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Objective To investigate the predictive value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI for microvascular invision (MVI) in hepatocellular carcinoma (HCC). Methods Retrospective analysis of 70 patients confirmed by pathology as HCC who underwent Gd-EOB-DTPA-enhanced MRI within 2 weeks prior to liver partial resection or liver transplantation surgery from January 2015 to May 2018 in Nantong Third People's Hospital. According to the pathological results of the postoperative pathology, MVI was divided into MVI positive group and MVI negative group, and alpha fetoprotein (AFP) was recorded. In Gd-EOB-DTPA-enhanced MRI, qualitative indicators including whether the tumor signal was uniform, peritumoral enhancement, tumor capsule, tumor margin, peritumor hypointensity and presence of fat in the tumor were assessed. Quantitative indicators including tumor diameter and the increase rate of liver-to-muscle ratio(ΔLMR) of post-enhancement arterial phase, portal vein phase, transitional phase and hepatobiliary phase were assessed and recorded. Theχ2 test was used to compare the qualitative parameters of the MVI-negative group and the MVI-positive group, and the Mann-Whitney U test was used to compare the non-normal quantitative parameters. In both inclusion and non-inclusion of peritumor hypointensity cases in the hepatobiliary phase. The multivariate logistic regression analysis was performed to indicate independent variables after univariate analysis. The prediction probability 1 (pre-1) and the prediction probability 2 (pre-2) were obtained, and the two as independent variables. with MVI as the gold standard, using ROC to analyze the diagnostic efficacy of both for HCC MVI, and using Z test to compare the area under the ROC of pre-1 and pre-2. Results There were 27 lesions in 26 cases of MVI-positive group and 50 lesions in 44 cases of MVI-negative group. There was a statistically significant difference between the MVI-negative group and the MVI-positive group in peritumoral enhancement, tumor capsule, tumor margin and peritumor hypointensity in the hepatobiliary phase (P<0.05), and there was no statistically significant difference in gender distribution, tumor signal uniformity and intratumoral fat (P>0.05). There was significant difference in lesion diameter between MVI-negative group and MVI-positive group (P<0.05) while no significant difference in age, AFP value andΔLMR between the two groups (P>0.05). Multivariate logistic regression analysis showed that tumor diameter, non-smooth tumor margin and peritumor hypointensity were independent risks of MVI when peritumor hypointensity was included, the sensitivity and specificity of the combined diagnosis of MVI were 77.8％ and 94.0％;Multivariate logistic regression analysis showed that tumor diameter and non-smooth tumor margin were independent risks of MVI when peritumor hypointensity was not included, the sensitivity and specificity of the combined diagnosis of MVI were 59.3％and 92.0％. The the area under the ROC of pre-1 and pre-2 were 0.900 and 0.816, their difference was statistically significant (P<0.05). Conclusion Gd-EOB-DTPA enhanced MRI can be used to predict HCC MVI preoperatively, especially peritumor hypointensity in hepatobiliary phase is important for the prediction of MVI.
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Objective To evaluate the value of T1 mapping in Gd-EOB-DTPA-enhanced MRI for the assessment of liver function with HBV-related cirrhosis according to the model for end-stage liver disease (MELD) score.Methods 158 patients with HBV-related cirrhosis were included in this prospective study,and divided into MELD score ≤10 (n =103) group and MELD score ＞ 10 (n =55) group.All patients un derwent non-enhanced and Gd-EOB-DTPA enhanced MRI of liver,and T1 mapping was performed using Look-Locker sequences with the same scan parameters and geometry position (the level of porta hepatis) preand post-contrast at 5,10,15 and 20 minutes after Gd-EOB-DTPA administration.T1 relaxation times of the liver were measured and reduction rates of T1 relaxation times (△T1) were calculated.Independent samples t test was performed to compare T1 relaxation times and △T1 between MELD score≤ 10 and MELD score ＞ 10 groups.Receiver operating characteristic curve (ROC) analysis were done to differentiate the diagnostic performance of T1 relaxation times and △T1 between MELD score ≤ 10 and MELD score ＞ 10 groups.Pearson correlation analysis was used to analyse the correction between T1 relaxation times,△T1 and MELD scores.Results T1 relaxation times pre-and post-contrast at 5,10,15 and 20 minutes and △T1 post-contrast at 5,10,15 and 20 minutes of MELD score≤10 group were (889.3 ±91.2) ms,(377.5 ± 55.0) ms,(350.8±61.2)ms,(328.0±69.4)ms,(302.7±73.7)ms,(57.4±5.6)％,(60.4± 6.5) ％,(63.0 ± 7.3) ％ and (65.9 ± 7.8) ％,respectively,and those of MELD score ＞ 10 group were (936.6 ±95.4) ms,(460.2 ±68.5) ms,(457.5 ±94.5) ms,(453.4 ± 116.4) ms,(444.6 ± 134.6) ms,(50.8 ± 5.7) ％,(51.3 ± 7.9) ％,(51.8 ± 10.3) ％ and (52.8 ± 12.2) ％,respectively,and T1 relaxation times and △T1 at all time points were significantly different (P ＜ 0.05) between the two groups.The areas under ROC curve of T1 relaxation time pre-and post-contrast at 5,10,15,20 minutes and △T1 post-contrast at 5,10,15,20 minutes for differentiating MELD score ≤ 10 and MELD score ＞ 10 groups were 0.638,0.824,0.832,0.832,0.830 and 0.795,0.814,0.820,0.825,respectively.The correlation coefficients between T1 relaxation time pre-and post-contrast at 5,10,15,20 minutes,△T1 post-contrast at 5,10,15,20 minutes and MELD scores were 0.256,0.499,0.540,0.538,0.548,-0.412,-0.495,-0.507 and-0.527,respectively.Conclusions T1 mapping on Gd-EOB-DTPA-enhanced MRI is helpful for evaluating liver function with HBV-related cirrhosis.T1 relaxation times post-contrast on different time points were equally accurate as △T1.T1 relaxation times post-contrast and △T1 were superior to T1 relaxation times pre-contrast.
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Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in assessing liver reserve function in patients with normal liver function and abnormal liver function.Methods Totally 99 hepatitis B cirrhosis patients with abnormal liver function were classified into the following three groups,i.e.Child-Pugh A group (n=48),Child Pugh B group (n=40),Child Pugh C group (n=11),while 21 patients without chronic liver disease were taken as normal liver function group.All patients underwent Gd-EOB-DTPA enhanced MRI.At 3 min,10 min and 20 min after intravenous administration of Gd-EOB-DTPA,the relative enhancement (RE) of whole liver and liver segments (S1-S8) was calculated,and the differences of liver RE were compared among different liver function groups and liver segments.Results At 3 min,10 min and 20 min after intravenous administration of Gd EOB-DTPA,the differences of whole liver RE and segmental liver RE among the Child Pugh A group,Child-Pugh B group,Child Pugh C group and normal liver function group were statistically different (all P＜0.05).At 3 min,10 min and 20 min after injection,RE of normal liver function group and Child Pugh A group was significantly different among different liver segments (S1-S8).At 10 min and 20 min after injection,RE of Child-Pugh B group was significantly different among different liver segments,while at 20 min after injection,RE of Child-Pugh C group was significantly different among different liver segments.Conclusion Gd-EOB-DTPA enhanced MRI can accurately assess whole liver and segmental liver function.
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Objective@#To explore the value of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA) enhanced MRI T1 mapping in diagnosing and distinguishing dysplastic nodule (DN) and hepatocellular carcinoma (HCC) with different degrees of differentiation.@*Methods@#A retrospective study in the first affiliated Hospital of Guangxi Medical University from September 2015 to December 2017 was conducted. Seventy-one patients with HCC or DN (a total of 79 lesions) that confirmed by biopsy or surgical pathology findings. Seventy-nine lesions were divided into DN (n=10), well differentiated HCC (n=15), moderately differentiated HCC (n=36) and poorly differentiated HCC (n=18) according to histopathology. All the patients underwent plain MRI scan and Gd-EOB-DTPA-MRI T1 mapping before surgery or needle biopsy. The T1 values of each lesion and non-tumorous liver parenchyma were measured on 20 min hepatobiliary phase (HBP) T1 mapping after Gd-EOB-DTPA administration, respectively. The increment rate of T1 value in lesions relative to non-tumorous liver parenchyma were calculated. One-way ANOVA was used to compare the differences of T1 value and the increment rate of T1 value of DN and 3 groups of HCC with different degrees of differentiation. Spearman correlation was used to evaluate the correlation between T1 mapping parameters and the malignancy degree of DN and HCC. Area under the receiver operating characteristic (ROC) curves were used to evaluate the efficacy of T1 mapping parameters in the differential diagnosis of DN and HCC with different degree of differentiation.@*Results@#Significant differences were found in T1 value and increase rate of T1 value of DN and HCC with different degrees of differentiation (P< 0.05). The T1 value and increase rate of T1 value showed an increasing trend from DN to poorly differentiated HCC after enhancement. The T1 value and increase rate of T1 value were positively correlated with the malignancy of DN and HCC (r=0.418 and 0.634, P<0.01). There were significant differences in the increase rate of T1 value between well-differentiated HCC and moderately-differentiated, well-differentiated HCC and poorly-differentiated HCC, respectively (P<0.05). The area under ROC curve of T1 value and the increase rate of T1 value for differentiating DN from well-differentiated, moderately differentiated and poorly differentiated HCC was 0.933, 0.928, 0.939 and 0.867, 0.961, 0.961, respectively. The area under ROC curve of the increase rate of T1 value for differentiating well-differentiated HCC from moderately-differentiated, well-differentiated HCC from poorly-differentiated HCC was 0.770 and 0.844, respectively.@*Conclusions@#Gd-EOB-DTPA enhanced MRI combined with T1 mapping can provide valuable diagnostic information for identifying DN and HCC with different degrees of differentiation.
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Objective To summarize the imaging features of ultrasound, computed tomography (CT) and gadolinium-ethoxybenzyl-diethylenetriamine pentoacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) of solitary extramedullary plasmacytoma (SEP) of liver, and investigate the key points of identification and diagnosis.Methods The clinical data of 1 patient with SEP of the liver who was admitted to the Southwest Hospital of the Third Military Medical University at 7 May, 2015 were retrospectively analyzed.The patient received contrast-enhanced ultrasound (CEUS) , plain and enhanced scan of CT and Gd-EOB-DTPA enhanced MRI.The patient underwent treatment after preoperative examinations.Pathological examination and immunohistochemical staining were done after operation.The patient was followed up by outpatient examination of color Doppler ultrasonography till 12 November, 2015.The location, size, shape, echo, density or signal, enhancement pattern, secondary performance were recorded by imageological examinations.Surgical treatment, results of pathological examination, immunohistochemical staining, postoperative recovery and recurrence of tumor were recorded.Results CEUS examination demonstrated a hypoechoic hepatic lesion at S7 segment of the right liver measuring 24 mm × 19 mm with clear boundary and dotted blood flow signal in the mass.In the arterial phase, the lesion was enhanced rapidly.Abdominal CT scan showed that the mass at the right liver lobe had slightly low density with clear boundary, the CT value of 34-64 HU, and liver capsule having no significant outer convex.On enhanced CT, the lesion presented a homogeneous enhancement and shape of posterior upper tributaries of right hepatic artery in the arterial phase, the lesion presented continuous enhancement which was slightly lower than that of liver parenchyma in the portal venous phase with the CT value of 77-102 HU, the lesion presented decreased enhancement with the CT value of 41-98 HU in the equilibrium phase.The maximum density projected image showed that the shape of an enlarged vascular image was found inside the lesion in the arterial phase and the lesion was adjacent to inferior vena cava and right hepatic vein which was compressed and displaced in the portal venous phase.On Gd-EOB-DTPA enhanced MRI, the right liver lobe showed a homogeneous T1-weighted and T2-weighted signal with clear boundary and without lipid component, hemorrhage or calcification.The lesion presented obvious enhancement in the arterial phase, homogeneous continuous enhancement which was slightly lower than that of liver parenchyma in the portal venous phase, decreased enhancement in the equilibrium phase.The lesion showed mild signal, adjacent to inferior vena cava and right hepatic vein which was compressed and displaced in the hepatobiliary phase.There was no obvious cirrhotic nodule in the liver.The patient received laparoscopic space-occupying lesion resection at the right liver lobe after finishing inspection.The grayish white lesion in hardness was seen, with clear boundary and capsule, adjacent to anterior wall of inferior vena cava and right hepatic vein in the operation.The results of pathological examination showed that the small tumor cells were scattered in bundle, nuclear were round or oval shape and eccentric with mitosis seen.The results of immunohistochemical staining showed that endothelium cell marker CD34, human multiple myeloma gene MUM1, vimentin, plasmacyte markers 38 and 138, expression of λ light chain protein were positive, the positive cell rate of proliferation activity marker Ki-67 was 10％.The results of blood routine test and blood biochemistry showed that the patient had no anemia, hypercalcemia, abnormal renal function or monoclonal immunoglobulin in the serum or urine.The results of postoperative bone marrow aspiration, immunoglobulin determination and whole body bone scan showed normal.Postoperative examinations confirmed the SEP of right liver.The patient recovered well and was discharged at postoperative day 9.Postoperative change at right liver lobe was detected by color Doppler ultrasonography at 1 month after operation.The patient was followed up for 6 months without tumor recurrence.Conclusion SEP of liver mainly locates at the right lobe of liver, and the imaging features include clear boundary, homogeneous echo, density or signal, adjacent capsule showing no significantly outer convex, surrounding vein demonstrating no violation and shifted by compression, enhancement pattern as fast-in and fast-out.
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Objective To investigate the utilization of liver enhancement in hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI for liver function evaluation.Methods Fifty-five patients who received enhanced MRI with Gd-EOB-DTPA were retrospectively analyzed.Images were obtained before injection and in hepatobiliary phase (5,10,and 20 minutes after Gd-EOB-DTPA injection).The patients were assigned into two subgroups according to individual liver function (n =35 in Group 1:normal liver and Child-Pugh class A; n =20 in Group 2:Child-Pugh class B and C).The relative liver enhancement (RE) was calculated at different time point.The general data (age,sex) and relevant laboratory results were recorded.Independent sample t-test was conducted to compare the RE between two groups at different time point.ROC curve was used to determine the best time point and RE threshold that can reflect the differences between two groups.Univariate analyses was performed to analyze the relationship between RE at the best time point and laboratory results.Multivariate analyses was performed to screen the independent influencing factor for RE at the best time point.Results The differences of RE between two groups were statistically significant at all time points (P ＜ 0.0001).10 minutes was the best time point for detecting the differences of liver function between two groups.When an RE cutoff value (＞ 1.52) was applied,normal or Child-Pugh class A could be predicted with sensitivity of 74.3％ and specificity of 90％.RE at the best time point was significantly related with total serum bilirubin level (TBil),serum albumin level (Alb) and prothrombin time (PT).And TBil was an independent influencing factor.Conclusion RE can be used to evaluate the liver function,and 10 minutes is the best time point that can be used to differentiate patients with normal or mild liver damage from those with moderate or severe liver damage.
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This paper reports on issues relating to the optimal use of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA MR imaging) together with the generation of consensus statements from a working group meeting, which was held in Seoul, Korea (2010). Gd-EOB-DTPA has been shown to improve the detection and characterization of liver lesions, and the information provided by the hepatobiliary phase is proving particularly useful in differential diagnoses and in the characterization of small lesions (around 1-1.5 cm). Discussion also focused on advances in the role of organic anion-transporting polypeptide 8 (OATP8) transporters. Gd-EOB-DTPA is also emerging as a promising tool for functional analysis, enabling the calculation of post-surgical liver function in the remaining segments. Updates to current algorithms were also discussed.