ABSTRACT
As a non-invasive， simple， and reproducible examination， Gd-EOB-DTPA-enhanced magnetic resonance imaging （MRI） has an important application value in evaluating liver reserve function. Currently in clinical practice， Gd-EOB-DTPA-enhanced MRI is mainly used to measure liver parenchymal signal intensity parameters， magnetic resonance relaxation time parameters， biliary tract enhancement parameters， and liver volume parameters to evaluate the liver reserve function of patients. In recent years， the use of Gd-EOB-DTPA-enhanced MRI in predicting liver reserve function in residual liver tissue after liver tumor surgery has become one of the hotspots in clinical research， and certain progress has been made in related studies in China and globally. This article reviews the research advances in recent years.
ABSTRACT
Objective:To compare the diagnostic performance in the hepatocellular carcinoma(HCC) with cirrhosis between the 2017 version of liver imaging reporting and data system (LI-RADS v2017) and 2018 version of LI-RADS (LI-RADS v2018) based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI.Methods:Clinical data of 213 patients with 246 hepatic lesions with cirrhosis who underwent Gd-EOB-DTPA enhanced MRI in the Third Affiliated Nantong Hospital of Nantong University from October 2015 to July 2020 were retrospectively collected. The MRI major features and LR categories of lesions were respectively reviewed by two radiologists according to LI-RADS v2017 and LI-RADS v2018, respectively. Taking postoperative histopathological results or follow-up imaging as references, with the LR-5 and LR-4+LR-5 as the diagnosis of HCC, the sensitivity, specificity and accuracy of the LI-RADS v2017 and LI-RADS v2018 were evaluated, respectively. The McNemar test or Fisher exact test was used to compare the diagnostic performance between the two LI-RADS versions.Results:In 246 hepatic lesions, 165 were HCCs, 31 were non-HCC malignancies and 50 were benign lesions. Due to the threshold growth and more simplified definition and changes in the LR-5 classification criteria in LI-RADS v2018, the categories of 38 (15.4%, 38/246) lesions were changed. The threshold growths of 84.6% (33/39) lesions in v2017 were reclassified to subthreshold growth in v2018. Using LI-RADS v2018, 10 lesions were down-categorized compared with LI-RADS v2017, including LR-5 to LR-4 in 7 lesions and LR-4 to LR-3 in 3 lesions, and 28 lesions were up-categorized LR-4 to LR-5, in which 25 were small HCC. With LR-5 as the diagnosis criteria of HCC, the sensitivity and accuracy of LI-RADS v2018 were 66.7% (110/165) and 73.6% (181/246); and the sensitivity and accuracy of LI-RADS v2017 were 55.8% (92/165) and 67.5% (166/246), both with statistical differences (χ2=4.13, P=0.001, χ2=6.20, P<0.001). No significant difference was found in the specificity values of LI-RADS v2018 and v2017 [87.7% (71/81) vs. 91.4% (74/81)], χ2=0.59, P=0.442). Compared with v2017, LI-RADS v2018 increased the sensitivity in the diagnosis of small HCC lesions (10-19 mm) [62.9% (56/89) vs. 40.4% (36/89), χ2=9.00, P<0.001]. With LR-4+LR-5 as the diagnostic criteria of HCC, there was no significant difference in the sensitivity, specificity and accuracy of LI-RADS v2017 and v2018 in the diagnosis of HCC (all P>0.05). Conclusions:Based on Gd-EOB-DTPA enhanced MRI, LI-RADS v2018 has higher sensitivity and similar specificity in the diagnosis of HCC compared to v2017, especially in the diagnosis of small HCC (10-19 mm).
ABSTRACT
Objective ToexplorethediagnosticvalueofenhancedCTandGd-EOB-DTPA-enhanced MRIinthedetectionofhepatocellular carcinoma (HCC).Methods 41patientswith52HCCsunderwentenhancedCTandGd-EOB-DTPA-enhancedMRIrespectively.The imagingmanifestationswereanalyzed,andthelesionsweregrouped.Theimagingdiagnositicresultswerecomparedwiththepathologicalresults, andtheefficacyofthetwomodalitieswasevaluatedusingtheaccuracyindex.Results Ofthetotal52HCCs,42lesionswereidentifiedexactlyby enhancedCT,and51byGd-EOB-DTPA-enhancedMRI.Foralllesions,includingsmalllesions(≤2cm),theaccuracyratioofGd-EOB-DTPA-enhancedMRIwashigherthanthatofenhancedCT withastatisticallysignificantdifference(P<0.05),however,therewasnosignificant differenceforthelesionsbiggerthan2cm (P>0.05).Conclusion EnhancedCTislimitedindiagnosisoftheHCCssmallerthanor equalto2cm.ThediagnosticefficacyofGd-EOB-DTPA-enhanced MRIishigherthanthatofenhancedCT,anditcansignificantly improvethediagnosisofsmallHCC.
ABSTRACT
Objective: The development of hepatocellular carcinoma (HCC) is not uncommon in patients who achieve eradication of the hepatitis C virus through direct-acting antiviral (DAA) treatment. The aim of this study was to identify the patients at high risk for novel HCC development after a sustained virologic response (SVR) by DAA treatment.Patients and Methods: A total of 518 patients with no history of HCC treatment and who achieved SVR by DAA treatment were evaluated retrospectively. The correlations between HCC development and the patients’ characteristics were evaluated. For patients who underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) or dynamic contrast-enhanced computed tomography, the relationship between the imaging findings and subsequent HCC development was also assessed.Results: HCC developed newly in 22 patients, and the 1-year and 3-year cumulative HCC rates were 2.0% and 8.5%, respectively. In multivariate analysis, a FIB-4 index >4.0 and a post-treatment α-fetoprotein >4.0 ng/ml were significant risk factors for HCC. In 26 of 118 patients who underwent an MRI before DAA treatment, a non-hypervascular hypo-intense nodule was seen in the hepatobiliary phase, and in 6 of 182 patients who underwent a CT, a non-hypervascular hypo-enhanced nodule was seen in the delayed phase. The sensitivity and specificity of the MRI-positive findings for the subsequent development of HCC were 0.92 and 0.87, respectively, and those of the CT were 0.40 and 0.99, respectively. In multivariate analysis of patients who underwent an MRI, a non-hypervascular hypo-intense nodule was the only factor that was significantly related to HCC development (HR 32.4, p = 0.001).Conclusion: Gd-EOB-DTPA-enhanced MRI was found to be reliable for risk evaluation of subsequent HCC development in patients after SVR by DAA treatment. Patients with a non-hypervascular hypo-intense nodule need more careful observation for incident HCC.
ABSTRACT
@#【Objective】 To investigate the predictive value of preoperative Gd- EOB- DTPA enhanced MRI in the expression of cytokeratin 19（CK19）in hepatocellular carcinoma（HCC）.【Methods】A total of 102 patients，including 94 male and 8 female，with single HCC confirmed by pathology after operation who underwent preoperative enhanced MRI were retrospectively analyzed. A total of 25 were CK19-positive HCC and 77 were CK19-negative HCC. Two radiologists evaluated MR features including tumor size，tumor margin，intratumoral vessels，signal intensity（SI）on arterial phase （AP） ，enhancement pattern ，arterial rim enhancement ，peritumoral enhancement ，internal cystic or necrotic portion，hemorrhage，intratumoral fat，tumor capsule，vascular invasion，lymph node metastasis，intratumoral septum， target sign on diffusion weighted imaging（DWI）or hepatobiliary phase（HBP），peritumor hypointensity，SI on ADC，SI on HBP ，T1 relaxation times and T1 reduction rate between pre- and post- contrast enhancement. The associations between these imaging features and CK19 expression were investigated. 【Results】SI on AP（P = 0.013），arterial rim enhancement（P = 0.018），target sign on DWI（P = 0.001）and target sign on HBP（P = 0.005）were significantly associated with CK19 expression. Delayed enhanced intratumoral septum（P = 0.042）was associated with CK19 expression between HCCs less than 5 cm. Target sign on DWI（P = 0.001，OR = 4.875，95%CI：1.838~12.927）were independent significant factors of CK19- positive HCC.【Conclusion】Preoperative enhanced MRI with Gd- EOB- DTPA is helpful to predict CK19 expression of HCC.
ABSTRACT
Objective To compare the diagnostic value of Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI and contrast-enhanced ultrasound (CEUS) in detection of small hepatocellular carcinoma (sHCC).Methods A total of 22 patients with 29 lesions who underwent Gd-EOB-DTPA enhanced MRI and CEUS scan,and confirmed as sHCCs by pathology were included in this study.Gd EOB DTPA enhanced MRI pattern for the conclusive diagnosis of sHCC were lesions showed iso or low signal on T1 WI,showed slightly high signal or high signal on T2 WI,showed high signal on DWI and obviously enhanced in the arterial phase and/or clearance in the hepatobiliary phase;CEUS pattern for the conclusive diagnosis of sHCC were rapidly increasing in the arterial phase and showing low echo in the delay phase.Results The diagnostic sensitivity of detecting sHCC by Gd EOB-DTPA enhanced MRI and CEUS were 82.76％ and 65.52％ respectively,and there was no statistical difference (x2 =2.248,P=0.134),the diagnosis specificity were both 100 ％.Conclusion Both of the diagnostic sensitivity and specificity for detecting sHCC by Gd EOB DTPA enhanced MRI and CEUS showed no difference,the value of diagnostic sensitivity of the former is higher.
ABSTRACT
Objective To probe the value of both liver volume(LV)measurement and Gd-EOB-DTPA enhanced MRI to evaluate hepatic reserve function in order to obtain a better assessment method.Methods Clinical and imaging data of 42 patients with hepatic focal lesions were analyzed retrospectively.Gd-EOB-DTPA enhanced MRI scan,Child-Pugh scoring and ICG clearance tests were performed in all patients,and the liver relative enhancement (RE)and LV were used to assess the hepatic reserve function.The differences of LV, LV/standard liver volume (SLV)and RE between the Child-Pugh class A and B were compared using independent student's t-test. Spearman correlation analysis was applied to analyze the relationship of indocyanine green retention rate at 1 5 minutes (ICG-R1 5) with the LV,LV/SLV,RE,RE×LV and RE×LV/SLV.Results There was no significant difference in LV between two groups(P>0.05), whereas the RE had significant difference(P=0.039).There were no significant correlations between ICG-R15 and LV,LV/SLV(P>0.05). ICG-R1 5 was negatively correlated with RE,RE×LV and RE×LV/SLV,and RE×LV/SLV showed significant correlation with ICG-R15 (r=-0.524,P=0.000).Conclusion Gd-EOB-DTPA enhanced MRI can assess the status of hepatic reserve function, while the combination of RE with LV is a more effective method.
ABSTRACT
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.
ABSTRACT
Objective To compare the effect of fluoroscopic triggering method and empirical delay method on image quality in the liver Gd-EOB-DTPA dynamic enhanced MRI,and to investigate the value of fluoroscopic triggering method in Gd-EOB-DTPA dynamic enhanced MRI.Methods The patients underwent Gd-EOB-DTPA dynamic enhanced MRI were randomly divided into two groups according to the starting modes in the artery phase.Group A used fluoroscopic triggering method and group B used empirical delay method.Eliminating the images with severe respiratory motion artifacts,the quality of the remaining images in 78 cases of group A and 85 cases of group B were assessed in scores (excellent=5 scores;good=4 scores).Data was statistically analyzed with Mann-whitney tests,and P<0.05 was considered statistically significant.Results The excellent rate of the images in group A was 96.15% (75/78).The excellent rate of the images in group B was 67.06% (57/85).There were significant differences between the two groups in the excellent rate (χ2=27.889, P<0.001)and the image quality scores (Z=-4.747,P<0.001).Conclusion For the liver Gd-EOB-DTPA dynamic enhanced MRI, fluoroscopic triggering method is more likely to get better image quality and higher success rate in artery phase than empirical delay method,which indicates that fluoroscopic triggering method have obviously advantages in clinical applications.
ABSTRACT
Objective To investigate the differences in GD-EOB-DTPA multi-modality MR images be-tween well-differentiated hepatocellular carcinoma(WHCC)and non well-differentiated HCC.Methods The clin-ical and MR images of 57 patients with pathologically proved HCC were retrospectively collected. All patients un-derwent abdominal enhancement MRI,including T1 weighted and T2 weighted imaging(T1WI and T2WI),diffu-sion weighted imaging(DWI),the apparent diffusion coefficient(ADC)map,and gadoxetic acid-enhanced multi-phase sequences. The patients were classified into well-differentiated HCC(WHCC)group and non-WHCC group which combined moderate HCC and poor differentiated HCC according to their histopathological differentiation.Dif-ferences of T1WI,T2WI,DWI,ADC map,the types of HCC on hepatobiliary phase(HBP)images,and enhance-ment patterns on dynamic images were compared. The chi-square test or Fisher exact was used for comparing the imaging signal differences between WHCC and non-WHCC. Multiple logistic regression analysis was performed to identify the independent predictors of WHCC. Results T1WI signal intensities,HBP signal types,enhancement patterns and ADC maps showed statistical significance between WHCC and non-WHCC(P<0.05).But,multiple logistic regression analysis showed that signal intensities on T1WI were independent risk factors for WHCC(P =0.001). In addition,hyperintense on T1WI showed higher statistical significance compared with isointense or hy-pointense on T1WI(P = 0.002). Conclusions Multi-modality of GD-EOB-DTPA MRI is useful for assessing WHCC. The signal intensities on T1WI are independent risk factors for evaluating WHCC. Moreover,WHCC are more likely in hyperintense T1WI signal intensity.
ABSTRACT
Objective To compare the diagnostic value of DSA with that of Gd-EOB-DTPA-enhanced MRI for postoperative recurrent tiny hepatocellular carcinoma (HCC) lesions.Methods The clinical data of a total of 38 patients,who were admitted to authors' hospital during the period from September 2011 to March 2016 as clinically they were suspected to have postoperative recurrent tiny HCC lesions,were retrospectively analyzed.DSA,DSA plus lipiodol CT scan and Gd-EOB-DTPA-enhanced MRI were performed in all patients.The positive and negative diagnosis rates were compared among different examination methods,the diagnostic sensitivity and specificity were calculated.The imaging diagnosis of each patient was made by two associationchief radiologists independently,both the pathological findings from surgery or puncture biopsy and the 6-month follow-up results were taken as the final diagnosis basis.Results A total of 47 lesions were detected in the 38 patients.The diameter of the lesions was 0.5-2.0 cm,with an average of (1.2+0.8) cm.Of the 47 lesions,41 were proved to be recurrent tiny HCC lesions.Among the 41 lesions,22 had pathological evidence,and the remaining 19 lesions were confirmed through clinical follow-up.Six lesions were non-HCC focus,which were proved by clinical follow-up.For all lesions,the diagnostic sensitivity and specificity were 72.2％ and 80.0％ respectively by conventional DSA,which were 90.2％ and 100％ respectively by DSA plus lipiodol CT scan,and were 95.1％ and 100％ respectively by Gd-EOB-DTPA-enhanced MRI.Statistical analysis indicated that significant differences in diagnostic sensitivity and specificity existed between conventional DSA and DSA plus lipiodol CT scan as well as between conventional DSA and Gd-EOB-DTPA-enhanced MRI (P＜0.05),while the differences in diagnostic sensitivity and specificity between DSA plus lipiodol CT scan and Gd-EOB-DTPA-enhanced MRI were not statistically significant (P＞0.05).Conclusion For the detection of postoperative recurrent tiny HCC lesions,DSA plus lipiodol CT scan has quite the same diagnostic value as Gd-EOB-DTPA-enhanced MRI does.For patients who are not suitable to receive MRI examination,the use of DSA plus lipiodol CT scan,as an alternative means of inspection,should be taken into consideration.
ABSTRACT
Objective To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of the myomatous hepatic angiomyolipoma (MHAML).Methods The retrospective cross-setional study was conducted.The clinicopathological data of 22 patients with MHAML who were admitted to the Southwest Hospital of the Third Military Medical University between January 2010 and June 2016 were collected.Patients underwent plain and enhanced scans of CT and MRI,and then received pathological examination after surgical resection or liver puncture and immunohistochemical staining.Observation indicators:(1) findings of CT and MRI,2 radiologists independently read films;(2) diagnostic consistency of 2 radiologists;(3) results of pathological examination.The Kappa test was used for evaluating the consistency,κ ≥0.75 as a good consistency,0.40＜κ＜0.75 as a normal consistency and κ ≤0.40 as a poor consistency.Results (1) Findings of CT and MRI:of 22 patients,16 received CT scans and 6 received CT and MRI scans.Tumors of 22 patients were single lesion,showing similar-circular type.Tumors located in the right liver lobe,left liver lobe and caudate lobe were respectively detected in 14,7 and 1 patients.① Plain and enhanced scans of CT:tumors of 22 patients showed low density.Twenty patients had clear boundary of tumor and 2 had an unclear boundary.Tumors of 22 patients demonstrated obvious enhancement in arterial phase by enhanced scans of CT,including fast-in and slow-out enhancement in 10 patients and fast-in and fast-out enhancement in 12 patients.The draining veins inside tumors were detected in 12 patients in early arterial phase by enhanced scans of CT.The dilated blood vessels inside tumors were found in 12 patients.The ring enhancement of tumor margin was detected in 16 patients,with formation of small blood vessels involving tumor blood supply.② MRI scan:tumors of 6 patients presented as low signal on T1WI and high signal on T2WI.Of 6 patients,5 had clear boundary of tumor and 1 had an unclear boundary.Tumors of 6 patients demonstrated obvious enhancement in arterial phase by enhanced scans of MRI,with a fast-in and fast-out enhancement.The draining veins inside tumors were detected in 3 patients in early arterial phase by enhanced scans of MRI.The dilated blood vessels inside tumors were found in 1 patient.The persistent ring enhancement of tumor margin was detected in 5 patients,with formation of small blood vessels.All the lesions of 6 patients using GD-EOB-DTPA MR contrast-enhanced scan demonstrated restricted diffusion with a high b value (b=800 s/mm2),an average apparent diffusion coefficient of 1.549× 10-3 mm2/s (1.209× 10-3-1.796× 10-3 mm2/s) and low a signal in liver phase.(2) Diagnostic consistency of 2 radiologists:there were good diagnostic consistencies of 2 radiologists in tumor location,density,T1WI,T2WI,bleeding,enhancement method and dilated blood vessels (κ=1.00,1.00,1.00,1.00,0.82,0.82,P＜0.05).There were normal diagnostic consistencies of 2 radiologists in tumor fat,calcification,component of cystolization,boundary,draining veins and enhancement of tumor margin (κ =0.46,0.45,0.64,0.54,P＜0.05).(3) Results of pathological examination:results of pathological examination of tumors from surgical resection of 17 patients and liver puncture of 5 patients showed that smooth muscle cells were the major components,and thick-walled vessels were found in the tumor of 12 patients.Results of immunohistochemical staining showed that anti melanoma specific monoclonal antibody (HMB-45) was positive.Conclusion The persistent enhancement of tumor margin,draining veins in early arterial phase by enhanced scans and dilated blood vessels might play roles in diagnosis of MHAML.
ABSTRACT
OBJECTIVE: To quantitatively measure hepatic fibrosis on gadoxetic acid-enhanced magnetic resonance (MR) in chronic hepatitis B (CHB) patients and identify the correlations with aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) values. MATERIALS AND METHODS: This study on gadoxetic acid-enhanced 3T MR imaging included 81 patients with CHB infection. To quantitatively measure hepatic fibrosis, MR images were analyzed with an aim to identify inhomogeneous signal intensities calculated from a coefficient of variation (CV) map in the liver parenchyma. We also carried out a comparative analysis between APRI and FIB-4 based on metaregression results. The diagnostic performance of the CV map was evaluated using a receiver-operating characteristic (ROC) curve. RESULTS: In the MR images, the mean CV values in control, groups I, II, and III based on APRI were 4.08 ± 0.92, 4.24 ± 0.80, 5.64 ± 1.11, and 5.73 ± 1.28, respectively (p < 0.001). In CHB patients grouped by FIB-4, the mean CV values of groups A, B, and C were 4.22 ± 0.95, 5.40 ± 1.19, and 5.71 ± 1.17, respectively (p < 0.001). The mean CV values correlated well with APRI (r = 0.392, p < 0.001) and FIB-4 (r = 0.294, p < 0.001). In significant fibrosis group, ROC curve analysis yielded an area under the curve of 0.875 using APRI and 0.831 using FIB-4 in HB, respectively. CONCLUSION: Gadoxetic acid-enhanced MR imaging for calculating a CV map showed moderate correlation with APRI and FIB-4 values and could be employed to quantitatively measure hepatic fibrosis in patients with CHB.
Subject(s)
Humans , Aspartate Aminotransferases , Aspartic Acid , Blood Platelets , Fibrosis , Hepatitis B, Chronic , Hepatitis, Chronic , Liver , Magnetic Resonance Imaging , ROC CurveABSTRACT
Purpose It has been demonstrated that hepatocytes uptake of Gd-EOB-DTPA obviously decreased,which would result in decreased liver-to-lesion contrast.Therefore,this study was to evaluate the potential of increasing flip angle to improve the image quality of Gd-EOB-DTPA enhanced MR.Materials and Methods A total of 114 patients with focal liver lesions (FLLs),who underwent Gd-EOB-DTPA-enhanced MR of the liver,were enrolled in this retrospective study.39 patients were noncirrhotic group,36 patients were Child-Pugh A group,23 patients were Child-Pugh B group,and 16 patients were ChildPugh C group.Tl-weighted with fat suppression volume interpolated breath hold examination (VIBE) sequence was acquired before and 5 min,10 min,15 min,20 min after the administration of Gd-EOB-DTPA with both conventional low FA (9 °) and high FA (27 °) protocols separately.Signal to noise ratio (SNR),liver to lesion contrast (LLC),the liver to lesion SI ratio (LLSIR) were calculated and analyzed between low and high FA protocol images in each group and each scan time.Results The LLC and LLSIR on GdEOB-DTPA-enhanced MR images using a high FA (27 °) protocol were significantly higher in comparison with the conventional low FA (9°).In Child B group and Child C group,the LLC and the LLSIR with low FA significantly reduced during 15～20 min after contrast agent injection,however with high FA,the value of LLC and LLSIR tended to be horizontal.Conclusion A high FA protocol in comparison with the conventional 9° FA can obviously improve the image quality,which is reliable for liver lesion depiction on GdEOB-DTPA-enhanced MR images,especially to those with severe liver cirrhosis.
ABSTRACT
With the developments of digital medicine, Gd-EOB-DTPA enhanced magnetic resonance imaging, molecular imaging and optical/acoustic multi-modality imaging, the hepatopancreatobiliary surgery have entered the era of precise diagnosis and treatment.Bidimensional pattern of disease diagnosis and treatment is developing toward three-dimensional pattern, which make the diagnosis and treatment more comprehensive and clear.Morphological imaging is gradually developing towards molecular imaging.Ultimately, the goal of truly precise diagnosis and accurate treatment will be achieved.
ABSTRACT
Gd-EOB-DTPA, a newly applicable hepatocyte-specific contrast agent, is excreted through the biliary tract and the kidney, showing the characteristics of nonspecific extracellular contrast agent and hepatocyte-specific contrast agent. It can provide both dynamic and hepatobiliary images and has been rapidly accepted by clinicians for the diagnosis of liver lesions and preoperative evaluation. Gd-EOB-DTPA can fulfill hepatic perfusion imaging, cholangiography, detection and characterization of focal liver lesions, and evaluation of liver function within the same examination in a relatively short time window. A large number of domestic and foreign studies have confirmed that hepatobiliary-specific contrast-enhanced MRI is significantly superior to MRI scan, contrast-enhanced CT, and ultrasound in diagnosing hepatocellular carcinoma, especially small hepatocellular carcinoma. The features of Gd-EOB-DTPA and its current status and prospect of application in the preoperative evaluation of hepatocellular carcinoma are reviewed in this article.
ABSTRACT
OBJECTIVE: To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE). MATERIALS AND METHODS: In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE. RESULTS: Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023). CONCLUSION: Relative enhancement imaging can be used to estimate FRL function after PVE.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Embolization, Therapeutic/methods , Gadolinium DTPA , Hepatectomy/methods , Indocyanine Green/pharmacokinetics , Liver/pathology , Liver Neoplasms/surgery , Magnetic Resonance Imaging/methods , Portal Vein/pathology , Regression Analysis , Retrospective Studies , Treatment OutcomeABSTRACT
Supradiaphragmatic liver is a rare condition. Establishing an accurate preoperative diagnosis is difficult. Operative exploration is necessary to differentiate this lesion from intrathoracic masses, such as a pleural based tumor, diaphragmatic tumor and peripheral lung tumor. However, with the aid of the hepatocyte-specific magnetic resonance imaging contrast agent, gadoxetic acid (Gd-EOB-DTPA), functional hepatocytes in the lesion can be identified in the hepatobiliary phase, potentially allowing an accurate and non-invasive diagnosis. We report a case of supradiaphragmatic liver diagnosed by Gd-EOB-DTPA-enhanced magnetic resonance imaging.
Subject(s)
Diagnosis , Hepatocytes , Liver , Lung , Magnetic Resonance ImagingABSTRACT
Image findings of hepatic lymphoma have been reported as variable, ranging from single or multiple small nodules to diffuse infiltrative patterns. On MRI, most hepatic lymphomas show T1 low signal intensity, T2 high signal intensity. Dynamic imaging reveals a hypointense appearance in the arterial phase, followed by delayed enhancement in the portal venous and transitional phase. In the hepatobiliary phase using a hepatocyte-specific contrast agent (which have recently aided in increasing the access to the focal liver lesions), hepatic lymphoma is known to exhibit low signal intensity. We report a case of hepatic lymphoma, which shows iso-signal intensity on hepatobiliary phase, using gadoxetic acid (Gd-EOB-DTPA).
Subject(s)
Liver , Lymphoma , Magnetic Resonance ImagingABSTRACT
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.