gadoxetic-acid-disodium and Cholangiocarcinoma

Topics: Bile Duct Neoplasms; Bile Ducts; Cholangiocarcinoma; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging

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

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 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

Although cavernous hemangioma is one of the most frequently encountered benign hepatic neoplasms, hepatic sclerosed hemangioma is very rare. We report a case of hepatic sclerosed hemangioma that was difficult to distinguish from an intrahepatic cholangiocarcinoma by imaging studies.. A 76-year-old male patient with right hypochondralgia was referred to our hospital. Abdominal ultrasonography revealed a heterogeneously hyperechoic tumor that was 59 mm in diameter in segment 7 of the liver. Dynamic computed tomography showed a low-density tumor with delayed ring enhancement. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) demonstrated a low-signal intensity mass with ring enhancement on T1-weighted images. The mass had several high-signal intensity lesions on T2-weighted images. EOB-MRI revealed a hypointense nodule on the hepatobiliary phase. From these imaging studies, the tumor was diagnosed as intrahepatic cholangiocarcinoma, and we performed laparoscopy-assisted posterior sectionectomy of the liver with lymph node dissection in the hepatoduodenal ligament. Histopathological examination revealed a hepatic sclerosed hemangioma with hyalinized tissue and collagen fibers.. Hepatic sclerosed hemangioma is difficult to diagnose preoperatively because of its various imaging findings. We report a case of hepatic sclerosed hemangioma and review the literatures, especially those concerning imaging findings.

Topics: Aged; Bile Duct Neoplasms; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Hemangioma; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Sclerosis; Tomography, X-Ray Computed

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

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

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

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

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 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

To identify imaging markers that independently predict the post-operative outcome of intrahepatic mass-forming cholangiocarcinoma (IMCC) using gadoxetate disodium-enhanced magnetic resonance imaging (MRI).. Data from 54 patients who underwent pre-operative gadoxetate disodium-enhanced MRI and curative surgery for IMCC were retrospectively evaluated. The prognostic power of various imaging and pathological features reportedly associated with recurrence-free survival (RFS) and overall survival (OS) was analyzed using Cox regression models. A model combining imaging and pathological features was developed and its performance was evaluated using the Harrell C-index and Akaike information criterion.. Capsule penetration (P = 0.016) and tumor size (P = 0.015) were independent markers for worse RFS, while capsule penetration (P = 0.012) and hepatic vein obstruction (HVO, P = 0.016) were independent markers for worse OS, respectively, in the imaging-based model. Capsule penetration was the only imaging marker identified in the combined prediction model of RFS, and the combined model showed a higher C-index and lower AIC value compared with the model based on pathological features alone.. Capsule penetration and HVO on MRI are significantly worse imaging prognostic factors for post-operative outcomes in patients with IMCC. Incorporation of capsule penetration and HVO into a surgical staging system may improve prediction of the post-operative prognosis of IMCC.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Preoperative Care; Prognosis; Retrospective Studies

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

To determine the differential features of inflammatory myofibroblastic tumor (IMT) and intrahepatic cholangiocarcinoma (ICC) manifesting as target appearance on gadoxetic acid-enhanced MRI.. Twenty-seven patients with 36 IMTs (1.2-6.0 cm) and 34 patients with 34 ICCs (1.5-6.0 cm) who underwent gadoxetic acid-enhanced MRI were enrolled in this study. Two reviewers evaluated morphology, signal intensity, and enhancement features of tumors on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and gadoxetic acid-enhanced imaging.. As for 32 IMTs with target appearance, IMTs most commonly demonstrated early target appearance characterized by a peripheral hypointense rim on unenhanced T1WI (n = 27, 84.4%), central enhanced area with a hypointense rim on arterial phase (AP) and portal venous phase (PVP) (n = 29, 90.6%), and transitional phase (TP) (n = 28, 87.5%). Meanwhile, most of the ICCs showed homogeneous hypointensity on T1WI (100%), a hyperenhancing rim on AP, late target appearance on TP (n = 32, 94.1%) and HBP (n = 32, 94.1%). Target appearance on DWI appearing as hyperintensity with central hypointense area was seen in 2 IMTs and 32 ICCs. On T2WI, 24 IMTs (n = 24, 75.0%) displayed central iso- and peripheral hyperintensity and 27 ICCs (84.4%) showed layered hyperintensity with either brighter or darker area in center. The remaining six IMTs with no target were observed as cystic appearing nodules (n = 3) or ill-defined hypovascular nodules (n = 2) and fibrotic mass (n = 1).. IMTs often show early target appearance on unenhanced T1WI, and early dynamic phases of gadoxetic acid-enhanced MRI. Target appearance on later phases, such as TP and HBP, and DWI target appearance were commonly in ICCs, but rare in IMTs.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Myofibroblasts; Retrospective Studies; Sensitivity and Specificity

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

Purpose To identify whether arterial enhancement pattern at MRI could predict the prognosis after surgical resection of intrahepatic mass-forming cholangiocarcinoma (IMCC). Materials and Methods Patients who underwent curative hepatic resection and preoperative MRI for IMCC from November 2007 to September 2016 were retrospectively evaluated. MRI enhancement pattern was classified by two radiologists. Recurrence and death data were retrieved until September 31, 2017. Prognostic factor analysis was performed by using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. Results Data in 134 patients (median age, 63.0 years; 87 men and 47 women) were evaluated; median tumor size was 4.5 cm. Arterial phase MRI showed diffuse hypoenhancement in 33 patients, peripheral rim enhancement in 81 patients, and diffuse hyperenhancement in 20 patients. The 5-year risk of death in patients with IMCC with diffuse hyperenhancement was lower than that of patients with diffuse hypoenhancement or peripheral rim enhancement (5-year risk of death: 5.9% vs 87.9% vs 59.2%). Diffuse hypoenhancement (hazard ratio [HR], 41; 95% confidence interval [CI]: 5, 312; P < .01) and peripheral rim enhancement (HR, 11; 95% CI: 2, 85; P = .02) were associated with an increased risk of death compared with diffuse hyperenhancement. Patients with diffuse hyperenhancement of IMCCs had more frequent chronic liver disease (13 of 20; 65%), less frequent vascular invasion (six of 20; 30%), and less frequent tumor necrosis (three of 20; 15%) than other enhancement group (P < .05 for all). Conclusion The MRI arterial enhancement pattern was a prognostic marker in the preoperative evaluation of patients with resectable intrahepatic mass-forming cholangiocarcinoma. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Yoon and Lee .

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Angiography; Male; Middle Aged; Prognosis; Retrospective Studies

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

To review the gadoxetic acid disodium (EOB)-enhanced magnetic resonance (MR) imaging features of cholangiolocellular carcinoma (CoCC) of the liver and compare them with those of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).. EOB-enhanced MR images of 19 patients with CoCC, 23 with ICC, and 51 with HCC were retrospectively evaluated qualitatively and quantitatively. Univariate and multivariate analyses were performed to determine the characteristic MR features of CoCC with histopathological-imaging correlation.. Multivariate logistic regression analysis showed that dot-/band-shaped internal enhancement during the arterial and portal phases (P < 0.001), and larger arterial ring enhancement ratio (CoCC, 0.13 ± 0.04; ICC, 0.074 ± 0.04; P = 0.013) were significantly independently associated with CoCC in contrast to ICC, whereas several MR features including progressive enhancement during the portal and late phases (P < 0.001), target appearance in the hepatocyte phase (P = 0.004), and vessel penetration (P = 0.013) were significantly more frequently associated with CoCC than HCC. The dot-/band-like internal enhancement (78.9% of CoCCs) histopathologically corresponded to the tumour cell nest with vascular proliferations and retained Glisson's sheath structure.. EOB-enhanced MR features of CoCC largely differ from those of HCC but are similar to those of ICC. However, the finding of thicker arterial ring enhancement with dot-/band-like internal enhancement could help differentiate CoCC from ICC.. • Gadoxetic acid-enhanced MR features of cholangiolocellular carcinoma (CoCC) resembled those of intrahepatic cholangiocarcinoma (ICC). • Gadoxetic acid-enhanced MR features of CoCC largely differed from those of hepatocellular carcinoma. • Dot-/band-like internal enhancement of CoCC may be helpful for differentiating from ICC. • Arterial ring enhancement of CoCC was larger than that of ICC.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis

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

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

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

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 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

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

To assess whether gadoxetic acid-enhanced MRI could be used as a prognostic factor for intrahepatic mass-forming cholangiocarcinomas (IMCCs).. Forty-one patients with pathologically proven IMCCs who underwent preoperative gadoxetic acid-enhanced MRI were included. The signal intensity of the IMCCs on hepatobiliary phase (HBP) MRI was qualitatively analyzed by two radiologists, and categorized into intermediate or hypointense groups. Analysis of clinicopathological prognostic factors and correlations of imaging and histology were also performed. Survival time and time to recurrence (TTR) were analyzed.. Of the 41 IMCCs, 23 were in the intermediate group and 18 were in the hypointense group on HBP MRI. IMCCs in the intermediate group were associated with shorter survival time (P = 0.048) and TTR (P = 0.002) than the IMCCs of the hypointense group. Only the intermediate group on HBP MRI had a significantly shorter TTR on multivariate analysis (P = 0.012). The IMCCs of the intermediate group showed a tendency for more abundant tumour fibrous stroma than those of the hypointense group (P = 0.027).. The enhancement of IMCCs on HBP gadoxetic acid-enhanced MRI appears to correlate with tumour aggressiveness and outcomes due to the tumour fibrous stromal component. Thus, HBP images could be a useful prognostic factor for IMCCs after surgery.. • The enhancement of IMCCs on HBP correlates with the tumour fibrous stroma. • The enhancement of IMCCs on HBP MRI appears to correlate with prognosis. • Gadoxetic acid-enhanced MRI is helpful for predicting prognosis of IMCCs after surgery.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Preoperative Care; Prognosis; Retrospective Studies

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

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

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

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

To investigate the utility of Liver Imaging Reporting and Data System (LI-RADS) v2014 for intrahepatic mass-forming cholangiocarcinomas (IMCC) on gadoxetic acid-enhanced magnetic resonance imaging (MRI).. This retrospective study was approved by our Institutional Review Board with waiver of informed consent. Pathologically confirmed IMCCs (n = 35) and hepatocellular carcinomas (HCCs) (n = 71) in patients with chronic hepatitis B or cirrhosis who had undergone gadoxetic acid-enhanced 3.0T or 1.5T MRI were included. Three radiologists independently assigned LI-RADS categories for each IMCC or HCC. Diagnostic performances of LR-M (probable malignancy, not specific for HCC) and LR-5/5v (definitely HCC) were investigated, and imaging features were compared between IMCCs of LR-M and non-LR-M.. In all, 88.6% (31/35), 80.0% (28/35), and 74.3% (26/35) of IMCCs and 12.7% (9/71), 22.5% (16/71), and 16.9% (12/71) of HCCs were assigned as LR-M by the three reviewers with substantial interobserver agreements (kappa = 0.664-0.741). Among IMCCs, 2.9% (1/35), 5.7% (2/35), and 11.4% (4/35) were categorized as LR-5/5v. IMCCs of non-LR-M (n = 8, using the consensus method) were significantly smaller (24.1 ± 17.4 vs. 62.8 ± 30.6 mm, P = 0.002) and showed higher frequencies of arterial hyperenhancement (75.0% (6/8) vs. 7.4% (2/27), P < 0.001) and lower frequencies of non-HCC malignancy-favoring features such as peripheral enhancement (12.5% (1/8) vs. 77.8% (21/27), P = 0.002) or the target appearance on the hepatobiliary phase (0% (0/8) vs. 81.5% (22/27), P < 0.001) than IMCCs of LR-M (n = 27).. Using LI-RADS, the majority of IMCCs can be accurately categorized as LR-M on gadoxetic acid-enhanced MRI; however, caution is warranted, as some atypical IMCCs may be assigned as LR-5/5v resulting in a false-positive diagnosis of HCC. J. Magn. Reson. Imaging 2016;44:1330-1338.

Topics: Algorithms; Cholangiocarcinoma; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Information Storage and Retrieval; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiology Information Systems; Reproducibility of Results; Sensitivity and Specificity; Software

To describe the Gd-EOB-DTPA-enhanced MRI appearances of cholangiocarcinoma, and evaluate the relative signal intensities (RSIs) changes of major abdominal organs, and investigate the effect of total bilirubin (TB) levels on the RSI.. 25 patients with pathologically-proven cholangiocarcinoma underwent Gd-EOB-DTPA-enhanced MRI. The visualization of the biliary system during biliary phase (BP) was observed. RSIs of the abdominal aorta (A), portal vein (V), liver (L), and spleen (S) were measured.. On hepatocellular phase (HP), exophytic tumors (n =10) and infiltrative tumors (n =10) were hypointense, polypoid tumors (n = 2) were hypointense, and combined type tumors (n = 3) had mixed appearances. While patients with normal TB levels (≤22 μmol/L, n = 12) had clear visualization of the biliary tree during BP, those with elevated TB levels (>22 μmol/L, n = 13) had obscured or no visualization. In addition, patients with normal TB levels had higher RSIA, RSIV and RSIS than those with elevated TB levels on all dynamic phases (P <0.001), and lower RSIA, RSIV and RSIS on HP and BP (P <0.001). Patients with normal TB levels had higher RSIL than those with elevated TB levels on all phases (P <0.001).. RSIs of major abdominal organs reflected underlying biliary function. Cholangiocarcinoma patients with elevated TB levels had delayed excretion of Gd-EOB-DTPA compared with patients with normal TB levels.

Topics: Adult; Aged; Bile Duct Neoplasms; Bilirubin; Cholangiocarcinoma; Female; Gadolinium DTPA; Humans; Jaundice; Magnetic Resonance Imaging; Male; Middle Aged; Tumor Burden; Young Adult

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

The optimal sequence for Gd-EOB-DTPA uptake measurement in the liver with the purpose of liver function measurement is still not defined.. To prospectively evaluate the effect of an increased flip angle (FA) of a T1-weighted fat-saturated 3D sequence for the measurement of hepatocyte uptake of Gd-EOB-DTPA magnetic resonance imaging (MRI) after right portal vein embolization (PVE).. Ten patients who received a PVE prior to an extended hemihepatectomy were examined 14 days after PVE using Gd-EOB-DTPA enhanced MRI of the liver using the standard FA of 10° and the increased FA of 30°.. Relative enhancement of the right liver lobe (RLL) was 0.52 ± 0.12 for 10° and 1.41 ± 0.39 for 30°. Relative enhancement of the left liver lobe (LLL) was 0.58 ± 0.11 for 10° and 2.05 ± 0.61 for 30°. Relative enhancement of the RLL was significantly higher for 30° than for 10° (P = 0.009) and significantly higher in the 30° than in the 10° sequences (P = 0.005) for the LLL.. A flip angle of 30° increases the contrast between liver partitions with and without portal venous embolization. Thereby, the sensitivity for differences in uptake intensity is increased. This could be of value for a more exact determination of differences in regional liver function and, consequently, the estimation of the future remnant liver function.

Topics: Adult; Aged; Cholangiocarcinoma; Contrast Media; Embolization, Therapeutic; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Prospective 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

To assess the benefit of adding diffusion-weighted (DW) imaging to gadoxetic acid-enhanced magnetic resonance (MR) imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma.. The institutional review board approved this retrospective study and waived the requirement for informed consent. The study included 52 patients (36 men, 16 women; mean age, 63.4 years) with surgically confirmed hilar cholangiocarcinoma who underwent gadoxetic acid-enhanced MR imaging and DW imaging at 3.0 T between August 2010 and December 2011. Two observers independently reviewed two image sets--a gadoxetic acid set, including images from MR cholangiopancreatography, and a combined gadoxetic acid set and DW imaging set--to evaluate the tumor involvement of each biliary confluence and vascular and liver invasion by using receiver operating characteristic (ROC) curve analysis.. For each observer, area under the ROC curve (Az) values for tumor involvement of the biliary confluence were 0.965 and 0.957 for the gadoxetic acid set and 0.980 and 0.975 for the combined set, respectively (P > .05). For detecting 105 biliary confluences with tumor involvement, the sensitivities with the combined set (97.1% [102 of 105] and 98.1% [103 of 105]) were higher than those with the gadoxetic acid set (91.4% [96 of 105] for both observers) (P = .029 and P = .016), although the specificities were similar with both image sets (P > .05). For the detection of liver invasion, the combined set (75.0% [15 of 20] for both observers) yielded better sensitivity than the gadoxetic acid set (50.0% [10 of 20] and 45.0% [nine of 20]) (P = .016 and P = .031). For evaluation of vascular invasion, the two image sets showed similar diagnostic performance.. In the preoperative evaluation of hilar cholangiocarcinoma, the addition of DW imaging to gadoxetic acid-enhanced MR imaging could improve sensitivity in the evaluation of tumor extent along the bile duct and liver invasion.

Topics: Aged; Bile Duct Neoplasms; Cholangiocarcinoma; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

To assess the added value of diffusion-weighted imaging (DWI) to conventional magnetic resonance imaging (MRI) for differentiating benign from malignant bile duct strictures.. Twenty-seven patients with a benign stricture and 42 patients with a malignant stricture who had undergone gadoxetic acid-enhanced MRI with DWI were enrolled. Qualitative (signal intensity, dynamic enhancement pattern) and quantitative (wall thickness and length) analyses were performed. Two observers independently reviewed a set of conventional MRI and a combined set of conventional MRI and DWI, and receiver operating characteristic (ROC) curve analysis was assessed.. Benign strictures showed isointensity (18.5-70.4 %) and a similar enhancement pattern (22.2 %) to that of normal bile duct more frequently than malignant strictures (0-40.5 % and 0 %) on conventional MRI (P < 0.05). Malignant strictures (90.5-92.9 %) showed hypervascularity on arterial and portal venous phase images more frequently than benign strictures (37.0-70.4 %) (P < 0.01) On DWI, all malignant strictures showed hyperintensity compared with benign cases (70.4 %) (P < 0.001). Malignant strictures were significantly thicker and longer than benign strictures (P < 0.001). The diagnostic performance of both observers improved significantly after additional review of DWI.. Adding DWI to conventional MRI is more helpful for differentiating benign from malignant bile duct strictures than conventional MRI alone.. • Accurate diagnosis and exclusion of benign strictures of bile duct are important. • Diffusion-weighted MRI helps to distinguish benign from malignant bile duct strictures. • DWI plus conventional MRI provides superior diagnostic accuracy to conventional MRI alone.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts; Cholangiocarcinoma; Constriction, Pathologic; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Male; Middle Aged; Retrospective Studies; ROC Curve

To evaluate MRI features of intraductal papillary neoplasm of the bile duct (IPNB) and to determine added value of diffusion-weighted MRI (DWI).. Twenty-three patients with surgically confirmed invasive (n = 12) and non-invasive (n = 11) IPNB, who underwent preoperative liver MRI were included. Two observers performed consensus review of gadoxetic acid-enhanced MRI and combined gadoxetic acid-enhanced MRI including DWI separately, with regard to conspicuity of intraductal tumor using five point scales, extent of tumors, and the presence of invasiveness.. On MRI, there was no significant difference in the conspicuity of intraductal tumors between gadoxetic acid MRI (mean, 4.35) and combined MRI (mean, 4.65) (P = 0.09). However, addition of DWI led seven cases revealed excellent conspicuity as compared with good or moderate conspicuity on gadoxetic acid MRI. With regard to invasiveness, 11 cases (48 %) and 17 (74 %) were correctly diagnosed with gadoxetic acid MRI and combined MRI, respectively (P = 0.06). In invasive tumors, both of the two image sets did not help assess accurate extent of the tumor.. The addition of DWI to gadoxetic acid-enhanced MRI has a potency to improve conspicuity for intraductal tumors of IPNB and is helpful in determining tumor invasiveness, but not tumor extent.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Papillary; Cholangiocarcinoma; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Invasiveness

To prospectively evaluate the early development of regional liver function after right portal vein embolisation (PVE) with Gd-EOB-DTPA-enhanced MRI in patients scheduled for extended right hemihepatectomy.. Ten patients who received a PVE before an extended hemihepatectomy were examined before and 14 days after PVE using Gd-EOB-DTPA-enhanced MRI of the liver. In these sequences representative region of interest measurements were performed in the embolised right (RLL) and the non-embolised left liver lobe (LLL). The volume as well as hepatic uptake index (HUI) was calculated independently for each lobe.. Relative enhancement 14 days after PVE decreased in the RLL and increased significantly in the LLL (P < 0.05). Average hepatic uptake index (HUI) for RLL was significantly lower 14 days after PVE than before PVE (P < 0.05) and significantly higher for LLL (P < 0.05).. A significant shift of contrast uptake from the right to the left liver lobe can be depicted as early as 14 days after right PVE by using Gd-EOB-DTPA-enhanced MRI, which could reflect the redirected portal venous blood flow and the rapid utilisation of a hepatic functional reserve.. • Preoperative portal vein embolisation (PVE) is widely performed before right-sided hepatic resection. • PVE increases intravenous contrast medium uptake in the left lobe of liver. • The hepatic uptake index for the left liver lobe increases rapidly after PVE. • Left liver lobe function increase may be visualised by Gd-EOB-DTPA-enhanced MRI.

Topics: Adult; Aged; Blood Flow Velocity; Cholangiocarcinoma; Contrast Media; Embolization, Therapeutic; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Prospective Studies

The purpose of this study was to describe the enhancement patterns of mass-forming intrahepatic cholangiocarcinomas on gadoxetate disodium-enhanced MR images using imaging-histologic correlation.. We retrospectively evaluated the preoperative gadoxetate disodium-enhanced MR images of 19 patients with mass-forming intrahepatic cholangiocarcinomas. Two readers independently interpreted enhancement patterns on arterial (globally high, rimlike), dynamic (washout, progressive), and hepatobiliary (target, nontarget) phase images. Dynamic enhancement was categorized as washout (hypoenhancement on later phase compared with arterial phase images) or progressive (persistent or gradually increased enhancement). Tumor enhancement ratio and tumor-to-liver signal difference curves were analyzed. The enhancement patterns were correlated with the extent of stromal fibrosis within the tumors.. Rimlike arterial enhancement (89%, reader 1; 84%, reader 2) and a progressive dynamic pattern (89%, both readers) were predominant. Tumor enhancement ratio increased gradually from the arterial to the equilibrium phase then decreased in the hepatobiliary phase, but the tumor signal intensities were lower than liver signal intensity in all phases. The two lesions that both readers considered to have globally high arterial enhancement and a washout dynamic pattern presented with minimal or scattered stromal fibrosis. Target appearance in the hepatobiliary phase (reader 1, 42%; reader 2, 47%) was more commonly seen in tumors with central stromal fibrosis (reader 1, p = 0.025; reader 2, p = 0.001).. Mass-forming intrahepatic cholangiocarcinomas may be characterized by rimlike enhancement and a progressive dynamic pattern on gadoxetate disodium-enhanced MR images, and these features seem related to the extent of stromal fibrosis in the tumor. Furthermore, mass-forming intrahepatic cholangiocarcinomas may have a pseudowashout pattern on gadoxetate disodium-enhanced MR images because of progressive background liver enhancement. Therefore, radiologists need to be aware of this pattern as a possible pitfall.

Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Cholangiopancreatography, Endoscopic Retrograde; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

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

This study was designed to investigate the clinical outcome of patients with irresectable, intrahepatic cholangiocarcinoma (IHC) treated with computed tomography (CT)-guided HDR-brachytherapy (CT-HDRBT) for local tumor ablation.. Fifteen consecutive patients with histologically proven cholangiocarcinoma were selected for this retrospective study. Patients were treated by high-dose-rate internal brachytherapy (HDRBT) using an Iridium-192 source in afterloading technique through CT-guided percutaneous placed catheters. A total of 27 brachytherapy treatments were performed in these patients between 2006 and 2009. Median tumor enclosing target dose was 20 Gy, and mean target volume of the radiated tumors was 131 (±90) ml (range, 10-257 ml). Follow-up consisted of clinical visits and magnetic resonance imaging of the liver every third month. Statistical evaluation included survival analysis using the Kaplan-Meier method.. After a median follow-up of 18 (range, 1-27) months after local ablation, 6 of the 15 patients are still alive; 4 of them did not get further chemotherapy and are regarded as disease-free. The reached median local tumor control was 10 months; median local tumor control, including repetitive local ablation, was 11 months. Median survival after local ablation was 14 months and after primary diagnosis 21 months.. In view of current clinical data on the clinical outcome of cholangiocarcinoma, locally ablative treatment with CT-HDRBT represents a promising and safe technique for patients who are not eligible for tumor resection.

Topics: Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Brachytherapy; Chi-Square Distribution; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radiography, Interventional; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome

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 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 evaluate the enhancement patterns of intrahepatic mass-forming cholangiocarcinomas (IMCCs) with emphasis on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance (MR) imaging.. This retrospective study was institutional review board approved, and the requirement for informed consent was waived. Fifty patients (41 men, nine women; mean age, 62.3 years; range, 44-76 years) with IMCC underwent unenhanced and gadoxetic acid-enhanced T1- and T2-weighted MR imaging including dynamic phase and hepatobiliary phase imaging between May 2008 and December 2010. Signal intensity and enhancement patterns of lesions were compared with those of the liver parenchyma in each phase. Conspicuity and margin sharpness of lesions on dynamic phase and HBP images were rated on a 4- or 5-point scale and compared by using the Wilcoxon signed-rank test. Percentage of relative enhancement was compared among pathologic subgroups by using the unpaired Student t test.. On dynamic phase images, 29 of 48 (60%) lesions showed a thin peripheral rim with centripetal or gradual progression. On HBP images, 48 of 50 (96%) IMCCs were hypointense, and two of 50 (4%) were hyperintense. Subjective ratings of conspicuity and margin sharpness were significantly higher on HBP (median scores, 5 and 4, respectively) (P < .001) than on the dynamic phase (median scores, 4 and 3, respectively) images (P < .001). Additional daughter nodules were found in five patients and intrahepatic metastasis was found in one. Percentage of relative enhancement on HBP images was significantly higher in moderately differentiated (66.4% ± 42.1) than in poorly differentiated (36.84% ± 21.5) tumors (P = .039) and in patients without (59.7% ± 28.8) than in those with (24.9% ± 14.7) (P = .036) lymph node metastasis.. The most prevalent enhancement pattern on gadoxetic acid-enhanced MR images of IMCCs was a thin peripheral rim with internal heterogeneous enhancement during the dynamic phase. HBP images showed increased lesion conspicuity and better delineation of daughter nodules and intrahepatic metastasis, which may aid in the diagnosis of IMCC.

Topics: Adult; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric

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

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