Improved Detection of Focal Liver Lesions at MR Imaging: Multicenter Comparison of Gadoxetic Acid–enhanced MR Images with Intraoperative Findings

111

Purpose:To evaluate the differences in enhancement of the abdominal solid organ and the major vessel on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) obtained with gadolinium ethoxybenzyldiethylenetriamine pentaacetic acid (Gd-EOB-DTPA: EOB) and gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) in the same patients. Materials and Methods:A total of 13 healthy volunteers underwent repeat assessments of abdominal MR examinations with DCE-MRI using either Gd-DTPA at a dose of 0.1 mmol/kg body weight or EOB at a dose of 0.025 mmol/kg body weight. DCE images were obtained at precontrast injection and in the arterial phase (AP: 25 seconds), portal phase (PP: 70 seconds), and equilibrium phase (EP: 3 minutes). The signal intensities (SIs) of liver at AP, PP, and EP; the SIs of spleen, renal cortex, renal medulla, pancreas, adrenal gland, aorta at AP; and the SIs of portal vein and inferior vena cava (IVC) at PP were defined using region-ofinterest measurements, and were used for calculation of signal intensity ratio (SIR). There was no significant difference in mean SIR of liver at PP between EOB (0.529 Ϯ 0.124) and Gd-DTPA (0.564 Ϯ 0.139). Conversely, the mean SIR of liver at EP was significantly higher with EOB (0.576 Ϯ 0.167) than with Gd-DTPA (0.396 Ϯ 0.093) (P Ͻ 0.001). Results Conclusion:Lower arterial vascular and parenchymal enhancement with Gd-EOB, as compared with Gd-DTPA, may require reassessment of its dose, despite the higher late venous phase liver parenchymal enhancement.

Section: Figurecontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Dynamic contrast‐enhanced magnetic resonance imaging of abdominal solid organ and major vessel: Comparison of enhancement effect between Gd‐EOB‐DTPA and Gd‐DTPA

Tamada

Ito

Sone

et al. 2009

111

“…Lesions that were identified only on hepatobiliary phase images were mostly small and showed some enhancement on dynamic images. However, those lesions showed marked hypointensity in the strongly enhanced background liver parenchyma (29). The improvement in lesion conspicuity on hepatobiliary phase imaging is supported by the significant increase in liver-to-lesion SR on both 10-minute and 20-minute delayed hepatobiliary phase images.…”

Section: Discussionmentioning

confidence: 74%

Detection of liver metastases using gadoxetic‐enhanced dynamic and 10‐ and 20‐minute delayed phase MR imaging

Jeong

Kim

Park

et al. 2011

Purpose: To assess the incremental value of hepatobiliary phase images in gadoxetate disodium-enhanced magnetic resonance imaging (MRI), and to compare diagnostic accuracy and lesion conspicuity on 10-and 20-minute delayed images for preoperative detection of hepatic metastases with subgroup analysis according to size and history of chemotherapy. Materials and Methods:Forty-six patients with 107 metastases who underwent surgery after gadoxetate disodium-enhanced MRI were evaluated. Four observers independently interpreted three sets: dynamic set comprising precontrast T1-, T2-weighted, and dynamic images; 10-minute set comprising dynamic set and 10-minute delayed; 20-minute set comprising 10-minute set and 20-minute delayed. Diagnostic accuracy was compared with subgroup analysis. Liver-to-lesion signal ratio (SR) was calculated using the region of interest method and compared.Results: Mean A z and sensitivities were significantly higher for 10-(A z ¼ 0.894, sensitivity ¼ 95.6%) and 20-minute (0.910, 97.2%) than dynamic set (0.813, 79.9%) (P < 0.001), with no significant difference between 10-and 20-minute sets (P ¼ 0.140). In patients with small ( 1 cm) metastases and a history of chemotherapy, sensitivities were significantly higher with 10-(88.2%) and 20-minute (91.6%) sets than dynamic set (48.6%) (P < 0.001). SR was significantly higher for 10-and 20-minute delayed than precontrast and dynamic, with significantly higher SR on 20-than 10-minute delayed. Conclusion:Regardless of size or prior chemotherapy, detection of hepatic metastases was significantly improved by adding hepatobiliary phase images without significant differences between 10-and 20-minute delayed.

“…Gadoxetic acid can effectively be used in dynamic and liver-specific static MRI with accurate delineation, classification, and characterization of liver tumors, in which excellent sensitivity and characterization for hepatocellular lesions are provided (10,12,14,(16)(17)(18)(19). The diagnosis of early HCC is one of the potential indication (20,21).…”

Section: Discussionmentioning

confidence: 99%

Outcome of hypovascular hepatic nodules revealing no gadoxetic acid uptake in patients with chronic liver disease

Motosugi

Ichikawa

Sano

et al. 2011

Purpose: To elucidate the natural history of hypovascular nodules that appear hypointense on hepatocyte-phase gadoxetic acid-enhanced MR images by focusing on hypervascularization over time. Materials and Methods:In this study, 135 hypovascular nodules revealing no gadoxetic acid uptake in 53 patients were examined. All nodules were retrospectively examined using serial follow-up computed tomography (CT) and MRI examinations until hypervascularity was observed on arterial-phase dynamic CT or gadoxetic acid-enhanced MR images, or on CT during hepatic arteriography. Logistic regression analysis was used to investigate the association between hypervascularization and MR findings including a presence of fat assessed by a signal drop on opposed-phase T1-weighted images.Results: Of the 135 nodules, 16 underwent hypervascularization. The size of the nodules and the presence of fat in the nodules were independent indicators of hypervascularization. The 1-year cumulative risk of hypervascularization was 15.6%. This risk was significantly increased in the case of nodules >10 mm (37.6%, P < 0.01) and fatcontaining nodules (26.5%, P < 0.01).Conclusion: Hypovascular nodules that appear hypointense on hepatocyte-phase gadoxetic acid-enhanced MR images may progress to conventional hypervascular hepatocellular carcinoma. Nodules more than 10 mm in diameter and containing fat are at high risk for developing hypervascularization.