Quantitative analysis of gadoxetic acid-enhanced MRI for the differential diagnosis of focal liver lesions: comparison between estimated intralesional gadoxetic acid retention by T1 mapping and conventional processing methods

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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Application Progress of Gd-EOB-DTPA-Enhanced MRI T1 Mapping in Hepatic Diffuse Diseases

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211130153450 ◽

2021 ◽

Vol 17 ◽

Author(s):

Xing Wen ◽

Xu Feng ◽

Yao Kang ◽

Long Xu

Keyword(s):

Liver Function ◽

T1 Mapping ◽

Future Research ◽

Focal Liver Lesions ◽

Hepatobiliary Phase ◽

Liver Lesions ◽

Scanning Time ◽

Hepatic Diseases ◽

Enhanced Mri ◽

New Research

Background: In recent years, T1 mapping imaging based on Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) has resulted in new research and clinical applications in hepatic diseases. Objective: The objective of the study is to analyze, prospect, and summarize the Gd-EOB-DTPA-enhanced MRI T1 mapping technology in hepatic diseases in recent years. Main Findings: Gd-EOB-DTPA-enhanced T1 mapping has been used more frequently in liver diseases regardless of 1.5T or 3.0T MRI equipment. Volume interpolated body examination (VIBE) mapping sequence seems to be the recommended MRI scan sequence. In the evaluation of T1 value on liver function, the hepatobiliary phase 10 minutes after enhancement is the recommended time point. The fat fraction and hepatic steatosis grade based on MRI-derived biomarkers are easier to implement and popularize than a liver biopsy. Gd-EOB-DTPA-enhanced MRI T1 mapping can not only be used to evaluate the degree of liver injury, the stage of liver fibrosis, and the liver reserve function of patients with liver cirrhosis but also to distinguish focal liver lesions and predict the differentiation degree of hepatocellular carcinoma. At the same time, it has some value in predicting tumor immunohistochemical indexes, such as Ki67, CD34. Conclusion : Gd-EOB-DTPA-enhanced MRI T1 mapping has great potential in the application of diffuse and focal liver lesions. It is a quantitative study, trying to select homogeneous research objects and try to use the same standards in scanning sequence and scanning time, especially for the study of liver function, which is a focus of future research. The research on the relationship between T1 value and tumor immunohistochemical indexes is worth consideration.

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Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid-enhanced MRI

Journal of Clinical Ultrasound ◽

10.1002/jcu.22499 ◽

2017 ◽

Vol 45 (9) ◽

pp. 542-550

Author(s):

Woo Young Yang ◽

Hee Sun Park ◽

Young Jun Kim ◽

Mi Hye Yu ◽

Sung Il Jung ◽

...

Keyword(s):

Gadoxetic Acid ◽

Focal Liver Lesions ◽

Hepatobiliary Phase ◽

Liver Lesions ◽

Enhanced Mri

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Differential diagnosis of focal liver lesions: role of spin-echo and contrast-enhanced dynamic MR imaging.

Radiology ◽

10.1148/radiology.193.1.8090922 ◽

1994 ◽

Vol 193 (1) ◽

pp. 59-65 ◽

Cited By ~ 69

Author(s):

Y Yamashita ◽

Y Hatanaka ◽

H Yamamoto ◽

A Arakawa ◽

T Matsukawa ◽

...

Keyword(s):

Differential Diagnosis ◽

Mr Imaging ◽

Spin Echo ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Dynamic Mr Imaging ◽

Contrast Enhanced ◽

Dynamic Mr

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

Radiology ◽

10.1148/radiol.2301020269 ◽

2004 ◽

Vol 230 (1) ◽

pp. 266-275 ◽

Cited By ~ 322

Author(s):

Alexander Huppertz ◽

Thomas Balzer ◽

Anthony Blakeborough ◽

Josy Breuer ◽

Andrea Giovagnoni ◽

...

Keyword(s):

Mr Imaging ◽

Gadoxetic Acid ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Mr Images

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Diagnostic Accuracy of CEUS in the Differential Diagnosis of Small (≤ 20 mm) and Subcentimetric (≤ 10 mm) Focal Liver Lesions in Comparison with Histology

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0031-1271114 ◽

2011 ◽

Vol 32 (06) ◽

pp. 593-597 ◽

Cited By ~ 53

Author(s):

D. Strobel ◽

T. Bernatik ◽

W. Blank ◽

A. Schuler ◽

C. Greis ◽

...

Keyword(s):

Differential Diagnosis ◽

Diagnostic Accuracy ◽

Power Doppler ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Eine Hohe ◽

Maligne Tumore

Zusammenfassung Hintergrund: Evaluierung der diagnostischen Treffsicherheit der Kontrastmittelsonografie in der Differenzialdiagnose kleiner Leberläsionen. Material und Methoden: 1349 Patienten mit im B-Bild und Power Doppler unklarem Lebertumor wurden prospektiv mittels KM-Sono multizentrisch mit standardisiertem Protokoll (mechanischer Index < 0,4, Phase/Puls-Inversion-Technik, Sonovue-Bolus-Injektion) untersucht. Die Differenzialdiagnose im KM-Sono basierte auf tumortypischen Vaskularisationsmustern in der arteriellen, portalvenösen Phase und Spätphase (EFSUMB-Leitlinie). 335 Patienten mit fokalen Leberläsionen (FLLs) ≤ 20 mm wurden analysiert. Die Tumorklassifizierung nach KM-Sono wurde mit der Histologie (73,2 %) oder in einigen Fällen mit CT und/oder MRT verglichen. Ergebnisse: Eine definitive Tumordiagnose war in 329 FLLs möglich. Die Enddiagnose der ≤ 20 mm FLLs mit histologischer Sicherung (n = 241) beinhaltete 87 benigne und 154 maligne Tumore. Die diagnostische Treffsicherheit des KM-Sono bei ≤ 20 mm histologisch gesicherten FLLs war 83,8 %. Die KM-Sono identifizierte 144 /154 maligne FLLs (Sensitivität 93,5 %) und 58 /87 benigne FLLs (Spezifität 66,7 %). 24 /241 FLLs blieben nach der KM-Sono unklar (9,9 %). Die KM-Sono klassifizierte 15 /241 FLLs (6,2 %) falsch (12 benigne und 3 maligne FLLs). Die positive Voraussagekraft der KM-Sono bei malignen FLLs war 92,3 %, die negative Voraussagekraft 95,1 %. Von 241 histologisch gesicherten FLLs waren 62 FLLs ≤ 10 mm (diagnostische Treffsicherheit KM-Sono 80,6 %) und 179 FLLs > 10 mm ≤ 20 mm (diagnostische Treffsicherheit KM-Sono 80,6 %). Schlussfolgerung: Die KM-Sonografie hat eine hohe diagnostische Treffsicherheit in der Differenzierung kleiner und kleinster (≤ 1 cm) FLL im klinischen Alltag.

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