Magnetic Resonance Imaging of Hepatocellular Carcinoma Using Contrast Media

Abstract

Magnetic resonance imaging (MRI) has been widely used for evaluation of focal lesions associated with hepatic carcinogenesis including hepatocellular carcinoma (HCC). By providing better tissue contrast compared to ultrasonography and computed tomography, MRI is considered the most sensitive modality for diagnosis of HCC. Dynamic MRI using gadolinium-based extracellular fluid (ECF) agents is useful for detection of hypervascular tumors and lesion characterization but has limitations in the diagnosis of hypovascular HCCs and lesion characterization of nonhypervascular tumors. MRI using superparamagnetic iron oxide agents may be useful for detecting and characterizing lesions that were not seen on dynamic MRI using ECF agents, but finding well-differentiated HCC and differentiating it from a dysplastic nodule can be difficult in some cases. Hepatobiliary agents that can be used in both dynamic MRI and delayed hepatobiliary phase imaging have great potential for improving characterization of focal lesions associated with hepatic carcinogenesis. Further studies are necessary to determine their roles in evaluation and management of HCCs.

Hepatocellular Carcinoma 2009 and Beyond: from the Surveillance to Molecular Targeted Therapy

“…Well-differentiated HCC having Kupffer cells with enhanced SPIO uptake and receiving portal blood flow has been difficult to characterize; however, it can be imaged clearly as defective regions using Gd-EOB-DTPA in many cases due to differences in the biological characteristics, indicating that this contrast agent may lead to a breakthrough in the diagnosis of early HCC [21, 22], which has been clinically difficult even when a biopsy sample is used.…”

Characterizing Venous Vasculatures of Hepatocellular Carcinoma Using a Multi-Breath-Hold Two-Dimensional Susceptibility Weighted Imaging

“…Current clinical practice guidelines suggest that HCC can be accurately diagnosed without biopsy in patients with the backgrounds of liver cirrhosis by a demonstration of hypervascularity in the arterial phase and early washout phase of T1-weighted DCE [21]. However, there are some hyperintensive lesions on unenhanced images in which it is difficult to discriminate [15].…”

Hepatocellular Carcinoma in 2011 and Beyond: From the Pathogenesis to Molecular Targeted Therapy

“…Well-differentiated early HCC having Kupffer cells with enhanced SPIO uptake and receiving portal blood flow on CTAP has been difficult to characterize by SPIO-MRI or CTAP; however, it can be imaged clearly as a hypointense nodule using Gd-EOB-DTPA MRI in many early HCC cases due to differences in biological characteristics, indicating that this contrast agent may lead to a breakthrough in the diagnosis of early HCC [46,47], which has been clinically difficult and difficult even by pathological diagnosis when a biopsy sample is used. In other words, this technique may be the most sensitive tool in the detection of the phenotypic change of early hepatocarcinogenesis, much more sensitive than CTAP, CTHA, or SPIO-MRI [48].…”