Reduced Gd-EOB-DTPA uptake might be an early event of hepatocarcinogenesis, preceding portal blood flow reduction. The hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help estimate histological grading, although difficulties exist in differentiating HCCs from DNs.

Superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging has been used for the detection of hepatic tumors. However, little is known about this technique in relation to hepatocellular carcinoma (HCC).The aim of this study was to investigate whether SPIOenhanced MR imaging can be useful in assessing histological grades of HCC. The authors studied histologically proven tumors including 31 HCCs and 6 dysplastic nodules. The ratio of the Kupffer-cell count in the tumorous tissue relative to that in the nontumorous tissue (Kupffer-cell-count ratio) decreased as HCCs became less well differentiated. The ratio of the intensity of the tumorous lesion to that of the nontumorous area on SPIO-enhanced MR images (SPIO intensity ratio) correlated inversely with Kupffer-cell-count ratio in HCCs and dysplastic nodules (r ‫؍‬ ؊.826, P < .001) and increased as the degree of differentiation of HCCs decreased, indicating that the uptake of SPIO in HCCs decreased as the degree of differentiation of HCCs declined. All of the dysplastic nodules and some well-differentiated HCCs showed hypointense or isointense enhancement, relative to the surrounding liver parenchyma, indicating greater or similar uptake of SPIO in the tumor when compared with nontumorous areas. These results suggest that SPIO-enhanced MR imaging reflects Kupffer-cell numbers in HCCs and dysplastic nodules, and is useful for estimation of histological grading in HCCs, although uncertainties persist in differentiating dysplastic nodules from well-differentiated HCCs. (HEPATOLOGY 2000;32:205-212.) Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and a major cause of death in patients with cirrhosis. [1][2][3][4] One of the characteristics of HCC detected by imaging modalities such as computed tomography (CT), magnetic resonance (MR) imaging, and CT angiography, is increased arterial blood flow accompanied by decreased portal blood flow, although some well-differentiated HCCs do not show such blood supply characteristics. [5][6][7][8][9] Another characteristic of HCC, distinct from other metastatic tumors, has recently been clarified by Tanaka et al., 10 namely, that some well-differentiated HCCs have similar numbers of Kupffer cells as do the surrounding nontumorous regions of the liver.Superparamagnetic iron oxide (SPIO) is a tissue-specific MR imaging contrast that is taken up by Kupffer cells in the liver and macrophages in the spleen. 11,12 Because metastatic liver cancers lack Kupffer cells, hepatic metastases do not take up SPIO and thus appear hyperintense relative to the surrounding liver, being useful for the detection of metastatic liver cancers. [11][12][13][14] In an animal model of HCC, Kawamori et al., 15 studied whether SPIO-enhanced MR imaging could allow HCC to be distinguished from hyperplastic nodules. They concluded that SPIO-enhanced MR imaging may be useful in differentiating HCC from hyperplastic nodules, although some HCC nodules were difficult to differentiate from hyperplastic nodules, even after S...

Double arterial phase imaging is recommended to improve detection of hypervascular HCCs and reduce false-positive lesions.

Gadoxetate disodium is a new liver-specific MR imaging contrast agent. Gadoxetate disodium-enhanced MRI helps the assessment of patients with liver disease. It showed high diagnostic accuracy for the detection of hepatocellular carcinoma.

Multi-detector row CT angiography was able to depict the hepatic vascular anatomy.