Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis

Park, Yang Shin; Lee, Changhee; Kim, Baek Hui; Lee, Jongmee; Choi, Jae Woong; Kim, Kyeong Ah; Ahn, Jeong Hwan; Park, Cheol‐Min

doi:10.1016/j.mri.2013.01.011

Cited by 34 publications

(22 citation statements)

References 23 publications

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“…It has actually become common to encounter cases where hypervascular HCC or nodule-in-nodule HCC that is undetectable by MDCT is detected in a routine screening by EOB-MRI because of early enhancement in the arterial phase or clear hypointensity in the hepatobiliary phase [11,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103]. Furthermore, studies comparing the diagnostic performance of EOB-MRI and MDCT for hypervascular HCC have shown that EOB-MRI is superior or, at the very l...…”

Section: Diagnostic Algorithmmentioning

confidence: 99%

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

et al. 2014

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Surveillance and diagnostic algorithms for hepatocellular carcinoma (HCC) have already been described in guidelines published by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver and the European Organisation for Research and Treatment of Cancer (EASL-EORTC), and the Japan Society of Hepatology (JSH), but the content of these algorithms differs slightly. The JSH algorithm mainly differs from the other two algorithms in that it is highly sophisticated and considers the functional imaging techniques of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI (EOB-MRI) and Sonazoid contrast-enhanced ultrasound (CEUS) to be very important diagnostic modalities. In contrast, the AASLD and EASL-EORTC algorithms are less advanced and suggest that a diagnosis be made based solely on hemodynamic findings using dynamic CT/MRI and biopsy findings. A consensus meeting regarding the JSH surveillance and diagnostic algorithm was held at the 50th Liver Cancer Study Group of Japan Congress, and a 2014 update of the algorithm was completed. The new algorithm reaffirms the very important role of EOB-MRI and Sonazoid CEUS in the surveillance and diagnosis of liver cancer and is more sophisticated than those currently used in the United States and Europe. This is now an optimized algorithm that can be used to diagnose early-stage to classical HCC easily and highly accurately.

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Section: Diagnostic Algorithmmentioning

confidence: 99%

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

et al. 2014

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“…The enhancement pattern of infiltrative HCC seen on images obtained during the hepatic arterial phase has been reported as minimal, patchy, or miliary (10,13,17,32,39) (Figs 2, 3, 5, 6). Although arterial hyperenhancement is a key diagnostic feature of nodular and massive HCC, infiltrative HCC may commonly appear as iso-or hypointense on images obtained during the arterial phase (33,34).…”

Section: Contrast-enhanced Ct and Mr Imagingmentioning

confidence: 97%

“…Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire lobe or the entire liver (10,13,17). Moreover, multiple smaller satellite lesions are reported in up to 52% of cases (10,32).…”

Section: Imaging Of Infiltrative Hccmentioning

confidence: 99%

“…Portal vein tumor thrombosis is a common finding in patients with infiltrative HCC, often affecting both extra-and intrahepatic branches (10,13,17,(32)(33)(34), with a frequency ranging from 68% to 100%. Moreover, because of the permeative appearance and subtle enhancement of the tumor, portal vein thrombosis may appear as the primary imaging feature (33).…”

Section: Imaging Of Infiltrative Hccmentioning

confidence: 99%

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Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know

Reynolds¹,

Furlan²,

Fetzer³

et al. 2015

RadioGraphics

119

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Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide. The macroscopic growth pattern of HCC is subdivided into three categories: nodular, massive, and infiltrative. Infiltrative HCC accounts for 7%-20% of HCC cases and is confirmed at pathologic analysis on the basis of the spread of minute tumor nodules throughout large regions of the liver. Infiltrative HCC may represent a diagnostic challenge because it is often difficult to distinguish from background changes in cirrhosis at imaging. Infiltrative HCC usually spreads over multiple hepatic segments, occupying an entire hepatic lobe or the entire liver, and it is frequently associated with portal vein tumor thrombosis. The tumor is usually ill defined at ultrasonography and shows minimal and inconsistent arterial enhancement and heterogeneous washout at contrast material-enhanced computed tomography and magnetic resonance (MR) imaging. The tumor may be more visible among the surrounding liver parenchyma at diffusion-, T1-, and T2-weighted MR imaging. Several liver diseases can mimic the infiltrative appearance of this malignancy, including focal confluent fibrosis, hepatic fat deposition, hepatic microabscesses, intrahepatic cholangiocarcinoma, and diffuse metastatic disease (pseudocirrhosis). The prognosis for patients with infiltrative HCC is poor because the tumor is often markedly advanced and associated with vascular invasion at presentation. Survival after surgical resection is decreased; thus, infiltrative HCC is a contraindication for resection and transplantation. Knowledge of the key tumor characteristics and imaging findings will help radiologists formulate a correct and timely diagnosis to improve patient management.

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“…Radiation-induced hepatic changes, such as peritumoral edema, hemorrhage, ring enhancement, and hepatic fibrosis, may render image analysis cumbersome (3) and may hamper early detection of recurrent HCC after radioembolization. Studies suggest that MR imaging using gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA [Primovist 0.25 mmol/mL injection solution; Bayer HealthCare, Leverkusen, Germany]) may help distinguish between these benign changes after radioembolization, such as focal confluent fibrosis or hypervascular pseudolesions, and HCC (4,5). Because it is unclear whether the use of the liver-specific intracellular MR imaging contrast agent Gd-EOB-DTPA improves therapy response assessment after radioembolization (6), this prospective single-center trial compared the utility of Gd-EOB-DTPA-enhanced MR imaging and gadobutrol-enhanced MR imaging for therapy response evaluation after radioembolization focusing on the early detection of HCC progression or recurrence.…”

mentioning

confidence: 99%

Therapy Response Assessment after Radioembolization of Patients with Hepatocellular Carcinoma—Comparison of MR Imaging with Gadolinium Ethoxybenzyl Diethylenetriamine Penta-Acetic Acid and Gadobutrol

Schelhorn

Best

Reinboldt

et al. 2015

Journal of Vascular and Interventional Radiology

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Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis

Cited by 34 publications

References 23 publications

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

Surveillance and Diagnostic Algorithm for Hepatocellular Carcinoma Proposed by the Liver Cancer Study Group of Japan: 2014 Update

Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know

Therapy Response Assessment after Radioembolization of Patients with Hepatocellular Carcinoma—Comparison of MR Imaging with Gadolinium Ethoxybenzyl Diethylenetriamine Penta-Acetic Acid and Gadobutrol

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