Comparison of hepatocellular carcinoma conspicuity on hepatobiliary phase images with gadoxetate disodium vs. delayed phase images with extracellular cellular contrast agent

Abstract

Objective To compare the conspicuity of hepatocellular carcinoma (HCC) on hepatobiliary phase of gadoxetate disodium-enhanced vs. delayed phase of gadodiamide-enhanced MR images, relative to liver function. Methods and materials We retrospectively identified 86 patients with newly diagnosed HCC between 2010 and 2013 and recorded the severity of liver disease by Child-Pugh class (CPC). 38 patients had gadodiamide-enhanced 5-min delayed and 48 had gadoxetate disodium-enhanced 20-min delayed hepatobiliary MR images. The conspicuity of 86 HCCs (mean size, 2.7 cm) was graded visually on a 3-point scale and quantified by liver-to-tumor contrast ratios (LTC). The relative liver parenchymal enhancement (RPE) was measured. For different CPCs, we compared the conspicuity of HCC and RPE between gadodiamide and gadoxetate. Results In patients with CPC A, the visual conspicuity and LTC of the 27 HCCs imaged with gadodiamide were significantly lower than those of the 38 HCCs with gadoxetate (P < 0.01, <0.01, respectively). RPE was lower in gadodiamide scans than gadoxetate scans (P < 0.01). Conversely, in patients with CPC B and C, HCCs appeared more frequently as definite hypointensity when imaged with gadodiamide (72.7%, 8/11) than gadoxetate (20%, 2/10, P = 0.03). LTC (mean 18.1 vs. 7.5, P = 0.04) and RPE (mean 75.5 vs. 45.4, P = 0.04) was significantly higher in the gadodiamide than gadoxetate scans. Conclusion In patients with compromised liver function, hypointensity of HCC is more conspicuous in the gadodiamide delayed phase than the gadoxetate hepatobiliary phase. This likely reflects the high extracellular accumulation of gadodiamide and poor hepatocyte uptakeof gadoxetate in patients with compromised liver function.

Imaging Modalities for Hepatocellular Carcinoma Surveillance: Expanding Horizons beyond Ultrasound

“… 28 Hepatic parenchymal enhancement can become heterogeneous and diminished in patients with compromised liver function, which affects lesion conspicuity during the HBP. 29 Thus, these could mitigate the sensitivity of MRI and also produce pseudolesions. To our knowledge, little has been reported about the effects of these factors on the performance of surveillance tests.…”

Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS)

“…Imaging in the HBP is a major advantage of gadoxetate. By achieving high signal‐to‐noise and contrast‐to‐noise ratios, the HBP may show HCC with higher conspicuity than other sequences . Some lesions detected in the HBP are identified and characterized in retrospect on other sequences …”

“…Additionally, the liver to portal vein signal intensity ratio in the HBP decreases with increasing severity of liver function . As a result of diminished parenchymal enhancement, conspicuity of HCC in the HBP is decreased in patients with poor hepatic function . In the setting of cirrhosis and severe hepatic dysfunction, increasing the delay of HBP imaging to 30 minutes or more may improve parenchymal enhancement .…”

“…By achieving high signal-to-noise and contrast-to-noise ratios, the HBP may show HCC with higher conspicuity than other sequences. [7][8][9][10][11][12] Some lesions detected in the HBP are identified and characterized in retrospect on other sequences. 13,14 FIGURE 1: A 49-year-old man with chronic hepatitis B. MRI with gadoxetate (a-d) and MRI with extracellular contrast agent (ECA) (eg) were performed 6 months apart.…”

“…105 As a result of diminished parenchymal enhancement, conspicuity of HCC in the HBP is decreased in patients with poor hepatic function. 12,106 In the setting of cirrhosis and severe hepatic dysfunction, increasing the delay of HBP imaging to 30 minutes or more may improve parenchymal enhancement. 107 However, this may not be cost-effective for some practices and may not work in all patients.…”