher than those of MDCT (33.3% and 78.0%) (P < 0.05).. Gadoxetic acid-enhanced MRI has a relatively high diagnostic ability to detect HCC even in recipients of LRLT, equivalent to the abilities of MDCT and angiography-assisted CT.

Topics: Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Liver Transplantation; Living Donors; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Postoperative Complications; Sensitivity and Specificity

We aimed to determine whether the controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique could improve the image quality of the hepatic arterial phase of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging.. A total of 320 patients underwent gadoxetic acid-enhanced liver MR imaging: a conventional protocol (a fixed scan delay and 2-mL/s injection) using a standard 3-T MR system (Trio-Tim; Siemens, commercialized since 2005) (group A), an optimized protocol (bolus tracking and 1-mL/s injection) using a standard 3-T MR (group B), an optimized protocol using a new 3-T MR (Skyra; Siemens, commercialized since 2012) (group C), and an optimized protocol with CAIPIRINHA using a new 3-T MR (group D). The image quality of the hepatic arterial phase was graded using a 4-point rating scale from 1 (no artifacts) to 4 points (non-diagnostic images with severe artifacts). The differences in image quality scores among the 4 groups were evaluated. In addition, the detection rates of hypervascular hepatocellular carcinomas among the 4 groups were evaluated.. Scores of 4 points were observed in groups A (n = 7), B (n = 5), and C (n = 3) but not in group D. The median image quality score was 2 in groups A and B and 1 in groups C and D. From group A to group D, the median image quality score decreased significantly (P = 0.0001). The median image quality score was significantly lower in group D than in groups A and B (P = 0.0001 and 0.001, respectively), whereas there was no significant difference observed between groups C and D (P = 0.656). The detection rates of hypervascular hepatocellular carcinomas on the hepatic arterial phase were not significantly different among the groups (all P > 0.03), except between groups A and D (P = 0.007).. The CAIPIRINHA technique improved the image quality of hepatic arterial phase imaging with gadoxetic acid, reducing the number of non-diagnostic arterial phase studies.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Angiography; Male; Middle Aged; Neovascularization, Pathologic; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The aim of our study was to evaluate the diagnostic accuracy of gadoxetic acid-enhanced magnetic resonance (MR) imaging both in the detection of hepatocellular carcinoma (HCC) and precancerous lesions and in the assessment of their evolution.. A retrospective study was undertaken on 56 patients with chronic liver disease and suspected liver lesions. We evaluated the number, size and signal intensity of the nodules on dynamic and hepatobiliary MR images. Follow-up studies were carried out every 3 months. Statistical analysis was performed using the Fisher's exact test.. A total of 120 nodules were identified in 41 patients. Of these, 92/120 nodules (76.6%; mean diameter 18.4 mm) showed the typical HCC vascular pattern: 90/92 nodules appeared hypointense and 2/92 were hyperintense on hepatobiliary phase images. An additional 28/120 hypointense, nonhypervascular nodules (23.3%; mean diameter 11 mm) were detected on hepatobiliary phase images, 15 of which showed hypointensity also on the equilibrium phase images. During the 3- to 12-month follow-up, 14/28 nodules (mean diameter 13.3 mm) developed the typical vascular pattern of HCC.. Gadoxetic acid-enhanced MR imaging is useful for detecting HCC as well as hypovascular nodules with potential progression to HCC. Lesions measuring more than 10 mm in diameter are at higher risk of developing into HCC (p = 0.0128).

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Precancerous Conditions; Retrospective Studies

Diffusion-weighted (DW) imaging is commonly used to distinguish between benign and malignant liver lesions.. To prospectively evaluate the true molecular-diffusion coefficient (D), perfusion-related diffusion coefficient (D*), perfusion fraction (f), and ADC of focal hepatic lesions using a free-breathing intravoxel incoherent motion (IVIM) DW sequence, and to determine if these parameters are useful for characterizing focal hepatic lesions.. One hundred and twenty hepatic lesions (34 metastases, 32 hepatocellular carcinoma [HCC], 33 hemangiomas, and 21 liver cysts) in 74 patients were examined. Mean D, D*, f, and ADC values of hepatic lesions were compared among pathologies. ROC curve analyses were performed to assess the performances of D, D*, f, and ADC values for the characterization of liver lesions as benign or malignant.. The mean D and ADC values of benign lesions were greater than those of malignant lesions (P < 0.001). Although the mean D and ADC values of liver cysts were greater than those of hemangiomas (P < 0.001), and these values were not significantly different between metastases and HCCs (P = 0.99). Area under the ROC curve for ADC values (0.98) was significantly greater (P = 0.048) than that for D values (0.96) for the differentiation of benign and malignant lesions. Sensitivity and specificity for the detection of malignant lesion were 89% and 98%, respectively, when an ADC cut-off value of 1.40 was applied.. D and ADC values have more potential for characterizing focal hepatic lesions than D* or f values, and for the differentiation of malignancy and benignity.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Cysts; Diagnosis, Differential; Female; Gadolinium DTPA; Hemangioma; Humans; Image Enhancement; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Respiration; ROC Curve; Sensitivity and Specificity

To determine whether adding diffusion-weighted imaging (DWI) to gadoxetic acid-enhanced 3.0T magnetic resonance imaging (MRI) can improve the detection of hepatocellular carcinoma (HCC), particularly for small lesions (≤2 cm) in patients with liver cirrhosis.. Data of patients diagnosed with focal liver lesions who had undergone gadoxetic acid-enhanced 3.0T MRI and DWI were retrospectively reviewed. Two radiologists (the observers) reviewed independently MRI images in two reading sessions, that is, gadoxetic acid-enhanced images alone and the combination of DWI (b values: 0 and 600 s/mm(2) ) and gadoxetic acid-enhanced images. They assigned to each lesion a confidence level based on a five-point scale. The area under the receiver operating characteristic curve (AUROC), sensitivity and positive predictive value (PPV) for the detection of HCC were calculated.. Both observers found the AUROC of the gadoxetic acid-enhanced images was slightly higher than that of the combined DWI and gadoxetic acid-enhanced MRI images in the detection of HCC (observer 1: 0.947 ± 0.030 vs 0.896 ± 0.042, Z = 1.478, P = 0.139; observer 2: 0.917 ± 0.038 vs 0.868 ± 0.048, Z = 1.296, P = 0.195). The sensitivity for the gadoxetic acid set alone was slightly higher than that for the combined set for observer 1 (97% vs 84%) and slightly lower for observer 2 (74% vs 82%). The PPVs were slightly higher for the gadoxetic acid set alone than for the combined set for both observers (observer 1, 89% vs 80%; observer 2, 93% vs 78%); however, none of the differences were statistically significant (P > 0.05).. There is no benefit in adding DWI to gadoxetic acid-enhanced MRI for the detection of HCC at 3.0T.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Early Detection of Cancer; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Observer Variation; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Young Adult

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.. 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.. 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).. Adding DWI to conventional MRI can improve the detection of viable HCC tumors treated with radiotherapy compared to conventional MRI alone.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Retrospective Studies

To compare the accuracy of multidetector computed tomography (MDCT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) for the detection of intrahepatic tumor recurrence after curative resection of hepatocellular carcinoma (HCC).. Fifty-six patients who underwent MDCT and gadoxetic acid-enhanced MRI for postoperative surveillance after resection of HCC were retrospectively analyzed; 26 patients had a recurrence (36 lesions) and 30 patients did not. Recurrent HCCs were confirmed by histological examinations in two, typical dynamic imaging findings on CT and/or MRI in 28, and by demonstration of growth or tumor staining on angiography on six. Two reviewers graded the confidence for the presence of recurrence on CT and MRI, using a five-point scale. The jackknife free-response receiver operating characteristic method was used to compare diagnostic performance. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.. For 36 recurrent lesions, the figure of merit was significantly higher for MRI than MDCT for detecting recurrence for both reviewers (p < 0.005 for both reviewers). In lesion-by-lesion analysis, the sensitivity was significantly higher on MRI (100% for reviewer 1 and 97% for reviewer 2) than on MDCT (44.4% and 66.6%) for both reviewers (p < 0.005 for both reviewers). Also in patient-by-patient analysis, sensitivity was significantly higher on MRI (100% and 96.1%) than on MDCT (57.6% and 76.9%) for both reviewers (p < 0.05 for both reviewers).. Gadoxetic acid-enhanced MRI is superior to MDCT for detecting intrahepatic recurrence after curative resection of HCC.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Iohexol; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Neoplasm Recurrence, Local; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity

Combined hepatocellular-cholangiocarcinoma (CHC), also referred to as primary liver carcinoma (PLC) with biphenotypic differentiation, is an increasingly recognized subtype of malignant PLC encompassing varying morphologic forms thought to arise either from progenitor cell lineage or dedifferentiation of mature liver cells. Tumor cells express both biliary and hepatocellular markers by immunohistochemistry, and may also express progenitor cell and stem cell markers. Due to the relative rarity of this tumor type, little is known about the risk factors, imaging appearance, or prognosis. Few studies have demonstrated risk factors that overlap with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC), though not all appear to arise in the background of cirrhosis. The imaging appearances of these tumors may overlap with those of HCC and CC and discriminating features such as classic enhancement patterns and biliary ductal dilation are not universally present. Serum tumor markers, such as alpha-fetoprotein and carbohydrate antigen 19-9, may be helpful when they are discordant with imaging or if both are elevated to a significant degree. In regards to management and prognosis, most studies demonstrate worse outcomes compared with HCC or CC. In the United States, the diagnosis of HCC is frequently made with imaging alone, and subsequent management decisions, including organ allocation for transplantation, rely upon the radiological diagnosis. Given the importance of radiological diagnosis, awareness of this tumor type is essential for appropriate management.

Topics: Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biomarkers, Tumor; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Phenotype; Risk Factors; Tomography, X-Ray Computed

Focal liver reaction (FLR) appears on radiographic images after stereotactic ablative body radiation therapy (SABR) in patients with hepatocellular carcinoma (HCC) and chronic liver disease. We investigated the threshold dose (TD) of FLR and possible factors affecting the TD on gadoxetate acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).. In 50 patients who were treated with SABR for small HCC and followed up by MRI for >6 months, FLR, seen as a hypointense area, was evaluated on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. The follow-up MRI with the largest extent of FLR was fused to the planning computed tomography (CT) image, and patients with good image fusion concordance were eligible. After delineating the border of the FLR manually, a dose-volume histogram was used to identify the TD for the FLR. Clinical and volumetric factors were analyzed for correlation with the TD.. A total of 45 patients were eligible for analysis with a median image fusion concordance of 84.9% (range, 71.6-95.4%). The median duration between SABR and subsequent hepatobiliary phase MRI with the largest extent of FLR was 3 months (range, 1-6 months). The median TD for FLR was 28.0 Gy (range, 22.3-36.4 Gy). On univariate analysis, pre-treatment Child-Pugh (CP) score and platelet count were significantly correlated with the TD. On multiple linear regression analysis, CP score was the only parameter that predicted TD. Median TDs were 30.5 Gy (range, 26.2.3-36.4 Gy) and 25.2 Gy (range, 22.3-27.5 Gy) for patients with CP-A and CP-B disease, respectively.. The TD was significantly correlated with baseline liver function. We propose 30 Gy for CP-A disease and 25 Gy for CP-B disease in 5 fractions as TDs for FLR after SABR for patients with HCC and chronic liver disease. Use of these TDs will help to predict potential loss of liver tissue after SABR.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiosurgery; Radiotherapy Dosage

To compare the association of intravoxel incoherent motion (IVIM)-derived parameters and apparent diffusion coefficient (ADC) with the histologic grade of hepatocellular carcinoma (HCC) and evaluate the relationship between IVIM-derived parameters and arterial enhancement degree.. This retrospective study was institutional review board-approved, and informed consent was waived. Forty patients with 42 surgically confirmed HCCs underwent diffusion-weighted magnetic resonance (MR) imaging with eight b values (0-800 sec/mm(2)). ADC, diffusion coefficient (D), pseudodiffusion coefficient, and perfusion fraction (f) were calculated. Two radiologists determined the enhancement degree in consensus, as well as the percentage of arterial enhancement of HCC. The relationship between the parameters and histologic grade, as well as arterial enhancement, was assessed by using the Spearman or Pearson correlation test. Receiver operating characteristic (ROC) analysis of discrimination between low-grade (grades 1 and 2) and high-grade (grades 3 and 4) HCC was performed for D and ADC values.. D and ADC values were both significantly correlated with histologic grade: r = -0.604 (P < .0001) and r = -0.448 (P = .002), respectively. D and ADC values were both significantly lower in high-grade HCC (D = [0.99 ± 0.13] × 10(-3)mm(2)/sec, ADC = [1.13 ± 0.14] × 10(-3)mm(2)/sec) than in low-grade HCC (D = [1.18 ± 0.16] × 10(-3)mm(2)/sec, ADC = [1.25 ± 0.17] × 10-(3)mm(2)/sec) (P < .0001 and P = .029, respectively). However, ROC analysis demonstrated a higher area under the ROC curve value for D than for ADC for differentiating high-grade HCC from low-grade HCC (0.838 vs 0.728; P = .026). The percentage of arterial enhancement was correlated with f (r = 0.621, P < .0001).. IVIM-derived D values of HCC showed significantly better diagnostic performance than ADC values in differentiating high-grade HCC from low-grade HCC, and significant correlation was observed between f and the percentage of arterial enhancement.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Neoplasm Grading; Retrospective Studies

To investigate optimal flip angle (FA) of three-dimensional fat-suppressed T1-weighted image on Gd-EOB-DTPA-enhanced MRI.. Forty-five patients with 35 hepatocellular carcinomas (HCCs) and 16 liver metastases (METs) were investigated. Signal-to-noise ratio (SNR), tumor-to-liver contrast (TLC) of HCC and MET, visual image quality (IQ) and lesion conspicuity (LeCo) were evaluated at hepatobiliary phase with different FAs (FA15°-30°-45°-60° in 13 patients, FA5°-10°-15°-20°-25° in 32 patients).. TLC gradually showed better in range from FA15° to FA60° and FA5° to FA25°, but SNRs gradually decreased. SNR and TLC-MET at FA15° were significantly better than those at FA45° and FA60°. SNR at FA10° was significantly higher than at FA5°, FA20°, and FA25°. TLC-HCC and TLC-MET at FA5° were inferior to other FAs. IQs and LeCos at FA15° and FA30° were superior to those at FA45° and FA60°. IQs at FA5° and FA25° were significantly lower than those at FA10°-20°, although LeCos for HCC and MET at FA25° were superior to those at FA5°-20°.. FA ranging from 10° to 20° is suitable for hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, to image HCC and MET.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To assess diagnostic performance and imaging features of gadoxetic acid-enhanced magnetic resonance (MR) imaging in small (≤1-cm) hepatocellular carcinoma (HCC) detection in patients with chronic liver disease.. The institutional review board approved this retrospective study and waived informed consent. Sixty patients (56 men, four women; mean age, 60.1 years) with HCC (146 lesions; 70 > 1 cm, 76 ≤ 1 cm) underwent gadoxetic acid-enhanced MR imaging. HCC was confirmed at surgical resection (72 lesions; 30 > 1 cm, 42 ≤ 1 cm) or by showing interval growth with typical enhancement patterns at follow-up dynamic computed tomography or MR imaging (74 lesions; 40 > 1 cm, 34 ≤ 1 cm). Two radiologists assessed MR imaging features and graded likelihood of HCC with a five-point confidence scale. Jackknife alternative free-response receiver operating characteristic (JAFROC) method was used.. Mean JAFROC figure of merit for small HCC was 0.717; that for large (>1-cm) HCC was 0.973 with substantial agreement (κ = 0.676). Mean sensitivity and positive predictive value (PPV) were 46.0% (70 of 152) and 48.3% (70 of 145) for small HCC versus 95.0% (133 of 140) and 78.2% (133 of 170) for large HCC, respectively. Eleven of 76 small HCCs (14%) were not seen on MR images, even after careful investigation. MR imaging features of small HCC included arterial enhancement (79%, 60 of 76), hypointensity on hepatobiliary phase (HBP) images (68%, 52 of 76), washout on 3-minute delayed phase images (50%, 38 of 76), hyperintensity on T2-weighted images (43%, 33 of 76), hypointensity on T1-weighted images (32%, 24 of 76), and restriction on diffusion-weighted images (28%, 20 of 72). Arterial enhancement and washout on 3-minute delayed phase images or hypointensity on HBP images occurred in 66% of small HCCs (50 of 76).. Diagnostic performance of gadoxetic acid-enhanced MR imaging for small HCC detection is still low, with mean sensitivity of 46.0% (70 of 152) and mean PPV of 48.3% (70 of 145). By adding hypointensity on HBP images as washout, diagnostic performance for small HCC detection can be improved.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Tumor Burden

To visualize liver uptake function using the uptake contrast-enhanced ratio in hepatobiliary phase (uptake CERH) magnetic resonance imaging.. Thirty-seven patients with hepatocellular carcinoma (HCC) and 23 with metastatic liver cancer were evaluated. Hepatobiliary phase images were acquired 20min after an intravenous bolus injection of gadoxetic acid disodium. We assumed that the contrast-enhanced ratio in the hepatobiliary phase (CERH) in the spleen was similar to the contrast-enhanced ratio in the extracellular matrix (CEREM). The Uptake CERH value was defined as the percentage signal gain between the precontrast and hepatobiliary phase images (without CEREM). The Uptake CERH value measured the tumor-free liver parenchyma. The association of the uptake CERH value with the biochemical liver function test results, and hepatocellular density in the liver parenchyma was assessed. Correlations were examined using Pearson correlation coefficient and the Mann-Whitney test.. The uptake CERH value was correlated with albumin, bilirubin, indocyanine green retention rate at 15min, prothrombin activity(%), platelet count, and cellular density in the liver parenchyma (p<0.01).. Uptake CERH images are useful for visualizing liver uptake function.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Indocyanine Green; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Photomicrography; Retrospective Studies

The purpose of this article is to investigate whether there is a difference in susceptibility to transcatheter arterial chemoembolization between hepatocellular carcinomas (HCCs) showing high uptake and those showing low uptake of gadoxetic acid in the hepatobiliary phase of MRI.. One hundred HCCs that achieved optimal chemoembolization, as assessed by immediate CT in 60 patients, were classified as having high (n = 19) or low (n = 81) uptake of gadoxetic acid on MRI performed before chemoembolization. The local recurrence rates were estimated using the Kaplan-Meier method, and differences between the groups were compared using the log-rank test. The following factors were also correlated with the local recurrence rate using the Cox proportional hazards model for a univariate analysis: high uptake of gadoxetic acid, number of feeding arteries, extrahepatic arterial supply, Child-Pugh class, clinical tumor stage, size, location, and iodized oil accumulation in the noncancerous tissue surrounding the lesion. Parameters that were significant at p < 0.05 were entered into a multivariate model.. The 1- and 3-year local recurrence-free rates were 95% in high-uptake HCCs and 66% and 54%, respectively, in low-uptake HCCs (log-rank test, p < 0.01). The low uptake of gadoxetic acid was the only significant predictor of early local recurrence (hazard ratio = 9.24; p = 0.03) by multivariate analysis.. HCCs showing high uptake of gadoxetic acid appear to be susceptible to chemoembolization.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Tomography, X-Ray Computed

The dynamic enhancement pattern of HCCs smaller than 3 cm in diameter on gadoxetic acid-enhanced magnetic resonance imaging (MRI) have not been extensively investigated. We aimed to evaluate the dynamic enhancement patterns of small HCCs (≤3 cm) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and compare enhancement patterns with multiphasic multidetector computed tomography (MDCT) based on tumour cellular differentiation and size.. We retrospectively included 55 patients with 67 surgically confirmed small HCCs (≤3 cm) who underwent multiphasic MDCT and gadoxetic acid-enhanced MRI. Dynamic enhancement patterns were analysed according to tumour cellular differentiation and size. Hepatobiliary phase images were also analysed to assess their additional value.. The proportion of small HCCs demonstrating the typical enhancement pattern differed depending on tumour cellular differentiation on both MRI (P = 0.001) and MDCT (P = 0.001), but differed depending on tumour size only on CT (P = 0.008). Gadoxetic acid-enhanced MRI more sensitively depicted the typical enhancement pattern than CT for all tumours (P = 0.001), for moderately or poorly differentiated HCCs (P = 0.021) and for HCCs ≤2 cm (P = 0.001). 80% of tumours with atypical enhancement could be diagnosed as HCC based on tumour size and hepatobiliary phase images.. On both gadoxetic acid-enhanced MRI and multiphasic CT, the dynamic enhancement patterns of small HCCs (≤3 cm) differed according to tumour cellular differentiation. Gadoxetic acid-enhanced MRI more frequently demonstrated the typical HCC enhancement pattern than CT in small HCCs.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Multiphasic Screening; Retrospective Studies

To assess the usefulness of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) for predicting lipiodol uptake in patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).. The institutional review board approved this study. 44 HCC patients underwent IVIM-DWI and Gd-EOB-DTPA-enhanced MRI prior to TACE. Using post-TACE CT as a reference standard, each HCC was classified into either lipiodol good uptake (LGU) or poor uptake (LPU) group. Apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion coefficient (D*), and perfusion fraction (f) in HCC were calculated. Arterial enhancement ratio (AER) and IVIM parameters were compared between those two groups using the Mann-Whitney U test.. Of the 51 HCCs, 37 (72.5%) were LGU group and 14 (27.5%) were LPU group. AER of HCC was significantly higher in LGU than LPU (0.99±0.54 and 0.67±0.45; P=.034). ADC, D, and f values were not significantly different (P=.073, .059, and .196, respectively) between these two groups. D* was significantly elevated in LGU than LPU (48.10±15.33 and 26.75±9.55; P=.001).. Both AER derived from contrast enhanced MRI and D* values derived from IVIM-DWI for HCC were significantly higher in LGU than in LPU. These parameters would be helpful for predicting the lipiodol uptake.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Diffusion Magnetic Resonance Imaging; Doxorubicin; Ethiodized Oil; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome

To assess the diagnostic value of hepatobiliary phase imaging with GD-EOB-DTPA for hepatocellular carcinomas (HCC) in cirrhosis.. A total of 43 cirrhotic patients with 45 HCC lesions underwent the examinations of T2WI, DWI, T1WI in-phase and opposed-phase and dynamic contrast enhancement and hepatobiliary phase. Two separate analyses of imaging set with and without hepatobiliary phase images were performed. The confidence scores for HCC diagnosis, consistency, area under the receiver operating characteristic (ROC) curve and sensitivity and positive predictive values of two observers were compared.. After adding hepatobiliary phase, there was a significant increase of confidence scores in diagnosing HCC by both observers (P < 0.05) and the consistency of two observers also increased. The area under the ROC curve improved by both observers, but no significant differences were detected (P > 0.05). The sensitivity increased significantly (P < 0.05) and no significant differences were observed for the positive predictive values by both observers (P > 0.05).. Hepatobiliary phase imaging may improve the diagnostic confidence and sensitivity of GD-EOB-DTPA for HCC in cirrhosis.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Sensitivity and Specificity

We present a case of a 69-year-old man with primary hepatic carcinosarcoma who underwent computed tomography that revealed a hypervascular hepatic tumor with local dense calcification. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging revealed hyperintense lesions in the hepatobiliary phase that indicated hepatocellular carcinoma with bile production. The patient underwent right lobectomy, and the presence of a sarcoma component within the tumor on histopathology confirmed liver carcinosarcoma that included hepatocellular carcinoma. In cases with atypical images that resemble this case, the hyperintensity of a lesion in the hepatobiliary phase aids differential diagnosis.

Topics: Aged; Carcinoma, Hepatocellular; Carcinosarcoma; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed

We report three cases of resected hepatocellular carcinomas with nodules showing different signal intensities in the hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI). One case involved a nodule-in-nodule type hepatocellular carcinoma that showed high signal intensity for the outer tumor and low intensity for the inner tumor in the hepatobiliary phase of EOB-MRI. The inner tumor was more dedifferentiated than the outer. The other two cases involved similar nodules, which showed different signal intensities in the hepatobiliary phase of EOB-MRI. In all three cases, the expression of OATP8 showed good correlation with high signal intensity in the hepatobiliary phase of EOB-MRI, whereas MRP2, MRP3, or both were also highly expressed. However, in the two nodules showing low intensities, the expression of one excreting transporter was independently high even though that of OATP8 was not high. The expression of excreting transporters is usually characterized by passive correspondence to OATP8 expression levels; nevertheless, it sometimes shows expression independent of OATP8.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

The purpose of this study was to elucidate the incidence and risk factors for the progression of hyperintense nodules, observed in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), to hypervascular hepatocellular carcinoma (HCC).. Hypovascular nodules (n = 157) showing hyperintensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 41 patients. All patients underwent computed tomography (CT) during hepatic arteriography and CT during arterial portography within one month of Gd-EOB-DTPA-enhanced MRI. The incidence of progression to hypervascular or classical HCC was calculated using the Kaplan-Meier method.. Tumor size was determined by univariate and multivariate analysis to be an important risk factor of hypervascularization (p = 0.041, odds ratio 1.135). The cumulative incidences of hypervascularization in hypovascular nodules showing hyperintensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were 2.4, 4.5, and 6.2 % at 12, 24, and 36 months, respectively. The incidence of hypervascularization was significantly increased in nodules >10 mm in diameter (p = 0.00035).. In patients with chronic liver disease, hypovascular nodules presenting as hyperintense in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI and >10 mm in diameter have malignant potential for progression to hypervascular HCC and require careful management.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Comorbidity; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Image Enhancement; Incidence; Kaplan-Meier Estimate; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed

To retrospectively determine the correlation between heptic tumor signal intensity on gadoxetic acid-enhanced and diffusion-weighted MR images and histopathological grading of hepatocellular carcinoma (HCC).. We retrospectively reviewed the MR images of 79 patients with 141 surgically resected HCCs. The signal intensity and its relationship with histopathological grade were assessed. We measured the apparent diffusion correlation (ADC) values and calculated arterial enhancement ratios, washout ratios, and relative intensity ratios of HCCs relative to the surrounding liver parenchyma in gadoxetic-enhanced MR images in order to determine their relationship to the histological grade.. Morphological evaluation showed that larger tumor size and extrahepatic extension were associated with higher histologic grade (p < 0.01). Multivariate logistic regression showed that low ADC value and low relative intensity ratio in the arterial phase (RIRa) predict high histological grade. ADC value (cut-off 1.7 × 10(-3) mm(2)/s, sensitivity 82.4%, specificity 83.2%) was the best predictor of well-differentiated HCC, and RIRa (cut-off 0.93, sensitivity 81.4%, specificity 93.9%) was superior to ADC for predicting poorly differentiated HCC.. Relative low arterial enhancement on gadoxetic acid-enhanced MR images and low ADC are predictive of worse histological grades of HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Male; Middle Aged; Neoplasm Grading; Retrospective Studies; Sensitivity and Specificity

In the current era of emerging molecular targeted drugs, it is necessary to identify before treatment the specific subclass to which a tumour belongs. Gadoxetic acid is a liver-specific contrast agent that is preferentially taken up by hepatocytes. Therefore, gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) should provide precise molecular information about hepatocellular carcinomas (HCCs). The aim of this study was to investigate the transporters of gadoxetic acid in HCC comprehensively and to analyse the molecular regulatory mechanism of such transporters.. Expression levels of transporters, transcriptional factors and Wnt target genes in clinical samples were examined by quantitative real-time reverse transcription polymerase chain reaction and immunohistochemistry. LiCl treatment of the HCC cell line KYN-2 was conducted in vitro to assess the effects of Wnt signalling activity.. Comprehensive analyses of transporter mRNAs and protein expressions revealed that the organic anion transporting polypeptide 1B3 (OATP1B3) had the strongest correlation with tumour enhancement in hepatobiliary-phase images of EOB-MRI. Association analysis with OATP1B3 expression revealed significant correlation with the expression of Wnt/β-catenin target genes. Further, LiCl treatment induced OATP1B3 mRNA expression in KYN-2 cells, indicating a strong association between OATP1B3 expression and Wnt/β-catenin signalling. The sensitivity and specificity to predict Wnt/β-catenin-activated HCC using tumour enhancement in EOB-MRI were 78.9% and 81.7%, respectively.. OATP1B3 was confirmed as the most important transporter mediating HCC enhancement in EOB-MRI. OATP1B3 expression showed a strong association with the expression of Wnt/β-catenin target genes, therefore, OATP1B3-upregulated HCC likely represents a specific subclass of Wnt/β-catenin-activated HCC.

Topics: Adult; Aged; Aged, 80 and over; beta Catenin; Carcinoma, Hepatocellular; Cell Line, Tumor; Contrast Media; Female; Gadolinium DTPA; Gene Expression; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organic Anion Transporters, Sodium-Independent; RNA, Messenger; RNA, Neoplasm; Solute Carrier Organic Anion Transporter Family Member 1B3; Wnt Signaling Pathway

To evaluate the prognosis of "strict" high-risk nodules (small hepatocellular nodules detected only in the hepatobiliary phase of initial Gd-EOB-DTPA-enhanced MR examination) in patients with cirrhosis or chronic hepatitis.. The study included thirty-three patients with 60 "strict" high-risk nodules showing hypointensity at the hepatobiliary phase that was undetectable at the vascular phase and other conventional sequences of initial Gd-EOB-DTPA-enhanced MR imaging. These nodules were observed on follow-up MR examinations until hypervascularity was detected. The potential predictive factors for hypervascular transformation were compared between two groups (group A showing hypervascular transformation, group B not showing hypervascularization).. Ten (16.7 %) of 60 "strict" high-risk nodules showed hypervascular transformation during follow-up periods (group A). The growth rates of the nodules in group A (6.3 ± 4.5 mm/year) were significantly higher than those in group B (3.4 ± 7.2 mm/year) (p = 0.003). Additionally, the median observation period in group A (177.5 ± 189.5 day) was significantly shorter than in group B (419 ± 372.2 day) (p = 0.045). The other predictive factors were not significantly correlated with hypervascularization.. Subsets of "strict" high-risk nodules showed hypervascular transformation during follow-up periods in association with increased growth rates, indicating that nodule growth rate is an important predictive factor for hypervascularization.. • "Strict" high-risk nodules are defined as hepatocellular nodules detected only in the hepatobiliary-phase. • Subsets of "strict" high-risk nodules showed hypervascular transformation during follow-up periods. • Increased growth rate is an important predictive factor for hypervascular transformation. • Management of patients with "strict" high-risk nodules becomes more appropriate.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Hepatitis, Chronic; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Retrospective Studies

We sought to evaluate the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with and without additional diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in pretransplant patients. We included 63 liver transplant patients (54 men and 9 women; mean age = 52 years) who had undergone gadoxetic acid-enhanced MRI with DWI at 3.0 T within 90 days before transplantation. Two image sets were reviewed for HCC in 2 separate sessions by 2 independent observers: the gadoxetic acid set and the combined set (gadoxetic acid plus DWI). The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each image set. In all, 113 HCCs (size range = 0.5-7.8 cm, mean = 2.0 ± 1.3 cm) were identified in the 52 liver explants. The per-lesion sensitivity of the combined set (78.8% for both observers) was higher than the sensitivity of the gadoxetic acid set [71.7% (P = 0.02) and 72.6% (P = 0.03) for the 2 observers], with the highest trend for Child-Pugh class A (94.4% and 97.2% for gadoxetic acid and 97.2% for combined), which was followed by class B (73.2% for gadoxetic acid and 82.9% for combined) and then class C (47.2% for gadoxetic acid and 55.6% for combined, P = 0.01). The per-patient negative predictive value of the combined set was higher than that of the gadoxetic acid set for both observers (P = 0.046). There was no difference in specificity between the 2 image sets (P > 0.05). The addition of DWI to gadoxetic acid-enhanced MRI resulted in significantly higher sensitivity to detect HCC. However, the sensitivity decreased with increasing cirrhosis severity for both imaging types.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

There are pros and cons to the use of gadoxetic acid in hepatocellular carcinoma (HCC) workup due to the potential for high false positive diagnosis. This study was conducted to investigate the preoperative diagnostic performance of gadoxetic acid-enhanced MRI protocol including diffusion-weighted imaging (DWI) with emphasis on tumor characterization developed in high risk HCC patients.. We included 144 patients (102 men, 42 women; age range 33-74 years) with chronic viral hepatitis or cirrhosis and 183 focal hepatic tumors (size range, 0.4-11.0 cm; mean, 3.2 cm), including 148 HCCs, 13 cholangiocarcinomas, 12 hemangiomas, three hepatocellular adenomas, two focal nodular hyperplasias, and five other tumors. All patients underwent gadoxetic acid-enhanced MRI protocol with DWI. MRIs were independently interpreted by three observers for the detection and characterization of hepatic tumors.. Sensitivities for detecting all 183 liver tumors were 98.4%, 97.8%, and 96.2% for each observer, respectively, with a 97.5% for pooled data. Among 183 hepatic tumors, 91.3% (n=167), 87.4% (n=160), and 86.9% (n=159) were correctly characterized according to their reference standard by each observer, respectively. In 13 cholangiocarcinomas, one to three were misinterpreted as HCC, and the remaining tumors were correctly characterized by each observer. The accuracies (Az) of MRI for HCC diagnosis were 0.952 for observer 1, 0.906 for observer 2, and 0.910 for observer 3, with 0.922 for pooled data. There was good inter-observer agreement.. The gadoxetic acid-enhanced MRI including DWI showed a reasonable performance for tumor characterization with high sensitivity for tumor detection in patients with chronic liver disease, despite concerns of high false positive diagnosis of hypervascular tumors.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; False Positive Reactions; Female; Fibrosis; Gadolinium DTPA; Hepatitis; Hepatocytes; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Observer Variation; Retrospective Studies

Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.

Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Drug Therapy, Combination; Embolization, Therapeutic; Fluorodeoxyglucose F18; Gadolinium DTPA; Genotype; Hepatitis B virus; Hepatitis C, Chronic; Humans; Liver Neoplasms; Lymph Nodes; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Tomography, X-Ray Computed

To evaluate whether gadoxetic acid (Gd-EOB-DTPA)-enhanced MR images of tumors taken during the hepatocyte-specific phase can aid in the differentiation between hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) in patients with atypical cirrhotic nodules detected on dynamic CT images.. Seventy-one patients with 112 nodules showing atypical dynamic enhancement on CT images underwent gadoxetic acid-enhanced MR imaging (MRI) studies. Using a reference standard, we determined that 33 of the nodules were DNs and that 79 were true HCCs. Tumor size, signal intensity on precontrast T1-weighted images (T1WI) and T2WI, and the pattern of dynamic enhancement on MR images taken in the hepatocyte-phase were determined.. There were significant differences in tumor size, hyperintensity on T2WI, hypointensity on T1WI, typical HCC enhancement pattern on dynamic MR images, or hypointensity on hepatocyte-phase images between DNs and HCC. The sensitivity and specificity were 60.8% and 87.9% for T2WI, 38.0% and 87.9% for T1WI, 17.7% and 100% for dynamic MR imaging, 83.5% and 84.9% for hepatocyte-phase imaging, and 60.8% and 87.9% for tumor size (threshold of 1.7 cm).. Gd-EOB-DTPA-enhanced hepatocyte-phase imaging is recommended for patients at high risk of HCC who present with atypical lesions on dynamic CT images.

Topics: Aged; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

To compare 64-slice contrast-enhanced computed tomography (CT) with 3-Tesla magnetic resonance imaging (MRI) using Gd-EOB-DTPA for the diagnosis of hepatocellular carcinoma (HCC) and evaluate the utility of diffusion-weighted imaging (DWI) in this setting.. 3-phase-liver-CT was performed in fifty patients (42 male, 8 female) with suspected or proven HCC. The patients were subjected to a 3-Tesla-MRI-examination with Gd-EOB-DTPA and diffusion weighted imaging (DWI) at b-values of 0, 50 and 400 s/mm2. The apparent diffusion coefficient (ADC)-value was determined for each lesion detected in DWI. The histopathological report after resection or biopsy of a lesion served as the gold standard, and a surrogate of follow-up or complementary imaging techniques in combination with clinical and paraclinical parameters was used in unresected lesions. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated for each technique.. MRI detected slightly more lesions that were considered suspicious for HCC per patient compared to CT (2.7 versus 2.3, respectively). ADC-measurements in HCC showed notably heterogeneous values with a median of 1.2±0.5×10-3 mm2/s (range from 0.07±0.1 to 3.0±0.1×10-3 mm2/s). MRI showed similar diagnostic accuracy, sensitivity, and positive and negative predictive values compared to CT (AUC 0.837, sensitivity 92%, PPV 80% and NPV 90% for MRI vs. AUC 0.798, sensitivity 85%, PPV 79% and NPV 82% for CT; not significant). Specificity was 75% for both techniques.. Our study did not show a statistically significant difference in detection in detection of HCC between MRI and CT. Gd-EOB-DTPA-enhanced MRI tended to detect more lesions per patient compared to contrast-enhanced CT; therefore, we would recommend this modality as the first-choice imaging method for the detection of HCC and therapeutic decisions. However, contrast-enhanced CT was not inferior in our study, so that it can be a useful image modality for follow-up examinations.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Tomography, X-Ray Computed

To determine the pathologic nature of non-hypervascular hypointense nodules (≥1 cm) on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) imaging and to describe the chronological changes of their imaging features on follow-up MR imaging.. This retrospective study was approved by our Institutional Review Board and the requirement for informed consent was waived. 69 patients with 115 non-hypervascular HBP hypointense nodules (≥1 cm in diameter) in cirrhotic livers were enrolled. 67 nodules were histologically diagnosed (group 1) and 52 nodules were followed up with MR for at least 12 months (group 2); 4 nodules belonged to both groups. Two radiologists reviewed the initial and follow-up MR images to determine the size and signal intensities on unenhanced T1- and T2-weighted images, dynamic phases and HBP images in consensus. In addition, two pathologists reviewed the histologic findings including H&E staining and four kinds of immunohistochemical staining in group 1.. In group 1, 73.1% (49/67) of nodules were hepatocellular carcinomas. In group 2, 32.7% (17/52) of nodules developed arterial hypervascularity on follow-up, and 78.8% (41/52) showed at least one of the three imaging features considered to indicate malignant changes during follow-up (mean 19 ± 10 months): increase in diameter by ≥5 mm (23/52, 44.2%), arterialization (17/52, 32.7%) and hyperintensity on T2-weighted images (18/52, 34.6%).. Our study results demonstrate that a significant proportion of non-hypervascular HBP hypointense nodules (≥1 cm in diameter) in patients with cirrhosis showed either malignant features on pathology (73.1%) or developed hypervascularity (32.7%) during follow-up.

Topics: Aged; Biopsy, Needle; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Cohort Studies; Early Detection of Cancer; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Immunohistochemistry; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Radiographic Image Enhancement; Retrospective Studies; Risk Assessment; ROC Curve; Time Factors

Topics: Ablation Techniques; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Electroporation; Ferric Compounds; Gadolinium DTPA; Hepatitis C; Humans; Iron; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Oxides; Tomography, X-Ray Computed; Ultrasonography, Interventional

We summarize here the consensus reached at the Symposium of the 48th Annual Meeting of the Liver Cancer Study Group of Japan held in Kanazawa on July 20th and 21st, 2012, on the role of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the management of hepatocellular carcinoma (HCC). Currently, dynamic CT is the first choice of imaging modality when HCC is suspected. EOB-MRI is useful for differentiation and definitive diagnosis of HCC when dynamic CT/MRI does not show conclusive findings for HCC. In addition, contrast- enhanced ultrasound with Sonazoid is useful for making a decision on whether or not to treat a hypovascular lesion <1 cm when the nodules are shown with low intensity in the hepatocyte phase of EOB-MRI. Furthermore, EOB-MRI should be performed in selected cases of HCC ultrahigh-risk groups every 3-4 months, or EOB-MRI should be performed at least once at the first visit in all HCC ultrahigh-risk groups.

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Japan; Liver Neoplasms; Magnetic Resonance Imaging

To investigate the usefulness of the ultrasonography (US) fusion imaging system for radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).. Since the US fusion imaging system became available in 2010, we have conducted RFA with this system in all cases. The characteristics of 75 patients with 120 HCCs and 89 patients with 123 HCCs who underwent RFA before the introduction of this system (period A) and after it (period B), respectively, were retrospectively compared.. Significant difference in the characteristics of the patients and HCCs between the two periods was found only in the proportion of HCCs with poor conspicuity on grayscale US treated with RFA (1.7%, 2/120 for period A vs. 15.4%, 19/123 for period B, p < 0.01). Among the 19 HCCs with poor conspicuity on grayscale US for period B, 5 and 9 HCCs were identified on grayscale US and contrast-enhanced US, respectively, by the use of the US fusion imaging system, whereas the 5 remaining undetectable HCCs were treated by using the system in conjunction with reference images displayed side-by-side with grayscale US.. Since the introduction of the US fusion imaging system, it has become possible to perform RFA for HCCs with poor conspicuity on grayscale US.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Chi-Square Distribution; Contrast Media; Ferric Compounds; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Oxides; Retrospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed; Ultrasonography, Interventional

In gadoxetic acid–enhanced liver magnetic resonance imaging(MRI), it is known that the pseudoglandular type of hepatocellular carcinoma (HCC) may demonstrate high signal intensity on 20-minutes delayed imaging unlike the microtrabecular counterpart. Herein we report a case of HCC which consisted of mixed components of hypo- and hyper-intensity in the hepatobiliary phase of gadoxetic acid-enhanced MRI, focusing on its imaging findings and pathologic features.

Topics: Antigens, CD34; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Immunohistochemistry; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed

We assessed the change in the therapeutic decision among curative treatments after adding Gd-EOB-DTPA-enhanced MRI to triple-phase MDCT for patients with early-stage HCC.. This study retrospectively investigated two groups: 33 pathologically confirmed HCC patients after liver transplantation in group 1; 34 HCC patients without pathology in group 2. In group 1, we simulated the therapeutic decision-making process by pretransplant MDCT and Gd-EOB-DTPA-enhanced MRI. In group 2, including the 34 early-stage HCC patients consecutively enrolled, we investigated the change of therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT.. In the simulation from group 1, after adding Gd-EOB-DTPA-enhanced MRI, 33.3% (11/33 patients) of treatment decisions were changed from the decision based on MDCT alone. Among 22 patients considered eligible for resection and 33 patients for radiofrequency ablation, the therapeutic decision was changed for 10 patients in the surgical group and 4 patients for the RFA group (45.5 and 12.1%). In group 2, the rate of change in the therapeutic decision after adding Gd-EOB-DTPA-enhanced MRI to MDCT was 41.2% (14/34 patients). In group 1 with explants pathology, the median diameter of HCCs not detected by MDCT but detected by Gd-EOB-DTPA-enhanced MRI was 1.15 cm (0.3-3.0 cm). The median diameter of HCCs seen only in the explanted liver was 1.0 cm (0.3-1.7 cm), and 60.7% of them were well-differentiated HCCs.. This study suggests that performing Gd-EOB-DTPA-enhanced MRI before deciding on curative treatment for early-stage HCC may improve the accuracy of treatment decision for early-stage HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; Decision Making; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Neoplasm Staging; Prognosis; Retrospective Studies

The purpose of the study was to determine significant imaging features to differentiate between infiltrative hepatocellular carcinoma (HCC) and confluent fibrosis (CF) in liver cirrhosis using Gd-EOB-DTPA-enhanced 3-T magnetic resonance imaging.. Nineteen infiltrative HCCs and eight CFs were included. We evaluated the difference in imaging findings and apparent diffusion coefficient (ADC) between the two entities. We compared T2-weighted image (WI) and hepatobiliary phase (HBP) in terms of the clarity of the lesion outer margin.. Seventeen infiltrative HCCs showed lobulated margin, while focal CFs showed either straight (n=3) or irregular margins (n=5) (P=.001). All infiltrative HCCs had intact or bulging contours, and all focal CFs showed capsular retraction (P=.001). Fourteen infiltrative HCCs and two focal CFs showed arterial enhancement (P=.035). The ADC of infiltrative HCCs was significantly lower than that of CFs (P=.001). Satellite nodules were noted in 10 infiltrative HCCs. In terms of outer margin clarity, infiltrative HCCs showed a more distinct margin on HBP than on T2-WI (P=.005), while these two sequences were not significantly different in focal CFs (P=1.000).. HBP improved the imaging characteristics of infiltrative HCC, allowing it to be distinguished from focal CF. Infiltrative HCC showed lower ADC values than focal CF. Lobular configuration, contour bulging, enhancement pattern, associated satellite nodules and portal vein thrombosis were still found to be highly suggestive MR findings for infiltrative HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Processing, Computer-Assisted; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

This study aims to determine the diagnostic accuracy of Primovist-enhanced MRI in the detection of hepatocellular carcinoma (HCC) in cirrhosis, using liver explant histopathology correlation.. Thirty patients underwent a Primovist-enhanced MRI prior to liver transplantation for cirrhosis at the Princess Alexandra Hospital from 2006 to June 2012. Pre-contrast T1, T2 and post-Primovist arterial, portal venous and delayed hepatobiliary phase sequences were routinely obtained. A retrospective audit of MRI reports determined whether HCCs was identified on pre-transplantation imaging. Results were correlated to the explant liver histopathology. Specificity and sensitivity of Primovist in HCC identification in cirrhosis was determined.. The time interval between preoperative MRI and transplantation ranged from the day of transplantation to 112 weeks pre-transplantation. Thirty-nine HCCs were identified histologically in explants. Fifteen HCCs were identified on pre-transplant MRI in 11 patients, ranging from 11 to 43 mm, all confirmed on histopathology. Fourteen MRI studies identified no lesion, concordant on histology. Twenty-four either well or moderately differentiated HCCs were identified on histopathology, all of which were less than 17 mm, were not depicted on MRI. No poorly differentiated HCCs were present in the explants. Two regenerative nodules were correctly identified on MRI. This correlated to a sensitivity of 42.5%, specificity of 100% and a positive predictive value of 100% and negative predictive value of 39.5%.. Primovist-enhanced MRI is very accurate in the identification of HCC in cirrhosis, especially if the tumour is greater than 17 mm and undifferentiated. However, sensitivity is reduced for well- and moderately differentiated HCC less than 17 mm.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Medical Audit; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Statistics as Topic; Young Adult

We evaluated molecular features of hypervascular hepatocellular carcinoma (HCC) that shows iso- or hyperintensity (hyperintense HCC) in the hepatobiliary phase (HB phase) of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI).. We investigated 89 surgically resected cases. Patients were divided into two groups according to the signal intensity in the HB phase of EOB-MRI: hyperintense HCCs (n = 18) and hypointense HCCs (n = 71). We performed immunohistochemical staining for uptake transporter of gadoxetic acid: organic anion transporter polypeptides (OATP8); tumor markers: alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA-II); hepatic stem cell markers: epithelial cell adhesion molecule (EpCAM), cytokeratin 19 (CK19), and neural cell adhesion molecule (NCAM); biliary marker: CK7; hepatocyte marker: hepatocyte paraffin 1 (HepPar1); markers of HCC differentiation: glypican-3; signaling: beta-catenin, and the respective grade was semiquantitatively determined.. Histopathologically, hyperintense HCCs showed significantly weaker expression of AFP (p < 0.05), PIVKA-II (p < 0.01), EpCAM (p < 0.005), glypican-3 (p < 0.005) relative to the hypointense HCCs, whereas OATP8 (p < 0.0001), HepPar1 (p < 0.05), and beta-catenin (p < 0.001) were overexpressed in hyperintense HCCs compared with hypointense HCCs.. Hyperintense HCC expressed OATP8 and showed a feature of mature hepatocytes with a weak expression of stem cell characteristics immunohistochemically. In addition, this type of HCC demonstrated a weaker expression of the poorer prognosis markers including, AFP, PIVKA-II, EpCAM, CK19, and glypican-3.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Immunoenzyme Techniques; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

This article reviews topics discussed during the Fifth International Forum for Liver MRI (with a focus on gadoxetic acid-enhanced MRI), which was held in Munich, Germany, in September 2011.. Growing evidence shows that gadoxetic acid-enhanced MRI has high sensitivity and specificity for diagnosing liver tumors. Hepatobiliary phase imaging adds new information for the characterization of borderline lesions. However, there is a need to develop standardized criteria for interpretation of gadoxetic acid-enhanced MRI in patients with cirrhosis or other risk factors for hepatocellular carcinoma.

Topics: Carcinoma, Hepatocellular; Contrast Media; Early Detection of Cancer; Gadolinium DTPA; Germany; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Practice Guidelines as Topic

The purpose of this study was to evaluate factors influencing hepatic enhancement and the conspicuity of hepatocellular carcinoma (HCC) on gadobenate dimeglu-mine- and gadoxetate disodium-enhanced hepatobiliary phase MR images.. Patients with chronic liver disease who underwent liver MRI with gadobenate dimeglumine (n = 93) or gadoxetate disodium (n = 92) were included in this study. The degree of hepatic enhancement on 1-hour and 3-hour delayed phase gadobenate dimeglumine-enhanced and 20-minute delayed phase gadoxetate disodium-enhanced hepatobiliary phase images were evaluated with quantitative and visual indexes. The conspicuity of 40 HCCs in the gadobenate dimeglumine group and 38 HCCs in the gadoxetate disodium group were graded on a 5-point scale. Correlation between hepatic enhancement indexes and clinical factors (age, body weight, serum bilirubin concentration, model for end-stage liver disease score, Child-Pugh class, and renal function stage) and association between the conspicuity of HCCs and clinical factors, lesion diameter, and hepatic enhancement indexes were evaluated.. In the gadobenate dimeglumine group, the visual index of hepatic enhancement independently correlated with Child-Pugh class on both 1- and 3-hour delayed images (p < 0.001) and with renal function stage only on 3-hour delayed images (p ≤ 0.031). In the gadoxetate disodium group, both quantitative and visual indexes of hepatic enhancement independently correlated with Child-Pugh class (p ≤ 0.019). The conspicuity of HCCs independently correlated with Child-Pugh class and lesion diameter on 3-hour delayed gadobenate dimeglumine-enhanced images (p ≤ 0.031) and on gadoxetate disodium-enhanced images (p = 0.033) and significantly correlated with the visual index of hepatic enhancement on both gadobenate dimeglumine- and gadoxetate disodium-enhanced images (p ≤ 0.001).. Liver enhancement and conspicuity of HCC are significantly affected by Child-Pugh class on both gadobenate dimeglumine- and gadoxetate disodium-enhanced hepatobiliary phase MR images.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric

Gadoxetic acid is a recently developed hepatobiliary-specific contrast material used for magnetic resonance imaging (MRI) which enables highly sensitive detection of hepatocellular carcinoma (HCC).. We performed a meta-analysis of all available studies of the diagnostic performance of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detection of HCC in patients with chronic liver disease.. Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.. Across 10 studies of 570 patients, Gd-EOB-MRI sensitivity was 0.91 (95 % CI 0.77, 0.97) and specificity was 0.93 (95 % CI 0.85, 0.97). Overall, LR+ was 13.6 (95 % CI 5.6, 33.2), LR- was 0.10 (95 % CI 0.04, 0.27), and DOR was 140.36 (95 % CI 28, 696). Among patients with high pre-test probabilities, MRI enabled confirmation of HCC; among patients with low pre-test probabilities, MRI enabled exclusion of HCC. Worst-case-scenario (pre-test probability, 50 %) post-test probabilities were 93 and 9 % for positive and negative MRI results, respectively. In studies in which both Gd-EOB-MRI and contrast enhanced computed tomography (CE-CT) were performed, Gd-EOB-MRI was more sensitive than CE-CT (0.93 vs. 0.78; p < 0.05). Subgroup analysis suggested average lesion size (<2 vs. >2 cm) did not affect the diagnostic accuracy of the test (p > 0.05).. A limited number of small studies suggest Gd-EOB-MRI has good diagnostic performance in the detection of HCC among patients with chronic liver disease. It is also confirmed to be a reliable tool for evaluation of small early-stage HCC.

Topics: Carcinoma, Hepatocellular; Contrast Media; End Stage Liver Disease; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Sensitivity and Specificity

The aim of this study was to evaluate the histologic diagnosis of hypovascular hepatic lesions showing hypointensity on hepatobiliary phase images of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI (EOB-MRI). In 38 patients with hepatocellular carcinoma (HCC) after curative treatments and 18 patients with liver cirrhosis, 105 hypovascular nodules that were hypointense at the hepatobiliary phase of EOB-MRI were biopsied and the clinical usefulness of these EOB-MRI findings for the diagnosis of HCC was examined. Of the 105 nodules (median diameter = 12mm), 78 (74.3%), 11 (10.5%), and 16 (15.2%) were diagnosed as HCC, dysplastic, and non-neoplastic, respectively. The positive predictive value (PPV) of hypointensity at the hepatobiliary phase of EOB-MRI for the diagnosis of HCC increased to 77-90% when combined with the following factors: washout appearance on the delayed phase of triple-phase CT, hyperintensity in diffusion-weighted image of MRI, or the appearance of a hypoechoic part in ultrasonography. PPV increased to 100% when all 3 factors were positive. A relatively large proportion of hypovascular lesions that showed hypo-intensity in the hepatobiliary phase were confirmed to be HCC, and the accuracy of HCC increased when combined with other imaging findings.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Risk Factors

The purpose of this article is to prospectively evaluate the optimal scan delay for gadoxetate disodium-enhanced hepatic arterial phase MRI of hypervascular hepatocellular carcinoma (HCC) using MR fluoroscopic triggering and a slow-injection technique.. Sixty-three patients (37 men and 26 women; age range, 33-92 years; mean age, 68.2 years) underwent gadoxetate disodium-enhanced MRI; there were 33 hypervascular HCCs (size range, 8-57 mm; mean size, 19.8 mm) in 19 patients. The time from the start of contrast agent injection to its arrival in the abdominal aorta (time to arrival) and the time from contrast agent arrival to peak enhancement (time to peak) were determined using MR fluoroscopy using IV slow injection at 1 mL/s of contrast material and a saline chaser. All patients underwent four-phase whole-liver imaging with a 3D keyhole gradient-echo sequence during a single breath-hold immediately after confirmation of aortic peak enhancement. Delays from peak aortic enhancement to k-space filling were 5-9, 10-14, 15-19, and 20-28 seconds, respectively, in the four phases. Time to arrival, time to peak, and HCC-to-liver contrast were evaluated.. The time to arrival (range, 11-24 seconds; mean, 16.2 seconds) and the time to peak (range, 3-10 seconds; mean, 6.8 seconds) showed considerable variation among patients. HCC-to-liver contrast peaked at the first phase in 58% of cases, at the second phase in 42% of cases, and at the third and fourth phases in 0% of cases. Mean HCC-to-liver contrast in the first and second phases was significantly higher than that in the third and fourth phases (p<0.01).. Optimal scan delays for imaging hypervascular HCCs with gadoxetate disodium-enhanced hepatic arterial phase MRI was 7-12 seconds after the peak aortic enhancement using a slow-injection protocol.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Injections, Intravenous; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Time Factors

The objective of our study was to investigate the diagnostic performance of C-arm CT and its value to predict response of hepatocellular carcinoma (HCC) to trans-catheter arterial chemoembolization (TACE) compared with gadoxetic acid-enhanced MRI.. Sixty-eight patients with HCCs (n=167; 145>1 cm, 22≤1 cm) underwent both C-arm CT immediately before TACE and gadoxetic acid-enhanced MRI within 2 weeks before TACE. Two radiologists rated the possibility of HCC using a 5-point confidence scale focused on the degree of arterial enhancement and the shape of the lesion seen on C-arm CT. They also graded the possibility of HCC on MRI based on the signal intensities on T1- and T2-weighted images, arterial enhancement, and hypointensity on both the late phase and the hepatobiliary phase. We also measured the apparent diffusion coefficient value. The diagnostic accuracy was evaluated using the alternative free-response receiver operating characteristic curve method. A multivariate logistic regression analysis was performed between the good-response and nonresponse HCCs for TACE.. The diagnostic accuracy of MRI was greater than that of C-arm CT (0.890 vs 0.681, respectively; p<0.001). However, in small HCCs (≤1 cm), C-arm CT showed a higher sensitivity than MRI (90.9% vs 70.5%, respectively; p=0.023) and a lower positive predictive value than MRI (40.8% vs 57.4%, p=0.073). Well-defined strong arterial enhancement on C-arm CT (odds ratio=8.08, p=0.05) was statistically significant for predicting therapeutic response of HCC to TACE.. C-arm CT showed greater sensitivity than gadoxetic acid-enhanced MRI in depicting small HCCs (≤1 cm). Furthermore, well-defined strong arterial enhancement on C-arm CT can be used to predict therapeutic response of HCC to TACE.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Treatment Outcome

We evaluated the diagnostic performance of fat-suppressed 3D T1-weighted gradient-echo magnetic resonance imaging (MRI) sequences for the hepatobiliary phase of gadoxetic-acid-enhanced liver MRI between low and high flip angle (FA) at 3T.. Forty-six patients with 62 HCCs were enrolled in this retrospective study from among 267 consecutive patients who underwent 3T MRI with low and high FA (10° and 25°) sequences at the hepatobiliary phase. A radiologist measured signal intensities and standard deviations (SD) of lesion, liver, and spleen and calculated signal-to-noise ratio, liver-spleen contrast, and liver-lesion contrast. Two reviewers assessed both image sequences using a five-point rating scale focusing on detecting hypointense lesions.. The high FA sequence showed significantly higher liver-spleen and liver-lesion contrast compared with those of low FA (p < 0.05, p < 0.05, respectively). Per-lesion sensitivities of high FA were higher than those of low FA (p < 0.05, p < 0.05, respectively), and per-person sensitivities were elevated on high FA (p < 0.05 in a reviewer). There were statistically significant differences for detecting HCCs larger than 1 cm (p < 0.05, p < 0.05, respectively).. Increasing FA in T1-weighted hepatobiliary-phase liver MRI may help in detecting HCC at 3T.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Data Interpretation, Statistical; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Spleen

The purpose of this article is to retrospectively evaluate the imaging characteristics and outcomes of indeterminate observations (Liver Imaging Reporting and Data System category 3) detected on MRI in patients with cirrhosis.. Sixty-nine indeterminate observations in 52 patients with cirrhosis were imaged with hepatobiliary contrast agent-enhanced MRI. Observations were evaluated retrospectively in terms of the location, size, enhancement pattern, and follow-up results. Each observation was categorized as stable or progressed observations according to serial follow-up MRI.. The mean follow-up interval was 11.2 months. Forty-six (67%) of the total observations showed arterial enhancement, and 23 (33%) observations showed isointense signal or low signal intensity on arterial phase. The indeterminate observations were classified as arterial enhancement with fade-out appearance (41 observations [59%]), arterial enhancement with washout appearance (five observations [7%]), and nonhyperenhancing observations (23 observations [33%]). Two of 69 observations (3%) were hyperintense on T2-weighted images, and four of 55 observations (7%) were hyperintense on hepatocellular phase. On the final follow-up MRI examinations, four (6%) observations proved to be probable or definite hepatocellular carcinoma, 55 (80%) remained stable, and 10 (14%) decreased in size or were no longer visible.. The most common cause of indeterminate observations on MRI is hypervascular pseudolesions that were clinically stable on follow-up imaging.

Topics: Adult; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Retrospective Studies

Hypovascular nodules that exhibit hypointensity in hepatocyte-phase images of gadoxetic acid-enhanced magnetic resonance (MR) imaging are frequently encountered in clinical practice. We investigated risk factors for the development of these nodules into hypervascular hepatocellular carcinoma (HCC).. We retrospectively reviewed our institutional database and identified 302 patients who underwent gadoxetic acid-enhanced MR imaging for suspected or confirmed HCC from February 1, 2008 to January 30, 2011. We excluded patients who were examined for metastasis of other malignancies or for other hepatic tumors, such as focal nodular hyperplasia. We identified hypovascular nodules that were hypointense in hepatocyte-phase images, recorded their characteristics, and calculated the cumulative hypervascularization rate for nodules that were followed up.. Of the 302 patients, 82 had hypovascular nodules (178 nodules; mean size, 9.3 mm). Sixty nodules were followed up for over 6 months, and eight progressed to hypervascular HCC. Hypervascularization occurred more frequently in nodules with fat than those without (P<0.01). The cumulative hypervascularization rate was 5.1% over a year.. The presence of intralesional fat was found to be a risk factor for hypervascularization of hypovascular nodules that exhibited hypointensity in the hepatocyte-phase images of gadoxetic acid-enhanced MR imaging.

Topics: Adipose Tissue; Aged; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Reproducibility of Results; Risk Factors; Sensitivity and Specificity

We present the case of a 59-year-old male with chronic hepatitis C. An ischemic low-signal intensity nodule was detected on hepatocyte-phase images at S8 obtained by gadolinium-ethoxybenzyl-diethylene-triaminepentaacetic acid (Gd-EOB-DTPA) -enhanced magnetic resonance imaging (MRI). The nodule remained unchanged in size but showed a high-intensity signal on hepatocyte phase images. Subsequently, the nodule increased in size, and dynamic computed tomography revealed hyperemic changes, suggestive of hepatocellular carcinoma. Hepatectomy was performed, and histopathological examination of the resected specimen revealed a bile-producing, moderately differentiated, hepatocellular carcinoma. Cell membrane expression of OATP1B3 was detected in the cancerous area, which was more densely stained than the noncancerous areas. We followed the clinical course of the patient, who gradually developed a green hepatoma, which presented as an ischemic low-signal intensity nodule that was detectable only on hepatocyte-phase images obtained by Gd-EOB-DTPA-enhanced MRI. We observed a gradual increase in size, hyperemic changes, and a shift to a high-intensity signal on the hepatocyte-phase images.

Topics: Carcinoma, Hepatocellular; Contrast Media; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

The purpose of this study was to evaluate the diagnostic capability of gadoxetate disodium (Gd-EOB)-MRI for the detection of hepatocellular carcinoma (HCC) compared with multidetector CT (MDCT). Fifty patients with 57 surgically proven HCCs who underwent Gd-EOB-MRI and MDCT from March 2008 to June 2011 were evaluated. Two observers evaluated MR and CT on a lesion-by-lesion basis. We analyzed sensitivity by grading on a 5-point scale, the degree of arterial enhancement and the differences in histological grades in the diffusion-weighted images (DWI). The results showed that the sensitivity of Gd-EOB-MRI was higher than that of MDCT especially for HCCs that were 1 cm in diameter or smaller. The hepatobiliary phase was useful for the detecting of small HCC. We had few cases in which it was difficult to judge HCC in the arterial enhancement between MRI and MDCT. In the diffusion-weighted image, well differentiated HCC tended to show a low signal intensity, and poorly differentiated HCC tended to show a high signal intensity. In moderately differentiated HCC's, the mean diameter of the high signal intensity group was larger than that of the low signal intensity group (24.5 mm vs. 15.8 mm). In conclusion, Gd-EOB-MRI tended to show higher sensitivity compared to MDCT in the detection of HCC.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cell Differentiation; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Multidetector Computed Tomography; Predictive Value of Tests; Retrospective Studies; Tumor Burden

We aimed to investigate the natural outcome of nonhypervascular lesions detected in the hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI by performing a longitudinal study retrospectively enrolled in a nationwide manner.. Between February 2008 and March 2011, 224 patients with 504 nodules that were diagnosed as nonhypervascular by imaging were recruited from institutions that participated in the present study. We examined the natural outcome of nonhypervascular lesions and evaluated the risk factors.. Of the 504 nodules, 173 (34.3%) showed hypervascular transformation. The overall cumulative incidence of hypervascular transformation was 14.9% at 12 months and 45.8% at 24 months. Multivariate analysis using the Cox regression model revealed previous treatment history for hepatocellular carcinoma (HCC; relative risk = 1.498; p = 0.036, 95% CI 1.03-2.19) and hyperintensity on T2-weighted images (relative risk = 1.724; p = 0.015, 95% CI 1.11-2.67) were identified as independent factors for hypervascular transformation.. Patients who have a previous treatment history for HCC and with hypointense nodules showing hyperintensity on T2-weighted images need careful follow-up because of the high incidence of hypervascular transformation.

Topics: Aged; Aged, 80 and over; Bile Ducts; Carcinoma, Hepatocellular; Disease Progression; Female; Gadolinium DTPA; Humans; Japan; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors

To determine the added value of hepatobiliary phase (HBP) gadoxetic acid-enhanced magnetic resonance imaging (MRI) in evaluating hepatic nodules in high-risk patients.. 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.. 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).. 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.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Tumor Burden

To examine if liver stiffness measured by magnetic resonance elastography (MRE) is a risk factor for hepatocellular carcinoma (HCC) in patients with chronic liver disease.. By reviewing the records of magnetic resonance (MR) examinations performed at our institution, we selected 301 patients with chronic liver disease who did not have a previous medical history of HCC. All patients underwent MRE and gadoxetic acid-enhanced MR imaging. HCC was identified on MR images in 66 of the 301 patients, who were matched to controls from the remaining patients without HCC according to age. MRE images were obtained by visualising elastic waves generated in the liver by pneumatic vibration transferred via a cylindrical passive driver. Risk factors of HCC development were determined by the odds ratio with logistic regression analysis; gender and liver stiffness by MRE and serum levels of aspartate transferase, alanine transferase, alpha-fetoprotein, and protein induced by vitamin K absence-II.. Multivariate analysis revealed that only liver stiffness by MRE was a significant risk factor for HCC with an odds ratio (95 % confidence interval) of 1.38 (1.05-1.84).. Liver stiffness measured by MRE is an independent risk factor for HCC in patients with chronic liver disease.

Topics: Aged; Carcinoma, Hepatocellular; Case-Control Studies; Chi-Square Distribution; Chronic Disease; Contrast Media; Elasticity Imaging Techniques; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Logistic Models; Male; Retrospective Studies; Risk Factors; Statistics, Nonparametric

To determine the differential MRI features of small mass-forming intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC).. Sixty-four patients with pathologically proven small ICCs (n = 32) and HCCs (n = 32) (≤ 3.0 cm in diameter) who had undergone preoperative gadoxetic acid-enhanced MRI and DWI were enrolled in this study. Images were analyzed for the shape of the lesions, the presence of biliary dilatation, hyperenhancement (>50 % of the tumor volume) or rim enhancement on the arterial phase, capsular enhancement, and the presence of target appearance (a central enhancement with hypointense rim) on the hepatobiliary phase and on DWI (a central hypointense area with a peripheral hyperintense rim). Statistical significance of these findings was determined by the χ(2) or Fisher's exact test. Multivariate analysis was performed to identify independent imaging findings that allow differentiation of the two diseases.. Univariate analysis revealed that the following significant parameters favor ICC over HCC: lobulating shape, rim enhancement on arterial phase, target appearance on the hepatobiliary phase, and DWI (P < 0.05). Multivariate logistic regression analysis revealed that only target appearance on the DWI was a significant and independent variable predictive of ICC, as 24 ICCs (75.0 %) and one HCC (3.1 %) showed this feature (P = 0.0003).. A target appearance on the DWI was the most reliable imaging feature for distinguishing small mass-forming ICC from small HCC.

Topics: Adenocarcinoma; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Logistic Models; Male; Middle Aged; Retrospective Studies

The purpose of this study was to assess the efficacy of arterial-dominant phase images of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB)-enhanced magnetic resonance imaging (MRI) for evaluation of arterial blood supply in hepatocellular carcinoma (HCC) in comparison with that of multiphasic dynamic computed tomography (CT). This study comprised 30 patients (22 men and 8 women, mean age: 68.0 years) with 40 pathologically proven HCCs (well differentiated: 3, moderately differentiated: 30, poorly differentiated: 7, mean diameter: 45.1 mm), all of whom underwent EOB-enhanced MRI and dynamic CT preoperative assessment. Regions of interest were placed over HCCs and the adjacent normal liver, and signal intensities or CT values were measured by two experienced abdominal radiologists on the arterial-dominant phase images of EOB-enhanced MRI and dynamic CT images. HCC-to-liver contrasts [Michelson's contrast: C(M)=(S(HCC)-S(Liver))/(S(HCC)+S(Liver))] were calculated and compared among the modalities. HCC-to-liver contrasts were also visually scored on a 5-point scale and compared. The mean C(M) and visual score for dynamic CT were significantly higher than those for EOB-enhanced MRI. Good agreements were obtained among the two observers. Dynamic CT is a more suitable modality than EOB-enhanced MRI for evaluation of arterial blood supply in HCC. This should be taken into account for diagnosis and management of HCC.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd-EOB-DTPA, in a North American population.. One hundred MRI examinations performed with the intravenous injection of Gd-EOB-DTPA in patients with cirrhosis were reviewed retrospectively. Nodules were classified as HCC (n = 70), indeterminate (n = 33), or benign (n = 22). Five readers independently reviewed each examination with and without hepatobiliary phase images (HBP). Lesion conspicuity scores were compared between the two readings. Lesion detection, confidence scores, and receiver operating characteristic (ROC) analysis were compared.. Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged.. Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd-EOB-DTPA.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Comorbidity; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; North Carolina; Prevalence; Reproducibility of Results; Risk Factors; Sensitivity and Specificity

To investigate the detectability of hepatocellular carcinoma (HCC) on Gd-EOB-enhanced MR images (Gd-EOB-MRI), we performed tumor-by-tumor analysis of pathologically confirmed tumors using explants from cirrhotic patients who had undergone liver transplantation.. We studied 11 explanted livers and classified the tumor intensity during the arterial phase (AP) and the hepatobiliary phase (HBP) as low in HBP with early enhancement (EE) in AP (A), as high in HBP with EE in AP (B), as low in HBP without EE in AP (C), as high in HBP without EE in AP (D), and as iso-intense in HBP with EE in AP (E). The diagnostic criteria for HCC were (i) pattern A and C, (ii) pattern A and E, (iii) pattern C and E, and (iv) patterns A, C, and E.. Of the 71 HCCs, 22 were not detected at MRI; of these, 9 were moderately differentiated and 13 were well-differentiated HCCs. The sensitivity of Gd-EOB-MRI for diagnostic criteria 1, 2, 3, and 4 was 63.4%, 52.1%, 22.5%, and 69.0%.. The maximum sensitivity of Gd-EOB-MRI for HCC was only 69.0% even when diagnostic criteria that included all previously reported HCC patterns were adopted.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cell Differentiation; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To evaluate the relative enhancement of liver, pancreas, focal nodular hyperplasia (FNH), pancreas-to-liver index, and FNH-to-liver index in the hepatic arterial dominant phase (HADP) after injection of hepatocyte-specific MRI contrast agents, gadoxetic acid and gadobenate dimeglumine, on 3 and 1.5 Tesla (T) MRI in the same patient.. The MRI database was retrospectively searched to identify consecutive patients who underwent abdominal MRI at 3T and 1.5T systems, using both 0.025 mmol/kg gadoxetic acid-enhanced and 0.05 mmol/kg gadobenate dimeglumine-enhanced MRI at the same magnetic strength field system. 22 patients were identified, 10 were scanned at 3T system and 12 at 1.5T system. The enhancement of liver, pancreas, and FNH was evaluated quantitatively on MR images.. The relative enhancement of liver in HADP in the gadobenate dimeglumine-enhanced group in all subjects was significantly higher than that in gadoxetic acid-enhanced group (P = 0.023). The gadobenate dimeglumine-enhanced group in HADP had better relative enhancement of pancreas and FNH, pancreas-to-liver index, and FNH-to-liver index than gadoxetic acid-enhanced group, but the difference was not statistically significant.. The 0.05 mmol/kg gadobenate dimeglumine-enhanced abdominal MRI studies at 3T and 1.5T MR systems are superior in relative enhancement of the liver in HADP to 0.025 mmol/kg gadoxetic acid-enhanced MRI. This type of assessment may provide comparative effectiveness data.

Topics: Adenoma, Liver Cell; Adult; Carcinoma, Hepatocellular; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Hemangioma; Hepatic Artery; Hepatocytes; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Mass Screening; Meglumine; Middle Aged; Organometallic Compounds; Pancreas; Retrospective Studies; Sensitivity and Specificity

Our objective was to evaluate whether the enhancement pattern, measured by changes in the signal- (SNRs) and contrast-to-noise ratios (CNRs), of hepatocellular carcinomas (HCCs) on gadoxetic acid-enhanced MRI reflects tumor differentiation.. Two hundred eighty-five patients with 286 surgically-confirmed HCCs who underwent gadoxetic acid-enhanced MRI were included (11 grade I, 267 grade II, 7 grade III, and 1 grade IV tumor). Unenhanced and dynamic images with a T1-weighted 3D turbo-field-echo sequence were obtained. Relative signal intensities of the tumors with respect to surrounding liver were evaluated and the SNRs and CNRs were calculated.. SNR measurements demonstrated a fluctuating pattern (an increase in the SNR, followed by a decrease and a subsequent increase [or a decrease in the SNR followed by an increase and a subsequent decrease]) in 282 of 286 (98.6%) tumors. The SNR measurements also showed a single-peak SNR in the arterial phase (1.0% [3/286]) and 3min delayed images (0.3% [1/286]) followed by a decrease in 4 (1.4% [4/286]) grade II tumors. Nearly all tumors (88.1% [252/286]), 9 (81.8% [9/11]) grade I, 236 (88.4% [236/267]) grade II, 6 (85.7% [6/7]) grade III, and 1 (100% [1/1]) grade IV tumor showed maximum absolute CNRs with negative values, which were most commonly found in 20min delayed images (67.5% [170/252]). The remaining 34 of 286 (11.9%) tumors showed maximum absolute CNRs with positive values.. Regardless of the tumor grades, the most common manifestation was a SNR with a fluctuating pattern with time and maximum absolute CNRs with negative values, which were most commonly noted in the hepatobiliary phase.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Signal-To-Noise Ratio

Imaging-based differentiation of hepatic lesions (≤ 30 mm) between well-differentiated hepatocellular carcinomas (w-HCC) and regenerative nodules (RN) presents difficulties. The aim was to compare the diagnostic abilities to differentiate w-HCC from RN using contrast-enhanced ultrasound and magnetic resonance imaging (MRI) both with liver-specific contrast agents.. This prospective study included 67 pathologically proven hepatic lesions (17.5 ± 5.4mm, 54 w-HCCs, 13 RNs) in 56 patients with chronic hepatitis/cirrhosis (male 40, female 16; 29-79y). Hepatic-arterial/liver-specific phase enhancements were assessed quantitatively by ultrasound with perflubutane microbubble agent and MRI with gadolinium-ethoxybenzyl-diethylenetriamine with respect to the histological findings.. Sensitivity, specificity and accuracy of hepatic-arterial phase hyper-enhancement for w-HCC were 59.3%, 100% and 67.2% by ultrasound and 46.3%, 100% and 56.7% by MRI without significant difference. Meanwhile, those of liver-specific-phase hypo-enhancement for w-HCC were 44.4%, 100% and 55.2% by ultrasound and 87.0% (p<0.0001), 46.2% (p=0.0052) and 79.1% (p=0.0032) by MRI. Diagnostic accuracies for w-HCC by area under the receiver operating characteristic curves were higher in the hepatic-arterial phase in ultrasound (0.8316) than MRI (0.6659, p=0.0101) and similar in the liver-specific phase in ultrasound (0.7225) and MRI (0.7347, p=0.8814).. Hypervascularity is a significant feature which distinguishes w-HCC from RN, and ultrasound exerts a beneficial impact better than MRI for such characterization. However, both imaging have comparable abilities in the characterization of non-hypervascular lesions, compensating mutually for the poor sensitivity of ultrasound and the poor specificity of MRI in the liver-specific phase.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Early Detection of Cancer; Female; Fluorocarbons; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography

To determine the importance of arterial enhancement in diagnosing small (<3 cm) hepatocellular carcinomas (HCCs) and to evaluate the added value of dynamic subtraction magnetic resonance imaging (MRI) in detecting arterial enhancement in small (<3 cm) hepatic nodules in high-risk patients.. Eighty-six patients with 135 pathologically confirmed small (<3 cm) hepatic nodules (104 HCCs, 31 benign nodules) underwent MRI before curative surgery. Arterial enhancement was determined by three methods: (1) visual assessment of the arterial phase alone, (2) visual comparison of the arterial phase with the unenhanced phase and (3) additional review of subtraction images. The diagnostic performance of each method was calculated and compared using generalised estimating equations analysis.. Arterial enhancement demonstrated high positive predictive value (PPV) (96.5-98.9 %) and specificity (90.3-96.8 %), but low negative predictive value (NPV) (54.6-62.5 %) and intermediate sensitivity (76-79.8 %) for diagnosing small HCCs. Diagnostic performance was highest for subtraction imaging. There were significant differences among the three methods in sensitivity (P = 0.04), accuracy (P = 0.044), PPV (P < 0.001) and NPV (P = 0.024), but not in specificity (P = 0.167).. The accurate detection of arterial enhancement in small hepatic nodules is important for diagnosing HCC and may be enhanced by subtraction imaging.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique

More information is needed on use of Primovist-enhanced magnetic resonance imaging (MRI) during initial staging analysis of patients with hepatocellular carcinoma (HCC) who are candidates for treatment with liver dynamic computed tomography (CT).. We studied 104 patients who were initially diagnosed as Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, without any other suspicious intrahepatic lesions, by liver dynamic CT from December 2009 to May 2012 at Inha University Hospital in Korea. We evaluated whether an addition of Primovist-enhanced MRI examination affected determination of BCLC stage, compared with liver dynamic CT.. On the basis of CT analysis, the median tumor size was 2.3 cm, and 98 patients had HCCs that met the Milan criteria (94.2%). All 104 patients (100%) had nodular type HCC. Abnormal intrahepatic findings were detected by Primovist-enhanced MRI in 41 patients (39.4%). Eighteen patients (17.3%) had new HCCs, but 6 patients who were initially of BCLC stage A remained at this stage, despite increases in tumor numbers. Of the 104 patients, 31 (29.8%) and 73 (70.2%) had BCLC stage 0 and A HCC before Primovist-enhanced MRI, respectively, and 26 (25.0%), 71 (68.3%), and 7 (6.7%) patients had BCLC stages 0, A, and B HCC after Primovist-enhanced MRI, respectively. In 12 of the 104 patients (11.5%), BCLC stage changed from 0 to A (5/31, 16.1%) or from A to B (7/73, 9.6%).. Primovist-enhanced MRI can provide additional information that can lead to the detection of new intrahepatic HCC lesions during initial staging analyses of patients with BCLC stage 0 or A HCC by liver dynamic CT, despite the absence of other suspicious liver lesions.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Diagnostic Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Republic of Korea; Tomography, X-Ray Computed

To compare the conspicuity of hypointense hepatocellular nodules in patients with chronic liver disease on hepatobiliary phase (HP) of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) acquired with low to high flip angles (FAs).. A total of 95 patients with chronic liver disease who underwent Gd-EOB-DTPA-enhanced MRI were included. HP images were obtained at 20 minutes, with 15°, 20°, and 30° FAs. For the detected hepatocellular nodule, liver-to-lesion contrast-to-phantom ratios (CPR) and lesion conspicuity (LCS) were assessed.. In all examinations, 96 hepatocellular nodules showing hypointensity on HP were identified. These lesions included 39 hypovascular nodules and 57 hypervascular nodules. Mean CPR and LCS showed the highest value on the 30° FA, followed by 20° and 15° FAs. CPR and LCS of 15° FA were significantly lower than those of 20° and 30° FAs (P < 0.001 to P = 0.007). CPR of 30° FA for hypervascular nodules was significantly greater than that of 20° FA (P < 0.001).. In the evaluation of hypointense hepatocellular nodules on HP of Gd-EOB-DTPA-enhanced MRI, higher FA such as 30° should be used rather than low FA such as 15°.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Japan; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prevalence; Reproducibility of Results; Sensitivity and Specificity

Gadoxetic acid and diffusion-weighted imaging (DWI) is increasingly used for the diagnosis of hepatocellular carcinoma (HCC). It is relevant to refine the diagnostic parameters for HCC, using state-of-the-art imaging techniques.. To validate usefulness of magnetic resonance imaging (MRI) criteria with gadoxetic acid-enhanced MRI and DWI for diagnosis of small HCC by differentiation from dysplastic nodule (DN) or regenerative nodule (RN) in cirrhotic patients with strongly suspected small HCC.. One hundred and eight patients with 102 HCCs and 29 benign nodules including 21 DNs and two large RNs (≤ 2.0 cm), and 40 patients with no HCC underwent gadoxetic acid-enhanced MRI and DWI. All patients also underwent MDCT. Index MR criteria for HCC were: (i) arterial hyperenhancement and hypointensity on hepatobiliary phase (HBP) with hyperintensity on DWI; (ii) hypovascular nodule with hyperintensity on DWI; (iii) arterial hyperenhancement and hypointensity on HBP without hyperintensity on DWI; (iv) arterial hyperenhancement and either iso- or hyperintensity on HBP, with hyperintensity on DWI; and (v) hyperintensity only on DWI. According to these criteria, MRI findings for HCCs and benign nodules were independently classified by two reviewers.. On multidetector-row computed tomography, 64 HCCs (62.7%) showed typical features for HCC while 13 (12.8%) were not identified. On MRI, 84 HCCs (82.4%) showed arterial hyperenhancement and hypointensity on HBP, and hyperintensity on DWI. Eight HCCs were regarded as hypovascular HCCs with hyperintensity DWI (category 2). One HCC (0.6 cm in diameter) was demonstrated only by DWI. For each observer, 101 (99.0%) and 100 HCCs (98.0%) were discernible when applying all MRI criteria for HCC, respectively. Three DNs also fit the HCC criteria, thus the specificity was 90.9% for both observers.. With the HCC criteria based on combined gadoxetic acid-enhanced MRI and DWI, it is possible to reliably diagnose small HCC including hypovascular HCCs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hepatitis, Viral, Human; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Sensitivity and Specificity

To define the histological characteristics of hepatocellular carcinomas (HCCs) showing atypical dynamic enhancement patterns on gadoxetic acid-enhanced dynamic magnetic resonance imaging (EOB-MRI).. We evaluated a total of 130 small (≤ 3 cm) HCCs from 114 patients that were surgically removed after EOB-MRI. Two radiologists blinded to the histological findings retrospectively classified the HCCs into typical or atypical lesions. Gross morphology, nuclear histological grade, presence of vascular invasion, and capsule formation and infiltration were compared between the two groups using Chi-square or Fisher tests.. Atypical dynamic enhancement patterns were seen in 23 HCCs (17.7%). None of the atypical HCC showed vascular invasion (P < 0.001). Atypical HCCs also showed more frequently smaller size (1.6 ± 0.6 cm versus 2.1 ± 0.6 cm, P = 0.001) with 86.9% (n = 20) of which 2 cm or less in diameter (P = 0.001), vaguely nodular appearance (56.5% vs 3.7%, P < 0.001), and nuclear grade I (69.6% versus 6.5%, P < 0.001), while less frequently showed capsule formation (26.1% versus 77.6%, P < 0.001) or capsular infiltration (16.7% versus 77.1%, P = 0.005).. Atypical HCCs on EOB-MRI may be characterized by the absence of vascular invasion, smaller (< 2 cm or less) size, vaguely nodular appearance, and well differentiation, and infrequent capsule formation or capsular infiltration.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Reproducibility of Results; Sensitivity and Specificity

Gadoxetic acid (Gd-EOB-DTPA) is a 'hepatocyte-specific' contrast agent for magnetic resonance (MR) in both the vascular and the hepatobiliary phases.. To evaluate the contribution of the hepatobiliary phase of Gd-EOB-DTPA MR in the diagnosis of small hepatocellular carcinoma (HCC) in cirrhotic patients under surveillance.. Between 2008 and 2011, 48 consecutive small (10-30 mm) liver nodules were detected in 33 patients, who prospectively underwent contrast-enhanced ultrasound (CEUS), Gd-EOB-DTPA-enhanced MR and helical-computed tomography (CT) in a blind study. The diagnosis of HCC was established according to AASLD 2005 criteria.. Of the 48 nodules, 38 (79%) were diagnosed as HCC, 24 (63%) of them based on AASLD non-invasive criteria, 11 diagnosed at histology and 3 during follow-up. The typical vascular pattern (arterial hypervascularisation and venous/late washout) was detected in 30 (79%) HCC nodules by MR, in 22 (58%) by CT and in 17 (45%) by CEUS. Hypointensity during the MR hepatobiliary phase was observed in all HCC nodules and in 3 nonmalignant nodules (sensitivity 100%, specificity 70%, positive predictive value 93%, negative predictive value 100%, positive likelihood ratio 3.33, negative likelihood ratio 0). Eight (21%) of the 38 HCC nodules, 7 of which lacked the typical vascular features at any of the imaging modalities, showed washout in the portal/venous phase and hypointensity in the hepatobiliary phase at MRI, while this pattern was not detected in any nonmalignant lesion.. Gadoxetic acid magnetic resonance may enhance the sensitivity of the non-invasive diagnosis of small hepatocellular carcinoma nodules in cirrhotic patients under surveillance. Double hypointensity in the portal/venous and hepatobiliary phases could be considered a new magnetic resonance pattern, highly suggestive of hypovascular hepatocellular carcinoma.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies

To assess the value of gadoxetic acid-enhanced magnetic resonance imaging (MRI) for the pre-therapeutic detection of hepatocellular carcinoma (HCC) using receiver operating characteristic (ROC) analysis with the combination of computed tomography (CT) arterial portography and CT hepatic arteriography (CTAP/CTHA).. A total of 54 consecutive patients with 87 nodular HCCs were retrospectively analyzed. All HCC nodules were confirmed pathologically. Three blinded readers independently reviewed 432 hepatic segments, including 78 segments with 87 HCCs. Each reader read two sets of images: Set 1, CTAP/CTHA; Set 2, gadoxetic acid-enhanced MRI including a gradient dual-echo sequence and diffusion-weighted imaging (DWI). The ROC method was used to analyze the results. The sensitivity, specificity, positive predictive value, negative predictive value and sensitivity according to tumor size were evaluated.. For each reader, the area under the curve was significantly higher for Set 2 than for Set 1. The mean area under the curve was also significantly greater for Set 2 than for Set 1 (area under the curve, 0.98 vs. 0.93; P=.0009). The sensitivity was significantly higher for Set 2 than for Set 1 for all three readers (P=.012, .013 and .039, respectively). The difference in the specificity, positive predictive values and negative predictive values of the two modalities for each reader was not significant (P>.05).. Gadoxetic acid-enhanced MRI including a gradient dual-echo sequence and DWI is recommended for the pre-therapeutic evaluation of patients with HCC.

Topics: Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

Topics: Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Incidental Findings; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

To compare the image quality between T1 high-resolution isotropic volume examination using the multi-echo Dixon technique (mDixon-eTHRIVE) and that using spectrally adiabatic inversion recovery (SPAIR-eTHRIVE) in gadoxetic acid-enhanced liver MRI, and to evaluate the detectability of hepatocellular carcinoma (HCC) on mDixon-eTHRIVE.. Seventy patients with 117 HCCs underwent gadoxetic acid-enhanced liver MRI using mDixon-eTHRIVE. All patients also underwent gadoxetic acid-enhanced MRI using SPAIR-eTHRIVE (mean interval of 96 days). Two radiologists performed a consensus review of MRIs for image quality, homogeneity of fat suppression, artifact, and anatomic sharpness using a four-point scale. The detectability for HCC with mDixon-eTHRIVE was assessed using alternative-free response receiver operating characteristic.. All mDixon-eTHRIVE images received higher scores for homogeneity of fat suppression and image quality (P < 0.05) compared with those for SPAIR-eTHRIVE. With respect to artifact and anatomic sharpness, there was no significant difference between two MRIs (P > 0.05). Diagnostic accuracy (Az) and sensitivity for detecting HCCs with mDixon-eTHRIVE images were mean 0.954 and 93.2%, respectively.. For gadoxetic acid-enhanced liver MRI, mDixon-eTHRIVE showed improved homogeneity of fat suppression and overall image quality compared with SPAIR-eTHRIVE.

Topics: Adipose Tissue; Adult; Aged; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Liver Neoplasms; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique

To identify patient characteristics and magnetic resonance (MR) imaging findings associated with subsequent hypervascularization in hypovascular nodules that show hypointensity on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with chronic liver diseases.. Institutional review board approval was obtained, and informed consent was waived. At multiple follow-up gadoxetic acid-enhanced MR imaging examinations of 68 patients, 160 hypovascular nodules were retrospectively reviewed. A Cox regression model for hypervascularization was developed to explore the association of baseline characteristics, including patient factors (Child-Pugh classification, etiology of liver disease, history of local therapy for hepatocellular carcinoma [HCC], and coexistence of hypervascular HCC) and MR imaging findings (fat content, signal intensity on T2-weighted images, and nodule size). In addition, the growth rate was calculated as the reciprocal of tumor volume doubling time to investigate its relationship with subsequent hypervascularization by using receiver operating characteristic and Kaplan-Meier analyses.. The prevalence of subsequent hypervascularization was 31% (50 of 160 nodules). Independent Cox multivariable predictors of increased risk of hypervascularization were hyperintensity on T2-weighted images (hazard ratio [HR] = 8.7; 95% confidence interval [CI]: 3.6, 20.8), previous local therapy for hypervascular HCC (HR = 5.0; 95% CI: 1.8, 13.6), Child-Pugh B cirrhosis (HR = 3.6; 95% CI: 1.4, 9.5) and coexistence of hypervascular HCC (HR = 2.0; 95% CI: 1.0, 3.8). The mean growth rate was significantly higher in nodules that showed subsequent hypervascularization than in those without hypervascularization. Kaplan-Meier analysis based on the receiver operating characteristic cutoff level (1.8 × 10(-3)/day [tumor volume doubling time, 542 days]) showed that nodules with a higher growth rate had a significantly higher incidence of hypervascularization (P = 5.2 × 10(-8), log-rank test).. Hyperintensity on T2-weighted images is an independent and strong risk factor at baseline for subsequent hypervascularization in hypovascular nodules in patients with chronic liver disease. Tumor volume doubling time of less than 542 days was associated with a high rate of subsequent hypervascularization.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Disease Progression; End Stage Liver Disease; Female; Gadolinium DTPA; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Proportional Hazards Models; Retrospective Studies; Risk Factors; ROC Curve; Sensitivity and Specificity

The gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) often depicts non-hypervascular hypointense hepatic nodules during the hepatobiliary phase in patients with hepatocellular carcinoma (HCC). It is unclear whether the presence of these nodules is associated with HCC recurrence after hepatectomy. We conducted a prospective observational study to investigate the impact of the presence of non-hypervascular hypointense hepatic nodules on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI on the recurrence of HCC after hepatectomy.. A total of 77 patients who underwent hepatectomy for primary, non-recurrent, hypervascular HCC were prospectively followed up after hepatectomy. Post-operative recurrence rates were compared according to the presence of non-hypervascular hypointense nodules on preoperative Gd-EOB-DTPA-enhanced MRI.. Recurrence rates after hepatectomy were higher in patients with non-hypervascular hypointense nodules (risk ratio 1.9396 [1.3615-2.7222]) and the presence of non-hypervascular hypointense nodules was an independent factor associated with postoperative recurrence (risk ratio 2.1767 [1.5089-3.1105]) along with HCC differentiation and portal vein invasion. While no differences were found in the rate of intrahepatic metastasis recurrence based on the preoperative presence of non-hypervascular hypointense hepatic nodules, the rate of multicentric recurrence was significantly higher in patients with preoperative non-hypervascular hypointense hepatic nodules.. Patients with preoperative non-hypervascular hypointense hepatic nodules detected during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI are at higher risk of HCC recurrence after hepatectomy, mainly due to multicentric recurrence.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Risk Factors

To investigate the patterns of imaging appearance of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance (MR) images and to assess their potential value as prognostic markers of HCC associated with tumor recurrence after surgery.. The institutional review board approved this retrospective study and informed consent was waived. A total of 216 patients with 304 pathologically proved HCCs underwent gadoxetic acid-enhanced MR imaging prior to surgery and were included in the study. Two reviewers, blinded to the clinical data, evaluated in consensus the imaging patterns of HCC according to enhancement patterns on dynamic phase images and signal intensity on hepatobiliary phase (HBP) images. The association of imaging features with clinical-pathologic findings was evaluated by using the Student t test, χ(2) test, Mann-Whitney U test, and linear-by-linear association. The dependence of time to tumor recurrence (TTR) after surgery was evaluated by using the Kaplan-Meier method, log-rank test, and Cox proportional hazard model.. HCCs with atypical enhancement pattern (P = .0167, P = .0450, P < .0001, respectively) and iso- to hyperintensity on HBP images (P = .0001, P = .0002, P < .0001, respectively) had smaller tumor size, lower histologic grade, and worse Child-Pugh class. The log-rank test (P = .0064) and Cox proportional hazards model (hazard ratio, 5.676; P = .0158) revealed that HCCs with iso- to hyperintensity on HBP images had significantly longer TTR than HCCs with hypointensity on HBP images.. HCCs can be classified into several imaging patterns on gadoxetic acid-enhanced MR images, which are associated with tumor aggressiveness and outcome. In addition, iso- to hyperintensity on HBP images may be a useful imaging biomarker to indicate longer TTR after surgery. .

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Proportional Hazards Models; Retrospective Studies; Statistics, Nonparametric

To investigate the usefulness of T2* mapping of liver on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI for estimating liver function.. 33 patients were classified into 3 groups as follows: normal liver function (NLF) (n = 7); mild liver damage (MLD) (n = 16) with Child-Pugh A; severe liver damage (SLD) (n = 10) with Child-Pugh B. T2*-weighted gradient-echo (T2*W-GRE) and T1-weighted gradient-echo (T1W-GRE) images were obtained before and after Gd-EOB-DTPA administration (3, 8, 13, and 18 min; 5, 10,15, and 20min; respectively). T2* mapping of liver was calculated from T2*W-GRE, then T2* values of liver and T2* reduction rates of T2* value between pre- and post-contrast enhancement were measured. The increase rates of liver-to-muscle signal intensity (LMS) ratio on T1W-GRE between pre- and post-contrast enhancement were calculated.. T2* values on pre- and post-contrast showed no significant differences among three groups. Significant differences in T2* reduction rates were found among groups, and those of LCB were lower than those of other groups (NLF:MLD:SLD, 3.8:6.0:0.6% at 3 min, 8.2:10.3:1.0% at 8 min, 10.7:11.5:1.2% at 13 min, and 16.1:13.2:3.5% at 18 min, respectively) (P<0.05). Significant differences in increase rates of LMS ratio on T1W-GRE were identified (NLF:MLD:SLD, 1.53:1.46:1.35 at 5 min, 1.68:1.64:1.37 at 10 min, 1.79:1.76:1.44 at 15 min, and 1.89:1.78:1.49 at 20 min, respectively).. T2* reduction rate and increase rate of LMS ratio on T1W-GRE may allow us estimation of liver function according to Child-Pugh score.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male

To compare the diagnostic performances of gadoxetic acid-enhanced magnetic resonance imaging (MRI) and multiphasic multidetector computed tomography (MDCT) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.. Institutional review board approval was obtained for this study and informed consent was obtained from all patients. Fifty-one patients (43 men, eight women; age range 32-80 years) with 73 HCCs underwent gadoxetic acid-enhanced MRI and multiphasic MDCT. Two readers independently analysed each image in three separate reading sessions. The alternative free-response receiver operating characteristic (AFROC) method was used to analyse the diagnostic accuracy. Positive and negative predictive values and sensitivity were evaluated.. A total of 73 HCCs were detected in 51 patients. Although not significant (p>0.05), the areas under the receiver operating characteristic curves were 0.877 and 0.850 for MDCT, 0.918 and 0.911 for dynamic MRI, and 0.905 and 0.918 for combined interpretation of dynamic and hepatobiliary phase MR images. Differences in sensitivity, specificity, and positive and negative predictive values between the readers were not statistically significant (p>0.05). Combined interpretation of dynamic and hepatobiliary phase MRI images was more useful than MDCT in the detection of HCC lesions ≤1cm in diameter for one reader (p=0.043).. Gadoxetic acid-enhanced MRI and MDCT show similar diagnostic performances for the detection of HCC in patients with chronic liver disease. However, the combined interpretation of dynamic and hepatobiliary phase MRI images may improve diagnostic accuracy in the detection of HCC lesions ≤1cm in diameter.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Reproducibility of Results; Retrospective Studies

To describe the imaging features of early hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in comparison with multidetector computed tomography (MDCT) examinations.. We analyzed imaging findings of 19 pathologically proven early HCC lesions in 15 patients who underwent both MDCT and Gd-EOB-MRI at 3.0 Tesla (T) units before surgery. MRI included in-phase and out-of-phase T1-weighted dual-echo gradient-recalled-echo sequences, dynamic T1-weighted images before and after bolus injection of gadoxetic acid disodium, fat-saturated T2-weighted fast spin-echo sequences, and T1-weighted hepatobiliary phase images 20 min after contrast injection. Two radiologists retrospectively evaluated the signal intensities and enhancement features on MRI and MDCT.. None of the lesions displayed arterial enhancement and washout on MDCT. On Gd-EOB-MRI, six (32%) lesions showed T2-hyperintensity, five (26%) lesions showed signal drop on opposed-phase. Three lesions (16%) showed arterial enhancement and washout. Twelve (63%), 13 (68%), and 15 (79%) lesions were hypointense on hepatic venous, equilibrium, and hepatobiliary phase, respectively.. Most early HCCs did not show arterial enhancement and washout pattern on both MDCT and Gd-EOB-MRI. Gd-EOB-MRI may provide several ancillary findings for diagnosis of early HCC such as decreased hepatobiliary uptake, T2 hyperintensity and signal drop in opposed phase.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed

To retrospectively compare the accuracy of detection of hypervascular hepatocellular carcinoma (HCC) by multiphasic multidetector CT and by gadoxetate disodium-enhanced MR imaging.. After ethical approval, we analysed a total of 73 hypervascular HCC lesions from 31 patients suspected of having HCC, who underwent both gadoxetate disodium-enhanced MR imaging and multiphasic multidetector CT. Five blinded observers independently reviewed CT images, as well as dynamic MR images alone and combined with hepatobiliary phase MR images. Diagnostic accuracy (Az values), sensitivities and positive predictive values were compared by using the Scheffe post hoc test.. The mean Az value for dynamic and hepatobiliary phase MR combined (0.81) or dynamic MR images alone (0.78) was significantly higher than that for CT images (0.67, P < 0.001, 0.005, respectively). The mean sensitivity of the combined MR images (0.67) was significantly higher than that of dynamic MR alone (0.52, P < 0.05) or CT images (0.44, P < 0.05). The mean positive predictive values were 0.96, 0.95 and 0.94, for CT, dynamic MR alone and combined MR images, respectively.. Compared with multiphasic multidetector CT, gadoxetate disodium-enhanced MR imaging combining dynamic and hepatobiliary phase images results in significantly improved sensitivity and diagnostic accuracy for detection of hypervascular HCC.. Gadoxetate disodium is a new liver-specific MR imaging contrast agent. Gadoxetate disodium-enhanced MRI helps the assessment of patients with liver disease. It showed high diagnostic accuracy for the detection of hepatocellular carcinoma.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Neovascularization, Pathologic; Observer Variation; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To determine whether peritumoral hypointensity seen on hepatobiliary phase images of preoperative gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) is useful for predicting microvascular invasion of hepatocellular carcinoma (HCC).. This study was approved by the Institutional Review Board. In all, 104 HCC masses in 104 patients who had undergone EOB-MRI and liver surgery within 1 month after EOB-MRI were evaluated. Two radiologists independently recorded the presence of a peritumoral hypointensity on hepatobiliary phase. Interobserver agreement was assessed and consensus records were used. Tumor size was measured. A chi-square test and independent t-test were used for univariate analysis. Multiple logistic regression was performed to determine factors for predicting microvascular invasion. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of peritumoral hypointensity were calculated.. Sixty HCCs had microvascular invasion and 44 did not. Interobserver agreement in determining peritumoral hypointensity was excellent (κ = 0.83). By univariate analysis, peritumoral hypointensity and tumor size were significant for predicting microvascular invasion of HCC. On multiple logistic regression analysis, only peritumoral hypointensity was significant in predicting microvascular invasion of HCC (P = 0.013). The sensitivity, specificity, PPV, and NPV of peritumoral hypointensity were 38.3%, 93.2%, 88.5%, and 52.6%, respectively.. Peritumoral hypointensity on the hepatobiliary phase of EOB-MRI is not sensitive but has high specificity for predicting microvascular invasion of HCC.

Topics: Adult; Aged; Area Under Curve; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Logistic Models; Male; Microcirculation; Middle Aged; Neoplasm Invasiveness; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity

Detection of hepatocellular carcinomas (HCCs) before microvascular invasion (MVI) occurs is important due to the poor outcomes associated with MVI. We retrospectively investigated the imaging features of small HCCs with MVI on gadoxetic acid-enhanced MR imaging.. Fifty patients (40 men and 10 women; mean age, 54 years) with 58 surgically proven small (2 cm or less) HCCs were evaluated by gadoxetic acid-enhanced MRI. Signal intensities on imaging sequences and the presence of the typical dynamic enhancement pattern (arterial enhancement and washout) were assessed. Fisher's exact tests were performed to evaluate the relationships between the presence of MVI, tumor size, and imaging findings.. None of the 12 small HCCs with diameters of 1cm or less had MVI, while 15 (33%) of the 46 small HCCs with diameters of 1.1-2.0 cm had MVI (p=0.025, Fisher's exact test). Among the small HCCs with diameters of 1.1-2.0 cm, all HCCs with MVI showed the typical dynamic pattern and hyperintensity on T2- and diffusion-weighted images. Most HCCs (54 lesions, 93%) were hypointense on hepatobiliary phase images regardless of the presence of MVI.. All small HCCs with MVI showed typical dynamic pattern and hyperintensity on T2-weighted and diffusion-weighted images, while atypical dynamic pattern and size of less than 1cm in diameter may suggest absence of MVI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microvessels; Middle Aged; Neoplasm Invasiveness; Neovascularization, Pathologic; Reproducibility of Results; Sensitivity and Specificity

To investigate the chronological relationship between scan delay and liver enhancement for the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI and evaluate the effects of liver function on liver enhancement.. Hepatobiliary-phase images were retrospectively evaluated in 125 patients with chronic liver disease. Hepatobiliary phase images were obtained at 5, 10, 15, and 20 min after injection. We calculated relative liver enhancement (RLE) at t min after injection by dividing the signal intensity (SI) of the liver at t min by precontrast SI. We compared RLE values at 5, 10, 15, and 20 min and evaluated the detectability of focal hepatic lesions. We analyzed the effect of liver function on RLE with the generalized linear model.. There was not significant difference in RLE and lesion detectability at 15 and 20 min. RLE in the Child-Pugh C group was significantly lower than in the Child-Pugh A and B groups. The serum albumin level and prothrombin time were significantly correlated with the liver enhancement.. A delay time of 15 min for the hepatobiliary phase was thought to be adequate in patients with mild liver dysfunction. The serum albumin level and prothrombin time would be predictive of liver enhancement in the hepatobiliary phase.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Time Factors

To compare the diagnostic performance of gadoxetic acid-enhanced MRI using 3.0 T with that of multiphasic 64-multirow detector CT (MDCT) for the detection of small (≤2 cm) hepatocellular carcinoma (HCC) in patients with chronic liver disease.. A total of 54 patients (44 men, 10 women; age range, 33-81 years) with 59 HCCs (≤2 cm in diameter) who underwent both multiphasic (arterial, portal venous, equilibrium) 64-MDCT and gadoxetic acid-enhanced 3.0 T MRI were enrolled in this study. Two observers independently and randomly reviewed the MR and CT images on a lesion-by-lesion basis. The diagnostic performance of these techniques for the detection of HCC was assessed by alternative free-response receiver operating characteristic (ROC) analysis, in addition to evaluating the sensitivity and positive predictive value.. For each observer, the areas under the ROC curve were 0.874 and 0.863 for MRI, respectively, as opposed to 0.660 and 0.687 for CT, respectively. The differences between the two techniques were statistically significant for each observer (p<0.001). The sensitivities (89.8% and 86.4%) of MRI for both observers were significantly higher than those (57.6% and 61.0% for each observer, respectively) of MDCT. No significant difference was seen between the positive predictive values for the two techniques (p>0.05).. Gadoxetic acid-enhanced 3.0 T MRI shows a better diagnostic performance than that of 64-MDCT for the detection of small (≤2 cm) HCCs in patients with chronic liver disease.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Cohort Studies; Comorbidity; Contrast Media; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Incidence; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Neoplasm Staging; Observer Variation; Predictive Value of Tests; Radiographic Image Enhancement; Reproducibility of Results; Retrospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity

We evaluated the efficacy of fusion imaging that fuses conventional sonography images with hepatobiliary phase contrast-enhanced MR images obtained with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) as the reference image for the detection of hepatocellular carcinomas (HCCs).. Eighty-seven HCCs with a maximum diameter of between 1 and 3 cm at the time of diagnosis were enrolled in this prospective study. We compared the detection rates of HCCs using three sonography modalities: conventional sonography, late phase of contrast-enhanced sonography with Sonazoid, and fusion imaging combining conventional sonography and the hepatobiliary phase of contrast-enhanced MRI with Gd-EOB-DTPA as the reference image. The comparisons were made using the McNemar test.. The detection rate of HCCs using fusion imaging (98%, 85/87) was significantly higher than the detection rates using conventional sonography (76%, 66/87) and contrast-enhanced sonography (83%, 72/87) (p<0.01, for both). For small HCCs (maximum diameter, 1-2 cm), the detection rate using fusion imaging (97%, 59/61) was also significantly higher than those using conventional sonography (66%, 40/61) and contrast-enhanced sonography (80%, 49/61) (p<0.01, for both). The detection rate for atypical HCCs was also significantly higher using fusion imaging (95%, 18/19) than using conventional sonography (53%, 10/19) and contrast-enhanced sonography (26%, 5/19) (p<0.01, for both).. Fusion imaging combining conventional sonography and the hepatobiliary phase of contrast-enhanced MRI with Gd-EOB-DTPA is more sensitive than conventional sonography or contrast-enhanced sonography for detecting HCCs, especially small or atypical HCCs.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Ferric Compounds; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Oxides; Prospective Studies; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Predictive Value of Tests; Ultrasonography

To evaluate hyperintense Gd-DTPA- compared with hyper- and hypointense Gd-EOB-DTPA-enhanced magnet resonance imaging (MRI) in c-myc/TGFα transgenic mice for detecting hepatocellular carcinoma (HCC).. Twenty HCC-bearing transgenic mice with overexpression of the protooncogene c-myc and transforming growth factor-alpha (TGF-α) were analyzed. MRI was performed using a 3-T MRI scanner and an MRI coil. The imaging protocol included Gd-DTPA- and Gd-EOB-DTPA-enhanced T1-weighted images. The statistically evaluated parameters are signal intensity (SI), signal intensity ratio (SIR), contrast-to-noise ratio (CNR), percentage enhancement (PE), and signal-to-noise ratio (SNR).. On Gd-DTPA-enhanced MRI compared with Gd-EOB-DTPA-enhanced MRI, the SI of liver was 265.02 to 573.02 and of HCC 350.84 to either hyperintense with 757.1 or hypointense with 372.55 enhancement. Evaluated parameters were SNR of HCC 50.1 to 56.5/111.5 and SNR of liver parenchyma 37.8 to 85.8, SIR 1.32 to 1.31/0.64, CNR 12.2 to 26.1/-30.08 and PE 42.08% to 80.5/-98.2%, (P < 0.05).. Gd-EOB-DTPA is superior to Gd-DTPA for detecting HCC in contrast agent-enhanced MRI in the c-myc/TGFα transgenic mouse model and there was no difference between the hyperintense or hypointense appearance of HCC. Either way, HCCs can easily be distinguished from liver parenchyma in mice.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Disease Models, Animal; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mice; Mice, Transgenic; Reproducibility of Results; Sensitivity and Specificity

To compare contrast-enhanced (CE) ultrasound with gadoxetate disodium-enhanced magnetic resonance (MR) imaging in the assessment of arterial hypervascularity of hepatocellular carcinoma (HCC) and dysplastic nodule (DN), with CT during hepatic arteriography (CTHA) as the reference standard.. This study included 54 consecutively diagnosed patients, with 57 histologically confirmed HCCs and 3 DNs (high-grade). All patients underwent CE ultrasound, gadoxetate disodium-enhanced MR imaging and CTHA. Two trained diagnostic radiologists interpreted the CTHA images and rated the degree of intratumoral arterial vascularity by consensus using a five-point confidence scale as the reference standard. In the observer study, the degrees of vascularity on CE ultrasound and gadoxetate disodium-enhanced MR images were qualitatively analysed by four independent readers using a five-point confidence scale. Diagnostic accuracy was analysed by receiver-operating characteristic (ROC) analysis.. The diagnostic accuracies of the average area under the ROC curve (AUC) were significantly greater with CE ultrasound (average AUC: 0.94; 95% confidence interval [CI]: 0.88-1.00) than with gadoxetate disodium-enhanced MR imaging (average AUC 0.84, 95% CI 0.74-0.93, P = 0.0014).. Contrast-enhanced ultrasound yields a significantly higher AUC value than gadoxetate disodium-enhanced MR imaging in the assessment of arterial hypervascularity of HCC and DN.. • Arterial hypervascularity is an important feature determining treatment options in hepatocellular carcinoma. • It can be assessed by contrast-enhanced (CE) ultrasound or magnetic resonance (MR) imaging. • CE ultrasound was more accurate than Gd-EOB-DTPA MRI in assessing intratumoral vascularity. • Hypovascular hepatic nodules should be further investigated using CE ultrasound.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Neovascularization, Pathologic; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography

To investigate the natural outcome and clinical implication of hypointense lesions in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.. Forty patients underwent Gd-EOB-DTPA-enhanced MRI for preoperative evaluation of HCC. Hypointense lesions in the hepatobiliary phase that were hypovascular 5mm of more were extracted for follow-up. We performed a longitudinal study retrospectively for these lesions regardless of whether classical HCC developed or emerged in a different area from that of the lesions being followed.. Thirty one patients displayed 130 hypointense lesions on MRI and only nine showed no hypointense lesions. In total, 17 (13.1%) of 130 hypointense lesions on MRI developed into classical HCC. The cumulative rates for these lesions to develop into classical HCC were 3.2% at 1 year, 11.1% at 2 years and 15.9% at 3 years. The total occurrence rates of classical HCC (25.8% at 1 year, 52.6% at 2 years and 76.4% at 3 years) were higher compared to those regarding only occurrence of classical HCC from hypointense lesions on MRI (10.0% at 1 year, 35.6% at 2 years and 44.6% at 3 years), although no significant difference was observed (p=0.073).. Hypointense lesions that are detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI have some malignant potential, although treating these lesions aggressively in patients who already have HCC may be too severe.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Reproducibility of Results; Sensitivity and Specificity

To validate the diagnostic performance of quadruple phase low tube voltage liver CT through the comparison with Gd-EOB-DTPA enhanced liver MRI for the detection of HCC.. Non-obese patients (38 men, eight women) with 68 HCCs underwent quadruple-phase CT at 16 MDCT (using low tube voltage, 80kVp; moderately high tube current, 280mAs) and Gd-EOB-DTPA-enhanced 3T MRI. Three observers independently and randomly reviewed the CT and MR images on a tumor-by-tumor basis. The diagnostic accuracy of these techniques for detecting HCC was assessed using alternative free-response receiver operating characteristic analysis. Sensitivity and positive predictive values were evaluated. The mean effective doses for the low dose CT were also evaluated.. The areas under the ROC curves were 0.963, 0.959, and 0.941 for low dose CT and 0.981, 0.982, and 0.976 for MRI. Differences in Az of the two techniques for each observer were not statistically significant (P>.05). Differences in sensitivity and positive predictive values between the two techniques for each observer were not also statistically significant: sensitivity (86.8%, 82.4%, 85.3% for CT and 95.6%, 94.1%, 91.2% for MRI) and positive predictive values (92.2%, 90.3%, 89.2% for CT and 92.9%, 92.8%, 92.5% for MRI). Six HCCs (8.8%) in five patients were observed only on hepatobiliary phase of MRI, and all were smaller than 1.5cm. The mean effective dose for CT was approximately 10.2mSv.. Quadruple-phase low-dose liver CT (80kVp, 280mAs) had relatively good diagnostic performance for detecting HCC in non-obese patients. Because no significant difference was observed between low-dose CT and MRI, the use of low-dose liver CT can be justified based on its reduced radiation effects.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

Diffusion weighted imaging (DWI) is an emerging technique for abdominal MR and usually performed before intravenous contrast injection. Recent studies performed in patients with normal liver function have shown that DWI can be performed after gadolinium administration. Aim of this study was to compare DWI before and after administration of different gadolinium compounds in patients with HCC and liver cirrhosis.. 15 patients with known HCC and liver cirrhosis underwent liver MRI at 1.5T (Magnetom Avanto, Siemens) including DWI on day 1 before and after administration of gadobutrol (Gadovist(®)) and on day 2 after administration of EOB-Gadolinium-DTPA (Primovist(®)). Signal to noise ratios (SNR) and contrast to noise ratios (CNR) of HCC lesions were determined for all DWI data sets. Furthermore, ADC values were compared using a Wilcoxon test. A p-value <0.05 indicated statistically significant differences.. There were no statistically significant differences regarding SNR pre-contrast (mean: 48.1), after gadobutrol (mean: 47.7) or after EOB-Gadolinium-DTPA (mean: 50.0; values for b=50s/mm(2)). Similarly, no significant differences were found for CNR (average values:34.4 vs. 32.3 vs. 30.7; b=50s/mm(2)) nor for ADC-values (mean: 1.5 vs. 1.4 vs. 1.5×10(-3)mm(2)/s) of HCC.. There is no significant difference regarding DWI in patients with cirrhosis before and after contrast injection. Hence, it is reliable to run DWI after gadolinium either as an alternative for unsuccessful pre-contrast DWI or as a gap filler to spare time in EOB-Gadolinium-DTPA imaging.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Organometallic Compounds; Reproducibility of Results; Sensitivity and Specificity

The purpose of our study was to determine whether gadoxetate disodium-enhanced MRI improves the detection of locally recurrent hepatocellular carcinoma (HCC) after radiofrequency ablation therapy.. Forty-two consecutive patients (26 men and 16 women; mean age, 70.9 years) who had undergone radiofrequency ablation therapy for HCC were examined by gadoxetate disodium-enhanced MRI. Three independent radiologists reviewed two sets of MR images separately. Set 1 contained unenhanced T1-weighted, T2-weighted, and contrast-enhanced extracellular phase images, and set 2 contained unenhanced T1-weighted, T2-weighted, and contrast-enhanced extracellular and hepatocyte phase images. Diagnostic accuracies were determined by receiver operating characteristic (ROC) curve analysis.. Of the 61 ablated lesions included, 10 developed local recurrence and 51 did not. Sensitivity (60-80% and 70-80% for sets 1 and 2, respectively), specificity (90-98% and 92-100%), and accuracy (87-95% and 89-97%) were not improved by adding hepatocyte phase images. Rather, mean area under the ROC curve (AUC) significantly decreased from 0.94 for set 1 to 0.82 for set 2 (p = 0.046), and the AUC of the radiologist with the least experience significantly decreased from 0.91 to 0.75 (p = 0.037).. For gadoxetate disodium-enhanced MRI, the detection of local recurrence of HCC after radiofrequency ablation therapy was not found to be improved by including hepatocyte phase images. Furthermore, detection may be further impaired when a less-experienced radiologist interprets the images.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric

The aim of this study was to investigate the role of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in predicting the histological grade of hepatocellular carcinoma (HCC) according to the hepatic function. Eighty-one consecutive patients with 122 histologically proven HCCs who underwent Gd-EOB-DTPA-enhanced MRI before resection (45 HCCs in 42 patients) or transplantation (77 HCCs in 39 patients) were analyzed retrospectively. We calculated the relative enhancement ratios (RER), which is the ratio of the relative intensity of a tumor versus the surrounding parenchyma on hepatobiliary phase images to the relative intensity on unenhanced MRI scans. We then analyzed the correlation between the RER and the tumor differentiation grade in patients with various degrees of hepatic function. The degree of tumor enhancement, which included the precontrast relative intensity ratio (RIR), the postcontrast RIR, and the RER, for well-differentiated (WD) HCCs was significantly higher than the degree of tumor enhancement for moderately differentiated and poorly differentiated (PD) HCCs (P = 0.001 and P = 0.001, respectively, for precontrast RIRs; P < 0.001 and P < 0.001, respectively, for postcontrast RIRs; and P = 0.01 and P = 0.001, respectively, for RERs). In a subgroup analysis based on liver function, the correlation between the histological grade and the enhancement ratio was demonstrated only in the group of patients with Child-Pugh class A cirrhosis. The accuracy of postcontrast RIRs for predicting WD and PD HCCs was favorable; the areas under the receiver operating characteristic curves were 0.896 [95% confidence interval (CI) = 0.817-0.974] and 0.769 (95% CI = 0.658-0.879), respectively. In conclusion, the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help to predict the differentiation of HCCs, especially in HCC patients with Child-Pugh class A cirrhosis before liver transplantation or resection.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity

Genetically engineered mouse models, such as double transgenic c-myc/TGFα mice, with specific pathway abnormalities might be more successful at predicting the clinical response of hepatocellular carcinoma (HCC) treatment. But a major drawback of the tumour models is the difficulty of visualizing endogenously formed tumours. The optimal imaging procedure should be brief and minimally invasive. Magnetic resonance imaging (MRI) satisfies these criteria and gadoxetate acid-enhanced MRI improves the detection of HCC. Fat content is stated to be an additional tool to help assess tumour responses, for example, in cases of radiofrequency ablation. Therefore the aim of this study was to investigate if gadoxetate acid-enhanced MRI could be used to detect HCC in c-myc/TGFα transgenic mice by determining the relation between the signal intensity of HCC and normal liver parenchyma and the corresponding fat content as a diagnostic marker of HCC. In our study, 20 HCC in c-myc/TGFα transgenic male mice aged 20-34 weeks were analyzed. On gadoxetate acid-enhanced MRI, the signal intensity was 752.4 for liver parenchyma and 924.5 for HCC. The contrast to noise ratio was 20.4, the percentage enhancement was 267.1% for normal liver parenchyma and 353.9% for HCC. The fat content was 11.2% for liver parenchyma and 16.2% for HCC. There was a correlation between fat content and signal intensity with r = 0.7791. All parameters were statistically significant with P < 0.05. Our data indicate that gadoxetate acid contrast enhancement allows sensitive detection of HCC in c-myc/TGFα transgenic mice and determination of the fat content seems to be an additional useful parameter for HCC.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Fats; Gadolinium DTPA; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mice; Mice, Transgenic; Proto-Oncogene Proteins c-myc; Transforming Growth Factor alpha

To examine the differential features of mass-forming intrahepatic cholangiocarcinoma (ICC) from atypical hypovascular hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. The institutional review board approved this retrospective study and waived informed patient consent. Seventy patients with pathologically proven ICCs (35) and hypovascular atypical HCCs (35) who had undergone preoperative gadoxetic acid-enhanced MRI were enrolled in this study. Images were analysed for the shape of the lesions and presence of hyperintensity on the T1-weighted image (T1WI) and hypo- or hyperintense areas on the T2-weighted image (T2WI). In addition, images were analysed for the presence of linear hyperintensity or multifocal, tiny, hyperintense foci on T2WI and the presence of rim enhancement during early dynamic phases and a central enhancement with a hypointense rim (target appearance) on the 10 and 20 min hepatobiliary phase images. The significance of these findings was determined by the X(2) test.. Univariate analysis revealed that the following significant parameters favour ICC or hypovascular HCC; the presence of T2 hypo- and hyperintense areas and target appearance on the 10 min hepatobiliary phase images favour ICC, and the presence of T2 linear hyperintensity and T2 multifocal hyperintense foci favour hypovascular HCC (p < 0.05). Multivariate analysis revealed that only target appearance on the 10 min hepatobiliary phase was predictive of ICC (p = 0.002) as 30 ICCs (85.7%) showed this feature. However, the target appearance was also observed in all six scirrhous HCCs.. A target appearance on the 10 min hepatobiliary phase images is the best predictor for identifying mass-forming ICC at gadoxetic acid-enhanced MRI.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To investigate the effectiveness of qualitative diffusion-weighted imaging (DWI), subtraction of unenhanced from arterial phase images, and hepatobiliary phase (HBP) images in estimating the histopathological grade of hepatocellular carcinoma (HCC).. We retrospectively reviewed gadoxetic acid-enhanced magnetic resonance images of 175 patients with 201 surgically resected HCCs. The signal intensity and its relationship with histopathological grade were assessed for each sequence and a combination of sequences.. There was a tendency towards higher grades in tumours showing restricted diffusion on DWI (P < 0.001) or arterial enhancement on subtraction imaging (P < 0.001), but not hepatocyte-defect on HBP images (P = 0.33). When lesions were divided into three groups based on combined findings on DWI and subtraction imaging, a linear trend was observed between group and grade (P < 0.001). The positive predictive value (PPV) of the combination of no restricted diffusion and no arterial enhancement in predicting well-differentiated HCC was 100%, higher than the PPV of individual findings on DWI (74%) or subtraction imaging (81%).. DWI and subtraction imaging are helpful for predicting the histopathological grade of HCC, especially when the two sequences are considered together.. • Predicting the histopathological grade of hepatocellular carcinoma (HCC) preoperatively is important. • Diffusion-weighted imaging (DWI) and subtraction imaging are recently developed MR techniques. • Retrospective study showed DWI and subtraction imaging helps predict HCC grades. • Management of patients with HCC becomes more appropriate.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Diffusion; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Reproducibility of Results; Subtraction Technique

We aimed to evaluate gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the detection of hepatocellular carcinomas (HCCs) and dysplastic nodules (DNs) compared with dynamic multi-detector row computed tomography (MDCT), and to discriminate between HCCs and DNs.. Eighty-six nodules diagnosed as HCC or DNs were retrospectively investigated. Gd-EOB-DTPA-enhanced MRI and dynamic MDCT were compared with respect to their diagnostic ability for hypervascular HCCs and detection sensitivity for hypovascular tumors. The ability of hepatobiliary images of Gd-EOB-DTPA-enhanced MRI to discriminate between these nodules was assessed. We also calculated the EOB enhancement ratio of the tumors.. For hypervascular HCCs, the diagnostic ability of Gd-EOB-DTPA-enhanced MRI was significantly higher than that of MDCT for tumors less than 2 cm (p = 0.048). There was no difference in the detection of hypervascular HCCs between hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI (43/45: 96%) and dynamic MDCT (40/45: 89%), whereas the detection sensitivity of hypovascular tumors by Gd-EOB-DTPA-enhanced MRI was significantly higher than that by dynamic MDCT (39/41: 95% vs. 25/41: 61%, p = 0.001). EOB enhancement ratios were decreased in parallel with the degree of differentiation in DNs and HCCs, although there was no difference between DNs and hypovascular well-differentiated HCCs.. The diagnostic ability of Gd-EOB-DTPA-enhanced MRI for hypervascular HCCs less than 2 cm was significantly higher than that of MDCT. For hypovascular tumors, the detection sensitivity of hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI was significantly higher than that of dynamic Gd-EOB-DTPA-enhanced MRI and dynamic MDCT. It was difficult to distinguish between DNs and hypovascular well-differentiated HCCs based on the EOB enhancement ratio.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To test new diagnostic criteria for the discrimination of early hepatocellular carcinoma (HCC) from benign hepatocellular nodules on gadoxetic acid-enhanced MRI (Gd-EOB-MRI).. We retrospectively analysed 34 patients with 29 surgically diagnosed early HCCs and 31 surgically diagnosed benign hepatocellular nodules. Two radiologists reviewed Gd-EOB-MRI, including diffusion-weighted imaging (DWI), and the signal intensity at each sequence, presence of arterial enhancement and washout were recorded. We composed new diagnostic criteria based on the lesion size and MRI findings, and then the diagnostic performance was compared with that of conventional imaging criteria with logistic regression and a generalised estimating equation method.. A size cut-off value (≥1.5 cm diameter) and MRI findings of T(1) hypointensity, T(2) hyperintensity, DWI hyperintensity on both low and high b-value images (b=50 and 800 s mm(-2), respectively), arterial enhancement, late washout and hepatobiliary hypointensity were selected as the diagnostic criteria. When lesions were considered malignant if they satisfied three or more of the above criteria, the sensitivity was significantly higher than when making a diagnosis based on arterial enhancement and washout alone (58.6% vs 13.8%, respectively; p=0.0002), while the specificity was 100.0% for both criteria.. Our new diagnostic criteria on Gd-EOB-MRI may help to improve the discrimination of early HCC from benign hepatocellular nodules.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

To investigate the predictive factors of malignant transformation of hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase images of gadoxetic acid-enhanced MRI (HHN).. The clinical data and imaging findings of dynamic contrast-enhanced computed tomography (DCE-CT) and gadoxetic acid-enhanced MRI for a total of 103 HHNs in 24 patients with chronic liver disease were retrospectively investigated. After the results of follow-up examinations were investigated, HHNs were categorized into the three groups for each comparison: (1) nodules with enlargement and/or vascularization and others, (2) nodules with only enlargement and others, (3) nodules with only vascularization and others. Enlargement and/or vascularization during the follow-up period were defined as malignant transformation of HHN. The frequency of each clinical datum and imaging finding in each group was compared to identify the predictive factors for malignant transformation in HHN.. Multivariate analysis showed that a nodule size of 9 mm or more on the initial gadoxetic acid-enhanced MRI was a significant predictive factor for the enlargement and/or vascularization of HHN (P<0.05). On the other hand, the hypoattenuation on the delayed phase imaging of the initial DCE-CT was a significant predictive factor for the enlargement or vascularization of HHN (P<0.05).. A nodule size of 9 mm or more on the initial gadoxetic acid-enhanced MRI and hypoattenuation on the delayed phase imaging of initial DCE-CT would be helpful for predicting the outcome of HHN in patients with a risk of hepatocellular carcinoma.

Topics: Aged, 80 and over; Carcinoma, Hepatocellular; Cell Transformation, Neoplastic; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Reproducibility of Results; Sensitivity and Specificity

To examine the differential features of combined hepatocellular and cholangiocarcinoma (HCC-CC) from mass-forming intrahepatic cholangiocarcinoma (ICC) on gadoxetic acid-enhanced MRI.. Forty patients with pathologically proven combined HCC-CC (n = 20) and ICCs (n = 20) who had undergone gadoxetic acid-enhanced MRI were enrolled in this study. MR images were analyzed for the shape of lesions, hypo- or hyperintense areas on the T2-weighted image (T2WI), rim enhancement during early dynamic phases, and central enhancement with hypointense rim (target appearance) on the 10-min and 20-min hepatobiliary phase (HBP). The significance of these findings was determined by the χ(2) test.. Irregular shape and strong rim enhancement during early dynamic phases, and absence of target appearance on HBP favored combined HCC-CCs (P < 0.05). Lobulated shape, weak peripheral rim enhancement, and the presence of complete target appearance on the 10-min and 20-min HBP favored ICCs (P < 0.05). However, 10 CC-predominant type of combined HCC-CC showed complete or partial target appearance on 10-min HBP.. The shape of tumors, degree of rim enhancement during early dynamic phases, and target appearance on HBP were valuable for differentiating between combined HCC-CC and mass-forming ICC on gadoxetic acid-enhanced MRI.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To elucidate the incidence of signal intensity patterns of borderline lesions of hepatocellular carcinoma (HCC) on hepatobiliary phase Gd-EOB-DTPA (EOB) enhanced MRI and clarify the natural histories of these lesions.. Total 99 borderline lesions of HCC were identified by angiography-assisted CT. The signal intensity of borderline lesions on hepatobiliary phase of EOB-enhanced MRI was analyzed. Progress rate from borderline lesions to hypervascular HCC was calculated with the Kaplan-Meier method among each signal intensity groups of nodules.. On hepatobiliary phase of EOB-enhanced MRI, 41.4% of the borderline lesions showed hypo-, 42.4% showed iso-, and 16.2% showed hyperintense, compared to background liver. Overall progress rates from borderline lesions to HCC were 10% in 1-year, 14% in 2-year and 20% in 3-year follow-up period. Progress rates to HCC in hypointense borderline lesions were 17% in 1-year, 28% in 2-year and 41% in 3-year follow-up period, and in isointense borderline lesions were 7% in 1-year, 7% in 2-year and 7% in 3-year follow-up period. No hyperintense borderline lesions progressed to HCC in follow-up period.. Although borderline lesions of HCC may show hypo-, iso- and hyperintensity on hepatobiliary phase of EOB-enhanced MRI, hypointense borderline lesions are high risk to progress HCC.

Topics: Aged; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Pattern Recognition, Automated; Reproducibility of Results; Sensitivity and Specificity

To determine if the combination of gadoxetic acid-enhanced magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging helps to increase accuracy and sensitivity in the diagnosis of small hepatocellular carcinomas (HCCs) compared with those achieved by using each MR imaging technique alone.. The institutional review board approved this retrospective study and waived the requirement for informed consent. The study included 130 patients (95 men, 35 women) with 179 surgically confirmed small HCCs (≤2.0 cm) and 130 patients with cirrhosis (90 men, 40 women) without HCC who underwent gadoxetic acid-enhanced MR imaging and DW imaging at 3.0 T between May 2009 and July 2010. Three sets of images were analyzed independently by three observers to detect HCC: a gadoxetic acid set (unenhanced, early dynamic, and hepatobiliary phases), a DW imaging set, and a combined set. Data were analyzed by using alternative-free response receiver operating characteristic analysis. Diagnostic accuracy (area under the receiver operating characteristic curve [A(z)]), sensitivity, specificity, and positive predictive value were calculated.. The mean A(z) values for the combined set (0.952) were significantly higher than those for the gadoxetic acid set (A(z) = 0.902) or the DW imaging set alone (A(z) = 0.871) (P ≤ .008). On a per-lesion basis, observers showed higher sensitivity in their analyses of the combined set (range, 91.1%-93.3% [163-167 of 179]) than in those of the gadoxetic acid set (range, 80.5%-82.1% [144-147 of 179]) or the DW imaging set alone (range, 77.7%-79.9% [139-143 of 179]) (P ≤ .003). Positive predictive values and specificity for all observers were equivalent for the three imaging sets.. The combination of gadoxetic acid-enhanced MR imaging and DW imaging yielded better diagnostic accuracy and sensitivity in the detection of small HCCs than each MR imaging technique alone.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; ROC Curve; Sensitivity and Specificity

As gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) have been widely used for the evaluation of hepatocellular carcinoma (HCC), it is clinically relevant to determine the diagnostic efficacy of gadoxetic acid-enhanced MRI and DWI for detection of HCCs with respect to the severity of liver cirrhosis.. To compare the diagnostic accuracy and sensitivity of gadoxetic acid-enhanced MRI and DWI for detection of HCCs with respect to the severity of liver cirrhosis.. A total of 189 patients with 240 HCCs (≤3.0 cm) (Child-Pugh A, 81 patients with 90 HCCs; Child-Pugh B, 65 patients with 85 HCCs; Child-Pugh C, 43 patients with 65 HCCs) underwent DWI and gadoxetic acid-enhanced MRI at 3.0 T. A gadoxetic acid set (dynamic and hepatobiliary phase plus T2-weighted image) and DWI set (DWI plus unenhanced MRIs) for each Child-Pugh class were analyzed independently by two observers for detecting HCCs using receiver-operating characteristic analysis. The diagnostic accuracy and sensitivity were calculated.. There was a trend toward decreased diagnostic accuracy for gadoxetic acid and DWI set with respect to the severity of cirrhosis (Child-Pugh A [mean 0.974, 0.961], B [mean 0.904, 0.863], C [mean 0.779, 0.760]). For both observers, the sensitivities of both image sets were highest in Child-Pugh class A (mean 95.6%, 93.9%), followed by class B (mean 83.0%, 77.1%), and class C (mean 60.6%, 60.0%) (P < 0.05).. In HCC detection, the diagnostic accuracy and sensitivity for gadoxetic acid-enhanced MRI and DWI were highest in Child-Pugh class A, followed by Child-Pugh class B, and Child-Pugh class C, indicating a tendency toward decreased diagnostic capability with the severity of cirrhosis.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Comorbidity; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity

To analyze intranodular signal intensity pattern of hypovascular high-risk borderline lesions of HCC that illustrate multi-step hepatocarcinogenesis within the nodule on Gd-EOB-DTPA-enhanced MRI.. A total of 73 nodules showing hypervascular foci in hypovascular high-risk borderline lesions identified by angiography-assisted CT were included in this study. The intranodular signal intensities of both the hypervascular foci and the hypovascular high-risk borderline lesions were evaluated on hepatobiliary-phase EOB-enhanced MRI obtained 20 min after intravenous injection of contrast media.. Among 59 hypervascular foci within hypointense hypovascular high-risk borderline lesions, 6 showed more hypointensity, 32 isointensity, and 21 hyperintensity compared to the surrounding hypointense, hypovascular portion of the nodules. Among 14 hypervascular foci within isointense hypovascular high-risk borderline lesions, 5 showed isointensity, and 9 hypointensity compared to the surrounding isointense hypovascular high-risk borderline lesions. No hypervascular foci showed hyperintensity compared to the surrounding isointense hypovascular high-risk borderline lesions.. In most of the hypovascular high-risk borderline lesions containing hypervascular foci within the nodule, the signal intensity was decreased in hypervascular foci as compared with hypovascular high-risk borderline lesions and the surrounding background liver parenchyma. This supports the concept of signal intensity decrease during the dedifferentiation process in multistep hepatocarcinogenesis. However, around 30% of the nodules did not follow this rule, and hypervascular foci showed hyperintensity relative to the hypovascular high-risk borderline lesions.

Topics: Aged; Aged, 80 and over; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Early Diagnosis; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Reproducibility of Results; Sensitivity and Specificity

To investigate the imaging features of hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced magnetic resonance (MR) images in patients with cirrhosis that may be associated with progression to hypervascular hepatocellular carcinoma (HCC).. The institutional review board approved this retrospective study and waived informed patient consent. This study included 135 patients with a diagnosis of hepatitis B-induced liver cirrhosis and 214 hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images. MR images were analyzed with respect to nodule size, degree of hypointensity at hepatobiliary phase (four grades), presence of fat, and signal intensity on T1- and T2-weighted and diffusion-weighted (DW) images. Univariate and multivariate Cox regression analyses were used to identify variables that are associated with developing hypervascular HCC.. On follow-up MR images, 139 nodules (65.0%) had no evidence of HCC (mean follow-up, 522 days) (group 1), but 75 (35.0%) became hypervascular HCC (mean follow-up, 388 days) (group 2). Univariable Cox analysis revealed that the degree of hypointensity on hepatobiliary phase images (P=.044 and .001) and hyperintensity on T2-weighted and DW images (P=.001 and .0001) was significantly related to the development of hypervascular HCC. According to the multivariable Cox analysis, no other variable significantly adjusted the model once hyperintensity at initial DW imaging was already included as an associated variable, (hazard ratio, 7.44; 95% confidence interval: 4.28, 12.94; P=.0001).. Hyperintensity on DW images in hypovascular hypointense nodules on hepatobiliary phase gadoxetic acid-enhanced MR images in patients with cirrhosis is strongly associated with progression to hypervascular HCC.

Topics: Aged; Artifacts; Biopsy; Carcinoma, Hepatocellular; Chi-Square Distribution; Diffusion Magnetic Resonance Imaging; Disease Progression; Female; Gadolinium DTPA; Hepatitis B; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Neovascularization, Pathologic; Proportional Hazards Models; Retrospective Studies; Statistics, Nonparametric

To retrospectively determine whether the hyperintense hepatocellular carcinomas (HCCs) seen on the hepatobiliary phase of gadoxetic acid-enhanced MR imaging (EOB-MRI) might have different histologic characteristics from usual hypointense HCCs.. Two hundred three surgically proven HCCs from 192 patients who underwent preoperative EOB-MRI were analyzed. The demographic and histologic characteristics of hyperintense HCCs were compared with usual hypointense HCCs by using the t-test or Fisher's exact test.. By visual assessment, 18 (8.8%) tumors were classified as hyperintense HCCs. Patients with hyperintense HCC were significantly (p<0.05) older (60.1 vs. 55.2 years) than those with hypointense HCCs. Hyperintense HCCs showed significantly lower rate of microvascular invasion (27.8% vs. 53.5%) and significantly higher rate of peliosis (61.1% vs. 30.8%). Hyperintense HCCs were more frequently expanding type, and none showed infiltrative type or scirrhous histologic pattern.. Hyperintense HCCs seem to have clinical and histologic features that might be related with more favorable outcomes.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

The purpose of this study was to elucidate the incidence and risk factors for the progression of hypointense nodules observed in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) of hypervascular hepatocellular carcinoma (HCC).. Hypovascular nodules (112) showing hypointensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 54 patients. All patients underwent computed tomography during hepatic arteriography and computed tomography during arterial portography (CTAP) within a month after Gd-EOB-DTPA-enhanced MRI. According to the tumor size, 112 nodules were divided into two groups: those >10 mm in diameter (group A, n = 39) and those ≤10 mm in diameter (group B, n = 73). The incidence of progression to hypervascular HCC was calculated using the Kaplan-Meier method.. The incidence of hypervascularization was significantly higher in group A nodules than in group B nodules (p < 0.0001). Tumor size (p < 0.0001) and hypoattenuation in CTAP (p = 0.0004) showed significant correlation with hypervascularization.. Hypointense nodules observed in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI with diameters of >10 mm had a high probability of hypervascularization.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors

The purpose of this study was to elucidate the clinicoradiologic characteristics of pseudolesions of the liver in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) as observed on gadoxetate disodium-enhanced MR images. A particular interest was correlation between the pseudolesion characteristics and TACE-MRI interval, during which sequential changes in pseudolesions may be revealed after TACE.. Forty-eight patients with HCC who underwent gadoxetate disodium-enhanced MRI after TACE were retrospectively recruited. Pseudolesions were defined as areas of decreased signal intensity in treated areas on hepatocellular phase images that were confirmed to be nontumorous areas at follow-up. The prevalence and MRI features of pseudolesions were correlated with various clinical parameters, including TACE-MRI interval.. Pseudolesions were found in 14 patients (29%). Within 1 month of TACE, the prevalence of pseudolesions was 83%. All of the pseudolesions had arterial enhancement, mimicking residual HCC. After 1 month, the prevalence of pseudolesions decreased, and these pseudolesions tended to exhibit no abnormality in any sequence other than the hepatocellular phase. Results of multivariate analysis suggested that size of HCC (p < 0.0001), duration of postembolization syndrome (p = 0.012), and TACE-MRI interval (p = 0.038) are independent indicators of the presence of pseudolesions.. The prevalence and appearance of pseudolesions differ at different intervals from TACE. Radiologists need to recognize the clinicoradiologic characteristics to differentiate pseudolesions from true residual or recurrent HCC.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric; Treatment Outcome

To analyze the correlation among biologic features, tumor marker production, and signal intensity at gadoxetic acid-enhanced MR imaging in hepatocellular carcinomas (HCCs).. Institutional ethics committee approval and informed consent were obtained for this retrospective study. From April 2008 to September 2011, 180 surgically resected HCCs in 180 patients (age, 65.0 years ± 10.3 [range, 34-83 years]; 138 men, 42 women) were classified as either hypointense (n = 158) or hyperintense (n = 22) compared with the signal intensity of the background liver on hepatobiliary phase gadoxetic acid-enhanced MR images. Pathologic features were analyzed and a fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) production were compared by means of serum analysis and immunohistochemical staining. Recurrence and survival rates were also evaluated. The Mann-Whitney and Pearson correlation tests were used for statistical analysis.. The grade of differentiation was higher (P = .028) and portal vein invasion was less frequent in hyperintense HCCs (13.6%) than in hypointense HCCs (36.7%) (P = .039). The serum levels of AFP, Lens culinaris agglutinin reactive fraction of AFP, and PIVKA-II were lower in hyperintense than in hypointense HCCs (P = .003, .004, and .026, respectively). Immunohistochemical AFP and PIVKA-II expression were lower in hyperintense than in hypointense HCCs (both P < .001). The recurrence rate was lower in hyperintense than in hypointense HCCs (P = .039).. The results suggest that hyperintense HCCs on gadoxetic acid-enhanced MR images are less aggressive than hypointense HCCs.. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120226/-/DC1.

Topics: Adult; Aged; Aged, 80 and over; alpha-Fetoproteins; Biomarkers; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Immunohistochemistry; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Organic Anion Transporters, Sodium-Independent; Protein Precursors; Prothrombin; Retrospective Studies; Solute Carrier Organic Anion Transporter Family Member 1B3; Survival Rate

To compare the diagnostic performance of Gd-EOB-DTPA-enhanced MRI with that of triple phase 64-MDCT in the detection of hepatocellular carcinoma (HCC).. Thirty-four patients with 52 surgically proven lesions underwent Gd-EOB-DTPA-enhanced MRI and triple phase 64-MDCT. Two observers independently evaluated MR and CT imaging on a lesion-by-lesion basis. Sensitivity, positive and negative predictive values and reproducibility were evaluated. The diagnostic accuracy of each modality was assessed with alternative-free response receiver operating characteristic (ROC) analysis.. Both observers showed higher sensitivity in detecting lesions with MRI compared to CT, however, only the difference between the two imaging techniques for observer 2 was significant (P=0.034). For lesions 1cm or smaller, MRI and CT showed equal sensitivity (both 62.5%) with one observer, and MRI proved superior to CT with the other observer (MRI 75% vs. CT 56.3%), but the latter difference was not significant (P=0.083). The difference in positive and negative predictive value between the two imaging techniques for each observer was not significant (P>0.05). The areas under the ROC curve for each observer were 0.843 and 0.861 for MRI vs. 0.800 and 0.833 for CT and the differences were not significant. Reproducibility was higher using MRI for both observers, but the result was not significant (MRI 32/33 vs. CT 29/33, P=0.083).. Gd-EOB-DTPA-enhanced MRI tended to show higher diagnostic accuracy, sensitivity and reproducibility compared to triple phase 64-MDCT in the detection of hepatocellular carcinoma, however statistical significance was not achieved.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

To describe the paradoxical high signal intensity of hepatocellular carcinoma (HCC) in the hepatobiliary phase on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).. A database search was performed to identify cases of HCC that showed unusual prolonged enhancement in the hepatobiliary phase of Gd-EOB-DTPA MRI. All patients received 3.0-T liver MRI including precontrast T1-weighted images, T2-weighted images and a post Gd-EOB-DTPA-enhanced dynamic study. The signal intensity of HCC was measured at pre-enhanced, arterial, portal, delayed and hepatobiliary phase using regions of interest. Radiologic and pathologic correlation was performed for the paradoxically prolonged enhancing portion of HCC in the hepatobiliary phase.. Four patients (all male, age range 44-70; mean 57.5 years) were included in this study. All patients showed HCC lesions that were low signal intensity (SI) on T1-WI, high SI on T2-WI, enhanced in arterial phase, and washed-out in delayed phase. All cases showed paradoxically high SI in hepatobiliary phase, which was unusual for HCC. Pathologically, they were all diagnosed as well-differentiated HCC with prominent cytoplasm and a bile secreting appearance.. HCC may demonstrate the prolonged high signal intensity at the hepatobiliary phase on Gd-EOB-DTPA enhanced MRI. These HCCs tended to be highly differentiated and to have prominent bile secretion.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

The aims of this study were to evaluate the morphologic characteristics and growth pattern of hepatic tumors in H-ras 12V transgenic (TG) mice using a micro-magnetic resonance (MR) system and to assess the usefulness of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) enhancement for the detection of hepatic tumors in these mice.. Hepatocellular carcinoma lines were established to allow insertion of the H-ras 12V transgene under the control of the albumin enhancer/promoter. Seven H-ras 12V TG mice and four wild-type mice were included in this study. The mice underwent various MR imaging examinations, including T1-weighted imaging (repetition time, 300 ms; echo time, 11 ms), Gd-EOB-DTPA-enhanced T1-weighted imaging (dose, 0.025 mmol/kg), and T2-weighted imaging (repetition time, 3500 ms; echo time, 36 ms), with a 4.7-T MR scanner, at 4, 6, 8, and 9 months of age. All mice were euthanized after the final MR imaging procedure, except for one TG mouse and two wild-type mice that were euthanized after MR imaging procedures at 4 months of age. For imaging analysis, the tumor characteristics in each MR sequence, including tumor size, number, and signal intensity (SI), were recorded, and the contrast-to-noise ratio and contrast enhancement ratio were calculated to quantify the SI of the tumor. The MR images were correlated with the findings of histopathologic examinations.. No tumors were detected in the four wild-type mice. In the six TG mice, a total of 67 tumors were found in histopathologic specimens obtained at 9 months of age. Of the 67 tumors, 62 were detected on Gd-EOB-DTPA-enhanced T1-weighted images with fat saturation. The majority of hepatic tumors showed high SI on T1-weighted images without fat saturation. The SI diminished on T1-weighted images with fat saturation. The tumor contrast-to-noise ratio for Gd-EOB-DTPA-enhanced T1-weighted imaging was significantly better than that for the other sequences. The tumors were histopathologically confirmed as hepatocellular adenomas (n = 32) and well-differentiated hepatocellular carcinomas (n = 35).. Micro-MR imaging can reveal the characteristics of hepatic tumors in a live murine model. Gd-EOB-DTPA-enhanced T1-weighted imaging is helpful in the detection of hepatic tumors in H-ras 12V TG mice.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Disease Models, Animal; Gadolinium DTPA; Genes, ras; Image Enhancement; Liver; Liver Neoplasms, Experimental; Magnetic Resonance Imaging; Mice; Mice, Transgenic; Observer Variation

The aim of this study was to reveal the relationship between intratumoral uptake of gadoliniumethoxylbenzyldiethylenetriaminepentaacetic acid (Gd-EOB-DTPA) of hepatocellular carcinoma (HCC) in the hepatobiliary phase and pathological features.. Sixty HCC nodules were confirmed at pathology in 56 patients who had undergone dynamic MRI. T1-weighted 3D gradient echo sequences before and 20 min (hepatobiliary phase) after the injection of Gd-EOB-DTPA were performed. Uptake of Gd-EOB-DTPA was defined as an increase in signal intensity in the hepatobiliary phase compared with the precontrast scan. All surgical specimens were fixed with formalin and then digitally photographed. The relationship between Gd-EOB-DTPA uptake and histological findings, including a macroscopic greenish area, was examined.. MR images showed uptake of Gd-EOB-DTPA in twenty-two nodules. Histological findings indicated twenty-six nodules contained a greenish area. There is a significant correlation between HCC showing Gd-EOB-DTPA uptake and the presence of a greenish area (p<0.001). On a nodule-by-nodule basis, more than two-thirds of the area of Gd-EOB DTPA uptake coincides with the greenish part in only 12 of 22 lesions (54.5%). More than two-thirds of the greenish area coincided with that of Gd-EOB-DTPA uptake in only 10 of 26 cases (38.5%).. The area of Gd-EOB-DTPA uptake does not always match the greenish part, but HCC with uptake of Gd-EOB-DTPA significantly correlated with green HCC.

Topics: Aged; Bile; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic

determine the effect of double-dose gadoxetic-acid (Gd-EOB-DTPA) on lesion-liver contrast ratio in arterial- and hepatocyte-phase images and arterial-phase image quality in patients with chronic liver disease.. the ethics committee at our institute approved this study. This study included 28 patients (13 with Child-Pugh class A and 15 with class B) with 54 hepatocellular carcinomas. All patients received the standard Gd-EOB-DTPA dose (0.025 mmol/kg bodyweight) and double dose (0.050 mmol/kg bodyweight). The lesion-liver contrast ratio was evaluated in arterial- and hepatocyte-phase images. The artifacts in arterial-phase images were evaluated with a 4-point scale. Wilcoxon signed-rank test were used for comparisons.. the hepatocyte-phase lesion-liver contrast ratio after the double dose was significantly higher than that after the standard dose in patients with Child-Pugh class B disease(standard dose vs. double dose; 0.20 ± 0.16 vs. 0.25 ± 0.17; P < 0.0001); however, the ratio after both the standard and double doses was equivalent in patients with Child-Pugh class A disease (0.35 ± 0.18 vs. 0.35 ± 0.14; P = 0.3038). The double dose significantly increased the arterial-phase lesion-liver contrast ratio (0.34 ± 0.19 vs. 0.58 ± 0.33; P < 0.0001). The artifacts in the arterial-phase images were more prominent after the standard dose (2.7 vs. 2.4 for reader 1, 2.8 vs. 2.4 for reader 2; P = 0.0195 and 0.0010).. administration of double dose of Gd-EOB-DTPA provided better arterial enhancement of hepatocellular carcinomas in patients with chronic liver disease, and also improved the lesion-liver contrast in hepatocyte-phase images in patients with Child-Pugh class B disease.

Topics: Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Statistics as Topic; Statistics, Nonparametric; Tomography, X-Ray Computed

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Hepatocytes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Middle Aged; Organometallic Compounds

To prospectively assess the additional value of the hepatobiliary (HB) phase of Gd-EOB-DTPA-MRI in identifying and characterising small (≤ 2 cm) hepatocellular carcinomas (HCCs) undetermined in dynamic phases alone because of their atypical features, according to the AASLD criteria.. 127 cirrhotic patients were evaluated with Gd-EOB-DTPA-MRI in two sets: unenhanced and dynamic phases; unenhanced, dynamic and HB phases. Sixty-two out of 215 nodules (29%) were atypical in 42 patients (33%).. 62 atypical nodules were reported at histology: high-grade dysplastic nodules (HGDN)/early HCC (n = 20), low-grade DN (LGDN) (n = 21), regenerative nodules (n = 17) and nodular regenerative hyperplasia (n = 4). The sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV) were increased by the addition of the HB phase: 88.4-99.4%, 88-95%, 88-98.5%, 97-99%, and 65-97.5%, respectively. Twenty atypical nodules were malignant (32%), 19 of which were characterised only during the HB phase.. The HB phase is 11% more sensitive in the classification of HGDN/early HCC than dynamic MRI, with an added value of 32.5% in the NPV. The high incidence (33%) of atypical nodules and their frequent malignancy (32%) suggest the widespread employment of Gd-EOB-DTPA-MRI in the follow-up of small nodules (≤ 2 cm) in cirrhosis.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Reproducibility of Results; Sensitivity and Specificity

The value of the hepatobiliary phase of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in patients with hepatocellular carcinoma (HCC) has not been evaluated in detail.. Between 2008 and 2009, 61 patients with HCC within the Milan criteria underwent Gd-EOB-DTPA-enhanced MRI and hepatectomy. The tumor margin was determined preoperatively based on hepatobiliary phase images. Microscopic portal vein invasion (MPVI), intrahepatic metastasis (IM), and recurrence of HCC within 1 year after hepatectomy were evaluated in 24 patients with non-smooth margins at the periphery of the tumor and 37 patients with smooth margins.. The number of patients with MPVI and IM of HCC was significantly higher among those with non-smooth margins (42 and 38%, respectively) than among those with smooth margins (3%; p = 0.0002 and 5%; p = 0.0042, respectively). A non-smooth margin was identified as a significant predictor of MPVI (odds ratio 18.814, p = 0.024) and IM (odds ratio 6.498, p = 0.036) of HCC on multivariate analysis. Furthermore, a non-smooth margin was identified as a significant predictor of recurrence within 1 year after hepatectomy (odds ratio 4.306, p = 0.04) on multivariate analysis.. A non-smooth tumor margin in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is useful to predict MPVI, IM, and early recurrence of HCC after hepatectomy.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Portal Vein; Reproducibility of Results; Retrospective Studies; Vascular Neoplasms

To determine the additive value of diffusion-weighted MRI (DWI) to gadoxetic acid-enhanced MRI for the detection of hepatic metastases and hepatocellular carcinoma (HCC).. Thirty-five patients with 38 liver metastases and 18 HCCs were included in this study. Ten patients also had hemangiomas (n = 3) or cysts (n = 8). Liver MRI consisted of pre-contrast and gadoxetic acid-enhanced 3D T1-weighted MRIs (arterial, portal, 2-min delay, 20 min hepatocyte-selective phases), a post-contrast T2-weighted image, and post-contrast DWI (b values: 0, 50, 600 s/mm²). Two observers independently analyzed the gadoxetic acid-enhanced MRI with and without DWI. The diagnostic accuracy and sensitivity for the detection of liver lesions were evaluated using receiver operating characteristic analysis.. Although there were no significant differences in diagnostic accuracy for detecting metastases and HCCs between the gadoxetic acid set alone and the combined DWI and gadoxetic acid set for both observers (mean Az, 0.974 vs 0.987), we found the sensitivity for detecting metastases to be significantly higher with the combined images (97.4%) than with the gadoxetic acid set alone (89.5%) for observer 1 (p = 0.008). Three and two metastases for each observer were clearly verified by adding DWI to gadoxetic acid-enhanced MRI. However, sensitivities for both image sets were equivalent in detecting HCCs.. The addition of DWI to gadoxetic acid-enhanced MRI has the potential to increase sensitivity for the detection of liver metastases. However, for detecting HCC, we found no additive value of DWI to gadoxetic acid-enhanced MRI.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Retrospective Studies; ROC Curve; Sensitivity and Specificity

To investigate optimal delay time of hepatic arterial phase in Gadoxetate-enhanced MR for detecting hypervascular hepatocellular carcinoma (HCC).. Forty-five patients with 85 hypervascular HCCs and 9 patients with 16 hypervascular HCCs underwent Gadoxetate- and Gd-DTPA-enhanced MR at 1.5 Tesla (T) system, respectively. All HCCs were analyzed 10-38 s after injection using a time-resolved dynamic MR sequence with keyhole data sampling. Seven sequential phase images (1 phase = 4 s) were obtained during a single breath hold of 28 s. Time-intensity curves of the abdominal aorta, liver parenchyma, and HCC were obtained, then aortic contrast arrival time, time of peak HCC enhancement, duration time of HCC and aortic enhancement, and time delay from aortic contrast arrival to peak enhancement of HCC were measured.. Aortic contrast arrival time was 15.1 ± 2.9 s, time of peak HCC enhancement 29.9 ± 4.6 s, duration time of HCC enhancement 17.4 ± 6.4 s postinjection of Gadoxetate. Duration of aortic enhancement (23.6 ± 3.5 s) of Gadoxetate-enhanced MR was significantly less than that of Gd-DTPA-enhanced MR (26.3 ± 2.8 s) (P < 0.0059).. Peak enhancement time of HCC on Gadoxetate-enhanced MR imaging occurred at 14.6 ± 4.6 s after aortic contrast arrival.

Topics: Aged; Aged, 80 and over; Aorta; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatitis; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Time Factors

To investigate the diagnostic efficacy of gadoxetic acid-enhanced magnetic resonance imaging (MRI) at 3.0 T for the detection of hepatocellular carcinomas (HCC) and compare with that at 1.5 T.. Forty patients with 54 HCCs (size range: 0.6-2.0 cm) underwent gadoxetic acid-enhanced MRIs at both 1.5 and 3.0 T with 3 to 8 days interval. The MRIs were compared quantitatively by measuring tumor-liver contrast-to-noise ratio, and qualitatively by evaluating tumor-liver contrast using matched pairs analysis. Diagnostic accuracy and sensitivity were also evaluated by the consensus readings of 2 reviewers using the alternative-free response receiver operator characteristic (ROC) method.. Although the tumor-liver contrast-to-noise ratio for the arterial phase was significantly higher at 3.0 T than at 1.5 T (30.2 ± 21.4 vs. 35.2 ± 22.9; P = 0.04), we found similar values for the hepatocyte phase (38.2 ± 24.6 vs. 38.4 ± 25.3; P = 0.762). Matched pairs analysis indicated that the relative tumor-liver contrast was better in 7 and 9 lesions in the arterial phase and hepatocyte phase at 3.0 T, respectively, than those at 1.5 T. The diagnostic accuracy and sensitivity of 3.0-T imaging [Az, 0.988; 92.6% (n = 50)] were slightly higher than those of 1.5-T imaging [Az, 0.981; 88.9% (n = 48)], but the difference was not statistically significant (P = 0.487).. Gadoxetic acid-enhanced MRIs at 1.5 and 3.0 T showed similar diagnostic performances for detecting small HCCs. However, there was a tendency toward increased reader confidence for the arterial phase and hepatocyte phase with 3.0 T compared with 1.5 T.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiography; Sensitivity and Specificity

To retrospectively assess imaging features that help differentiate early-enhancing non-tumorous (EN) hepatic lesions from hepatocellular carcinomas (HCCs) on gadoxetate disodium-enhanced MR imaging.. Our institutional review board approved this retrospective study. We reviewed the studies of 158 patients (92 men and 65 women; age range: 29-91; mean age: 65.6 years) with chronic liver damage, who underwent gadoxetate disodium-enhanced MR imaging at 3T MR scanner. Hypervascular lesions identified during the hepatic artery phase were selected for a study cohort. The location, shape, size (maximum diameter and maximum area), and contrast enhancement signal intensity characteristics of the lesions were evaluated, then compared between the EN and HCC lesions.. A total of 65 EN lesions (range: 3-60mm, mean: 13.6 ± 10.6 mm) from 35 patients and 33 HCCs (range: 9-61 mm, mean: 19.3 ± 12.6 mm) from 20 patients were identified. Lesions were more frequently round or oval in shape for HCCs (n=29; 88%) than ENs (n=26; 40%) (P<0.01). Unexpectedly, some ENs (n=12; 18%) showed hypointensity on hepatocyte-phase, and 6 (50%) of them were T2 hyperintense. For lesions smaller than 2 cm (9 ENs and 21 HCCs) on hepatic arterial-phase images, the mean area of hypointensity in hepatocyte-phase (54.2 ± 33.1 mm(2)) was significantly smaller than those of the corresponding hyperintensity in hepatic arterial-phase (97.1 ± 42.0 mm(2)) for EN lesions (P=0.019), whereas no significant difference in area was found for HCCs.. EN lesions may occasionally present with hypointensity during the hepatocyte-phase; presenting a diagnostic dilemma. In this situation, EN lesions may be differentiated from HCCs when a hypointense area in hepatocyte-phase is smaller than the corresponding hypervascular area in hepatic-arterial phase.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric

To assess the value of hepatobiliary phase gadoxetic acid (EOB)-enhanced magnetic resonance imaging (MRI) for the diagnosis of early stage hepatocellular carcinoma (HCC) (<3 cm) compared to triple-phase dynamic multidetector computed tomography (MDCT).. In all, 52 patients with 60 pathologically proven HCCs underwent both EOB-enhanced MRI and triple-phase dynamic MDCT. Two radiologists independently and blindly reviewed three image sets: 1) MDCT, 2) dynamic MRI (unenhanced and EOB-enhanced dynamic MR images), and 3) combined MRI (dynamic MRI + hepatobiliary phase images) using a five-point rating scale on a lesion-by-lesion basis. Receiver operating characteristics (ROC) analysis was performed, and sensitivity and specificity were calculated.. The area under the ROC curve (Az) of dynamic MRI was equivalent to that of MDCT for both readers. For both readers, Az and sensitivity of combined MRI for smaller lesions (<1.5 cm) were significantly higher than that of dynamic MRI and MDCT (P < 0.0166). The majority of false-negative nodules on dynamic MRI or MDCT (75% and 62%, respectively) were due to a lack of identified washout findings.. Hepatobiliary phase images can increase the value of EOB-enhanced MRI in the diagnosis of early stage HCC. The sensitivity and accuracy were significantly superior to MDCT for the diagnosis of lesions less than 1.5 cm.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

The purpose of this study was to determine the finding most predictive for characterizing hypervascular hepatocellular carcinoma (HCC) measuring 1 cm or less at gadoxetic acid-enhanced MRI that includes diffusion-weighted images.. In this retrospective study, between May 2008 and June 2009, 66 patients with 108 hypervascular HCCs 1 cm or smaller underwent gadoxetic acid-enhanced 3-T MRI that included diffusion-weighted images. The diagnosis of HCC was determined by surgical resection in 32 cases, percutaneous biopsy in three cases, or interval growth to larger than 1 cm on follow-up images in accordance with the American Association for the Study of Liver Diseases guidelines in 73 cases. MRI findings of HCC and 33 benign hypervascular lesions in a control group were analyzed by two radiologists in consensus. They based their assessments on the presence or absence of the following five findings: hyperintensity on T2-weighted images, hyperintensity on diffusion-weighted images with low b values, washout pattern, capsular enhancement, and hypointensity on gadoxetic acid-enhanced hepatobiliary phase images. The findings were compared by use of univariate and multivariate analyses.. No HCC with capsular enhancement was found. Fifty-seven HCCs (52.8%) had four findings, 36 (33.3%) had three, nine (8.3%) had two findings, and six (5.6%) had one finding. Univariate analysis showed significant differences between the HCC and control groups with respect to four findings (p < 0.0001). Multivariate analysis showed that hyperintensity on T2-weighted (p < 0.0001) and diffusion-weighted (p = 0.0081) images were statistically significant MRI findings for predicting HCC.. Hyperintensity on both T2- and diffusion-weighted images is helpful in the diagnosis of hypervascular HCC smaller than 1 cm in diameter.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Hepatocellular; Chi-Square Distribution; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Predictive Value of Tests; Retrospective Studies

To clarify the changes in organic anion-transporting polypeptide 8 (OATP8) expression and enhancement ratio on gadoxetic acid-enhanced MR imaging in hepatocellular nodules during multistep hepatocarcinogenesis.. In imaging analysis, we focused on 71 surgically resected hepatocellular carcinomas (well, moderately and poorly differentiated HCCs) and 1 dysplastic nodule (DN). We examined the enhancement ratio in the hepatobiliary phase of gadoxetic acid enhanced MR imaging [(1/postcontrast T1 value-1/precontrast T1 value)/(1/precontrast T1 value)], then analysed the correlation among the enhancement ratio, tumour differentiation grade and intensity of immunohistochemical OATP8 expression. In pathological analysis, we focused on surgically resected 190 hepatocellular nodules: low-grade DNs, high-grade DNs, early HCCs, well-differentiated, moderately differentiated and poorly differentiated HCCs, including cases without gadoxetic acid-enhanced MR imaging. We evaluated the correlation between the immunohistochemical OATP8 expression and the tumour differentiation grade.. The enhancement ratio of HCCs decreased in accordance with the decline in tumour differentiation (P < 0.0001, R = 0.28) and with the decline of OATP8 expression (P < 0.0001, R = 0.81). The immunohistochemical OATP8 expression decreased from low-grade DNs to poorly differentiated HCCs (P < 0.0001, R = 0.15).. The immunohistochemical expression of OATP8 significantly decreases during multistep hepatocarcinogenesis, which may explain the decrease in enhancement ratio on gadoxetic acid-enhanced MR imaging.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Gene Expression Regulation; Humans; Immunohistochemistry; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organic Anion Transporters, Sodium-Independent; Solute Carrier Organic Anion Transporter Family Member 1B3

High-intensity focused ultrasound (HIFU) is a noninvasive method that can cause complete coagulation necrosis without requiring the insertion of any instruments. The purpose of this study was to evaluate the safety and efficacy of HIFU treatment for small liver cancers without performing transcatheter arterial chemoembolization (TACE) or rib resection. HIFU ablation was performed without rib resection or the aid of TACE or percutaneous ethanol injection (PEI) in 12 patients with hepatocelullar carcinoma. The HIFU system (Chongqing Haifu Tech, Chongqing, China) was used under ultrasound guidance. All 12 patients completed the treatment without experiencing any adverse events. Complete coagulation was achieved by applying the sonications from the intercostal space when the tumor was located in the right lobe. After treatment, serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels were significantly higher than the baseline values; these levels recovered within 1 week. C-reactive protein (CRP) levels increased 1 week after treatment but decreased within 1 month. An epidural anesthetic provided sufficient pain suppression during the procedure. Edema of the subcutaneous tissue was detected in five cases, but the edema disappeared within 1 month. None of the patients developed acute hepatic failure, liver abscess or renal dysfunction. In conclusion, HIFU is effective for the treatment of patients with small liver cancer.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Ferric Compounds; Gadolinium DTPA; High-Intensity Focused Ultrasound Ablation; Humans; Iron; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Oxides; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnostic Imaging; Ferric Compounds; Gadolinium DTPA; Humans; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Multidetector Computed Tomography; Oxides

The purpose of this study was to define imaging features that may help characterize hyperintense lesions seen in the hepatobiliary phase of gadoxetic acid-enhanced hepatic MRI examinations.. This retrospective study included 48 hyperintense nodules depicted on gadoxetic acid disodium-enhanced hepatobiliary phase MR images: 16 hepatocellular carcinomas (HCCs), 14 lesions of focal nodular hyperplasia, and 18 benign nodules associated with cirrhosis. Two observers independently reviewed hepatobiliary phase images and recorded the shape, margin, focal defects in contrast uptake, nodule-in-nodule pattern of uptake, central scar, internal septation, and presence of a hypointense rim around the lesion. Interobserver agreement was assessed with kappa statistics, and consensus opinions were reached by conference. For quantitative analysis, one observer measured lesion-to-liver contrast ratio (signal intensity of tumor divided by signal intensity of liver) on hepatobiliary phase images. Logistic regression analysis was used to determine the value of individual clinical and MR findings in prediction of malignancy.. Compared with benign lesions, hyperintense HCC more commonly had focal defects in uptake (68.8% vs 3.1%, respectively; p < 0.001), nodule-in-nodule appearance (75.0% vs 0%, p < 0.001), absence of a central scar (100% vs 46.9%, p < 0.001), internal septation (50.0% vs 3.1%, p < 0.001), and a hypointense rim (75.0% vs 15.6%, p < 0.001) on hepatobiliary phase MR images. The mean contrast ratios of HCC (1.31) and benign lesions (1.28) were not significantly different (p = 0.63). Multiple logistic regression analysis showed that a focal defect in contrast uptake (p = 0.025) and a hypointense rim (p = 0.019) were significant predictors of HCC, having odds ratios of 36.8 (95% CI, 1.56-870.0) and 17.5 (1.60-191.4).. On gadoxetic acid-enhanced MR images, hyperintense nodules can be differentiated with several imaging characteristics, especially a focal defect in contrast uptake and a hypointense rim, that indicate the diagnosis of hyperintense HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Young Adult

We sought to determine whether hypointense hepatocellular nodules observed in the hepatobiliary phase of MRI enhanced with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium) progress to hypervascular hepatocellular carcinoma.. Gadoxetate disodium-enhanced MRI was repeated for 30 patients with 49 nodules determined to be hypointense in the hepatobiliary phase but nonenhancing in the arterial phase of dynamic MRI. The correlation between characteristics of hypointense nodules with slightly or markedly low signal intensity relative to surrounding liver parenchyma and their progression to hypervascular hepatocellular carcinoma was analyzed in cirrhotic livers. All patients underwent angiography-assisted CT before MRI. The rate of progression to classic hepatocellular carcinoma was calculated by the Kaplan-Meier method.. The overall 6- and 12-month cumulative incidences of vascularization were 27.6% and 43.5%. The 6- and 12-month cumulative incidences of vascularized nodules with a maximum diameter 15 mm or greater were 43.3% and 77.3% and a maximum diameter less than 15 mm were 16.9% and 16.9%. The difference between these incidences was significant (p = 0.0147).. Hypointense nodules with a maximum diameter of at least 15 mm often become hypervascular. Therefore, patients with hypointense nodules characterized by a maximum diameter of 15 mm or greater should be observed carefully because of the high incidence of vascularization.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To determine the association of early changes in posttreatment apparent diffusion coefficient (ADC) and venous enhancement (VE) with tumor size change after transarterial chemoembolization (TACE) by using an investigational semiautomated software.. This retrospective HIPAA-compliant study was approved by the institutional review board, with waiver of informed consent. Patients underwent magnetic resonance (MR) imaging at 1.5 T before TACE, as well as 1 and 6 months after TACE. Volumetric analysis of change in ADC and VE 1 month after TACE compared with pretreatment values was performed in 48 patients with 71 hepatocellular carcinoma (HCC) lesions. Diagnostic accuracy was evaluated with receiver operating characteristic (ROC) analysis, using tumor response at 6 months according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST as end points.. According to RECIST criteria, 6 months after TACE, 30 HCC lesions showed partial response (PR), 35 showed stable disease (SD), and six showed progressive disease (PD). Increase in ADC and decrease in VE 1 month after TACE were significantly different between PR, SD, and PD. At area under the ROC curve (AUC) analysis of the ADC increase, there was an AUC of 0.78 for distinguishing PR from SD and PD and an AUC of 0.89 for distinguishing PR and SD from PD. The AUC for decrease in VE was 0.73 for discrimination of PR from SD and PD and 0.90 for discrimination of PR and SD from PD.. Volumetric analysis of increase in ADC and decrease in VE 1 month after TACE can provide an early assessment of response to treatment. Volumetric analysis of multiparametric MR imaging data may have potential as a prognostic biomarker for patients undergoing local-regional treatment of liver cancer.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

The purpose of this study was to assess whether gadoxetate disodium-enhanced hepatobiliary phase MRI could predict the histologic factors of hepatocellular carcinomas (HCCs).. Fifty-three HCCs histopathologically proved by surgery in 51 patients were evaluated retrospectively. All patients underwent gadoxetate disodium-enhanced MRI before surgical resection. The differences in contrast enhancement ratio of the lesions and differences in contrast-to-noise ratio (CNR) among the histologic grades of HCC were compared by using the Kruskal-Wallis test. The Spearman method was used to determine the correlations among contrast enhancement ratio, CNR, cell density ratio, and positivity for anti-hepatocyte antibody, keratin 7, and keratin 19.. Of 53 HCCs, 50 showed low signal intensity on hepatobiliary phase images, whereas three HCCs were hyperintense on hepatobiliary phase images compared with surrounding hepatic parenchyma. Although well-differentiated HCCs tended to show higher contrast enhancement, there was no statistical significance between contrast enhancement ratio of the tumors and histologic grade (p = 0.414). No significant difference was observed between CNR and histologic grade (p = 0.965). The contrast enhancement ratios of the tumors were significantly lower in the keratin 19-positive group than in the keratin 19-negative group (p = 0.015). There was no significant correlation among contrast enhancement ratio, anti-hepatocyte antibody positivity, cell density ratio, and keratin 7 positivity (p > 0.05).. The contrast enhancement ratio and CNR of HCCs were not correlated with histologic grades. The contrast enhancement ratio was significantly lower in keratin 19-positive HCCs.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Keratin-19; Keratin-7; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric

We present the case of a metastatic adrenal tumour from hepatocellular carcinoma (HCC) showing the uptake of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) on MRI. To our knowledge, this is the first case of metastatic HCC in which Gd-EOB-DTPA uptake was shown on MRI and this finding facilitated the accurate pre-operative diagnosis of a metastatic adrenal tumour.

Topics: Adrenal Gland Neoplasms; Aged; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Radionuclide Imaging

The purpose of the study was to validate diffusion-weighted imaging (DWI) in the assessment of hypervascular hepatocellular carcinoma (HCC) compared with superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the cirrhotic liver.. Forty-six consecutive patients with 106 hypervascular focal lesions in the cirrhotic liver who underwent DWI using three b factors and gadopentetate dimeglumine-enhanced dynamic MRI followed by SPIO-enhanced MRI were enrolled. Two independent radiologists evaluated two separated image sets (SPIO set, dynamic MRI and SPIO-enhanced T2*-weighted images; DWI set, DWI and dynamic MRI) and assigned confidence levels for diagnosis of HCC using a five-point scale for each lesion. Area under the receiver operating characteristic curve (A(z)) was calculated for each image set.. The A(z) value of the DWI set was larger than the SPIO set by both readers (reader 1, 0.936 vs. 0.900, P=.050; reader 2, 0.938 vs. 0.905, P=.110). For the sensitivity (reader 1, 93.1% vs. 86.2%, P=.146; reader 2, 95.4% vs. 88.5%, P=.070) and specificity (reader 1, 89.5% vs. 73.7%, P=.250; reader 2, 79.0% vs. 73.7%, P=1.000) of HCC diagnosis, DWI sets were superior to SPIO sets without statistically significant differences.. For assessment of hypervascular HCC, DWI in combination with dynamic MRI provides comparable or slightly better information compared with the combination of dynamic and SPIO-enhanced MRI.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Ferric Compounds; Fibrosis; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Observer Variation; Radiology; ROC Curve; Sensitivity and Specificity

To evaluate the relationship between the signal intensity of hepatobiliary phase images on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and histological grade.. Fifty-nine patients with 82 hepatocellular lesions were evaluated retrospectively. Hepatobiliary phase images on gadoxetic acid-enhanced MRI were classified into 3 groups: low, iso or high. Angiography-assisted computed tomography (CT) findings were also classified into 3 groups: CT during arterial portography, and CT hepatic arteriography: A: iso, iso or low; B: slightly low, iso or low; and C: low, high. We correlated angiography-assisted CT, hepatobiliary phase findings during gadoxetic acid-enhanced MRI and histological grades. Furthermore, correlations between MRI findings and histological grade for each hemodynamic pattern were performed. Correlations among radiological and pathological findings were statistically evaluated using the chi-square test and Fisher' s exact test.. There was a significant correlation between histological grade and hemodynamic pattern (P < 0.05). There was a significant correlation between histological grade and signal intensity in the hepatobiliary phase (P < 0.05) in group A lesions. There was no significant correlation between histological grade and signal intensity in the hepatobiliary phase in group B or C lesions (P > 0.05).. Signal intensity in the hepatobiliary phase correlated with histological grade in the lesions that maintained portal blood flow, but did not correlate in lesions that showed decreased or defective portal blood flow.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Female; Gadolinium DTPA; Hemodynamics; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To describe imaging findings of early hepatocellular carcinoma (HCC) at gadoxetic acid-enhanced magnetic resonance (MR) imaging, dynamic contrast material-enhanced computed tomography (CT), CT during arterial portography (CTAP), and CT during hepatic arteriography (CTHA) and to compare the diagnostic performance of each modality for small (≤ 2 cm) HCC.. The institute ethics committee deemed study approval unnecessary. One hundred eight resected small lesions in 64 patients were diagnosed as a dysplastic nodule (DN) (n = 12), progressed HCC (n = 66), or early HCC (n = 30). All but two patients underwent all imaging examinations. The imaging characteristics of the lesions with each modality were determined. To evaluate the diagnostic performance of the modalities, two radiologists graded the presence of HCC with use of a five-point confidence scale. The area under the receiver operating characteristic curve (A(z)), sensitivity, and specificity of each modality were compared.. The imaging features that are statistically significant for differentiating an early HCC from a DN include fat-containing lesions at dual-echo T1-weighted MR imaging (seen in 16 of the 30 early HCCs and none of the DNs), low attenuation at unenhanced CT (seen in 13 of the 30 early HCCs and none of the DNs), low attenuation at CTAP (seen in 11 of the 30 early HCCs and none of the DNs), and low signal intensity at hepatocyte phase gadoxetic acid-enhanced MR imaging (seen in 29 of the 30 early HCCs and none of the DNs). The diagnostic performance of gadoxetic acid-enhanced MR imaging (A(z), 0.98 and 0.99) was significantly greater than that of contrast-enhanced CT (A(z), 0.87) and CTHA-CTAP (A(z), 0.85 and 0.86) owing to its significantly higher sensitivity (P < .001).. Gadoxetic acid-enhanced MR imaging is the most useful imaging technique for evaluating small HCC, including early HCC.

Topics: Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Early Diagnosis; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Iohexol; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

The purpose of this article is to evaluate the value of gadoxetic acid-enhanced hepatobiliary phase imaging and high-b-value diffusion-weighted imaging (DWI) for distinguishing well-differentiated hepatocellular carcinomas (HCCs) from benign hepatocellular nodules in patients with chronic liver disease using 3-T MRI.. Forty-five patients with 46 well-differentiated HCCs (mean, 2.3 cm) and 21 patients with 24 benign hepatocellular nodules (five large regenerative nodules and 19 dysplastic nodules; mean, 1.8 cm) were included in this study. Diagnosis of well-differentiated HCCs and benign hepatocellular nodules was made histopathologically by percutaneous biopsy (n = 12 and n = 11, respectively) or surgical resection (n = 34 and n = 13, respectively). Gadoxetic acid-enhanced MRI was performed for all patients, and DWI (b values of 0 and 800 s/mm(2)) was performed for 31 well-differentiated HCCs and 11 benign hepatocellular nodules. Two radiologists performed a consensus review of the MRI scans for signal intensity compared with that of the surrounding liver parenchyma on hepatobiliary phase images and DWI (b value, 800 s/mm(2)) for qualitative analysis. The contrast-to-noise ratio (CNR) and relative contrast enhancement of lesions on hepatobiliary phase images and the apparent diffusion coefficient (ADC) values were assessed for quantitative analysis.. In the qualitative analysis, 39 well-differentiated HCCs (85%) and 14 benign hepatocellular nodules (58%) were hypointense on hepatobiliary phase images, and seven well-differentiated HCCs (15%) and 10 benign hepatocellular nodules (42%) were iso- or hyperintense (p = 0.04). Twenty-five well-differentiated HCCs (81%) and three benign hepatocellular nodules (27%) were hyperintense on DWI, with b value of 800 s/mm(2), and six well-differentiated HCCs (19%) and eight benign hepatocellular nodules (73%) were iso- or hypointense (p = 0.01). When lesion hypointensity on hepatobiliary phase images or hyperintensity on DWI were considered signs of HCC in cirrhotic liver, our results yielded sensitivities of 85% and 81% and specificities of 42% and 73%, respectively. In the quantitative analysis, the mean (± SD) relative contrast enhancement ratio of the well-differentiated HCCs (0.76 ± 2.30) was significantly higher than that of benign hepatocellular nodules (0.25 ± 0.97) (p = 0.02). The lesion-to-liver CNRs and the mean ADC values were not significantly different between the two groups (p > 0.05).. Hypointensity on gadoxetic acid-enhanced hepatobiliary phase images and hyperintensity on high-b-value DWI to surrounding liver parenchyma suggest well-differentiated HCCs rather than benign hepatocellular nodules in chronic liver disease.

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric

To evaluate, whether image fusion of contrast enhanced ultrasound (CEUS) with CT or MRI affects the diagnosis and characterization of liver lesions or the therapeutic strategy of surgical or interventional procedures compared to the preliminary diagnosis.. In a retrospective study the image fusion scans of CEUS with contrast enhanced CT or MRI of 100 patients (71 male, mean age 59 years, 0.3-85 years) with benign or malignant liver lesions were evaluated. Fundamental B-scan, color Doppler imaging and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1-5 MHz, LOGIQ 9/GE) and volume navigation (Vnav). After a bolus injections of up to 2.4 ml SonoVue® (BRACCO, Italy) digital raw data was stored as cine-loops up to 5 min. In 74 patients, CEUS was fused with a pre-existing ceCT, in 26 patients a ceMRI was used.. In all 100 patients (100%) the image quality in all modalities (ceCT, ceMRI and CEUS) was excellent or with only minor diagnostic limitations. Regarding the number of lesions revealed in image fusion of CEUS/ceCT/ceMRI and the preceding diagnostic method, concordant results were found in 84 patients. In 12 patients, additional lesions were found using fusion imaging causing subsequently a change of the therapeutical strategy. In 15 out of 21 patients with either concordant or discordant results regarding the number of lesions, image fusion allowed a definite diagnosis due to a continuous documentation of the microcirculation of the tumor and its contrast enhancement. A significant coherency (p < 0.05) among image fusion with either ceCT or ceMRI and CEUS and a subsequent change of therapeutic strategy was found.. Image fusion with volume navigation (VNav) of CEUS with ceCT or ceMRI frequently allows a definite localization and diagnosis of hepatic lesions in patients with primary hepatic carcinoma or metastatic diseases. This might cause a change of the therapeutic strategy in many patients with hepatic lesions.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Child; Child, Preschool; Computer Systems; Contrast Media; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Infant; Liver Circulation; Liver Neoplasms; Magnetic Resonance Imaging, Cine; Male; Microbubbles; Microcirculation; Middle Aged; Phospholipids; Radiography, Interventional; Retrospective Studies; Sulfur Hexafluoride; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden; Ultrasonography, Doppler, Color; Ultrasonography, Interventional; Young Adult

To determine whether intravenous administration of gadoxetic acid disodium (Gd-EOB-DTPA) affects lesion conspicuity and apparent diffusion coefficient (ADCs) in diffusion-weighted imaging (DWI) for hepatic magnetic resonance imaging (MRI) at 3.0 T.. Thirty-four patients with 50 focal hepatic lesions (18 hepatocellular carcinomas, 12 metastases, 1 cholangiocarcinoma, 7 haemangiomas, 12 cysts) underwent DWI at 3.0 T before and after administration of Gd-EOB-DTPA. Non-breath-hold DWI was performed with b values of 0, 200, 400 and 800 s/mm(2). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of each lesion, and ADCs of the liver and lesion were calculated for unenhanced and enhanced images. Statistical differences between unenhanced and enhanced data were assessed.. SNRs and ADCs of the liver on enhanced images were significantly lower than on unenhanced images. On DW images at b = 200 s/mm(2), CNRs of malignant and overall lesions were significantly higher on enhanced than on unenhanced images. CNRs of focal lesions tended to be higher, especially in malignant lesions, on DW images at b = 0 and 400 s/mm(2), but without reaching statistical significance. ADCs of focal hepatic lesions were not significantly different before and after administration of contrast agent.. DWI after Gd-EOB-DTPA administration can be used as a substitute for unenhanced DWI at 3.0 T without compromising CNR and ADC of focal hepatic lesions.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Cysts; Female; Gadolinium DTPA; Hemangioma; Humans; Image Interpretation, Computer-Assisted; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Statistics, Nonparametric

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Organic Anion Transporters, Sodium-Independent; Rats; Solute Carrier Organic Anion Transporter Family Member 1B3

To determine the characteristic enhancing features of hepatocellular carcinoma (HCC) and arterial-enhancing pseudolesion (AEP) on gadoxetic acid (Primovist)-enhanced magnetic resonance imaging (MRI) and to assess its performance compared with that of multirow detector computed tomography (MDCT) for differentiating small HCC (< or =2 cm in diameter) from AEP in cirrhotic liver.. A total of 69 patients with 97 small, arterial enhancing hepatic lesions (0.5-2 cm in diameter), ie, 44 HCCs and 53 AEPs, detected on gadoxetic acid-enhanced MRI, were included in this study. HCCs were diagnosed either through histopathology confirmation (n = 16) or by a combination of liver computed tomography (CT), angiographic findings, lipiodol CT, and AFP levels (n = 28). AEPs were diagnosed either through histopathology confirmation (n = 2) or were based on the angiographic findings, liver CT, and follow-up imaging (n = 51). Two radiologists jointly analyzed the morphologic features and the enhancement characteristics on the gadoxetic acid-enhanced MRI. Of the 69 study patients, 42 patients with 60 arterial enhancing lesions underwent quadruple-phase CT in addition to their MRI examination within 4 weeks before or after the MRI, and 2 other radiologists who were blinded to the final diagnosis independently reviewed the MRI and CT images in random order, at an interval of 2 weeks. Diagnostic performance was evaluated using receiver operating characteristics. The Kappa test was used to evaluate interobserver agreement.. Among 44 HCCs, 42 (95.4%) demonstrated low signal intensity (SI) and only 2 showed iso- or high SI on the hepatobiliary phase of gadoxetic acid-enhanced MRI. Alternatively, most AEPs showed iso SI on the hepatobiliary (n = 50, 94.3%) phase, and only 2 AEPs showed low SI. Compared with the diagnostic performance of the 2 imaging modalities, the mean areas under the receiver-operator characteristic curves on MR imaging were 0.975 for reviewer 1 and 0.966 for reviewer 2, whereas those of CT imaging were 0.892 for reviewer 1 and 0.888 for reviewer 2 (P = 0.069 and P = 0.106, respectively). The sensitivity for each reviewer with MR imaging (93.9% and 90.9%, respectively) was significantly higher than that with multiphasic CT (54.5%, in both) (P = 0.001 and 0.0018, respectively).. HCCs and AEPs show different enhancing features on the delayed dynamic and hepatobiliary phases of gadoxetic acid-enhanced MRI. Gadoxetic acid-enhanced MRI may, therefore, help to differentiate between HCC and AEP.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Peripheral Vascular Diseases; Reproducibility of Results; Sensitivity and Specificity

We compared the diagnostic performance of ferucarbotran-enhanced magnetic resonance imaging (MRI) with that of gadoxetic acid-enhanced MRI for the preoperative detection of hepatocellular carcinoma (HCC) of 27 consecutive patients (male-female, 21:6; 33-76 years) with 38 surgically proven HCCs (mean diameter, 2.8 cm; range, 0.8-10.2 cm) on a 3.0-T unit. 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, sensitivity, positive and negative predictive values was evaluated. For each observer, the values of the area under the receiver operating characteristic curve (Az) were 1.000, 1.000, and 0.974 for ferucarbotran-enhanced MRI and 1.000, 0.987, and 1.000 for gadoxetic acid-enhanced MRI, and the differences were not statistically significant between 2 techniques for each observer (P > 0.05). For each observer, sensitivities were 100%, 100%, and 92.1% for ferucarbotran-enhanced MRI and 100%, 94.7%, and 100% for gadoxetic acid-enhanced MRI with no statistical significance (P > 0.005). The differences of the positive and negative predictive values of 2 techniques for each observer were not statistically significant (P > 0.05). Ferucarbotran-enhanced MRI and gadoxetic acid-enhanced MRI show a similar diagnostic performance for the preoperative detection of HCCs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Dextrans; Female; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Preoperative Care; Reproducibility of Results; ROC Curve; Sensitivity and Specificity

Hepatocellular carcinoma (HCC) is responsible for approximately 600,000-700,000 deaths worldwide. It is highly prevalent in the Asia-Pacific region and Africa, and is increasing in Western countries. Alpha fetoprotein (AFP) alone is insufficient for HCC screening. A combination with other tumor markers, such as PIVKA-II and AFP-L3, and periodical ultrasound surveillance is necessary. Sensitivity of AFP in depicting HCC is highest, followed by PIVKA-II and AFP-L3, but the order of the specificity is inverse, AFP-L3, PIVKA-II, and AFP. Sonazoid-enhanced ultrasound (US) is extremely useful to characterize hepatic tumors equal to or more than multidetector row computed tomography (MDCT). Sonazoid-enhanced US with defect re-perfusion imaging is a breakthrough technique in the treatment of HCC. Defect re-perfusion imaging will markedly change the therapeutic strategy for liver cancer. Gd-EOB-DTPA-magnetic resonance imaging is a newly developed imaging technique in the detection and diagnosis of HCC. It is the most sensitive tool in the differentiation of early HCC from dysplastic nodules. Regarding the treatment strategy, there has been no established systemic chemotherapy for advanced HCC, except for Sorafenib. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective in response rate and overall survival for advanced HCC with vascular invasion. Sorafenib in combination with transcatheter arterial chemoembolization or adjuvant use after ablation or resection will significantly prolong the life expectancy if ongoing clinical trials provide positive results. In conclusion, it is expected that readers will gain deeper insight into the latest progress and updated diagnosis and treatment of HCC described in this review.

Topics: Algorithms; alpha-Fetoproteins; Antineoplastic Agents; Benzenesulfonates; Biomarkers; Biomarkers, Tumor; Carcinoma, Hepatocellular; Contrast Media; Early Detection of Cancer; Gadolinium DTPA; Humans; Infusion Pumps; Japan; Liver Neoplasms; Magnetic Resonance Imaging; Mass Screening; Neoplasm Staging; Niacinamide; Phenylurea Compounds; Population Surveillance; Protein Precursors; Prothrombin; Pyridines; Sensitivity and Specificity; Sorafenib; Survival Rate

To compare the diagnostic accuracy and sensitivity of gadoxetic acid-enhanced MRI and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) for the detection of hepatocellular carcinoma (HCC).. Eighty-nine patients (118 HCCs) who underwent three-dimensional gadoxetic acid-enhanced MRI and SPIO-enhanced MRI with a mean interval of 4.7 days (range 3-7 days), were included in this study. Two observers reviewed the gadoxetic acid set (unenhanced, early dynamic, 10 and 20 min hepatocyte-phase images) and SPIO set [unenhanced and ferucarbotran-enhanced T1-, T2-turbo spin-echo (TSE), and T2* weighted imaging (WI)] in consensus. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operator characteristic (ROC) method.. The area under ROC curve (Az value) and sensitivity of the gadoxetic acid set (Az 0.964; sensitivity 90.7%) were significantly higher than those of the SPIO set (Az 0.830; sensitivity 84.7%; p<0.05). There were 14 and seven lesions that were verified only on the gadoxetic acid set and only on the SPIO set, respectively. Four HCCs were clearly revealed as hypointense only on gadoxetic acid-enhanced hepatocyte phase imaging, but were occult on other sequences, including the SPIO set.. Gadoxetic acid-enhanced MRI is better than SPIO-enhanced MRI for the detection of HCCs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To determine the added value of hepatobiliary phase images in gadoxetic acid-enhanced magnetic resonance (MR) imaging in the evaluation of hepatocellular carcinoma (HCC).. Institutional review board approved this retrospective study and waived the informed consent. Fifty-nine patients with 84 HCCs underwent gadoxetic acid-enhanced MR examinations that included 20-minute delayed hepatobiliary phase imaging. MR imaging was performed with a 1.5-T system in 19 patients and a 3.0-T system in 40 patients. A total of 113 hepatic nodules were documented for analysis. Three radiologists independently reviewed two sets of MR images: set 1, unenhanced (T1- and T2-weighted) and gadoxetic acid-enhanced dynamic images; set 2, hepatobiliary phase images and unenhanced and gadoxetic acid-enhanced dynamic images. For each observer, the diagnostic accuracy was compared by using the area under the alternative free-response receiver operating characteristic curve (A(z)). Sensitivity and specificity were also calculated and compared between the two sets.. For all observers, A(z) values were higher with the addition of the hepatobiliary phase. The observer who had the least experience in abdominal imaging (2 years) demonstrated significant improvement in A(z), from 0.895 in set 1 to 0.951 in set 2 (P = .049). Sensitivity increased with the addition of hepatobiliary phase images but did not reach statistical significance. Nine HCCs (10.7%) in six patients (10.1%) were seen only on hepatobiliary phase images.. Hepatobiliary phase images obtained after gadoxetic acid-enhanced dynamic MR imaging may improve diagnosis of HCC and assist in surgical planning.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; ROC Curve; Sensitivity and Specificity

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

To retrospectively investigate enhancement patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI in relation to histological grading and portal blood flow.. Sixty-nine consecutive patients with 83 histologically proven HCCs and DNs were studied. To assess Gd-EOB-DTPA uptake, we calculated the EOB enhancement ratio, which is the ratio of the relative intensity of tumorous lesion to surrounding nontumorous area on hepatobiliary phase images (post-contrast EOB ratio) to that on unenhanced images (pre-contrast EOB ratio). Portal blood flow was evaluated by CT during arterial portography.. Post-contrast EOB ratios significantly decreased as the degree of differentiation declined in DNs (1.00 ± 0.14) and well, moderately and poorly differentiated HCCs (0.79 ± 0.19, 0.60 ± 0.27, 0.49 ± 0.10 respectively). Gd-EOB-DTPA uptake, assessed by EOB enhancement ratios, deceased slightly in DNs and still more in HCCs, while there was no statistical difference in the decrease between different histological grades of HCC. Reductions in portal blood flow were observed less frequently than decreases in Gd-EOB-DTPA uptake in DNs and well-differentiated HCCs.. Reduced Gd-EOB-DTPA uptake might be an early event of hepatocarcinogenesis, preceding portal blood flow reduction. The hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help estimate histological grading, although difficulties exist in differentiating HCCs from DNs.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnostic Imaging; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Medical Oncology; Middle Aged; Portal Vein; Retrospective Studies

To investigate the mechanism of enhancement of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced hepatobiliary phase magnetic resonance (MR) images and to characterize HCC thus enhanced.. This retrospective study was approved by the institutional review board, and patient informed consent for research use of the resected specimen was obtained. MR images in 25 patients (20 men, five women; mean age, 68 years; range, 49-82 years) with 27 resected hypervascular HCCs (one well, 13 moderately, 13 poorly differentiated) that demonstrated hepatocyte-selective enhancement on gadoxetic acid-enhanced MR images, were quantitatively studied, and findings were correlated with results of immunohistochemical staining for a sinusoidal transporter, organic anion transporting polypeptide (OATP) 1B1 (OATP1B1) and/or OATP1B3 (OATP1B1 and/or -1B3), and a canalicular transporter, multidrug resistance-associated protein 2 (MRP2), and also with bile accumulation in tumors. Statistical analysis was performed with the Student t test and Scheffé post hoc test.. Combined with positive OATP1B1 and/or -1B3 expression (O+), two patterns of MRP2 expression contributed to high enhancement: decreased expression (M-, n = 3) and increased expression at the luminal membrane of pseudoglands (M+[P], n = 3). Nodules without OATP1B1 and/or -1B3 expression (O-, n = 13) and nodules with O+ associated with increased MRP2 expression only at the canaliculi (M+[C], n = 8) induced significantly lower enhancement than those with the two expression patterns described before (O+/M- group vs O- group, P = .002; O+/M- group vs O+/M+[C] group, P = .047; O+/M+[P] group vs O- group, P < .001; O+/M+[P] group vs O+/M+[C] group, P < .001). Nodules with bile pigment (n = 12) showed significantly higher enhancement (P = .004); all five nodules (one well differentiated HCC, four moderately differentiated HCCs), which were enhanced more than adjacent liver parenchyma, contained bile pigment.. High hepatocyte-selective enhancement is induced by expression patterns of transporters, which may result in accumulation of gadoxetic acid in cytoplasm of tumor cells or in lumina of pseudoglands. An HCC with gadoxetic acid enhancement is characterized by bile accumulation in tumors.

Topics: Aged; Aged, 80 and over; Bile; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Immunoenzyme Techniques; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidrug Resistance-Associated Proteins; Organic Anion Transport Protein 1; Retrospective Studies

To retrospectively determine findings at gadoxetic acid-enhanced magnetic resonance (MR) imaging in hypervascular pseudolesions that were observed at computed tomography (CT) during hepatic arteriography, with special focus on distinguishing these pseudolesions from hypervascular hepatocellular carcinomas (HCCs).. The institute ethics committee deemed study approval unnecessary. The study population comprised 80 patients (55 men, 25 women) with chronic liver disease who underwent CT during hepatic arteriography and arterial portography, gadoxetic acid-enhanced MR imaging, and follow-up dynamic contrast material-enhanced CT. The diagnosis of 104 pseudolesions and 123 HCCs was confirmed by means of histopathologic or multimodality evaluation. Two radiologists assessed the MR imaging findings of HCCs and pseudolesions in consensus, including the signal intensities (SIs) of the lesions on T2-weighted, diffusion-weighted (DW), and contrast-enhanced hepatocyte-phase images. The findings of nodular pseudolesions and HCCs were compared with the Fisher exact test. Additionally, the hepatocyte-phase SI ratio (ratio of lesion SI to liver SI) for HCCs and pseudolesions was compared by means of the Mann-Whitney U test.. There were 62 wedge-shaped, 32 nodular, and 10 linear pseudolesions. On gadoxetic acid-enhanced hepatocyte-phase MR images, 15% of pseudolesions (16 of 104) were hypointense compared with surrounding liver tissue. The mean hepatocyte-phase SI ratio of HCCs (0.65 +/- 0.14 [standard deviation]) was significantly lower (P < .01) than that of the nodular pseudolesions (0.95 +/- 0.11). The optimal cutoff value of hepatocyte-phase SI ratio for distinguishing between HCC and nodular pseudolesion was 0.84. No nodular pseudolesions were visible on DW images.. Gadoxetic acid-enhanced hepatocyte-phase MR imaging and DW imaging could be used to distinguish hypervascular pseudolesions from hypervascular HCCs; a hepatocyte-phase SI ratio below 0.84 and visibility on DW images were findings specific for HCCs rather than pseudolesions.

Topics: Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, X-Ray Computed

To evaluate the effect of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) for the diagnosis of hepatocellular carcinoma (HCC).. The phantom signal intensity was measured. We also evaluated 72 patients including 30 patients with HCC. T2WI and DWI were obtained before and then 4 and 20 min after injecting the contrast medium. The signal to noise ratio (SNR), contrast to noise ratio (CNR), and apparent diffusion coefficient (ADC) were calculated in the tumor and liver parenchyma.. The phantom signal intensity increased on T2WI at a concentration of contrast medium less than 0.2 mmol/L but decreased when the concentration exceeded 0.4 mmol/L. SNR of the liver parenchyma on T2WI was significantly different between before and 4 min after injecting the contrast medium, while there were no significant differences between before and 4 and 20 min after injection. On T2WI, SNR, and CNR of HCC showed no significant differences at any time. SNR, CNR, and ADC of the liver parenchyma and tumor on DWI also showed no significant differences at any time.. It is acceptable to perform T2WI and DWI after injection of Gd-EOB-DTPA for the diagnosis of HCC.

Topics: Aged; Analysis of Variance; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Dose-Response Relationship, Drug; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Neoplasms; Male; Observer Variation; Phantoms, Imaging; Prospective Studies; Time Factors

A hepatocyte-specific contrast agent, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), was approved in Japan in 2008. This contrast agent enhances the blood pool and also is hepatocyte specific: it is taken up by hepatocytes and excreted into the biliary tract. Approximately 50% of the administered dose of Gd-EOB-DTPA is taken up by normal hepatocytes and subsequently excreted into the biliary tract, while the remaining 50% is excreted via the kidney. Hepatocellular uptake is considered to represent passive diffusion mediated by organic anion transporter polypeptide 1 (OATP1), which is expressed on the hepatocyte membrane. Gd-EOB-DTPA-enhanced MRI may offer a breakthrough for the diagnosis of liver tumors, particularly early hepatocellular carcinoma (HCC). The differentiation of dysplastic nodules from early HCC has remained difficult, even for pathologists specialized in liver tumors, but Gd-EOB-DTPA MRI facilitates an objective diagnosis with accuracy close to that of HCC-specialized pathologists. In conclusion, Gd-EOB-DTPA MRI facilitates the diagnosis of hypervascular advanced HCC and the differentiation of early HCC and dysplastic nodules, which used to be difficult, even with CT during arterial portography, and offers a high accuracy rate. Thus, Gd-EOB-DTPA MRI will have a significant impact on diagnostic algorithm for HCC.

Topics: Algorithms; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

To investigate whether gadoxetic acid-enhanced magnetic resonance imaging (MRI) has the diagnostic capability and sensitivity comparable to the combination of gadopentetate dimeglumine-enhanced MRI and superparamagnetic iron oxide-enhanced MRI (double-contrast MRI) in the detection of small hepatocellular carcinomas (HCCs).. Forty-one patients with 56 HCCs (size range, 0.5-2.0 cm) who underwent gadoxetic acid-enhanced MRI and double-contrast MRI with a mean interval of 4 days (range, 3-9 days) were included in this study. HCCs were diagnosed by histology (n = 25) and imaging findings (n = 31). Two observers independently reviewed the gadoxetic acid set (unenhanced, early dynamic, and hepatocyte phase images) and the double-contrast MRI set, at an initial reading session, and then reached consensus. Diagnostic accuracy and sensitivity were evaluated using the alternative-free response receiver operator characteristic method.. Diagnostic accuracy (AZ) and sensitivity were similar for both image sets (0.955, 83.9% for gadoxetic acid set; 0.952, 80.4% for double-contrast MRI set) (P > 0.05). There were 5 and 3 HCCs that were verified only on the gadoxetic acid set and double-contrast MRI set, respectively. All 9 HCCs that were not verified on the gadoxetic acid set were assigned a low confidence rating of 1 or 2. However, 3 of the 11 HCCs, which were not verified on double-contrast MRI, were not seen even upon retrospective review.. Gadoxetic acid-enhanced MRI can replace double-contrast MRI for the detection of HCCs. Because all HCCs were delineated on gadoxetic acid-enhanced MRI, even with a low confidence rating, and 3 HCCs were not seen on double-contrast MRI, gadoxetic acid-enhanced MRI could be more advantageous than double-contrast MRI for HCC work-up.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Confidence Intervals; Contrast Media; Female; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed

The purpose of this report was to describe pseudolesions of the liver that mimicked residual hypervascular hepatocellular carcinoma (HCC), as observed on gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) obtained shortly after transarterial chemoembolization (TACE). Between June 2008 and December 2008, three patients underwent MRI within 12 days after TACE to rule out remaining viable cancerous tissue or to assess the treatment effect. In all three patients, nontumorous liver tissue adjacent to the treated HCC exhibited focal arterial enhancement on dynamic phase and subsequent diminished uptake of gadoxetate disodium on hepatocellular phase images, which mimicked residual HCC. All three patients had mild postembolization syndrome at the time of EOB-MRI and showed no evidence of residual or recurrent tumors on follow-up. The findings of these areas may represent transient focal hyperemia and damage to the liver cell function caused by TACE. Radiologists should be aware that EOB-MRI obtained shortly after TACE may show pseudolesions around the treated tumors and should not mistake them for residual or recurrent tumors.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Diagnosis, Differential; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Treatment Outcome

To analyze the correlation between signal intensity in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (MR) imaging and the expression of hepatocyte transporters with histopathologic features in hepatocellular carcinoma (HCC).. Institutional ethics committee approval and informed consent were obtained. Forty surgically resected HCCs were classified as hypointense (n = 32) or iso- or hyperintense (n = 8) on the basis of findings in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging. The following were compared between hypointense and iso- or hyperintense HCCs: the time-signal intensity curves at gadoxetic acid-enhanced MR imaging, the expression levels of seven transporters (four organic anion-transporting polypeptides [OATPs] and three multidrug-resistant proteins [MRPs]) at polymerase chain reaction (PCR) (for 22 nodules), results of immunostaining of OATP8, and histologic features. Statistical analysis (unpaired t test, Mann-Whitney test, chi(2) test, and Fisher exact test) was performed for each result.. On the time-signal intensity curves, hypointense HCCs showed a decreasing pattern, whereas iso- or hyperintense HCCs showed an increasing pattern after the dynamic phase. PCR revealed that expression of OATP8 (an uptake transporter) in hypointense HCCs was lower and that in iso- or hyperintense HCCs was higher than in background liver (P < .001). The expression level of MRP3 (a sinusoidal export transporter) showed a similar trend to that of OATP8 (P < .001). Immunostaining revealed that OATP8 expression was weak in hypointense HCCs, whereas it was sustained in iso- or hyperintense HCCs (P < .001). At histologic examination, a pseudoglandular proliferation pattern with bile plugs was more commonly observed in iso- or hyperintense HCCs than in hypointense HCCs (P = .01 for proliferation patterns and P = .006 for bile plugs).. The enhancement ratio of HCCs in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging positively correlated with expression levels of OATP8 and MRP3, indicating that gadoxetic acid is taken up by OATP8 and excreted by MRP3.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Female; Gadolinium DTPA; Humans; Immunohistochemistry; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidrug Resistance-Associated Proteins; Organic Anion Transporters, Sodium-Independent; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Solute Carrier Organic Anion Transporter Family Member 1B3; Statistics, Nonparametric

To prospectively compare gadoxetate disodium-enhanced magnetic resonance (MR) imaging with multiphasic 64-section multidetector computed tomography (CT) in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis.. Institutional review board approval and informed patient consent were obtained for this prospective study. Fifty-eight patients (39 men, 19 women; mean age, 63 years; age range, 35-84 years) underwent gadoxetate disodium-enhanced MR imaging and multiphasic 64-section multidetector CT. The imaging examinations were performed within 30 days of each other. The two sets of images were qualitatively analyzed in random order by three independent readers in a blinded and retrospective fashion. Using strict diagnostic criteria for HCC, readers classified all detected lesions with use of a four-point confidence scale. The reference standard was a combination of pathologic proof, conclusive imaging findings, and substantial tumor growth at follow-up CT or MR imaging (range of follow-up, 90-370 days). The diagnostic accuracy, sensitivity, and positive predictive value were compared between the two image sets. Interreader variability was assessed. The accuracy of each imaging method was determined by using an adjusted modified chi(2) test.. Eighty-seven HCCs (mean size +/- standard deviation, 1.8 cm +/- 1.5; range, 0.3-7.0 cm) were confirmed in 42 of the 58 patients. Regardless of lesion size, the average diagnostic accuracy and sensitivity for all readers were significantly greater with gadoxetate disodium-enhanced MR imaging (average diagnostic accuracy: 0.88, 95% confidence interval [CI]: 0.80, 0.97; average sensitivity: 0.85, 95% CI: 0.74, 0.96) than with multidetector CT (average diagnostic accuracy: 0.74, 95% CI: 0.65, 0.82; average sensitivity: 0.69, 95% CI: 0.59, 0.79) (P < .001 for each). No significant difference in positive predictive value was observed between the two image sets for each reader. Interreader agreement was good to excellent.. Compared with multiphasic 64-section multidetector CT, gadoxetate disodium-enhanced MR imaging yields significantly higher diagnostic accuracy and sensitivity in the detection of HCC in patients with cirrhosis.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

To compare the diagnostic performance of gadoxetic acid-enhanced MRI with that of multi-phase 40- or 64-multidetector row computed tomography (MDCT) to evaluate viable tumors of hepatocellular carcinomas (HCCs) treated with image-guided tumor therapy.. A total of 108 patients with 162 HCCs (56 lesions with viable tumor and 106 without viable tumor) treated by means of transcatheter arterial chemoembolization or radiofrequency ablation were retrospectively included in this study. All patients underwent multi-phase CT at 40- or 64-MDCT and gadoxetic acid-enhanced MRI using 3.0 Tesla (T). Two observers independently and randomly reviewed the CT and MR images of the treated lesions. The diagnostic performance of two techniques for the evaluation of the viable tumors in the treated lesions was assessed with a receiver operating characteristic (ROC) analysis.. For each observer, the areas under the ROC curve were 0.953 and 0.969 for MRI, and 0.870 and 0.888 for MDCT (P < 0.05). The diagnostic accuracies (96.3% for each observer) and sensitivities (92.9% and 96.4%) of MRI in two observers were significantly higher than those (82.7% and 80.9%, 53.6% for each observer, respectively) of MDCT (P < 0.001). The negative predictive values (96.3% and 98.1%) of MRI in two observers were significantly higher than those (80.0% and 79.5%) of MDCT (P < 0.001). For each observer, specificities and positive predictive values did not differ significantly between the two techniques (P > 0.05).. Gadoxetic acid-enhanced MRI shows better diagnostic performance than that of MDCT for evaluating the viable tumors of HCCs treated with image-guided tumor therapy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Cohort Studies; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Observer Variation; Prospective Studies; Radiographic Image Enhancement; ROC Curve; Tomography, X-Ray Computed; Treatment Outcome

To determine histological and MR imaging differences between areas with Gd-EOB-DTPA (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid) uptake and without in hepatocellular carcinomas (HCCs) as seen on Gd-EOB-DTPA-enhanced hepatobiliary-phase MR images.. This study included nine patients with nine histopathologically proven HCCs (mean size, 1.9 cm) that consisted of two portions of a non-hypointense (Gd-EOB-DTPA uptake) and hypointense area (no Gd-EOB-DTPA uptake) in one tumor as depicted on hepatobiliary-phase MR images. Two radiologists and one pathologist compared the histological and MR finding differences between the two portions in consensus.. In eight specimens, non-hypointense areas of six specimens showed a green color and two specimens did not show a green color. Microscopically, two of nine showed a higher percentage of bile pigments in the non-hypointense area as compared to the hypointense area and the remaining seven showed no difference. Six were homogeneous Edmondson-Steiner grade II, and one was grade I. In two, non-hypointense areas were grade II and hypointense areas were grade I. No difference between the two portions was found for necrosis, hemorrhage, fibrosis, and a fibrous capsule. Seven on T1/T2-weighted images and eight on arterial and portal phase images showed no different signal intensity between the two portions.. Although macroscopically, a non-hypointense area of an HCC seen on GD-EOB-DTPA-enhanced hepatobiliary-phase images may be associated with the area with a green color, no definite microscopic and MR imaging findings that could discriminate a non-hypointense from a hypointense area of an HCC was found.

Topics: Aged; Biopsy, Needle; Carcinoma, Hepatocellular; Cohort Studies; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Immunohistochemistry; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; Sensitivity and Specificity

To evaluate the efficacy of hepatocyte-phase imaging (HP) in characterization of focal hepatic lesions in cirrhotic liver using gadoxetic acid-enhanced magnetic resonance imaging (MRI).. A total of 66 nodules of 38 patients with liver cirrhosis undergoing gadoxetic acid-enhanced MRI were prospectively enrolled in this study. The histological examination revealed 15 dysplastic nodules (DNs), 7 well-differentiated hepatocellular carcinomas (wHCCs), and 44 moderately differentiated HCCs (mHCCs). Two imaging sets (Set A without HP, Set B with HP) were prepared to evaluate the efficacy of HP in lesion characterization.. The mean enhancement ratios (ERs) of mHCC were significantly increased in arterial phase followed by a subsequent decreased in hepatocyte phases. The mean ERs of wHCC were increased in dynamic study and followed by a plateau in the hepatocyte phase. The mean ERs of DNs were increased in dynamic study and hepatocyte phase. The mean liver-to-lesion contrasts of mHCCs were increased in arterial phase and HP (P < 0.05). wHCCs were only increased in HP (P < 0.05). DNs showed no significant difference in any phase (P > 0.05). There were seven additional HCCs that were detected in HP using imaging Set B compared to Set A. The diagnostic performance of Set B was significantly higher than that of Set A (P = 0.016).. The combination of gadoxetic acid-enhanced dynamic study and hepatocyte-phase T1WI may provide better diagnostic performance than only dynamic study in characterization of focal lesions in cirrhotic liver.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Cell Differentiation; Contrast Media; Female; Fibrosis; Gadolinium DTPA; Hepatocytes; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

To compare enhancenent patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) between gadoxetate- and ferucarbotran-enhanced MRI.. Patients recruited from ultrasound surveillance for HCC in chronic liver diseases were enrolled in this prospective study approved by institutional review board. Thirty-six patients with 37 histologically proven HCC, including 22 well-differentiated HCCs (wHCC), 15 moderately to poorly differentiated HCCs (mpHCCs), and 4 DNs, underwent gadoxetate-enhanced and ferucarbotran-enhanced MRI. We compared hepatobiliary phase image of gadoxetate-enhanced MRI with ferucarbotran-enhanced MR image regarding signal intensity of HCC and DN relative to surrounding liver parenchyma. We calculated contrast ratios between tumor and liver on pre-enhancement, hepatobiliary phase of gadoxetate-enhanced MRI and ferucarbotran-enhanced MRI.. On ferucarbotran-enhanced MRI, all mpHCCs showed hyper-intensity, while 14 wHCCs (14/22;63%) showed iso-intensity. On hepatobiliary phase of gadoxetate-enhanced MRI, 13 mpHCCs (13/15;86%) and 20 wHCCs (20/22;91%) showed hypo-intensity. Two DNs and the other two showed iso- and hypo-intensity, respectively, on gadoxetate-enhanced MRI, whereas all DNs revealed iso-intensity on ferucarbotran-enhanced MRI. Gadoxetate-postcontrast ratio was significantly lower than ferucarbotran-postcontrast ratio in wHCC (P = 0.015).. The uptake function of hepatocytes that are targeted by gadoxetate is more sensitive than that of Kupffer cells targeted by ferucarbotran in stepwise hepatocarcinogenesis.

Topics: Aged; Carcinoma, Hepatocellular; Cell Differentiation; Contrast Media; Dextrans; Female; Gadolinium DTPA; Humans; Kupffer Cells; Liver; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds; Rats

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is an MRI contrast agent with perfusion and hepatoselective properties. The purpose of the study was to examine uptake of Gd-EOB-DTPA in the hepatobiliary phase in hepatocellular carcinoma (HCC).. A retrospective analysis of 22 patients with HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI was performed. Enhancement ratios (ERs) and expression levels of the organic anion transporter (OATP) 1B3 protein were examined.. Gd-EOB-DTPA accumulated in the hepatobiliary phase in 6 of the 22 cases. All 6 Gd-EOB-DTPA-positive cases were moderately differentiated HCC, but 11 other moderately differentiated HCCs did not show Gd-EOB-DTPA uptake. Histopathologically, 4 Gd-EOB-DTPA-positive HCCs and 5 Gd-EOB-DTPA-negative HCCs produced bile. HCCs with Gd-EOB-DTPA uptake overexpressed OATP1B3 compared with HCCs without Gd-EOB-DTPA uptake, and OATP1B3 levels were significantly correlated with ERs (r=0.91, P<0.0001).. Uptake of Gd-EOB-DTPA in HCC is determined by expression of OATP1B3 rather than by tumor differentiation or bile production.

Topics: Bile; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organic Anion Transporters, Sodium-Independent; Retrospective Studies; Solute Carrier Organic Anion Transporter Family Member 1B3

We compared the diagnostic performance of gadoxetic acid-enhanced MRI with that of triple-phase 16-, 40-, and 64-MDCT in the preoperative detection of hepatocellular carcinoma (HCC).. Sixty-two consecutively registered patients (54 men, eight women; age range, 31-67 years) with 83 HCCs underwent triple-phase (arterial, portal venous, equilibrium) CT at 16-, 40-, or 64-MDCT and gadoxetic acid-enhanced 3-T MRI. The diagnosis of HCC was established after surgical resection. Three observers independently and randomly reviewed the MR and CT images on a tumor-by-tumor basis. The diagnostic accuracy of these techniques in the detection of HCC was assessed with alternative free response receiver operating characteristic (ROC) analysis. Sensitivity, positive and negative predictive values, and sensitivity according to tumor size were evaluated.. For each observer, the areas under the ROC curve were 0.971, 0.959, and 0.967 for MRI and 0.947, 0.950, and 0.943 for CT. The differences were not statistically significant between the two techniques for each observer (p > 0.05). The differences in sensitivity and positive and negative predictive values between the two techniques for each observer were not statistically significant (p > 0.05). Among 10 HCCs 1 cm in diameter or smaller, each of the observers detected seven tumors with MRI. With CT, one observer detected five, one observer detected four, and one observer detected three HCCs with no statistically significant difference (p > 0.05).. Gadoxetic acid-enhanced MRI and triple-phase MDCT have similar diagnostic performance in the preoperative detection of HCC, but MRI may be better than MDCT in the detection of HCC 1 cm in diameter or smaller.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Preoperative Care; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

To elucidate whether a contrast agent dilution method (dilution method), in which gadoxetate disodium (Gd-EOB-DTPA) is diluted with saline, is useful for good-quality arterial-phase images.. In this study we observed 494 hypervascular hepatocellular carcinomas (HCCs) in 327 patients with chronic liver disease. Three Gd-EOB-DTPA injection methods were adopted for comparison: 1) test injection method (undiluted Gd-EOB-DTPA and modified scan delay), in which a test dose of 0.5 mL of Gd-EOB-DTPA was injected to determine scan delay; 2) conventional method (undiluted Gd-EOB-DTPA and fixed scan delay); and (3) dilution method (diluted Gd-EOB-DTPA and fixed scan delay), in which Gd-EOB-DTPA was diluted to 20 mL with saline. Lesion-liver contrast was calculated. Image quality and lesion detectability were evaluated by two radiologists blinded to the injection methods.. The lesion-liver contrast of the dilution method was significantly higher than that of the other two methods. Lesion detectability of the conventional method (64%) was significantly lower than that of the other two methods (contrast agent dilution method, 95%; test injection method, 93%). The image quality of the contrast agent dilution method was significantly better than that of the other two methods.. The dilution method contributed to improved image quality, high lesion-liver contrast, and high lesion detectability in the arterial-phase images of GD-EOB-DTPA-enhanced MRI.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Carcinoma, Hepatocellular; Contrast Media; Dose-Response Relationship, Drug; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sodium Chloride

The patient was a 75-year-old female. In 2005, abdominal computer tomography (CT) revealed a 18 mm-in-diameter early enhanced lesion (tumor A) in S8, which was diagnosed as hemangioma of liver with abdominal simple MRI examination. However, abdominal computer tomography (CT) revealed a 16 mm-in-diameter early enhanced lesion (tumor B) near the tumor A to at S8 in April 2008. Both tumor A and tumor B led to a diagnosis of hepatocellular carcinoma (HCC) with Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) (tumor A was suspected to HCC with adipose components, and tumor B was suspected to HCC with bile excretion disorder). In July 2008, he received S8 partial hepatectomy at these hepatic tumors. In this resected specimen, a new lesion was detected as a 7 mm-in-diameter HCC, sandwiched in previous two tumors. Previous two tumors were diagnosed as well differentiated HCCs and a new lesion was diagnosed as moderately differentiated HCC. This patient is still alive with no recurrence after 14 months from hepatectomy. In conclusion, Gd-EOB-DTPA enhanced MRI might be useful in diagnosis of hepatic tumor characteristics.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging

Local recurrences are problematic following radiofrequency ablation (RFA) of hepatocellular carcinoma. Intraoperative magnetic resonance imaging (iMRI) is a potentially useful tool for the assessment of the extent of the thermal injury produced by RFA. The use of gadoxetic acid disodium, a hepatocyte-specific contrast agent with prolonged retention, is described as a method of improved assessment of the ablative margins relative to the tumor margins.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Gadolinium DTPA; Humans; Intraoperative Care; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged

To detect hepatocyte-selective enhancement of focal lesions with gadoxetic acid at magnetic resonance (MR) imaging and to correlate enhancement in hepatocyte-selective phases with histopathologic findings and in arterial and portal venous phases with biphasic computed tomographic (CT) findings.. Study was supported by local ethics committee; all patients gave written informed consent. In 19 men and 14 women recruited in three clinical studies, histopathologic correlation and CT scans of 41 focal lesions (13 primary malignant lesions, 21 metastases, three adenomas, three cases of focal nodular hyperplasia [FNH], and one cystadenoma) and ultrasonographic confirmation of five cysts were available. MR was performed before and during arterial and portal venous phases and in hepatocyte-selective phases 10 and 20 minutes after injection of gadoxetic acid. Enhancement was evaluated in consensus by two observers. Enhancement pattern and morphologic features during arterial and portal venous phases were correlated between gadoxetic acid-enhanced MR and CT images by means of adjusted chi(2) test.. Hepatocyte-selective uptake was observed 10 and 20 minutes after injection in FNH (three of three), adenoma (two of three), cystadenoma (one of one), and highly differentiated hepatocellular carcinoma (HCC [grade G1], two of four). Uptake was not detected in metastases (21 of 21), cholangiocarcinoma (three of three), combined hepatocellular cholangiocarcinoma (one of one), undifferentiated carcinoma (one of one), moderately or poorly differentiated HCC (grade G2-G3) (four of four), HCC (grade G1, two of four), adenoma with atypia (one of three), or cysts (five of five). During arterial and portal venous phases, there was high overall agreement rate of 0.963 between gadoxetic acid-enhanced MR and CT (simultaneous 95% confidence interval: 0.945, 0.981).. Liver-specific enhancement of focal lesions is hepatocyte selective and correlates with various histopathologic diagnoses regarding presence of certain hepatocytic functions. Arterial and portal venous MR images obtained with gadoxetic acid are comparable to those of CT.

Topics: Adenoma; Adult; Aged; Carcinoma, Hepatocellular; Cholangiocarcinoma; Cystadenoma; Cysts; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed

To evaluate the suitability of the liver-specific MRI contrast agent Gd-EOB-DTPA as a nonviral vector for gene therapy of hepatocellular carcinoma.. Specific uptake of Gd-EOB-DTPA was quantified by relaxometry in rat cultured hepatocytes and the hepatoma cells HepG2 and Huh7. Nonviral vectors for gene transfer were synthesized by coupling Gd-EOB-DTPA to polyethyleneimine or polylysine as DNA condensing agents, and their efficiency was studied using beta-galactosidase (lacZ) as the reporter gene.. Gd-EOB-DTPA was specifically taken up by rat cultured hepatocytes (4.32 vs. 1.08 mmol/L in nonhepatocyte control cells) but not by the hepatoma cells; this uptake was concentration-dependently inhibited by Bromsulphtalein. Polycation linkages were achieved with yields of 0.9 Gd-EOB-DTPA molecule per polyethyleneimine molecule and 10 Gd-EOB-DTPA molecules per polylysine molecule. Incubating the cells with plasmids containing lacZ reporter gene and polyethyleneimine-Gd-EOB-DTPA resulted in a few blue (transfected) cells, whereas no blue cells were observed on incubation with polylysine-Gd-EOB-DTPA.. Gd-EOB-DTPA is taken up by normal hepatocytes but not by HepG2 and Huh7 cells, probably because of the lack of the organic anion transporter in these hepatoma cells. The Gd-EOB-DTPA polycation conjugates, such as polyethyleneimine-Gd-EOB-DTPA, could serve as transfer vectors of interest for gene targeting imagery at the early stage of hepatocarcinogenesis. However, the transfer efficiency of such conjugates is low and requires improvement.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Gadolinium DTPA; Genetic Therapy; Hepatocytes; Liver Neoplasms; Rats; Transfection; Tumor Cells, Cultured

The authors compare the potential value of unenhanced and gadoxetate disodium-enhanced spin-echo images for the detection of hepatocellular carcinoma in a rat model.. Eleven rats with chemically induced hepatocellular carcinoma underwent unenhanced T2-weighted fast spin-echo imaging followed by T1-weighted spin-echo imaging before and at 5 minutes, 30 minutes, 3 hours, 1 day, and 3 days after intravenous administration of 60 micromol/kg gadoxetate disodium at 4.7 tesla. Tumor and liver enhancement, and tumor-to-liver contrast-to-noise (C/N) ratio were calculated.. After gadoxetate disodium administration, the tumors showed less enhancement than the liver. Tumor-to-liver C/N ratio increased from 5.5 +/- 0.8% on unenhanced T1-weighted images to 12.9 +/- 2.4% on gadoxetate-enhanced T1-weighted images (P = 0.02). However, the C/N ratio on unenhanced T2-weighted images (23.5 +/- 3.6%) remained higher than that on gadoxetate-enhanced T1-weighted images, a difference that is statistically significant (P < 0.01).. In the experimental setting of our study, the higher tumor-to-liver C/N ratio on unenhanced T2-weighted spin-echo images suggests that unenhanced T2-weighted spin-echo images are superior to gadoxetate disodium-enhanced T1-weighted spin-echo images for the detection of hepatocellular carcinoma.

Topics: Animals; Carcinoma, Hepatocellular; Cell Division; Contrast Media; Gadolinium DTPA; Image Enhancement; Infusions, Intravenous; Liver; Liver Neoplasms, Experimental; Magnetic Resonance Imaging; Male; Rats; Rats, Wistar