gadoxetic-acid-disodium and Carcinoma

The purpose was to describe magnetic resonance imaging (MRI) findings of breast cancer liver metastasis using gadoxetic acid (Gd-EOB-DTPA) with an emphasis on the added value of the hepatobiliary phase (HBP).. Nine patients with 13 liver metastases were included in the study after the medical records of 29 breast cancer patients who underwent Gd-EOB-DTPA-enhanced MRI between February 2008 and June 2010 were reviewed. The diagnoses of liver metastasis were established by percutaneous liver biopsy or surgery and on the basis of image findings. Two radiologists retrospectively evaluated signal intensity (SI) and sizes of metastases and patterns of enhancement in an HBP. The SI ratio was calculated as the SI of the central hyperintense portion in "target" lesions divided by the SI of nearby normal liver parenchyma on the HBP. We also measured apparent diffusion coefficient (ADC) values from Diffusion Weighted Image (DWI).. Liver metastases were all hypointense [n=13/13 (100%)] on T1-weighted imaging (WI), and many lesions had a "target" appearance with a central high SI and a peripheral low SI rim (47%) on T2WI. Dynamic study showed rim enhancement on the arterial phase (85%) and a "target" appearance, consisting of a central enhancing portion with peripheral washout or hypointense rim, on the HBP (62%). The mean SI ratio was 0.7. The mean ADC value of "target" appearing metastases was 1.25 (×10(-3) mm(2)/s; range 1.3-1.6) compared with a mean value of 0.8 (×10(-3) mm(2)/s; range 0.8-1.4) in homogeneous defect on the HBP. There was statistically significant difference (P<.05).. Breast cancer liver metastases commonly demonstrated as a peripheral ring enhancement on arterial dominant phase and a target sign with a central round enhancing portion and a peripheral hypointense rim on the HBP.

Topics: Breast Neoplasms; Carcinoma; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Reproducibility of Results; Sensitivity and Specificity; Tissue Distribution

To assess liver and lesion enhancements by dynamic MR imaging after bolus injection of the hepatobiliary contrast agent gadolinium ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) in patients with liver metastases and to compare the effect of different doses.. A randomized double-blinded trial with doses of 12.5, 25 and 50 micromol/kg Gd-EOB-DTPA was performed in 35 patients with liver metastases. Liver enhancement, tumor enhancement and liver lesion contrast-to-noise (C/N) ratios were calculated from breath-hold gradient echo images (100/5/80 degrees) recorded precontrast and at different times up to 10 min postcontrast.. Normal liver showed a characteristic enhancement pattern, with a rapid enhancement in the first 45 s postcontrast and a slight but significant further increase up to 600 s. The initial enhancement in the lesions was also pronounced, but the enhancement was slightly decreased after 240 s postcontrast. At dose levels of 12.5 and 25 micromol/kg Gd-EOB-DTPA, C/N ratios significantly increased compared to baseline from 90 to 600 s. Postcontrast C/N-values obtained using 50 micromol/kg Gd-EOB-DTPA were not significantly increased, except for the examinations 480 s postcontrast.. In liver metastases, C/N ratios obtained with doses of 12.5 and 25 micromol/kg Gd-EOB-DTPA were slightly superior to 50 micromol/kg Gd-EOB-DTPA. This finding is probably due to a more pronounced extracellular effect of the contrast medium at higher doses.

Topics: Adult; Aged; Artifacts; Biopsy, Needle; Carcinoma; Contrast Media; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Injections, Intravenous; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Melanoma; Middle Aged; Statistics as Topic; Time Factors

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

Topics: Adult; Breast Neoplasms; Carcinoma; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Fluorodeoxyglucose F18; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Multimodal Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Spinal Neoplasms; Thoracic Vertebrae; Tomography, X-Ray Computed

To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy.. Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis.. Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3-82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6-80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3-72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9-68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4-93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1-95.1). Differences were statistically significant (P < 0.001). Notably, similar results were obtained analysing only small lesions (<1 cm).. The combination of DWI with Gd-EOB-DTPA-enhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions.

Topics: Aged; Antineoplastic Agents; Carcinoma; Colorectal Neoplasms; Contrast Media; Drug Therapy; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Preoperative Care; Reproducibility of Results; Sensitivity and Specificity

To evaluate the added value of diffusion-weighted magnetic resonance (MR) imaging in diagnostic performance of conventional MR imaging for diagnosis of ampullary carcinoma.. This retrospective study was institutional review board approved, and informed consent was waived. Twenty-three patients with malignant ampullary obstruction and 39 patients with benign ampullary obstruction were included. Qualitative (signal intensity and enhancement pattern) and quantitative (apparent diffusion coefficient [ADC]) analyses were conducted for visible or expected locations of duodenal papillae. Two observers independently reviewed conventional MR images and subsequently reviewed combined conventional and diffusion-weighted MR images. A five-point scale for likelihood of ampullary carcinoma was used. Fisher exact test and Mann-Whitney U test were used for comparing groups, and diagnostic performance (receiver operating characteristic [ROC] curve analysis), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated.. Visible or expected duodenal papillae in benign group showed isointensity (27-38 of 39, 69%-97%) and similar enhancement pattern (27 of 39, 69%) to that of normal duodenal wall more frequently than in malignant group (seven to 18 of 23 [30%-78%] and three of 23 [13%], respectively) on conventional MR images (P < .05). On diffusion-weighted images, 21 of 23 (91%) ampullary carcinomas showed hyperintensity, whereas all benign cases showed isointensity compared with normal duodenal wall (P < .001). Mean ADC of ampullary carcinomas (1.23 × 10(-3) mm(2)/sec) was significantly lower than that of benign group (1.69 × 10(-3) mm(2)/sec) (P < .001). Diagnostic performance (area under ROC curve [Az]) of both observers improved significantly after additional review of diffusion-weighted images; Az improved from 0.923 to 0.992 (P = .029) for observer 1 and from 0.910 to 0.992 (P = .025) for observer 2. In addition, diagnostic accuracy, sensitivity, specificity, PPV, and NPV of combined conventional and diffusion-weighted MR images were higher than those of conventional MR images alone.. Addition of diffusion-weighted imaging to conventional MR imaging improves detection of ampullary carcinoma when compared with conventional MR imaging alone.

Topics: Adult; Aged; Ampulla of Vater; Carcinoma; Cholangiopancreatography, Magnetic Resonance; Common Bile Duct Neoplasms; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Male; Middle Aged; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric

To determine specific imaging features of hepatic metastasis from colorectal cancer, focusing on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI.. Over a 2-year period, 79 hepatic metastatic lesions were identified from 32 patients (22 men and 10 women) who proven colorectal cancer and underwent gadoxetic acid-enhanced 3.0T MRI. Hepatic metastases were proven pathologically in 16 patients: by surgical liver resection (n=14) and by US-guided biopsy (n=2). The remaining 16 patients were considered to have hepatic metastasis based on imaging studies and clinical information. Two radiologists evaluated the imaging features of each MRI sequence, including high resolution T2WI, dynamic contrast enhancement study with hepatobiliary phase, and diffusion weighted image. We also compared SI of the lesions on T2WI and HBP.. T2WI showed homogeneous high SI (n=25; 31.7%), target appearance (n=3; 3.8%), reversed target appearance (n=2; 2.6%), and heterogeneously high SI (n=49; 62%). On HBP, homogeneous defect were seen in 22 lesions (27.9%), target appearance in five lesions (6.4%), reversed target appearance in two lesions (2.5%), and heterogeneous defect in 50 lesions (63.3%); including reticular (70%), partially globular (26%), and diffuse GGO-like (4%) patterns. According to the imaging features on HBP, the homogeneous defect and heterogeneous defect groups had a mean ADC value of 0.99 × 10(-3) and 1.07 × 10(-3)mm(2)/s, respectively, without statistically significant difference.. Hepatic metastasis from colorectal cancer usually showed as a heterogeneous defect on HBP and a heterogeneous high SI on T2WI. The generally accepted "true defect" was not a common finding in hepatic metastasis from colorectal cancer.

Topics: Adult; Aged; Carcinoma; Colorectal Neoplasms; Contrast Media; False Negative Reactions; Female; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To compare diffusion-weighted imaging (DWI) and Gd-EOB-DTPA-enhanced magnetic resonance (MR) imaging for the detection and characterisation of focal liver lesions (FLLs) in patients with colorectal carcinoma.. Seventy-three patients underwent MR imaging including echoplanar DWI (MR-DWI) and dynamic (MR-Dyn) and hepatobiliary phase (MR-Late) Gd-EOB-DTPA-enhanced images. Two blinded readers independently reviewed 5 different image sets using a 5-point confidence scale. Accuracy was assessed by the area (A(z)) under the receiver operating characteristic curve, and sensitivity and specificity were calculated.. A total of 332 FLLs were evaluated. Detection rates were significantly higher for MR-Late images (94.4% for benign and 100% for malignant lesions) compared with MR-DWI (78.3% and 97.5%) and MR-Dyn images (81.5% and 89.9%). Accuracy was 0.82, 0.76 and 0.89 for MR-DWI, MR-Dyn and MR-Late images while sensitivity was 0.98, 0.87 and 0.95, respectively. For characterisation of subcentimetre lesions sensitivity was highest for MR-DWI (0.92). Combined reading of unenhanced and contrast-enhanced images had an identical high accuracy of 0.98.. Late-phase Gd-EOB-DTPA-enhanced images were superior for the detection of FLLs, while DWIs were most valuable for the identification of particularly small metastases. Combined interpretation of unenhanced images resulted in precise characterisation of FLLs.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Colorectal Neoplasms; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Reproducibility of Results; ROC Curve; Sensitivity and Specificity

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 investigate the dose dependency of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) for interstitial magnetic resonance (MR) lymphography and the detection of lymph node metastasis in rabbits.. Eighteen VX2 tumor-bearing rabbits were subjected to MR lymphography using clinical MRI equipment. The enhancement of popliteal lymph nodes was studied in these rabbits before and at 2.5 to 10 minutes after the subcutaneous administration of 4, 8, or 17 micromol Gd/kg of Gd-EOB-DTPA in TSE and 3D-FLASH (n = 6). Signal-to-noise ratio and contrast-to-noise ratio were statistically compared between each group by the Tukey test. After MR imaging, the popliteal lymph nodes were removed, and sections were prepared for microscopic examination.. In the histologic findings, all metastases (3-12 mm) in the popliteal lymph nodes were detected by 3D-FLASH images. Gd-EOB-DTPA-enhanced T1WI showed a hypointense region for metastasis and a hyperintense region for nontumor regions, although the lymph nodes containing metastasis were detected as a hyperintense region by conventional PDWI and T2WI. Signal enhancement of the nontumor regions and contrast between the nontumor regions and metastasis showed dose dependency and reached a plateau at 8 micromol Gd/kg on T1WI (signal-to-noise ratio: 13.9 +/- 1.6; contrast-to-noise ratio: -12.7 +/- 1.7).. This study showed that interstitial MR lymphography with Gd-EOB-DTPA can detect metastasis and that the optimal dose in rabbits is 8 micromol Gd/kg as a subcutaneous application.

Topics: Animals; Carcinoma; Contrast Media; Dose-Response Relationship, Drug; Gadolinium DTPA; Hindlimb; Image Enhancement; Image Processing, Computer-Assisted; Injections, Subcutaneous; Lymph Nodes; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Rabbits