Gadobenate Dimeglumine-Enhanced Liver MRI as the Sole Preoperative Imaging Technique: A Prospective Study of Living Liver Donors

An, So Young; Lee, Jeong Min; Suh, Kyung Suk; Lee, Nam Jun; Kim, Se Hyung; Kim, Young-Joon; Han, Joon Koo; Choi, Buyng Ihn

doi:10.2214/ajr.05.0584

Cited by 48 publications

(47 citation statements)

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“…Because it is taken up by functioning hepatocytes and excreted in bile, use of gadobenate dimeglumine results in marked and prolonged enhancement of normal liver parenchyma for as long as 2 hours on T1-weighted images with minimal or no enhancement of nonhepatocellular tumors, improving the utility of MRI in characterizing focal liver lesions [21][22][23]. In addition, several studies have shown successful use of gadobenate dimeglumine in MR angiography of a variety of vascular territories and in MRI of the brain [24][25][26].…”

Section: Choi Et Almentioning

confidence: 99%

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Choi

Lee

et al. 2008

American Journal of Roentgenology

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529sis determines patient eligibility for and the potential success of curative treatments. Therefore, CT and MRI aided by technologic advances that afford improved spatial, temporal, and contrast resolution are regarded as promising alternative surveillance tools for detecting HCC [4,5]. Contrast-enhanced dynamic multiphasic imaging has substantial performance benefits because most HCCs are hypervascular lesions that typically become enhanced during the hepatic arterydominant phase of imaging [6]. OBJECTIVE. The purpose of this study was to retrospectively evaluate the diagnostic performance of dynamic gadobenate dimeglumine-enhanced MRI with explant pathologic correlation in the detection of hepatocellular carcinoma (HCC) in patients undergoing liver transplantation. Hepatocellular Carcinoma in H e p a t o b i l i a r y I m ag i ng • O r ig i n a l R e s e a rc hMATERIALS AND METHODS. Forty-seven patients (28 men, 19 women; mean age, 49 years) underwent dynamic gadobenate dimeglumine-enhanced MRI within 3 months before primary liver transplantation. Dynamic imaging was performed before (unenhanced) and after (hepatic arterial, portal venous, equilibrium, and 1-hour delayed phases) IV bolus administration of gadobenate dimeglumine at 0.1 mmol/kg body weight. Retrospective image analysis to detect HCC nodules was performed independently by two abdominal radiologists who had no pathologic information. On a per-nodule basis, the sensitivity and positive predictive value were calculated for the two observers. Sensitivity and specificity in the diagnosis of HCC also were evaluated. Fisher's exact test was performed to determine whether there was a detection difference between HCC nodules 1 cm in diameter or larger and nodules smaller than 1 cm and to evaluate the differences in causes of false-positive MRI findings based on lesion size (≥ 1 cm vs < 1 cm).RESULTS. Twenty-seven patients had 41 HCCs. In HCC detection, gadobenate dimeglumine-enhanced MRI had a sensitivity of 85% (35 of 41 HCCs) and a positive predictive value of 66% (35 of 53 readings) for observer 1 and a sensitivity of 80% (33 of 41 HCCs) and a positive predictive value of 65% (34 of 52 readings) for observer 2. For both observers, sensitivity in the detection of HCCs 1 cm in diameter and larger (91-94%) was significantly different (p < 0.05) from that in detection of HCCs smaller than 1 cm (29-43%). Nonneoplastic arterial hypervascular lesions more often caused false-positive diagnoses of lesions smaller than 1 cm in diameter (80-86%) on MR images than of those 1 cm in diameter and larger (0-25%). The difference was statistically significant (p < 0.05) for both observers. In diagnosis, gadobenate dimeglumine-enhanced MRI had a sensitivity of 87% (20 of 23 patients) and a specificity of 79% (19 of 24 patients) for both observers.CONCLUSION. Dynamic gadobenate dimeglumine-enhanced MRI has a sensitivity of 80-85% and a positive predictive value of 65-66% in the detection of HCC. The technique, however, is of limited value for detecting and characterizi...

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Section: Choi Et Almentioning

confidence: 99%

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Choi

Lee

et al. 2008

American Journal of Roentgenology

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“…Contrast-enhanced magnetic resonance cholangiography (MRC) using hepatobiliary contrast agents, in combination with T1-weighted two-dimensional (2D) or threedimensional (3D) gradient-echo (GRE) sequences, is considered an alternative to conventional techniques for the evaluation of the biliary tree [1,2]. Recent studies have shown that contrast-enhanced MRC is particularly useful for the evaluation of biliary tract abnormalities in healthy individuals (e.g., potential living liver donors), and in patients suspected to have a biliary leak [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have shown that contrast-enhanced MRC is particularly useful for the evaluation of biliary tract abnormalities in healthy individuals (e.g., potential living liver donors), and in patients suspected to have a biliary leak [1,[3][4][5]. Although contrast-enhanced MRC is increasingly used by radiologists, there is paucity of data in the literature with regard to the degree and extent of biliary excretion of hepatobiliary contrast agents.…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma

et al. 2008

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Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma Abstract The purpose of this study was to assess the quality of biliary duct visualization using Gd-EOB-DTPA-enhanced magnetic resonance cholangiography (EOB-MRC) in patients with liver cirrhosis. Forty adult patients with liver cirrhosis (cirrhosis group) and 20 adult individuals with normal liver parenchyma (control group) underwent EOB-MRC using T1-weighted GRE imaging up to 180 min after Gd-EOB-DTPA administration. Two observers assessed the visualization of each biliary structure and the overall anatomical visualization of the biliary tree. Child-Pugh, MELD score and laboratory findings were compared. The grade of visualization for each evaluated biliary structure was statistically different in the two groups (P=0.004 to <0.001). The overall EOB-MRC quality was rated as sufficient for anatomical visualization of the biliary tree in all individuals of the control group 20 min after Gd-EOB-DTPA application, but in only 16/40 patients (40%) of the cirrhosis group within 30 min after application. Analysis of the ROC curves revealed that the cut-off values, for non-sufficient visualization of the biliary tree 20 min after Gd-EOB-DTPA application, were MELD scores ≥11 and total serum bilirubin levels ≥30 μmol/l. Consecutively, EOB-MRC in patients with liver cirrhosis resulted in a decreased or even non-visualization of the biliary tree in a substantial percentage of patients.

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“…This contrast agent combines the properties of a gadolinium-based extracellular contrast agent as a hepatocyte-direct excreted at about 2%-4% through the biliary tract. An et al (25) have described an accuracy of 75% with MR cholangiography T2-weighted sequences, 79% with paramagnetic contrast-enhanced T1-weighted sequences, and an increase to 92% in accuracy with the evaluation by means of a combination of both methods.…”

Section: Discussionmentioning

confidence: 99%

O papel da colangiografia por ressonância magnética na avaliação da anatomia biliar em doadores de transplante hepático intervivos

Arruda¹,

Coelho

Yokochi

et al. 2008

Radiol Bras

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Brazil. Cholangiographic images were analyzed and results were compared with intraoperative findings. Only anatomical alterations that affected the surgical strategy and had not been previously observed at magnetic resonance cholangiography were considered as being in disagreement. RESULTS: Anatomical variations were found in 7 donors at magnetic resonance cholangiography, and in 14 during surgery. Agreement between imaging and surgical findings was observed in 41 of the 50 patients, and disagreement in 9. Magnetic resonance cholangiography sensitivity, specificity, positive and negative predictive values, and accuracy were respectively 43%, 97%, 86%, 81% and 81.6%. CONCLUSION: Magnetic resonance imaging is a safe and noninvase method for preoperative evaluation of the biliary tract in living liver donors. However some anatomical abnormalities are not detected by magnetic resonance cholangiography. Keywords: Liver transplant; Living donors; Magnetic resonance imaging; Biliary tract.OBJETIVO: Avaliar a acurácia da colangiografia por ressonância magnética no estudo da anatomia biliar de doadores de fígado em correlação com achados operatórios. MATERIAIS E MÉTODOS: Estudo retrospectivo de 50 doadores submetidos a transplante hepático intervivos no Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. As colangiografias foram analisadas e os resultados dos exames foram comparados com os achados intra-operatórios. Apenas alterações anatômicas que promoveram mudança de estratégia cirúrgica, não-evidenciadas previamente pela colangiografia por ressonância magnética, foram consideradas como discordantes. RESULTADOS: Foram encontradas variações pela colangiografia por ressonân-cia magnética em 7 doadores e em 14 durante a cirurgia. Do total de pacientes, 41 resultados foram concordantes e 9 foram discordantes. A sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acurácia da colangiografia por ressonância magnética foram, respectivamente, de 43%, 97%, 86%, 81% e 81,6%. CONCLUSÃO: Conclui-se que a ressonância magnética é um método de imagem seguro e não-invasivo para avaliação pré-operatória das vias biliares de doadores e que algumas anomalias não são detectadas pela colangiografia por ressonância magnética. should be dedicated to the planning for management of the biliary ducts during liver lobe resection and implantation, considering that the high variability of the biliary anatomy in the population and the pattern of second order biliary branches could change the surgical technique or even represent a contraindication for liver donation

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Gadobenate Dimeglumine-Enhanced Liver MRI as the Sole Preoperative Imaging Technique: A Prospective Study of Living Liver Donors

Cited by 48 publications

References 29 publications

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma

O papel da colangiografia por ressonância magnética na avaliação da anatomia biliar em doadores de transplante hepático intervivos

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