Double-contrast magnetic resonance imaging of hepatocellular carcinoma after transarterial chemoembolization

Abstract

Background: The purpose of this study was to assess the accuracy of double-contrast magnetic resonance (MR) imaging for the treatment response evaluation of hepatocellular carcinoma (HCC) in cirrhotic liver after transarterial chemoembolization (TACE). Methods: Twenty-two patients with 30 HCC nodules treated by TACE underwent double-contrast MR imaging 1 month after treatment. MR images were obtained before and after the sequential administration of superparamagnetic iron oxide (SPIO) and gadopentetate dimeglumine contrast agent within the same imaging session. Two observers retrospectively assessed all treated nodules for evidence of residual viable tumor after TACE. The diagnostic performance of gadoliniumenhanced, SPIO-enhanced, and double-contrast enhanced images was calculated. Histopathological and angiographical findings served as standard of reference. Receiver operating characteristic curves and areas under the curves (A z ) were calculated. Results: Double-contrast technique (A z = 0.95) was significantly (p = 0.036) more accurate than SPIOenhanced technique (A z = 0.92) and gadolinium-enhanced technique (p = 0.005) (A z = 0.81) in viable tumor detection after TACE. Double-contrast technique was significantly more sensitive (92%) than SPIOenhanced technique (80%) and gadolinium-enhanced technique (68%). Kappa values for interobserver agreement ranged from 0.67 to 0.87 and were significantly different from zero (all p < 0.001).

Whole-body PET/MRI in oncology: current status and clinical applications

“…The potential of integrated PET/MRI must be fully explored, since this hybrid methodology will likely play a key role in evaluating recurrence and therapy response in breast cancer patients. Both in chemoembolization and in radio frequency ablation of liver tumors, both primary and metastatic, FDG PET/CT and MRI (with the addition of fMRI) demonstrated better performances than CT, with high accuracy [75,76]. Similar results have been obtained in the evaluation of neoadjuvant chemoradiotherapy in colorectal cancer [77,78].…”

Hepatocellular carcinoma: Assessment of response to transarterial chemoembolization with image subtraction

“…However, at the present time, there is no clear consensus on which imaging method should be used to monitor response of HCC to TACE (5). While most clinical studies have used CT or ultrasonography for determining treatment success rates (5–12), several studies have also focused on MRI (5, 13–15). Current MRI techniques for assessing treatment response in HCC post‐TACE are based primarily on contrast‐enhanced T1‐weighted imaging (CE T1WI).…”

Focal Liver Lesions: Detection and Characterization at Double-Contrast Liver MR Imaging with Ferucarbotran and Gadobutrol versus Single-Contrast Liver MR Imaging

“…Bolus administration of ferucarbotran shortens the examination time for MR imaging of the liver. So far, there is limited experience using ferucarbotran in doublecontrast MR imaging (26,27,32). To our knowledge, in no previous study had investigators evaluated the role of doublecontrast MR imaging with ferucarbotran for the detection and characterization of both benign and malignant liver lesions in patients with and without liver cirrhosis.…”

“…However, there is limited knowledge on the performance of double-contrast MR imaging, as compared with single-contrast MR imaging, in the detection and characterization of different histologic entities, including focal benign and malignant liver lesions detected at intraindividual comparisons performed in the same patients (25). In addition, there is little knowledge on double-contrast MR imaging performed by using the bolus-injectable SPIO ferucarbotran for focal liver lesion characterization (26,27). The purpose of this study was to retrospectively compare, in a multiobserver study, double-contrast MR imaging (with sequential administration of ferucarbotran and gadobutrol) with singlecontrast ferucarbotran-enhanced and postferucarbotran dynamic gadobutrol-enhanced MR imaging for the detection and characterization of benign and malignant focal liver lesions.…”