Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI

Ohama, Hideko; Imai, Yumiko; Nakashima, Osamu; Kogita, Sachiyo; Takamura, Manabu; Hori, Masatoshi; Seki, Yasushi; Sawai, Yoshiyuki; Igura, Takumi; Fukuda, Kazuto; Makino, Yuki; Morimoto, Osakuni; Ohsawa, Masahiko; Sakamoto, Michiie; Murakami, Takamichi

doi:10.1007/s00535-013-0859-1

Cited by 39 publications

(34 citation statements)

References 25 publications

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“…All of these nodules showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. These results are compatible with the report by Ohama et al [36] that described that most hypovascular well-differentiated HCCs are depicted as an isoechoic nodule during the post-vascular phase of CEUS, whereas almost all hypovascular well-differentiated HCCs show hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.…”

Section: Discussionsupporting

confidence: 83%

Comparison of Contrast-Enhanced Ultrasound and Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI for the Diagnosis of Macroscopic Type of Hepatocellular Carcinoma

Inomata

Imai

Kogita

et al. 2016

Dig Dis

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Objective: We compared the efficacy of contrast-enhanced ultrasound sonography (CEUS) with sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI for the assessment of macroscopic classification of nodular hepatocellular carcinoma (HCC). Methods: Seventy-seven consecutive patients with 79 surgically resected HCCs who underwent both preoperative CEUS and Gd-EOB-DTPA-enhanced MRI were enrolled in this retrospective study. Based on the macroscopic diagnosis of resected specimens, nodules were categorized into the simple nodular (SN) and non-SN type HCC. Two hepatologists independently assessed image datasets of the post-vascular phase of CEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to compare their diagnostic performance. Results: Gd-EOB-DTPA-enhanced MRI enabled the evaluation of macroscopic classification in a significantly larger number of nodules than CEUS (78/79 (98.7%) vs. 70/79 (88.6%), p < 0.05). Of 70 nodules that could be evaluated by both modalities, 41 and 29 nodules were pathologically categorized as SN and non-SN, respectively. The areas under the receiver operating characteristic curve (AUC) for non-SN did not differ between CEUS and Gd-EOB-DTPA-enhanced MRI (reader 1: 0.748 for CEUS, 0.808 for MRI; reader 2: 0.759 for CEUS, 0.787 for MRI). The AUC of combined CEUS and Gd-EOB-DTPA-enhanced MRI for SN HCC was 0.855 (reader 1) and 0.824 (reader 2), indicating higher AUC values for the combined modalities. Conclusions: The diagnostic performance for macroscopic classification of nodular HCC of CEUS was comparable with that of Gd-EOB-DTPA-enhanced MRI, although some HCCs could not be evaluated by CEUS owing to lower detectability. The combination of the 2 modalities had a more accurate diagnostic performance.

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Section: Discussionsupporting

confidence: 83%

Comparison of Contrast-Enhanced Ultrasound and Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI for the Diagnosis of Macroscopic Type of Hepatocellular Carcinoma

Inomata

Imai

Kogita

et al. 2016

Dig Dis

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“…The Kupffer defect is assessed in the Kupffer phase 6-10 min after arterial enhancement of the target nodule. Some investigators have tried to differentiate borderline hepatic nodules using a contrast agent [47,50,51]. According to these studies, although no DNs showed hypoechogenicity in the Kupffer phase, 64-91% of well-differentiated HCCs showed almost complete isoechogenicity.…”

Section: Imaging-based Characterization Of Borderline Hepatic Nodulesmentioning

confidence: 99%

“…Furthermore, approximately 30% of new hypervascular HCCs manifest as nonhypervascular and hypointense nodules on HBP before arterial hypervascularity develops on serial follow-ups with Gd-EOB-DTPA-enhanced MRI [88]. Meanwhile, Ohama et al [51] reported that 31 of 33 hypovascular well-differentiated HCCs showed hypointensity on the HBP of Gd-EOB-DTPA-enhanced MRI, whereas only 3 of 33 hypovascular well-differentiated HCCs were hypoechoic on the Kupffer phase images on the Sonazoid-enhanced US. This study suggests that uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA in stepwise hepatocarcinogenesis.…”

Section: Imaging-based Characterization Of Borderline Hepatic Nodulesmentioning

confidence: 99%

How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis

et al. 2017

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Background: Rapid advances in liver imaging have improved the evaluation of hepatocarcinogenesis and early diagnosis and treatment of hepatocellular carcinoma (HCC). In this situation, detection of early-stage HCC in its development is important for the improvement of patient survival and optimal treatment strategies. Because early HCCs are considered precursors of progressed HCC, precise differentiation between a dysplastic nodule (DN), especially a high-grade DN, and early HCC is important. In clinical practice, these nodules are frequently called “borderline hepatic nodules.” Summary: This article discusses radiological and pathological characteristics of these borderline hepatic nodules and offers an understanding of multistep hepatocarcinogenesis by focusing on the descriptions of the imaging changes in the progression of DN and early HCC. Detection and accurate diagnosis of borderline hepatic nodules are still a challenge with contrast enhanced ultrasonography, CT, and MRI with extracellular contrast agents. However, gadoxetic acid-enhanced MRI may be useful for improving the diagnosis of these borderline nodules. Key Messages: Since there is a net effect of incomplete neoangiogenesis and decreased portal venous flow in the early stage of hepatocarcinogenesis, borderline hepatic nodules commonly show iso- or hypovascularity. Therefore, precise differentiation of these nodules remains a challenging issue. In MRI using hepatobiliary contrast agents, signal intensity of HCCs on hepatobiliary phase (HBP) is regarded as a potential imaging biomarker. Borderline hepatic nodules are seen as nonhypervascular and hypointense nodules on the HBP, which is important for predicting tumor behavior and determining appropriate therapeutic strategies.

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“…Focally decreased enhancement in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI in the early stage of multistep hepatocarcinogenesis can signal early HCC [9,10,11,12]. Gd-EOB-DTPA-enhanced MRI has been reported to have higher diagnostic accuracy and sensitivity compared with dynamic computed tomography (CT) and now plays an important role in the detection of HCCs [13,14,15,16,17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Prospective Comparison of Gd-EOB-DTPA-Enhanced MRI with Dynamic CT for Detecting Recurrence of HCC after Radiofrequency Ablation

Imai

Katayama

Hori³

et al. 2017

Liver Cancer

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Background: We prospectively compared the efficacy of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) with that of dynamic multidetector computed tomography (MDCT) for detection of recurrent hypervascular hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Methods: Institutional review board approval and written informed consent were obtained for this multicenter study. Ninety-seven HCC patients treated with curative RFA underwent both Gd-EOB-DTPA-enhanced MRI and dynamic MDCT every 3-4 months. HCC diagnosis was made based on the typical enhancement pattern of HCC on MRI and/or CT by on-site consensus reading. Two blinded observers independently assessed image datasets to compare diagnostic accuracy, sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUROC). Results: Recurrence was observed in 48 of 97 patients. Among these, 22 were diagnosed by both Gd-EOB-DTPA-enhanced MRI and MDCT; the remainder were diagnosed by only one of these 2 modalities. Recurrence was diagnosed in more patients by Gd-EOB-DTPA-enhanced MRI than by MDCT (44 vs. 26 patients, p < 0.001). Patient-based analysis revealed that the accuracy, sensitivity, and AUROC of Gd-EOB-DTPA-enhanced MRI were significantly higher than those of MDCT for both observers (p < 0.005). The AUROC of Gd-EOB-DTPA- enhanced MRI and MDCT was 0.95 and 0.76 for observer 1 and 0.90 and 0.74 for observer 2, respectively. The κ values for MRI and MDCT were 0.83 and 0.70, respectively. Conclusions: Compared with dynamic MDCT, Gd-EOB-DTPA-enhanced MRI had higher diagnostic accuracy and sensitivity for detection of recurrent hypervascular HCC and may be a better tool for following patients after RFA.

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Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI

Cited by 39 publications

References 25 publications

Comparison of Contrast-Enhanced Ultrasound and Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI for the Diagnosis of Macroscopic Type of Hepatocellular Carcinoma

Comparison of Contrast-Enhanced Ultrasound and Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI for the Diagnosis of Macroscopic Type of Hepatocellular Carcinoma

How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis

Prospective Comparison of Gd-EOB-DTPA-Enhanced MRI with Dynamic CT for Detecting Recurrence of HCC after Radiofrequency Ablation

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