Hepatic hemangiomas: difference in enhancement pattern on 3T MR imaging with gadobenate dimeglumine versus gadoxetate disodium

Purpose

To compare intraindividual differences in enhancement pattern of hepatic hemangiomas between gadobenate dimeglumine (Gd-BOPTA) and gadoxetate disodium (Gd-EOB-DTPA)-enhanced 3T MR imaging.

Materials and methods

This is a HIPAA-compliant, IRB-approved retrospective study with waiver for informed consent granted. From 10/07 to 5/09, 10 patients (2 males, 8 females; mean age, 57.3 years) with 15 hepatic hemangiomas (mean diameter, 4.4 ± 5.6 cm) underwent both Gd-BOPTA- and Gd-EOB-DTPA-enhanced 3T MR imaging (mean interval, 266 days; range, 38–462 days). Diagnosis of hemangioma was based on strict imaging criteria. MR imaging was obtained during three arterial, portal venous, and up to four delayed phases. During each phase, hemangioma-to-liver contrast-to-noise ratio (CNR) was measured for each lesion on both examinations. Statistical analysis was performed using paired Student's t-test.

Results

Hemangioma-to-liver CNR peaked during the portal venous phase (Gd-BOPTA: 48.9 ± 65.8, Gd-EOB-DTPA: 0.7 ± 3.8). During all imaging phases except the first arterial phase, hemangioma-to-liver CNR was significantly lower on Gd-EOB-DTPA-enhanced compared to Gd-BOPTA-enhanced MR images (p < 0.05). Notably, Gd-EOB-DTPA yielded negative hemangioma-to-liver CNR (−2.5 ± 2.4) compared to Gd-BOPTA (40.7 ± 56.4) during the first delayed phase (7–8 min after contrast administration), remaining negative for the rest of the delayed phases (up to 26 min after contrast administration).

Conclusion

The enhancement patterns of hepatic hemangiomas differs significantly between Gd-BOPTA and Gd-EOB-DTPA-enhanced 3T MR imaging. The smaller dose, shorter plasma half-life, and increased hepatobiliary uptake of Gd-EOB-DTPA leads to a negative CNR of hemangioma-to-liver on delayed phases and could create an imaging pitfall with this agent.     

Relationship between signal intensity on hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging and prognosis of borderline lesions of hepatocellular carcinoma

Purpose

To elucidate the incidence of signal intensity patterns of borderline lesions of hepatocellular carcinoma (HCC) on hepatobiliary phase Gd-EOB-DTPA (EOB) enhanced MRI and clarify the natural histories of these lesions.

Materials and methods

Total 99 borderline lesions of HCC were identified by angiography-assisted CT. The signal intensity of borderline lesions on hepatobiliary phase of EOB-enhanced MRI was analyzed. Progress rate from borderline lesions to hypervascular HCC was calculated with the Kaplan–Meier method among each signal intensity groups of nodules.

Results

On hepatobiliary phase of EOB-enhanced MRI, 41.4% of the borderline lesions showed hypo-, 42.4% showed iso-, and 16.2% showed hyperintense, compared to background liver. Overall progress rates from borderline lesions to HCC were 10% in 1-year, 14% in 2-year and 20% in 3-year follow-up period. Progress rates to HCC in hypointense borderline lesions were 17% in 1-year, 28% in 2-year and 41% in 3-year follow-up period, and in isointense borderline lesions were 7% in 1-year, 7% in 2-year and 7% in 3-year follow-up period. No hyperintense borderline lesions progressed to HCC in follow-up period.

Conclusion

Although borderline lesions of HCC may show hypo-, iso- and hyperintensity on hepatobiliary phase of EOB-enhanced MRI, hypointense borderline lesions are high risk to progress HCC.     

Relaxivity of Gd-EOB-DTPA in the normal and biliary obstructed guinea pig

After injection of Gd-EOB-DTPA, T1 and T2 were determined on a clinical MR scanner (1.5 T) in the liver and kidneys of sacrificed but intact guinea pigs with normal and obstructed biliary systems and in bile, urine, and blood collected postmortem. Tissue [Gd] was determined by radioassay of ¹⁵³Gd and relaxivities (R1 and R2; units of s^?1·mmol^?1·kg) of Gd-EOB-DTPA calculated. Compared with R1 in 2% agarose gel (4.49 ± 0.03), in normal animals R1 was increased in liver (9.3 ± 0.5), similar in kidney cortex (4.1 ± 0.5), but reduced in kidney medulla (2.5 ± 0.4) and papilla (2.7 ± 0.4). Chronic biliary obstruction did not change R1 in liver (9.7 ± 4.3) but reduced R1 further in kidney tissues (1.0–0.4). In normal animals, R2 values of all tissues (9.5–18.4) were greater than R2 in gel (5.72 ± 0.12). Biliary obstruction possibly elevated R2 in liver (40.1 ± 63.5), severely depressed R2 in kidney cortex (?4.2 ± 6.2) and medulla (?2.3 ± 5.4), and reduced R2 in papilla (5.4 ± 4.6). Obstruction had little effect on R1 and R2 in bile and urine. Water content, macromolecular binding, microviscosity, compartmentalization, and susceptibility effects can readily account for the R1 and R2 observed in liver and kidney. Negative R2 could be a result of several factors, including reduced endogenous magnetic field gradients due to “susceptibility matching” as [Gd] increased, changes in tissue T2 with period of ligation, or a physiological effect of EOB-DTPA. These results show that disease can alter both R1 and R2 from their values in normal tissues.     

Measuring hepatic functional reserve using T1 mapping of Gd-EOB-DTPA enhanced 3T MR imaging: A preliminary study comparing with 99mTc GSA scintigraphy and signal intensity based parameters

PurposeTo determine the utility of liver T1-mapping on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance (MR) imaging for the measurement of liver functional reserve compared with the signal intensity (SI) based parameters, technetium-99m-galactosyl serum albumin (^99mTc-GSA) scintigraphy and indocyanine green (ICG) clearance.Materials and methodsThis retrospective study included 111 patients (Child-Pugh-A 90; −B 21) performed with both Gd-EOB-DTPA enhanced liver MR imaging and ^99mTc-GSA (76 patients with ICG). Receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic performances of T1-relaxation-time parameters [pre-(T1pre) and post-contrast (T1hb) Gd-EOB-DTPA], SI based parameters [relative enhancement (RE), liver-to-muscle-ratio (LMR), liver-to-spleen-ratio (LSR)] and ^99mTc-GSA scintigraphy blood clearance index (HH15)] for Child-Pugh classification. Pearson’s correlation was used for comparisons among T1-relaxation-time parameters, SI-based parameters, HH15 and ICG.ResultsA significant difference was obtained for Child-Pugh classification with T1hb, ΔT1, all SI based parameters and HH15. T1hb had the highest AUC followed by RE, LMR, LSR, ΔT1, HH15 and T1pre. The correlation coefficients with HH15 were T1pre 0.22, T1hb 0.53, ΔT1 −0.38 of T1 relaxation parameters; RE −0.44, LMR −0.45, LSR −0.43 of SI-based parameters. T1hb was highest for correlation with HH15. The correlation coefficients with ICG were T1pre 0.29, T1hb 0.64, ΔT1 −0.42 of T1 relaxation parameters; RE −0.50, LMR −0.61, LSR −0.58 of SI-based parameters; 0.64 of HH15. Both T1hb and HH15 were highest for correlation with ICG.ConclusionT1 relaxation time at post-contrast of Gd-EOB-DTPA (T1hb) was strongly correlated with ICG clearance and moderately correlated HH15 with ^99mTc-GSA. T1hb has the potential to provide robust parameter of liver functional reserve.     

Optimization of hepatobiliary phase delay time of Gd-EOB-DTPA-enhanced magnetic resonance imaging for identification of hepatocellular carcinoma in patients with cirrhosis of different degrees of severity

AIM To optimize the hepatobiliary phase delay time(HBPDT) of Gd-EOB-DTPA-enhanced magnetic resonance imaging(GED-MRI) for more efficient identification of hepatocellular carcinoma(HCC) occurring in different degrees of cirrhosis assessed by Child-Pugh(CP) score.METHODS The liver parenchyma signal intensity(LPSI), the liver parenchyma(LP)/HCC signal ratios, and the visibility of HCC at HBP-DT of 5, 10, 15, 20, and 25 min(i.e., DT-5, DT-10, DT-15, DT-20, and DT-25) after injection of GdEOB-DTPA were collected and analyzed in 73 patients with cirrhosis of different degrees of severity(including 42 patients suffering from HCC) and 18 healthy adult controls.RESULTS The LPSI increased with HBP-DT more significantly in the healthy group than in the cirrhosis group(F = 17.361, P 0.001). The LP/HCC signal ratios had a significant difference(F = 12.453, P 0.001) among various HBP-DT points, as well as between CP-A and CP-B/C subgroups(F = 9.761, P 0.001). The constituent ratios of HCC foci identified as obvious hypointensity(+++), moderate hypointensity(++), and mild hypointensity or isointensity(+/-) kept stable from DT-10 to DT-25: 90.6%, 9.4%, and 0.0% in the CP-A subgroup; 50.0%, 50.0%, and 0.0% in the CP-B subgroup; and 0.0%, 0.0%, and 100.0% in the CP-C subgroup, respectively.CONCLUSION The severity of liver cirrhosis has significant negative influence on the HCC visualization by GED-MRI. DT-10 is more efficient and practical than other HBP-DT points to identify most of HCC foci emerging in CP-A cirrhosis, as well as in CP-B cirrhosis; but an HBP-DT of 15 min or longer seems more appropriate than DT-10 for visualization of HCC in patients with CP-C cirrhosis.     

钆塞酸二钠增强磁共振成像对小肝癌术后复发的预测价值

目的:探讨钆塞酸二钠增强磁共振(MRI)序列肝胆特异期的影像形态学征象及定量参数对肝细胞肝癌术后复发的预测价值。方法:回顾性纳入88例术前行钆塞酸二钠增强磁共振检查且术后病理证实为肝细胞肝癌(直径3 cm)的患者临床资料,多因素回归分析筛选与术后复发相关的影像特征,并比较不同影像征象组患者术后复发率的差异。结果:定量分析结果表明:MRI肝胆特异期肿瘤与肝实质对比度、肿瘤对比增强率均与肝癌术后复发相关(P0.05)。多因素Cox回归分析显示肝胆特异期肿瘤边界不规则(HR=4.07,P=0.001)、肿瘤对比增强率(HR=0.97,P=0.014)与肝癌的术后复发独立相关。肿瘤边界不规则组较边界规则组患者术后复发率高(P=0.002),肿瘤低对比增强率组较高对比增强率组患者复发率高(P0.001)。结论:钆塞酸二钠增强磁共振成像肝胆特异期肿瘤边界、肿瘤对比增强率与肝癌患者术后复发相关。     

钆塞酸二钠增强MRI特征对肝细胞癌微血管侵犯的预测价值

目的 探讨术前钆塞酸二钠增强MRI特征预测肝细胞癌（HCC）微血管侵犯（MVI）的价值。 方法 回顾性分析83例经手术病理确诊的HCC病人的术前影像及临床资料,其中男75例,女8例,平均（57.6±11.4）岁。所有病人均进行了MRI平扫和增强检查,分析其常规MRI征象和肝胆期征象。根据术后病理结果将病人分为MVI阳性组30例及MVI阴性组53例。采用t检验或χ²检验比较2组间临床和影像特征的差异,将差异有统计学意义的特征纳入多因素Logistic回归分析,获得独立危险因素后分别建立单独预测模型及联合预测模型,采用受试者操作特征曲线评估不同模型的预测效能,计算其曲线下面积（AUC）,并采用DeLong检验比较不同模型预测MVI的AUC。 结果 与MVI阴性组相比,MVI阳性组的肝胆期肿瘤最大径、瘤周晕征、肿瘤边缘分型中的单结节外突/多结节融合型占比均更高,肿瘤信号强度比值较低;常规MRI征象中包膜不完整性、瘤周强化的占比更高;AFP水平大于MVI阴性组（均P<0.05）。多因素Logistic回归分析显示肝胆期的肿瘤最大径、瘤周晕征和单结节外突/多结节融合型均为HCC MVI的独立危险因素（OR值分别为1.424、26.998、6.144,均P<0.05）,肿瘤最大径越大、瘤周晕征阳性及单结节外突/多结节融合型表现的病人发生MVI的风险越高。联合预测模型、肿瘤最大径模型、单结节外突/多结节融合型模型和瘤周晕征模型预测MVI的AUC分别为0.926、0.803、0.792、0.823。联合模型预测MVI的敏感度、特异度和AUC值均最高,且AUC值分别高于肿瘤最大径模型、单结节外突/多结节融合型模型和瘤周晕征模型（均P<0.05）。 结论 钆塞酸二钠增强MRI上肿瘤最大径、单结节外突/多结节融合型和肝胆期瘤周晕征是预测MVI的独立危险因素,且三者联合预测效能更高。     

钆塞酸二钠增强MRI引导肝脏病灶穿刺活检的可行性

目的 观察钆塞酸二钠（Gd-EOB-DTPA）增强MRI用于引导肝脏病灶穿刺活检的可行性。方法 对15例肝脏病变患者行Gd-EOB-DTPA增强MRI引导下穿刺活检,统计总操作时间及技术成功率（以取样标本满足病理、基因等检测要求为技术成功）,观察术中及术后并发症。以手术病理或随访结果为标准,评估MRI引导肝脏病灶穿刺活检的诊断效能。结果 于Gd-EOB-DTPA增强MRI引导下穿刺15个肝脏病灶,均一次穿刺成功,病灶最大径0.40~2.81 cm,平均（1.58±0.69） cm;肝胆期MRI 13个病灶呈明显低信号、2个呈稍低信号,图像质量均满足操作要求;技术成功率100%（15/15）;总操作时间33~54 min,平均（40.33±6.56） min。5例术中见少量针道渗血,沿针道推入明胶海绵条后止血;其余10例术中、术后均未出现并发症。穿刺标本病理诊断10例肝细胞癌（HCC）、1例结肠癌肝转移、1例肝腺瘤及3例肝脏不典型增生结节伴轻度肝硬化,其中1例穿刺病理结果为肝脏不典型增生结节伴轻度肝硬化者术后病理结果为早期小HCC,其余穿刺病灶病理诊断均与最终临床诊断一致。MRI引导肝脏病灶穿刺活检的诊断敏感度为91.67%（11/12）,特异度为100%（3/3）,准确率为93.33%（14/15）。结论 Gd-EOB-DTPA增强MRI用于引导肝脏病灶穿刺活检安全、可行。     

钆塞酸二钠增强磁共振和弥散加权成像诊断肝细胞癌TACE术后 存活或复发病灶的价值

目的:探究钆塞酸二钠（Gd-EOB-DTPA）增强磁共振（MRI）和弥散加权成像（DWI）诊断肝细胞癌（HCC）经导管肝 动脉化疗栓塞（TACE）术后存活或复发病灶的价值。方法:前瞻性连续纳入初次接受TACE治疗的96 例患者的129 个 HCC病灶。以CT 和/或MRI 随访，手术病理为诊断金标准，探究Gd-EOB-DTPA增强MRI 和DWI 对TACE术后1~2 月 HCC病灶存活或复发的诊断准确性，并采用ROC曲线分析ADC值对存活或复发病灶的鉴别诊断价值。运用卡方检验分 析T1WI信号、T2WI信号、形态、包膜、DWI信号、动脉期增强表现及肝特异期信号判断TACE术后存活或复发的价值。结 果:（1）金标准证实TACE术后存活病灶29个，肝内复发病灶18个，完全坏死病灶82个；（2）TACE术后HCC存活或复发病 灶多呈现出T1WI 低信号、T2WI 高信号、DWI 高信号的表现，89.36%（42/47）病灶动脉期强化，91.49%（43/47）肝细胞期未 见造影剂摄取呈低信号；（3）Gd-EOB-DTPA增强MRI 和DWI 诊断TACE术后存活或复发病灶的敏感度、特异度分别为 93.62%和91.49%、96.34%和95.12%，两者联合诊断的敏感度和特异度为95.74%、100.00%；（4）病灶无包膜、DWI高信号、 动脉期增强是判断TACE术后存活或复发的独立重要因素（P<0.05）。结论:Gd-EOB-DTPA增强MRI和DWI对TACE术 后HCC存活或复发病灶具有较高的诊断价值，可应用于TACE术后临床随访。     

肝脏乏血供病变的Gd-EOB-DTPA MRI表现

由于肝脏乏血供病变的常规影像表现相似,故术前对病变的良恶性鉴别诊断有一定困难。MRI是肝脏病变诊断最有价值的成像方法,利用非特异性细胞外对比剂钆塞酸二钠（Gd-EOB-DTPA）在肝胆期可以被肝细胞特异性摄取的特点,能够提高病变的检出率和诊断准确性。就多种肝脏乏血供良恶性病变的病生理特点及Gd-EOB-DTPA的MR影像征象予以综述。