Non-Hypervascular Hypointense Hepatic Nodules during the Hepatobiliary Phase of Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI as a Risk Factor of Intrahepatic Distant Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma

2017 ◽  
Vol 35 (6) ◽  
pp. 574-582 ◽  
Author(s):  
Takayuki Iwamoto ◽  
Yasuharu Imai ◽  
Takumi Igura ◽  
Sachiyo Kogita ◽  
Yoshiyuki Sawai ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Distant Recurrence ◽  
Intrahepatic Recurrence ◽  
Hepatobiliary Phase ◽  
Enhanced Mri ◽  
Hypervascular Transformation ◽  
Independent Risk Factors ◽  
The Relationship ◽  
Diethylenetriamine Pentaacetic Acid

Background: Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI have been reported to be associated with intrahepatic distant recurrence (IDR) after hepatectomy or radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). IDR is categorized into hypervascular transformation of non-hypervascular hypointense hepatic nodules and new intrahepatic recurrence. The aim of this study was to evaluate the relationship between non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI and IDR after RFA, focusing on new intrahepatic recurrence. Methods: Ninety-one consecutive patients with 115 HCCs undergoing pretreatment Gd-EOB-DTPA-enhanced MRI and RFA for treatment of HCC were enrolled. Results: Of the 91 patients who underwent RFA for HCC, 24 had non-hypervascular hypointense hepatic nodules on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrences were observed in 15 and 19 patients with and without non-hypervascular hypointense hepatic nodules, respectively. Of the 15 recurrences in patients with non-hypervascular hypointense hepatic nodules, 10 patients had new intrahepatic recurrences. The cumulative incidence of new intrahepatic recurrence was significantly higher in patients with non-hypervascular hypointense hepatic nodules than in those without non-hypervascular hypointense hepatic nodules (p < 0.0001). Multivariate analysis revealed that the presence of non-hypervascular hypointense hepatic nodules and Child-Pugh score were independent risk factors for new intrahepatic recurrence. Conclusions: Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were a useful predictive factor for IDR, particularly for new intrahepatic recurrence, after RFA.

Comparison of Contrast-Enhanced Ultrasound and Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI for the Diagnosis of Macroscopic Type of Hepatocellular Carcinoma

2016 ◽  
Vol 34 (6) ◽  
pp. 679-686 ◽  
Author(s):  
Takayuki Iwamoto ◽  
Yasuharu Imai ◽  
Sachiyo Kogita ◽  
Takumi Igura ◽  
Yoshiyuki Sawai ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Performance ◽  
Characteristic Curve ◽  
Hepatobiliary Phase ◽  
Contrast Enhanced Ultrasound ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Macroscopic Classification ◽  
Diethylenetriamine Pentaacetic Acid

Objective: We compared the efficacy of contrast-enhanced ultrasound sonography (CEUS) with sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI for the assessment of macroscopic classification of nodular hepatocellular carcinoma (HCC). Methods: Seventy-seven consecutive patients with 79 surgically resected HCCs who underwent both preoperative CEUS and Gd-EOB-DTPA-enhanced MRI were enrolled in this retrospective study. Based on the macroscopic diagnosis of resected specimens, nodules were categorized into the simple nodular (SN) and non-SN type HCC. Two hepatologists independently assessed image datasets of the post-vascular phase of CEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to compare their diagnostic performance. Results: Gd-EOB-DTPA-enhanced MRI enabled the evaluation of macroscopic classification in a significantly larger number of nodules than CEUS (78/79 (98.7%) vs. 70/79 (88.6%), p < 0.05). Of 70 nodules that could be evaluated by both modalities, 41 and 29 nodules were pathologically categorized as SN and non-SN, respectively. The areas under the receiver operating characteristic curve (AUC) for non-SN did not differ between CEUS and Gd-EOB-DTPA-enhanced MRI (reader 1: 0.748 for CEUS, 0.808 for MRI; reader 2: 0.759 for CEUS, 0.787 for MRI). The AUC of combined CEUS and Gd-EOB-DTPA-enhanced MRI for SN HCC was 0.855 (reader 1) and 0.824 (reader 2), indicating higher AUC values for the combined modalities. Conclusions: The diagnostic performance for macroscopic classification of nodular HCC of CEUS was comparable with that of Gd-EOB-DTPA-enhanced MRI, although some HCCs could not be evaluated by CEUS owing to lower detectability. The combination of the 2 modalities had a more accurate diagnostic performance.

scholarly journals A Novel Correlation of Preoperative Gd-EOB-DTPA-contrast-enhanced MRI with FGFR4 Expression and Its Value in Targeted Therapy for Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Zhiqing Mo ◽  
Liling Long ◽  
Hao Ding ◽  
Xiaojiao Zhou
Keyword(s):  
Gene Expression ◽  
Hepatocellular Carcinoma ◽  
Protein Expression ◽  
Signal Intensity ◽  
Image Features ◽  
Arterial Phase ◽  
Hepatobiliary Phase ◽  
Enhanced Mri ◽  
Mri Features ◽  
The Relationship

Abstract Purpose: To assess the relationship between preoperative gadolinium ethoxy-benzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) features and fibroblast growth factor receptor 4 (FGFR4) gene expression in hepatocellular carcinoma (HCC).Materials and methods: Fifty-nine HCC patients (54 males, 5 females) who underwent preoperative enhanced MRI were retrospectively enrolled in this study. Quantitative and qualitative features of Gd-EOB-DTPA-enhanced MRI were analyzed in these pathologically confirmed HCC patients. Immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) were performed to determine the mRNA and protein levels of FGFR4 in HCC. The relationship between these image features and the level of FGFR4 gene expression in HCC was evaluated by correlation analysis.Results: The FGFR4 mRNA and protein expression has significant correlation with the change of signal intensity in the phase of hepatobiliary, IHC analysis revealed significant correlation between the protein expression of FGFR4 and the qualitative enhanced MRI feature, mainly the manifestation of the intratumoral vessels at the arterial phase. Furthermore, the presence of intratumoral vessels (P =0.034, OR=4.71) and heterogeneous 3 signal performance in the hepatobiliary phase (P =0.008, OR=4.2) were identified as independent indicators for high FGFR4 expression in HCC. Conclusions: The findings demonstrate novel correlation between enhanced MRI features and FGFR4 gene expression, suggesting the heterogeneous signal intensity at the phase of hepatobiliary and the present of intratumoral vessels in the arterial phase as indicators for high FGFR4 expression in HCC. Our study may have clinical implication that enhanced MRI holds promise as useful modality in treatment selection of targeted therapies to HCC patients.

scholarly journals Prediction of Microvascular Invasion in Hepatocellular Carcinoma: Preoperative Gd-EOB-DTPA-Dynamic Enhanced MRI and Histopathological Correlation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Mengqi Huang ◽  
Bing Liao ◽  
Ping Xu ◽  
Huasong Cai ◽  
Kun Huang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prediction Model ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Microvascular Invasion ◽  
Arterial Phase ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Tumor Margin ◽  
Enhanced Mri

Objective. To investigate the imaging features observed in preoperative Gd-EOB-DTPA-dynamic enhanced MRI and correlated with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Methods. 66 HCCs in 60 patients with preoperative Gd-EOB-DTPA-dynamic enhanced MRI were retrospectively analyzed. Features including tumor size, signal homogeneity, tumor capsule, tumor margin, peritumor enhancement during mid-arterial phase, peritumor hypointensity during hepatobiliary phase, signal intensity ratio on DWI and apparent diffusion coefficients (ADC), T1 relaxation times, and the reduction rate between pre- and postcontrast enhancement images were assessed. Correlation between these features and histopathological presence of MVI was analyzed to establish a prediction model. Results. Histopathology confirmed that MVI were observed in 17 of 66 HCCs. Univariate analysis showed tumor size (p=0.003), margin (p=0.013), peritumor enhancement (p=0.001), and hypointensity during hepatobiliary phase (p=0.004) were associated with MVI. A multiple logistic regression model was established, which showed tumor size, margin, and peritumor enhancement were combined predictors for the presence of MVI (α=0.1). R2 of this prediction model was 0.353, and the sensitivity and specificity were 52.9% and 93.0%, respectively. Conclusion. Large tumor size, irregular tumor margin, and peritumor enhancement in preoperative Gd-EOB-DTPA-dynamic enhanced MRI can predict the presence of MVI in HCC.

scholarly journals Higher Enhancement Intrahepatic Nodules on the Hepatobiliary Phase of Gd-EOB-DTPA-Enhanced MRI as a Poor Responsive Marker of Anti-PD-1/PD-L1 Monotherapy for Unresectable Hepatocellular Carcinoma

Liver Cancer ◽  
2021 ◽  
pp. 1-14
Author(s):  
Tomoko Aoki ◽  
Naoshi Nishida ◽  
Kazuomi Ueshima ◽  
Masahiro Morita ◽  
Hirokazu Chishina ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Checkpoint Inhibitors ◽  
Objective Response ◽  
Evaluation Criteria ◽  
Progression Free Survival ◽  
Imaging Biomarker ◽  
Hepatobiliary Phase ◽  
Enhanced Mri ◽  
Phase Images ◽  
Magnetic Resonance Imaging Mri

<b><i>Introduction:</i></b> Immune checkpoint inhibitors (ICIs) are promising agents for the treatment of hepatocellular carcinoma (HCC). However, the establishment of noninvasive measure that could predict the response to ICIs is challenging. This study aimed to evaluate tumor responses to ICIs using the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI), which was shown to reflect Wnt/β-catenin activating mutation. <b><i>Methods:</i></b> A total of 68 intrahepatic HCC nodules from 18 patients with unresectable HCC and Child-Pugh class A liver function who received anti-programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) monotherapy were enrolled in this study. All patients had viable intrahepatic lesions evaluable using the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI within the 6 months prior to the treatment. The relative enhancement ratio was calculated, and the time to nodular progression (TTnP) defined as 20% or more increase in each nodule was compared between higher or hypo-enhancement HCC nodules. Then, the progression-free survival (PFS) and objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) were compared between patients with and without HCC nodules with higher enhancement on hepatobiliary phase images. <b><i>Results:</i></b> The median PFS was 2.7 (95% confidence interval [CI]: 1.4–4.0) months in patients with HCC nodules with higher enhancement (<i>n</i> = 8) and 5.8 (95% CI: 0.0–18.9) months in patients with hypointense HCC nodules (<i>n</i> = 10) (<i>p</i> = 0.007). The median TTnP of HCC nodules with higher enhancement (<i>n</i> = 23) was 1.97 (95% CI: 1.86–2.07) months and that of hypointense HCC nodules (<i>n</i> = 45) was not reached (<i>p</i> = 0.003). The ORR was 12.5% (1/8) versus 30.0% (3/10); the disease control rate was 37.5% (3/8) versus 70.0% (7/10), respectively, in patients with or without higher enhancement intrahepatic HCC nodules. <b><i>Conclusion:</i></b> The TTnP on HCC nodules with higher enhancement and the median PFS in patients who carried higher enhancement intrahepatic HCC nodules were significantly shorter than those in hypointense HCC nodules with anti-PD-1/PD-L1 monotherapy. The intensity of the nodule on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is a promising imaging biomarker for predicting unfavorable response with anti-PD-1/PD-L1 monotherapy in patients with HCC.

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