gadoxetic-acid-disodium and Hepatitis

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

There are pros and cons to the use of gadoxetic acid in hepatocellular carcinoma (HCC) workup due to the potential for high false positive diagnosis. This study was conducted to investigate the preoperative diagnostic performance of gadoxetic acid-enhanced MRI protocol including diffusion-weighted imaging (DWI) with emphasis on tumor characterization developed in high risk HCC patients.. We included 144 patients (102 men, 42 women; age range 33-74 years) with chronic viral hepatitis or cirrhosis and 183 focal hepatic tumors (size range, 0.4-11.0 cm; mean, 3.2 cm), including 148 HCCs, 13 cholangiocarcinomas, 12 hemangiomas, three hepatocellular adenomas, two focal nodular hyperplasias, and five other tumors. All patients underwent gadoxetic acid-enhanced MRI protocol with DWI. MRIs were independently interpreted by three observers for the detection and characterization of hepatic tumors.. Sensitivities for detecting all 183 liver tumors were 98.4%, 97.8%, and 96.2% for each observer, respectively, with a 97.5% for pooled data. Among 183 hepatic tumors, 91.3% (n=167), 87.4% (n=160), and 86.9% (n=159) were correctly characterized according to their reference standard by each observer, respectively. In 13 cholangiocarcinomas, one to three were misinterpreted as HCC, and the remaining tumors were correctly characterized by each observer. The accuracies (Az) of MRI for HCC diagnosis were 0.952 for observer 1, 0.906 for observer 2, and 0.910 for observer 3, with 0.922 for pooled data. There was good inter-observer agreement.. The gadoxetic acid-enhanced MRI including DWI showed a reasonable performance for tumor characterization with high sensitivity for tumor detection in patients with chronic liver disease, despite concerns of high false positive diagnosis of hypervascular tumors.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; False Positive Reactions; Female; Fibrosis; Gadolinium DTPA; Hepatitis; Hepatocytes; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Observer Variation; Retrospective Studies

To evaluate the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging (EOB-MRI) in differentiating between simple steatosis and nonalcoholic steatohepatitis (NASH), as compared with MR in-phase/out-of-phase imaging. The correlations between the MR features and histological characteristics were preliminarily investigated.. From April 2008 to October 2011, 25 patients (13 simple steatosis and 12 NASH) who underwent both EOB-MRI and in-phase/out-of-phase imaging were analyzed. The hepatobiliary-phase enhancement ratio and signal intensity loss on opposed-phase T1-weighted images (fat fraction) were compared between the simple steatosis and NASH groups. In the simple steatosis and NASH groups, the correlations between enhancement ratio and histological grade/stage were explored. In the NASH group, fat fraction was correlated with the steatosis score.. The enhancement ratio in NASH was significantly lower than that in simple steatosis (P = 0.03). In the simple steatosis and NASH groups, the enhancement ratio was significantly correlated with the fibrosis stage (r = -0.469, P = 0.018). Fat fraction in NASH was strongly correlated with the steatosis score (r = 0.728, P = 0.007).. In simple steatosis and NASH, the hepatobiliary-phase enhancement ratio of EOB-MRI showed significant association with fibrosis stage, and may be a useful discriminating parameter compared with the fat fraction measured by in-phase/out-of-phase imaging.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Fatty Liver; Female; Gadolinium DTPA; Hepatitis; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To investigate optimal delay time of hepatic arterial phase in Gadoxetate-enhanced MR for detecting hypervascular hepatocellular carcinoma (HCC).. Forty-five patients with 85 hypervascular HCCs and 9 patients with 16 hypervascular HCCs underwent Gadoxetate- and Gd-DTPA-enhanced MR at 1.5 Tesla (T) system, respectively. All HCCs were analyzed 10-38 s after injection using a time-resolved dynamic MR sequence with keyhole data sampling. Seven sequential phase images (1 phase = 4 s) were obtained during a single breath hold of 28 s. Time-intensity curves of the abdominal aorta, liver parenchyma, and HCC were obtained, then aortic contrast arrival time, time of peak HCC enhancement, duration time of HCC and aortic enhancement, and time delay from aortic contrast arrival to peak enhancement of HCC were measured.. Aortic contrast arrival time was 15.1 ± 2.9 s, time of peak HCC enhancement 29.9 ± 4.6 s, duration time of HCC enhancement 17.4 ± 6.4 s postinjection of Gadoxetate. Duration of aortic enhancement (23.6 ± 3.5 s) of Gadoxetate-enhanced MR was significantly less than that of Gd-DTPA-enhanced MR (26.3 ± 2.8 s) (P < 0.0059).. Peak enhancement time of HCC on Gadoxetate-enhanced MR imaging occurred at 14.6 ± 4.6 s after aortic contrast arrival.

Topics: Aged; Aged, 80 and over; Aorta; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Hepatitis; Humans; Liver Cirrhosis; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Time Factors

Topics: Animals; Contrast Media; Dextrans; Disease Models, Animal; Female; Ferrosoferric Oxide; Gadolinium DTPA; Hepatitis; Iron; Liver Cirrhosis, Experimental; Magnetic Resonance Imaging; Magnetite Nanoparticles; Organometallic Compounds; Oxides; Rats; Rats, Sprague-Dawley