gadoxetic-acid-disodium and Focal-Nodular-Hyperplasia

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

Topics: Adenoma, Liver Cell; Contrast Media; Diagnosis, Differential; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Magnetic Resonance Imaging

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

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

We aimed to systematically review the gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) findings of focal nodular hyperplasia (FNH) and its diagnostic value.. A thorough literature search was conducted in Ovid-MEDLINE and EMBASE databases to identify studies evaluating Gd-EOB-DTPA-MRI findings of FNH. To evaluate the frequency of characteristic imaging findings on Gd-EOB-DTPA-MRI, pooled proportions of high/iso signal intensity (SI) on the hepatobiliary phase (HBP), arterial enhancement, high/iso SI on the portal-venous phase (PVP) or equilibrium phase (EP), and the central scar were calculated. Meta-analysis was performed to evaluate the diagnostic accuracy of high/iso SI on HBP for distinguishing FNH from hepatocellular adenoma.. A review of 96 articles identified ten eligible articles with 304 patients with FNHs for meta-analysis. Pooled proportion of the Gd-EOB-DTPA-MRI findings showed that high/iso SI on the HBP, arterial enhancement, and high/iso SI on the PVP/EP were observed in 93% (95% CI, 90-97%), 99% (95% CI, 97-100%), and 97% (95% CI, 95-99%) of FNHs, respectively, while a central scar was observed in 61% of FNHs (95% CI, 47-74%). High/iso SI on the HBP was highly accurate for distinguishing FNH from hepatocellular adenoma, with a summary sensitivity of 93.9% (95% CI, 89.1-97.1%) and a specificity of 95.3% (95% CI, 88.4-98.7%).. High/iso SI on the HBP of Gd-EOB-DTPA-MRI is characteristic and a prevalent finding of FNHs and can be helpful in the management of patients with FNH.. • The vast majority (94-97 %) of FNHs show high/iso SI on HBP. • High/iso SI on HBP was accurate for distinguishing FNH from hepatocellular adenoma. • HBP of Gd-EOB-DTPA-MRI can reduce unnecessary biopsies for the diagnosis of FNHs.

Topics: Biopsy; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Magnetic Resonance Imaging; Reproducibility of Results; Sensitivity and Specificity

To perform a systematic review to evaluate the diagnostic accuracy of hepatobiliary (HPB) phase gadoxetic acid-enhanced MR imaging of the liver in the diagnosis of focal nodular hyperplasia (FNH) versus hepatocellular adenoma (HCA) and to identify the rate of (a) reported HCAs that are iso- or hyperintense to liver and (b) reported FNHs that are hypointense to liver on HPB phase MR images.. The institutional review board granted a waiver for this study type, and multiple databases were searched for studies in which researchers distinguished between FNH and HCA with gadoxetic acid-enhanced MR imaging. Studies to evaluate diagnostic accuracy were included; case reports and series were included to analyze the rate of iso- or hyperintense HCAs on HPB phase MR images. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Sensitivity and specificity were plotted with a forest plot; pooling was not performed because a small number of heterogeneous studies were included. Rate of iso- or hyperintense HCA on HPB phase gadoxetic acid-enhanced MR images was evaluated.. Six studies (309 patients; 164 with HCA, 233 with FNH) were included for diagnostic accuracy assessment. Twelve case series (129 patients; 81 with HCA, 70 with FNH) were included (studies with insufficient 2 × 2 table data for diagnostic accuracy assessment). Sensitivity was high (range, 0.91-1.00; lower margin of the 95% confidence interval: 0.77). Specificity was high (range, 0.87-1.00; lower margin of the 95% confidence interval: 0.54). Specificity was lowest among studies in which molecular subtyping of HCA was performed. Rate of iso-or hyperintensity of HCA on HPB phase MR images was variable (range, 0%-67%) and occurred more frequently in the inflammatory subtype. High risk of bias was identified in the domains of patient selection and reference standard.. The reported diagnostic accuracy of HPB phase gadoxetic acid-enhanced MR imaging in the diagnosis of HCA versus FNH is high; however, studies are few, heterogeneous, and at high risk for bias, indicating that diagnostic accuracy may be overestimated.

Topics: Adenoma, Liver Cell; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging

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

Focal nodular hyperplasia is a benign hypervascular hepatic tumour, frequently detected in asymptomatic patients undergoing imaging studies for unrelated reasons. Magnetic resonance imaging (MRI) generally allows a confident differential diagnosis with other hypervascular liver lesions, either benign or malignant. In addition, due to the recent development of hepatospecific MRI contrast agents, MRI concomitantly enables functional and morphological information to be obtained, thus providing important clues for the detection and characterization of focal nodular hyperplasia lesions.

Topics: Adult; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Iron Compounds; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

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

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

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

Topics: Adenoma, Liver Cell; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging

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

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

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

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

To investigate the hepatobiliary enhancement patterns of gadoxetic acid (Gd-EOB-DTPA) MRI and the temporal evolution of focal nodular hyperplasia (FNH)-like lesions in pediatric cancer survivors.. We retrospectively included pediatric cancer survivors who had new liver lesions detected during surveillance imaging and who were diagnosed with FNH-like lesions by Gd-EOB-DTPA MRI without the aid of a hepatobiliary phase. The hepatobiliary enhancement patterns of FNH-like lesions were categorized as homogeneous hyperintense/isointense, heterogeneous hyperintense, and ring-like enhancement. Temporal changes in the FNH-like lesions were evaluated by follow-up Gd-EOB-DTPA MRI. Statistical analyses included one-way analysis of variance and Spearman's rank correlation test.. A total of 132 radiologically diagnosed FNH-like lesions in 18 patients showed the three different hepatobiliary enhancement patterns: homogeneous hyperintense/isointense (n = 65, 49%), heterogeneous hyperintense (n = 24, 18%), and ring-like enhancement (n = 43, 33%). A weak positive correlation was found between the lesion size and the hepatobiliary enhancement pattern (p = 0.015). Follow-up MRI showed alterations in the size and number of 55 FNHs in 8 patients, including stable size (n = 15, 27%), increased size (n = 17, 31%), decreased size (n = 11, 20%), disappearance (n = 12, 22%), and 74 new lesions (5 patients, 63%).. FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns and various temporal changes. Recognition of the radiological characteristics of FNH-like lesions may avoid unnecessary invasive procedures and reduce patients/parents' anxiety.. • FNH-like lesions in pediatric cancer survivors showed three different hepatobiliary enhancement patterns. The most common was homogeneous hyperintense/isointense, followed by heterogeneous hyperintense, and ring-like enhancement. • FNH-like lesions in pediatric cancer survivors can show various temporal changes during follow-up.

Topics: Cancer Survivors; Child; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies

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

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

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

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

To describe the different morphological enhancement patterns of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-DTPA MRI) and to determine their added value in their differential diagnosis.. A retrospective analysis of imaging findings in 185 benign hepatocellular lesions (154 FNH; 31 HCA) in 108 patients who underwent Gd-EOB-DTPA MRI was performed by two independent reviewers. Six patterns on HBP were recorded: 1) homogeneous enhancement; 2) peripheral ring-like enhancement with hypointense central core; 3) peripheral ring-like enhancement with hyperintense central core; 4) central core enhancement with hypointense periphery; 5) heterogeneous enhancement; and 6) the absence of enhancement.. Peripheral ring-like enhancement with hypointense central core and peripheral ring-like enhancement with hyperintense central core showed the highest specificity for the diagnosis of FNH (100% and 96.8%, respectively). The absence of enhancement and central core enhancement with hypointense periphery were only present in 0.6% and 1.9% of FHN, respectively. All other patterns were observed with similar frequencies in FNH (22.1% to 26.6%). Six HCA showed contrast uptake on the HBP: homogeneous (6.5%), peripheral ring-like enhancement with hyperintense central core (3.2%) and heterogeneous (9.7%).. Both FNH and HCA may demonstrate enhancement in the HBP of Gd-EOB-DTPA MRI, limiting its specificity. A significant improvement in specificity can be achieved by the evaluation of morphological enhancement patterns: Peripheral ring-like enhancement with hypointense or hyperintense central core was highly specific for FNH diagnosis. On the other hand, the absence of HBP enhancement makes the diagnosis of FNH unlikely.

Topics: Adenoma, Liver Cell; Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

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

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

We aimed to assess the MRI findings and follow-up of multiple focal nodular hyperplasia (FNH)- like lesions in pediatric cancer patients diagnosed by imaging findings.. We retrospectively analyzed clinical data and MRI examinations of 16 pediatric patients, who had been scanned using gadoxetate disodium (n=13) and gadobenate dimeglumine (n=3). Hepatic nodules were reviewed according to their number, size, contour, T1- and T2-weighted signal intensities, arterial, portal, delayed and hepatobiliary phase enhancement patterns. Follow-up images were evaluated for nodule size, number, and appearance.. All 16 patients received chemotherapy in due course. Time interval between the initial diagnosis of cancer and detection of the hepatic nodule was 2-14 years. Three patients had a single lesion, 13 patients had multiple nodules. The median size of the largest nodules was 19.5 mm (range, 8-41 mm). Among 16 patients that received hepatocyte-specific agents, FNH-like nodules appeared hyperintense in 11 and isointense in 5 on the hepatobiliary phase. During follow-up, increased number and size of the nodules were seen in 4 patients. The nodules showed growth between 6-15 mm.. Liver MRI using hepatocyte-specific agents is a significant imaging method for the diagnosis of FNH-like lesions, which can occur in a variety of diseases. Lesions can increase in size and number in pediatric patients.

Topics: Adolescent; Child; Child, Preschool; Contrast Media; Drug Therapy; Female; Focal Nodular Hyperplasia; Follow-Up Studies; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Infant; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Organometallic Compounds; Retrospective Studies

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

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

Current imaging guidelines do not specify the preferred hepatobiliary contrast agent when differentiating hepatocellular adenoma (HCA) from focal nodular hyperplasia (FNH) on MRI.. To analyze intrapatient differences in the hepatobiliary phase (HBP) after use of both gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI to differentiate HCA from FNH.. Retrospective.. Patients who underwent both Gd-BOPTA and Gd-EOB-DTPA-enhanced MRI, including 33 patients with 82 lesions (67 HCA; 15 FNH), with a step-down reference standard of pathology, 20% regression, identical appearance to earlier biopsied lesions, and stringent imaging findings.. 1.5T and 3T HBP of Gd-BOPTA and Gd-EOB-DTPA-enhanced MRI, precontrast fat-suppressed T. Signal intensities relative to the surrounding liver in the HBP were assessed by two observers.. Sensitivity and specificity of HCA diagnosis were calculated for both contrast agents. Interobserver agreement was evaluated using Cohen's kappa; differences in degree of certainty for scoring a lesion were calculated by means of the Wilcoxon signed rank test. Differences in signal intensity between Gd-BOPTA and Gd-EOB-DTPA were calculated using McNemar's test.. Almost perfect agreement was found between observers for scored signal intensities with both contrast agents. In 30 of the 82 lesions (37%) a difference was observed between contrast agents in the HBP, with Gd-EOB-DTPA proving correct in all but one of the discordant lesions. When distinguishing HCA from FNH, Gd-BOPTA showed a sensitivity of 46% (31/67) and a specificity of 87% (13/15), while the sensitivity and specificity of Gd-EOB-DTPA was 85% (57/67) and 100% (15/15), respectively. A risk of misclassifying HCA as FNH typically occurs for Gd-BOPTA when lesions are intrinsically hyperintense (P < 0.005).. The HBP of Gd-EOB-DTPA shows superior accuracy in ruling out HCA in comparison with Gd-BOPTA, especially when the lesion is intrinsically hyperintense on T. 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:700-710.

Topics: Adenoma, Liver Cell; Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Middle Aged; Observer Variation; Organometallic Compounds; Reference Standards; Reproducibility of Results; Retrospective Studies; Young Adult

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

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

We aimed to qualitatively and quantitatively compare the enhancement pattern of focal nodular hyperplasia after gadobenate dimeglumine and gadoxetate disodium injection in the same patient.. 1.5 T magnetic resonance imaging (MRI) examinations of 16 patients with 21 focal nodular hyperplasias studied after the injection of both contrast media were evaluated. Both MRI studies were performed in all patients. A qualitative analysis was performed evaluating each lesion in all phases. For quantitative analysis we calculated signal intensity ratio, lesion-to-liver contrast ratio and liver parenchyma signal intensity gain on hepatobiliary phase. Statistical analysis was performed with the Wilcoxon sign-rank test for clustered paired data and the McNemar test for paired frequencies. A P value < 0.05 was considered statistically significant.. At qualitative analysis no statistically significant differences were evident during any of the contrast-enhanced phases. Signal intensity ratio (P = 0.048), lesion-to-liver contrast ratio (P = 0.032) and liver parenchyma signal intensity gain (P = 0.012) were significantly higher on hepatobiliary phase after gadoxetate disodium injection.. There were no significant differences in the MRI findings of focal nodular hyperplasia after the injection of a weight-based dose of either gadobenate dimeglumine or gadoxetate disodium.

Topics: Adult; Contrast Media; Evaluation Studies as Topic; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Retrospective Studies

We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA).. A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA. We analysed the cost and effectiveness, i.e. probability of successful diagnosis of each strategy. Costs were based on utilisation rates and Medicare reimbursements in the USA and South Korea.. In the base case analysis of our decision tree model, the effectiveness of the three strategies was similar. The cost of the EOB-MRI strategy ($1283 in USA, $813 in South Korea) was lowest compared with the biopsy strategy ($1725 in USA, $847 in South Korea) and the conventional MRI strategy ($1750 in USA, $962 in South Korea). One-way, two-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range.. EOB-MRI strategy is the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver.. • The effectiveness of the three strategies was similar. • The cost of the EOB-MRI strategy was lowest. • EOB-MRI strategy is the most cost-effective for differentiating FNH from HCA.

Topics: Adenoma, Liver Cell; Adult; Contrast Media; Cost-Benefit Analysis; Decision Trees; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Medicare; Middle Aged; Republic of Korea; United States

To characterize the MRI appearance of inflammatory hepatic adenomas using hepatobiliary contrast agents.. MRI was performed using hepatobiliary contrast agents (3 with gadobenate dimeglumine and 24 with gadoxetic acid) in 27 patients with immunohistochemistry-confirmed diagnosis of inflammatory hepatic adenoma. The appearance of the lesions on T2 and diffusion-weighted images, pre-gadolinium T1-weighted images, dynamic post-gadolinium images, and hepatobiliary phase images was assessed.. Seven lesions (26%) showed predominant hyperenhancement on hepatobiliary phase images in comparison with adjacent hepatic parenchyma: 1 lesion showed diffuse, mildly heterogeneous hyperenhancement, and the remaining 6 lesions showed peripheral hyperenhancement and central hypoenhancement. Twenty lesions (74%) were predominantly hypoenhancing compared to adjacent liver on hepatobiliary phase images. Nine lesions showed a pattern of peripheral hyperenhancement and central hypoenhancement on hepatobiliary phase images; in 6 of these lesions a majority of the mass appeared hyperenhancing, while the remaining 3 lesions showed predominant hypoenhancement.. This investigation shows that a significant percentage of inflammatory hepatic adenomas appear isointense or hyperintense in comparison to adjacent normal liver on hepatobiliary phase images, and therefore this feature should not be used to distinguish hepatic adenomas from focal nodular hyperplasia without additional supporting evidence.

Topics: Adenoma; Adult; Contrast Media; Diffusion Magnetic Resonance Imaging; Fatty Liver; Female; Focal Nodular Hyperplasia; Gadolinium; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Inflammation; Liver; Liver Neoplasms; Male; Meglumine; Middle Aged; Organometallic Compounds; Retrospective Studies; Young Adult

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

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

Topics: Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver; Magnetic Resonance Imaging; Oxaliplatin

Topics: Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver; Magnetic Resonance Imaging; Oxaliplatin

To elucidate the relationship between the ADCs of the liver graft and the remnant liver and the degree of liver regeneration in LDLT.. 15 recipients and 15 corresponding donors underwent magnetic resonance imaging and computed tomography 1-2 weeks after living donor liver transplantation (LDLT). For diffusion-weighted imaging (DWI), a single-shot echo-planar sequence with b-factors of 0, 500, and 1000s/mm. The mean liver volume ratio of the recipients (41.3±9.8%) tended to be smaller than that of the donors (51.8±13.8%). The mean ADC 0-500 of the remnant liver (1.72±0.33) was significantly higher than that of the graft (1.43±0.32). The regeneration rate of the graft (2.07±0.41) was significantly higher than that of the remnant liver (1.53±0.49).. ADC 0-500 can describe differences in blood perfusion between liver grafts and the remnant liver according to the degree of liver regeneration.

Topics: Adult; Contrast Media; Diffusion Magnetic Resonance Imaging; End Stage Liver Disease; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver; Liver Regeneration; Liver Transplantation; Living Donors; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Transplant Donor Site; Transplants; Young Adult

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

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

Evaluation of enhancement characteristics of histopathologically confirmed focal nodular hyperplasias (FNHs) and hepatocellular adenomas (HCAs) with gadoxetic acid-enhanced MRI.. Sixty-eight patients with 115 histopathologically proven lesions (FNHs, n=44; HCAs, n=71) examined with gadoxetic acid-enhanced MRI were retrospectively enrolled (standard of reference: surgical resection, n=53 patients (lesions: FNHs, n=37; HCAs, n=53); biopsy, n=15 (lesions: FNHs, n=7; HCAs, n=18)). Two radiologists evaluated all MR images regarding morphological features as well as the vascular and hepatocyte-specific enhancement in consensus.. For the hepatobiliary phase, relative enhancement of the lesions and lesion to liver enhancement were significantly lower for HCAs (mean, 48.7 (±48.4)%and 49.4 (±33.9) %) compared to FNHs (159.3 (±92.5) %; and 151.7 (±79) %; accuracy of 89%and 90 %, respectively; P<0.001). Visual strong uptake of FNHs vs. hypointensity of HCAs in the hepatobiliary phase resulted in an accuracy of 92 %. This parameter was superior to all other morphological and dynamic vascular criteria alone and in combination (accuracy, 54–85 %).. For differentiation of FNHs and HCAs by means of MRI, gadoxetic acid uptake in the hepatobiliary phase was found to be superior to all other criteria alone and in combination.. EOB-MRI is well suited to differentiate FNHs and hepatocellular adenomas. For this purpose hepatobiliary phase is superior to unenhanced and dynamic imaging. Hepatobiliary phase (peripheral) hyper- or isointensity is typical for FNH. Hepatobiliary phase hypointensity is typical for hepatocellular adenomas. EOB-MRI helps to avoid misinterpretations of benign hepatocellular lesions.

Topics: Adenoma, Liver Cell; Adolescent; Adult; Aged; Biopsy; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Circulation; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms; Retrospective Studies; Sensitivity and Specificity; Young Adult

Inflammatory hepatocellular adenoma (HCA) is a recently categorized entity of hepatocellular neoplasms. We investigated whether gadoxetic acid-enhanced MRI can distinguish inflammatory HCA from focal nodular hyperplasia (FNH).. From January 1, 2009, through January 1, 2013, gadoxetic acid-enhanced MRI examinations from two institutions were reviewed for HCA, with specific histologic features of inflammatory HCA. Biopsy and resection slides were reviewed, and immunohistochemistry for glutamine synthetase was performed in a subset to confirm the initial diagnosis.. A total of 10 possible cases of inflammatory HCA were identified in the pathology database. On the basis of glutamine synthetase staining performed for this study, three cases were rediagnosed as FNH and thus were excluded from the study. Therefore, a total of seven patients with inflammatory HCA were identified. On gadoxetic acid-enhanced MRI, four of these patients had classic features of FNH (group A, FNH mimics), and three had imaging features suggestive of HCA (group B, typical inflammatory HCA). Imaging features that were considered diagnostic of FNH included isointense or minimal T2 hyperintensity, arterial enhancement, and diffuse hyperintensity on hepatobiliary phase. Three of the four patients with FNH mimics had slides available for pathologic rereview, and the diagnosis of inflammatory HCA was supported by glutamine synthetase immunohistochemistry findings. The pathology reports of the remaining four cases were rereviewed and were also found to have features consistent with inflammatory HCA.. Inflammatory HCA can mimic FNH on MRI, including hepatobiliary phase hyperintensity. Moreover, conventional pathology using histopathology alone may lead to misclassification of inflammatory HCA.

Topics: Adenoma, Liver Cell; Adult; Contrast Media; Diagnosis, Differential; False Positive Reactions; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Hepatitis; Humans; Image Enhancement; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Observer Variation; Reproducibility of Results; Sensitivity and Specificity

The aim of this study was to assess the enhancement patterns of hepatic focal nodular hyperplasia (FNH) on gadoxetic acid-enhanced MRI and diffusion-weighted (DW) MRI.. This retrospective study had institutional review board approval. Gadoxetic acid-enhanced and DW MR images were evaluated in 23 patients with 30 FNHs (26 histologically proven and 4 radiologically diagnosed). The lesion enhancement patterns of the hepatobiliary phase images were classified as heterogeneous or homogeneous signal intensity (SI), and as dominantly high/iso or low SI compared with those of adjacent liver parenchyma. Heterogeneous (any) SI lesions and homogeneous low SI lesions were categorised into the fibrosis group, whereas homogeneous high/iso SI lesions were categorised into the non-fibrosis group. Additionally, lesion SI on T2 weighted images, DW images and apparent diffusion coefficient (ADC) values were compared between the two groups.. The lesions showed heterogeneous high/iso SI (n=16), heterogeneous low SI (n=5), homogeneous high/iso SI (n=7) or homogeneous low SI (n=2) at the hepatobiliary phase MR images. The fibrosis group lesions were more likely to show high SI on DW images and T2 weighted images compared with those in the non-fibrosis group (p<0.05). ADC values tended to be lower in the fibrosis group than those in the non-fibrosis group without significance.. FNH showed variable enhancement patterns on hepatobiliary phase images during gadoxetic acid-enhanced MRI. SI on DW and T2 weighted images differed according to the fibrosis component contained in the lesion.. FNH shows a wide spectrum of imaging findings on gadoxetic acid-enhanced MRI and DW MRI.

Topics: Adult; Aged; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

To assess the range of hepatobiliary enhancement patterns of focal nodular hyperplasia (FNH) after gadoxetic-acid injection, and to correlate these patterns to specific histological features.. FNH lesions, imaged with Gadoxetic-acid-enhanced MRI, with either typical imaging findings on T1, T2 and dynamic-enhanced sequences or histologically proven, were evaluated for hepatobiliary enhancement patterns and categorized as homogeneously hyperintense, inhomogeneously hyperintense, iso-intense, or hypo-intense-with-ring. Available histological specimens of FNHs (surgical resection or histological biopsy), were re-evaluated to correlate histological features with observed enhancement patterns.. 26 FNHs in 20 patients were included; histology was available in six lesions (four resections, two biopsies). The following distribution of enhancement patterns was observed: 10/26 homogeneously hyperintense, 4/26 inhomogeneously hyperintense, 5/26 iso-intense, 6/26 hypointense-with-ring, and 1/26 hypointense, but without enhancing ring. The following histological features associated with gadoxetic-acid uptake were identified: number and type of bile-ducts (pre-existent bile-ducts, proliferation, and metaplasia), extent of fibrosis, the presence of inflammation and extent of vascular proliferation.. FNH lesions can be categorized into different hepatobiliary enhancement patterns on Gadoxetic-acid-enhanced MRI, which appear to be associated with histological differences in number and type of bile-ducts, and varying the presence of fibrous tissue, inflammation, and vascularization.

Topics: Antigens, CD34; Biliary Tract; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Immunohistochemistry; Liver; Magnetic Resonance Imaging

To evaluate the relative enhancement of liver, pancreas, focal nodular hyperplasia (FNH), pancreas-to-liver index, and FNH-to-liver index in the hepatic arterial dominant phase (HADP) after injection of hepatocyte-specific MRI contrast agents, gadoxetic acid and gadobenate dimeglumine, on 3 and 1.5 Tesla (T) MRI in the same patient.. The MRI database was retrospectively searched to identify consecutive patients who underwent abdominal MRI at 3T and 1.5T systems, using both 0.025 mmol/kg gadoxetic acid-enhanced and 0.05 mmol/kg gadobenate dimeglumine-enhanced MRI at the same magnetic strength field system. 22 patients were identified, 10 were scanned at 3T system and 12 at 1.5T system. The enhancement of liver, pancreas, and FNH was evaluated quantitatively on MR images.. The relative enhancement of liver in HADP in the gadobenate dimeglumine-enhanced group in all subjects was significantly higher than that in gadoxetic acid-enhanced group (P = 0.023). The gadobenate dimeglumine-enhanced group in HADP had better relative enhancement of pancreas and FNH, pancreas-to-liver index, and FNH-to-liver index than gadoxetic acid-enhanced group, but the difference was not statistically significant.. The 0.05 mmol/kg gadobenate dimeglumine-enhanced abdominal MRI studies at 3T and 1.5T MR systems are superior in relative enhancement of the liver in HADP to 0.025 mmol/kg gadoxetic acid-enhanced MRI. This type of assessment may provide comparative effectiveness data.

Topics: Adenoma, Liver Cell; Adult; Carcinoma, Hepatocellular; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Hemangioma; Hepatic Artery; Hepatocytes; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Magnetic Resonance Imaging; Male; Mass Screening; Meglumine; Middle Aged; Organometallic Compounds; Pancreas; Retrospective Studies; Sensitivity and Specificity

The purpose of this study was to evaluate enhancement characteristics of histopathologically confirmed focal nodular hyperplasia (FNHs) with gadoxetic acid-enhanced MRI.. Twenty-seven patients with all histopathologically proven FNHs were retrospectively identified. MRI consisted of T1- and T2-weighted (w) sequences with and without fat saturation (FS), multiphase dynamic T1-w images, and FS T1-w images during the hepatobiliary phase. Standard of reference was surgical resection (n=24) or biopsy (n=3). Images were analyzed for morphology and contrast behavior including signal intensity (SI) measurement on T1-w images normalized to the pre-contrast base line.. In total 36 FNHs were evaluated. All FNHs showed enhancement in the arterial phase, significant reduction contrast enhancement ("wash-out") in the late dynamic phases was not present. In the hepatobiliary phase, all FNHs (100%) showed enhancement (overall SI increase, 118% (±91%), P<0.001) with at least partial hyperintensity to the liver. Upon visual comparison, 3 of 36 FNHs appeared with heterogeneous/partial enhancement (8%) and 7 (19%) showed rim-accentuated enhancement.. The typical enhancement pattern of FNH with gadoxetic acid consists of arterial hyperperfusion, no wash-out during the venous phase, and at least partial hyperintensity compared to the liver in the hepatobiliary phase. Partial hypointensity or rim-accentuated enhancement rarely occurs.

Topics: Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To determine whether a multiphase method with high spatiotemporal resolution (STR) by means of a combination of parallel imaging, pseudorandom sampling and temporal view sharing improves the capture and intensity of gadoxetate arterial phase images as well as lesion enhancement.. Thirty-seven patients were imaged with a conventional spoiled gradient echo acquisition and 48 with a high STR multiphase acquisition after the administration of gadoxetate. Arterial phase capture, image quality, and quality of fat suppression were qualitatively graded. Fourteen lesions in the conventional group and 28 in the high STR multiphase group were imaged, including 34 focal nodular hyperplasias. The ratio of lesion to parenchyma enhancement as well as relative hepatic artery enhancement were calculated. Chi-squared, Mann-Whitney U and student t-tests were used to compare differences.. The high STR multiphase acquisition included the arterial phase more frequently than conventional acquisitions (P < 0.001), with the arterial phase missed in 17% (95% CI of 4-28%) of patients with conventional acquisition compared with 2% (95% CI of 0-6%) with the high STR multiphase acquisition. There was no loss of image quality or degree of fat saturation. Additionally, there was increased relative intensity of the hepatic arteries (P < 0.001) as well as lesion enhancement (P = 0.01).. The high STR multiphase acquisition resulted in more reliable gadoxetate arterial phase capture compared with a conventional acquisition while preserving image quality with robust fat saturation.

Topics: Arteries; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Reproducibility of Results; Retrospective Studies; Software; Time Factors

The purpose of this study is to evaluate the performance of gadoxetate disodium-enhanced MRI in the characterization of focal nodular hyperplasia (FNH) and hepatocellular adenoma and to assess potential advantages of hepatocyte phase imaging in identifying features that distinguish FNH from hepatocellular adenoma.. Gadoxetate disodium-enhanced MRI examinations of 12 patients with hepatocellular adenoma and 35 patients with FNH were retrospectively evaluated by three blinded readers. Diagnoses and confidence scores were recorded before and after disclosure of hepatocyte phase images. The data obtained were combined to create receiver operating characteristic curves, and the areas under the curves were compared. Imaging characteristics, including signal intensity, were recorded. Lesion-to-liver enhancement ratio was calculated for each contrast-enhanced phase.. The readers' average receiver operating characteristic area was significantly higher after disclosure of hepatocyte phase images (p=0.024). FNHs were correctly diagnosed in 74.3-97.1% of cases before and 97.1-100% of cases after the disclosure of hepatocyte phase images; hepatocellular adenoma was correctly diagnosed in 83-100% and 91.7-100% of cases (p>0.05). The presence of a central scar in FNH and fat on hepatocellular adenoma were the only morphologic features that were statistically significantly different (p<0.05). FNH had greater average contrast-enhanced signal intensity and enhancement ratio in all phases (p<0.001). A hepatocyte phase enhancement ratio of less than 0.7 was 100% specific and 91.6% sensitive for hepatocellular adenoma, with accuracy of 97.1% for these data.. Gadoxetate disodium-enhanced MRI had high accuracy in diagnosis of FNH and hepatocellular adenoma, and the hepatocyte phase improved their distinction. FNH enhances significantly more than hepatocellular adenoma. An enhancement ratio, particularly in the hepatocyte phase, can be potentially used as an additional distinguishing feature.

Topics: Adenoma, Liver Cell; Adolescent; Adult; Area Under Curve; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; ROC Curve

To retrospectively evaluate the utility of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the differential diagnosis of hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH).. This study had institutional review board approval; the requirement for informed consent was waived. Eighty-two patients (58 patients with FNH and 24 patients with HCAs) with 111 lesions were included in the study. There were 74 female patients and eight male patients (mean age, 41.9 years±13.2 [standard deviation]; age range, 11-78 years). Two readers reviewed all images in terms of signal intensity (SI) features on unenhanced, dynamic, and hepatobiliary phase images. For quantitative analysis, contrast enhancement ratio (CER), lesion-to-liver contrast (LLC), and SI ratio on dynamic and hepatobiliary phase images were calculated.. The CER of FNH in the arterial phase (mean, 94.3%±33.2) was significantly higher than that of HCAs (mean, 59.3%±28.1) (P<.0001). During the hepatobiliary phase, the LLC of FNH showed minimally positive values (mean, 0.05±0.01) and that of HCAs demonstrated strong negative values (mean, -0.67±0.24) (P<.0001). The area under the receiver operating characteristic curve of the hepatobiliary phase SI ratio for differentiation of the two tumors was 0.97, and a sensitivity of 92% and specificity of 91% were found with a cutoff value of 0.87. Among six FNH lesions that showed atypical hypointensity during the hepatobiliary phase, four had a large central scar, one contained a substantial fat component, and one had abundant radiating fibrous septa. Three HCAs were isointense during the hepatobiliary phase owing to severe hepatic steatosis.. Gadoxetic acid-enhanced MR imaging facilitates the differentiation of FNH from HCA.

Topics: Adenoma, Liver Cell; Adolescent; Adult; Aged; Child; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver Neoplasms; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Young Adult

Topics: Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Magnetic Resonance Imaging

Our aim was to evaluate the hepatocyte transporters in focal nodular hyperplasia (FNH) and FNH-like lesions and to correlate the grade of its expression with signal intensity on the hepatobiliary phase (HB phase) of gadoxetic-acid-enhanced magnetic resonance imaging (EOB-MRI).. Thirteen histopathological confirmed cases including eight with EOB-MRI were studied. Immunohistochemical staining for transporter was performed and its grade semiquantitatively analyzed.. Histopathologically, ten cases showed almost equal organic anion transporter polypeptide (OATP) 8 expression relative to the surrounding liver; the remaining three showed stronger OATP8 expression. In eight cases with EOB-MRI, two demonstrated more hyperintensity on the HB phase, and their OATP8 expression was stronger compared with the surrounding liver. The remaining six cases showed isointensity on the HB phase and revealed almost equal OATP8 expression. The expression of export transporter multi-drug-resistant proteins (MRP) 1 and 2 were almost equal relative to the surrounding liver in most cases (11/12, 92 %; 11/12, 92 %, respectively), whereas MRP3 focally overexpressed in 75 % (9/12) of cases.. FNH and FNH-like nodules revealed equal or stronger OATP8 expression than background liver. OATP8 expression showed significant correlation with signal intensity on the HB phase.

Topics: Adolescent; Adult; Aged, 80 and over; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Liver; Magnetic Resonance Imaging; Male; Membrane Transport Proteins; Middle Aged; Retrospective Studies; Young Adult

To characterize imaging features of histologically proven hepatic adenoma (HA) as well as histologically and/or radiologically proven focal nodular hyperplasia (FNH) using delayed hepatobiliary MR imaging with 0.05 mmol/kg gadoxetic acid.. Five patients with six HAs with histological correlation were retrospectively identified on liver MRI studies performed with gadoxetic acid, and T1-weighted imaging acquired during the delayed hepatobiliary phase. Additionally, 23 patients with 34 radiologically diagnosed FNH lesions (interpreted without consideration of delayed imaging) were identified, two of which also had histological confirmation. Signal intensity ratios relative to adjacent liver were measured on selected imaging sequences.. All six hepatic adenomas (100%), which had histological confirmation, demonstrated hypointensity relative to adjacent liver on delayed imaging. Furthermore, all of the FNH (including 34 radiologically proven, 2 of which were also histologically proven) were either hyperintense (23/34, 68%) or isointense (11/34, 32%) relative to the adjacent liver on delayed imaging. None of the FNHs were hypointense relative to liver.. Distinct imaging characteristics of HA versus FNH on delayed gadoxetic acid-enhanced MRI, with adenomas being hypointense and FNH being iso- or hyperintense on delayed imaging may improve specificity for characterization, and aid in the differentiation of these two lesions.

Topics: Adenoma; Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Neoplasms; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Young Adult

The purpose of this article is to prospectively determine the sensitivity of hepatobiliary phase gadoxetate disodium-enhanced MRI combined with standard MRI in differentiating focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA).. Patients suspected of having FNH or HCA larger than 2 cm underwent gadoxetate disodium-enhanced MRI. Standard MRI was evaluated separately from the additional hepatobiliary phase by two blinded radiologists. For the largest lesion in each patient, findings were compared with histologic diagnosis. Sensitivity, positive predictive value (PPV), and distinctive features were analyzed using McNemar and analysis of variance tests.. Fifty-two patients completed the study. Histologic diagnosis revealed 24 HCAs and 28 FNHs. Characterization on standard MRI was inconclusive in 40% (21/52) and conclusive in 60% (31/52) of lesions. The sensitivity of standard MRI for HCA was 50% (12/24) with a PPV of 100% (12/12). The sensitivity for FNH was 68% (19/28) with a PPV of 95% (18/19). After review of hepatobiliary phase, the sensitivity for HCA improved to 96% (23/24) with a PPV of 96% (23/24). The sensitivity for FNH improved to 96% (27/28) with a PPV of 96% (27/28). Features with significant predictive value for diagnosis in HCA included bleeding (p < 0.001), fat (p = 0.010), and glycogen (p = 0.024). The presence of a central scar was predictive for FNH (p < 0.001).. This study shows high sensitivity of gadoxetate disodium-enhanced MRI when standard series are combined with the hepatobiliary phase for differentiation of FNH and HCA in lesions larger than 2 cm.

Topics: Adenoma, Liver Cell; Adult; Analysis of Variance; Biopsy; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Reference Values; Sensitivity and Specificity; Young Adult

The purpose of this article is to report the results from a multicenter retrospective MRI study comparing gadobenate dimeglumine and gadoxetate disodium for diagnosis of hepatic focal nodular hyperplasia (FNH).. Thirty patients (28 women and two men; mean age, 37.1 years) with hepatic FNH who underwent both gadobenate dimeglumine- and gadoxetate disodium-enhanced MRI at 1.5 T were assessed. MRI was performed during the arterial, portal venous, late venous, and hepatobiliary contrast-enhanced phases (10 and 20 minutes or 1-3 hours after contrast administration, respectively, for gadoxetate disodium and gadobenate dimeglumine). Qualitative (lesion conspicuity score) and quantitative (lesion signal intensity [SI] ratio and lesion contrast ratio) assessments were performed.. In 30 patients, 51 FNHs were assessed (mean size 3.1 ± 1.5 cm). There was equivalent qualitative lesion conspicuity in the arterial phase between the two contrast agents and higher qualitative lesion conspicuity and SI ratio in the hepatobiliary phase with gadoxetate disodium (p < 0.002). Lesion contrast ratio was significantly higher in the arterial and late venous phases with gadobenate dimeglumine (p < 0.009), with no difference in the portal venous and hepatobiliary phases between the two contrast agents (p > 0.22).. These results indicate an advantage for gadobenate dimeglumine for detection of FNH at the dynamic phase and for gadoxetate disodium at the hepatobiliary phase. However, the equivalent or better qualitative lesion conspicuity coupled with the ability to obtain a comprehensive evaluation of the liver within a standard 30-minute imaging window suggests that gadoxetate disodium may be a better choice for diagnosis of FNH.

Topics: Adolescent; Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Retrospective Studies; Young Adult

We evaluated the diagnostic efficacy of gadoxetic acid- and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging for focal nodular hyperplasia (FNH).. We retrospectively evaluated 11 patients with 11 FNHs. Both gadoxetic acid- and SPIO-enhanced MR imaging were performed. A 3-dimensional (3D) volumetric interpolated breath-hold examination was used with the gadoxetic acid dynamic study. SPIO-enhanced MR imaging included T₂- and T₂*-weighted images. We quantitatively and qualitatively compared lesion-specific enhancement of both contrast media.. The mean signal-to-noise (S/N) ratio of the FNH lesions differed significantly on pre- and postenhanced imaging of each contrast medium (P<0.05); mean contrast-to-noise (C/N) ratio did not (P>0.05). All observers described all lesions as hyperintense in the arterial phase on gadoxetic acid-enhanced MR imaging and observed the presence of central scar, fibrous septa, and rim most clearly in gadoxetic acid-enhanced hepatobiliary phase images.. Gadoxetic acid-enhanced MR imaging was more useful than SPIO-enhanced MR imaging in characterizing FNH.

Topics: Adult; Aged; Contrast Media; Dextrans; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

Topics: Adolescent; Budd-Chiari Syndrome; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Follow-Up Studies; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver; Liver Failure, Acute; Liver Function Tests; Magnetic Resonance Imaging; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications; Tomography, X-Ray Computed; Ultrasonography

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

The purpose of this study was to define imaging features that may help characterize hyperintense lesions seen in the hepatobiliary phase of gadoxetic acid-enhanced hepatic MRI examinations.. This retrospective study included 48 hyperintense nodules depicted on gadoxetic acid disodium-enhanced hepatobiliary phase MR images: 16 hepatocellular carcinomas (HCCs), 14 lesions of focal nodular hyperplasia, and 18 benign nodules associated with cirrhosis. Two observers independently reviewed hepatobiliary phase images and recorded the shape, margin, focal defects in contrast uptake, nodule-in-nodule pattern of uptake, central scar, internal septation, and presence of a hypointense rim around the lesion. Interobserver agreement was assessed with kappa statistics, and consensus opinions were reached by conference. For quantitative analysis, one observer measured lesion-to-liver contrast ratio (signal intensity of tumor divided by signal intensity of liver) on hepatobiliary phase images. Logistic regression analysis was used to determine the value of individual clinical and MR findings in prediction of malignancy.. Compared with benign lesions, hyperintense HCC more commonly had focal defects in uptake (68.8% vs 3.1%, respectively; p < 0.001), nodule-in-nodule appearance (75.0% vs 0%, p < 0.001), absence of a central scar (100% vs 46.9%, p < 0.001), internal septation (50.0% vs 3.1%, p < 0.001), and a hypointense rim (75.0% vs 15.6%, p < 0.001) on hepatobiliary phase MR images. The mean contrast ratios of HCC (1.31) and benign lesions (1.28) were not significantly different (p = 0.63). Multiple logistic regression analysis showed that a focal defect in contrast uptake (p = 0.025) and a hypointense rim (p = 0.019) were significant predictors of HCC, having odds ratios of 36.8 (95% CI, 1.56-870.0) and 17.5 (1.60-191.4).. On gadoxetic acid-enhanced MR images, hyperintense nodules can be differentiated with several imaging characteristics, especially a focal defect in contrast uptake and a hypointense rim, that indicate the diagnosis of hyperintense HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Young Adult

Congenital extrahepatic portocaval shunt is a rare condition that is described mostly in female patients. We report an unusual case of a young adult male patient with type 1 congenital extrahepatic portocaval shunt with associated development of a focal nodular hyperplasia on a background of regenerative nodules. With multi-slice CT utilisation, there is increased detection of portocaval malformation in asymptomatic patients. This congenital variant is clinically significant with associated development of hepatocellular lesions, hepatic dysfunction and/or encephalopathy.

Topics: Adult; Arteriovenous Malformations; Contrast Media; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Portal System; Radiographic Image Enhancement; Tomography, X-Ray Computed; Young Adult

We report a case of focal nodular hyperplasia in a patient for whom gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and histological analysis results were available. Dynamic contrast-enhanced computed tomography showed a well-defined hypervascular lesion 14 mm in diameter with no visible central scars. Gd-EOB-DTPA-enhanced MRI demonstrated strong peripheral enhancement of the lesion during the hepatobiliary phase, resulting in ring-like enhancement. The pathology examination revealed that the lesion was focal nodular hyperplasia (FNH). Immunohistochemistry showed positive expression of OATP8 in the hepatocytes in the peripheral areas of the lesion, whereas expression of OATP8 was lacking in hepatocytes surrounding the central radiating scar. Ring-like enhancement during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may be an important clue for the diagnosis of small FNH.

Topics: Adult; Contrast Media; Diagnosis, Differential; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Image Enhancement; Liver; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed

Gadoxetic acid (Gd-EOB-DTPA) is a contrast media used in magnetic resonance imaging (MRI) for the detection and characterization of hepatic lesions. It shows combined properties of extracellular and biliary excretion, with 50% of the administered dose eliminated by the hepatobiliary pathway. One of its applications, therefore, is the characterization of focal hepatic lesions, including those of hepatocellular nature, such as focal nodular hyperplasia and hepatocellular adenoma. Patients with focal nodular hyperplasia (FNH) are usually asymptomatic and rarely reveal complications. In other hand, hepatocellular adenoma may suffer complications, such as intraperitoneal or intratumoral (sometimes massive) bleeding and the possible progression to malignancy.. To determine the value of MRI with Gd-EOB-DTPA in characterizing hepatic lesions, particularly in the differentiation between HNF and AHC.. A retrospective study was carried out by investigating cases of FNH and HCA referred for MR evaluation with Gd-EOB-DTPA in the Department of Radiology of the University Hospitals of Coimbra (HUC) between August 2009 and December 2010. We evaluated 32 patients, 24 with FNH and 8 AHC. The diagnosis was established by histology, follow-up or agreement between imaging methods. In order to evaluate the enhancement after contrast administration in the hepatobiliary phase, we calculated the values of Signal-to-noise ratio (SNR), Contrast-to-noise ratio (CNS) and percentage of enhancement. Statistical analysis was performed with SPSS, version 18, and the tests were evaluated at a significance level of 5%.. The SNR and CNR after contrast is significantly different for the two types of lesion (p <0.001 and p = 0.03, respectively), with higher values for both parameters in the group of focal nodular hyperplasia. As for the % of enhancement, there is a statistically significant difference between groups (p = 0.006), again with the FNH group presenting higher values. There are significant differences in both groups among the studies pre-and post-contrast for the CNR (FNH: p <0.001; adenoma: p = 0.017), but for the SNR of the lesion the difference manifests in the HNF group (p <0,001); the CNR values increase in FNH and decrease in hepatocellular adenoma, while for the SNR of the lesion post-contrast values are higher than pre-contrast, in both groups.. Magnetic resonance imaging with hepatospecific contrast is a valuable method for characterization of benign hepatic lesions, helping to differentiate FNH from HCA, based on the different patterns of uptake and retention of Gd-EOB-DTPA.

Topics: Adenoma, Liver Cell; Adolescent; Adult; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

Topics: Aged; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Liver Cirrhosis, Alcoholic; Magnetic Resonance Imaging; Male

To illustrate the unusual enhancement pattern of the focal nodular hyperplasia central scar using Gadoxetate Disodium.. Over a 10-month period, six patients, with a total of seven focal nodular hyperplasia lesions with typical central scar, had MRI of the liver using Gadoxetate Disodium (Eovist, Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ). Four of the six patients had a prior Gadobenate Dimeglumine (Multihance, Bracco Diagnostics Inc., Princeton, NJ) -enhanced MRI of the liver performed within the previous year. The dynamic enhancement pattern of the central scar on the 10 liver MRIs was independently analyzed by two abdominal imaging radiologists who were blinded to the contrast agent used.. On the Gadoxetate Disodium-enhanced MRIs and during the arterial phase, 1-min, 2-min, and 3-min delay, none of the central scars demonstrated enhancement. However, all four of the lesions that were previously scanned using Gadobenate Dimeglumine demonstrated typical enhancement after a 3-min delay.. On Gadoxetate Disodium-enhanced MRIs of the liver, the central scar of focal nodular hyperplasia lesions does not typically demonstrate delayed enhancement.

Topics: Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Gadolinium DTPA; Humans; Hyperplasia; Image Processing, Computer-Assisted; Liver; Magnetic Resonance Imaging; Meglumine; Middle Aged; Time Factors