Added value of smooth hypointense rim in the hepatobiliary phase of gadoxetic acid-enhanced MRI in identifying tumour capsule and diagnosing hepatocellular carcinoma

Background Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in clinical practice. However, scientific evidence is lacking for recommending a particular sequence for measuring tumor size. Purpose To retrospectively compare the size of hepatocellular carcinoma (HCC) measured on different gadoxetic acid-enhanced MRI sequences using pathology as a reference. Material and Methods A total of 217 patients with single HCC who underwent gadoxetic acid-enhanced MRI before surgery were included. The size of the HCC was measured by two abdominal radiologists independently on the following sequences: T1-weighted; T2-weighted; b-500 diffusion-weighted imaging (DWI); and arterial, portal venous, transitional, and hepatobiliary phases. Tumor size measured on MRI was compared with pathological size by using Pearson correlation coefficient, independent-sample t test, and Bland–Altman plot. Agreement between two readers was evaluated with intraclass correlation coefficient (ICC). Results Correlation between the MR images and pathology was high for both readers (0.899–0.955). Absolute error between MRI and pathologic assessment was lowest on hepatobiliary phase images for both readers (reader 1, 2.8±4.2 mm; reader 2, 3.2±3.4 mm) and highest on arterial phase images for reader 1 (4.9±4.4 mm) and DWI phase images for reader 2 (5.1±4.9 mm). Absolute errors were significantly different for hepatobiliary phase compared with other sequences for both readers (reader 1, P≤0.012; reader 2, P≤0.037). Inter-reader agreements for all sequence measurements were strong (0.971–0.997). Conclusion The performance of gadoxetic acid-enhanced MRI sequences varied with HCC size, and the hepatobiliary phase may be optimal among these sequences.

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Retrospective validation of a new diagnostic criterion for hepatocellular carcinoma on gadoxetic acid-enhanced MRI: can hypointensity on the hepatobiliary phase be used as an alternative to washout with the aid of ancillary features?

European Radiology ◽

10.1007/s00330-018-5727-1 ◽

2018 ◽

Vol 29 (4) ◽

pp. 1724-1732 ◽

Cited By ~ 34

Author(s):

Ijin Joo ◽

Jeong Min Lee ◽

Dong Ho Lee ◽

Ju Hyeon Jeon ◽

Joon Koo Han

Keyword(s):

Hepatocellular Carcinoma ◽

Gadoxetic Acid ◽

Hepatobiliary Phase ◽

Enhanced Mri ◽

Diagnostic Criterion ◽

Ancillary Features

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Gadoxetic acid-enhanced MRI for hepatocellular carcinoma and hypointense nodule observed in the hepatobiliary phase

La radiologia medica ◽

10.1007/s11547-013-0364-x ◽

2013 ◽

Cited By ~ 4

Author(s):

Elsa Iannicelli ◽

Marco Di Pietropaolo ◽

Massimo Marignani ◽

Chiara Briani ◽

Giulia Francesca Federici ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Gadoxetic Acid ◽

Hepatobiliary Phase ◽

Enhanced Mri

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MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging

Insights into Imaging ◽

10.1186/s13244-020-00894-3 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Bardia Moosavi ◽

Anuradha S. Shenoy-Bhangle ◽

Leo L. Tsai ◽

Robert Reuf ◽

Koenraad J. Mortele

Keyword(s):

Gadoxetic Acid ◽

Added Value ◽

Rank Test ◽

Focal Liver Lesions ◽

Hepatobiliary Phase ◽

Liver Lesions ◽

Enhanced Mri ◽

Phase Images ◽

Cirrhotic Patients

Abstract Background To evaluate the added value of the hepatobiliary (HPB) phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) in characterizing newly discovered indeterminate focal liver lesions in non-cirrhotic patients. Results One-hundred and twenty-five non-cirrhotic patients (median age, 46 years; range, 20–85 years; 100 females) underwent gadoxetic acid-enhanced MRI, including the 20-min delayed HPB phase, for characterization of newly discovered focal liver lesions. Images were independently evaluated by two blinded, board-certified abdominal radiologists (R1 and R2) who characterized liver lesions without and with assessment of the HPB phase images in two separate readout sessions. Confidence in diagnosis was scored on a scale from 0 to 3. Inter-observer agreement was assessed using Cohen κ statistics. Change in diagnosis and confidence in diagnosis were evaluated by Wilcoxon signed rank test. There was no significant change in diagnosis before and after evaluation of the HPB phase for both readers (p = 1.0 for R1; p = 0.34 for R2). Confidence in diagnosis decreased from average 2.8 ± 0.45 to 2.6 ± 0.59 for R1 and increased from 2.6 ± 0.83 to 2.8 ± 0.46 for R2. Change in confidence was only statistically significant for R1 (p = 0.003) but not significant for R2 (p = 0.49). Inter-reader agreement in diagnosis was good without (k = 0.66) and with (k = 0.75) inclusion of the HPB phase images. Conclusions The added information obtained from the HPB phase of gadoxetic acid-enhanced MRI does not change the diagnosis or increase confidence in diagnosis when evaluating new indeterminate focal liver lesions in non-cirrhotic patients.

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Intra-individual comparison of hepatocellular carcinoma imaging features on contrast-enhanced computed tomography, gadopentetate dimeglumine-enhanced MRI, and gadoxetic acid-enhanced MRI

Acta Radiologica ◽

10.1177/0284185117728534 ◽

2017 ◽

Vol 59 (6) ◽

pp. 639-648 ◽

Cited By ~ 7

Author(s):

Yo Na Kim ◽

Ji Soo Song ◽

Woo Sung Moon ◽

Hong Pil Hwang ◽

Young Kon Kim

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Contrast Ratio ◽

Gadopentetate Dimeglumine ◽

Gadoxetic Acid ◽

Arterial Phase ◽

Hepatobiliary Phase ◽

Imaging Features ◽

Enhanced Mri ◽

Individual Comparison

Background Gadoxetic acid is being widely used for detection and characterization of hepatic nodules. However, there are no data regarding intra-individual comparison of imaging features of hepatocellular carcinoma (HCC) on dynamic computed tomography (CT), gadopentetate dimeglumine-enhanced magnetic resonance imaging (Gd-DTPA-MRI), and gadoxetic acid-enhanced MRI (Gd-EOB-MRI). Purpose To evaluate typical imaging features of HCC and capsule appearance with dynamic CT, Gd-DTPA-MRI, and Gd-EOB-MRI. Material and Methods We retrospectively reviewed 56 HCCs in 49 patients. Lesion attenuation/signal intensity was graded using a five-point scale based on dynamic phase and hepatobiliary phase (HBP) imaging. Subjective washout and capsule appearance were evaluated on portal venous phase (PVP) or delayed/transitional phase (DP/TP) imaging. The tumor-to-liver contrast ratio (TLCR) was calculated. Results Gd-DTPA-MRI and Gd-EOB-MRI was graded higher than CT on arterial phase ( P < 0.001). Gd-EOB-MRI was graded lower than Gd-DTPA-MRI on PVP and DP/TP ( P < 0.05). The detection rate of subjective washout and capsule appearance did not differ among the three imaging studies on either PVP or DP/TP. TLCR of Gd-EOB-MRI was lower than CT on PVP ( P = 0.004) and was lower than Gd-DTPA-MRI on DP/TP ( P = 0.001). Conclusion Arterial phase hyperenhancement and washout appearance of HCC were well demonstrated in Gd-EOB-MRI. The detection of capsule appearance using Gd-EOB-MRI was not inferior to Gd-DTPA-MRI or CT.

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