Detection of hepatocellular carcinoma (HCC) using super paramagnetic iron oxide (SPIO)‐enhanced MRI: Added value of diffusion‐weighted imaging (DWI)

Purpose:

To evaluate whether diffusion‐weighted imaging (DWI) improves the detection of hepatocellular carcinoma (HCC) on super paramagnetic iron oxide (SPIO)‐enhanced MRI.

Materials and Methods:

This retrospective study group consisted of 30 patients with 50 HCC nodules who underwent MRI at 1.5 Tesla. Two combined MR sequence sets were compared for detecting HCC: SPIO‐enhanced MRI (axial T2‐weighted fast spin‐echo (FSE) and T1‐/T2*‐weighted fast field echo (FFE) scanned before and after administration of ferucarbotran) and SPIO‐enhanced MRI + DWI (SPIO‐enhanced MRI with axial DWI scanned before and after administration of ferucarbotran). Three blinded readers independently reviewed for the presence of HCC on a segment‐by‐segment basis using a four‐point confidence scale. The performance of the two combined MR sequence sets was evaluated using receiver operating characteristic (ROC) analysis.

Results:

The average area under the ROC curve (Az) of the three readers for the SPIO‐enhanced MRI + DWI set (0.870 ± 0.046) was significantly higher that that for the SPIO‐enhanced MRI set (0.820 ± 0.055) (P = .025). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of HCC were 66.0%, 98.0%, 90.0%, and 91.4%, respectively, for the SPIO‐enhanced MRI set, and 70.0%, 98.6%, 92.9%, and 92.4%, respectively, for the SPIO‐enhanced MRI + DWI set.

Conclusion:

The SPIO‐enhanced MRI + DWI set outperformed the SPIO‐enhanced MRI set for depicting HCC. J. Magn. Reson. Imaging 2010; 31: 373–382. © 2010 Wiley‐Liss, Inc.     

High‐b‐value diffusion‐weighted MR imaging of hepatocellular lesions: Estimation of grade of malignancy of hepatocellular carcinoma

Purpose:

To evaluate the effectiveness of diffusion‐weighted magnetic resonance imaging (DWI) in estimating the grade of malignancy of hepatocellular carcinoma.

Materials and Methods:

Dynamic contrast‐enhanced computed tomography (CE‐CT) and DWI (b value, 1000 s/mm²) were performed on 73 patients. Using DW images, the lesions were classified as “visible” or “invisible.” The apparent diffusion coefficient (ADC) of the lesions was measured. Furthermore, the lesions were classified as hypervascular or iso‐hypovascular using arterial phase CE‐CT images. The image findings for each lesion type were compared.

Results:

The 73 patients had 98 hepatocellular lesions, of which 12 were histologically diagnosed as dysplastic nodules; 39, well‐differentiated HCCs; 33, moderately differentiated HCCs; and 14, poorly differentiated HCCs. The mean ADC values of moderately poorly‐differentiated HCCs were significantly lower than well‐differentiated HCCs and dysplastic nodules (P < 0.01). On DW images, >90% of moderately (30/33) and poorly differentiated HCCs (13/14) were visible, while 51% of well‐differentiated HCCs (20/39) and all dysplastic nodules were invisible. Of 22 iso‐hypovascular lesions, 4 were visible on DW images and were poorly differentiated HCCs, whereas 18 were invisible and were dysplastic nodules (12/18) or well‐differentiated HCCs (6/18).

Conclusion:

A combination of hypovascularity and visibility on DW images can help distinguish poorly differentiated HCCs from low‐grade hepatocellular lesions (dysplastic nodules and well‐differentiated HCCs). J. Magn. Reson. Imaging 2009;30:1005–1011. © 2009 Wiley‐Liss, Inc.     

Effect of superparamagnetic iron oxide on tumor‐to‐liver contrast at T2*‐weighted gradient‐echo MRI: Comparison between 3.0T and 1.5T MR systems

Purpose

To compare 3.0T and 1.5T MR systems in terms of the effect of superparamagnetic iron oxide (SPIO) on tumor‐to‐liver contrast in T2*‐weighted gradient‐echo MRI.

Materials and Methods

SPIO‐enhanced gradient‐echo MR images of the liver with four different TEs (3, 5.3, 6.5, and 8.5 msec) were obtained by means of 1.5T and 3.0T systems. Quantitative analyses of relative signal intensities (SIs) and relative tumor contrast and qualitative analyses of image quality and lesion conspicuity of the liver were performed in 22 patients, 16 of whom had malignant liver tumors.

Results

With both 1.5T and 3.0T, at TE = 8.4 msec, the relative SI of liver and relative tumor contrast were significantly (P < 0.01) lower and higher, respectively, than that for any of the other TEs. There were no significant differences in the relative SI of the liver, relative tumor contrast, image quality, and tumor conspicuity for the same TE between the 1.5T and 3.0T systems.

Conclusion

Our results showed that the effect of SPIO on tumor‐to‐liver contrast at T2*‐weighted gradient‐echo imaging was similar for the 1.5T and 3.0T systems, and that the 8.4‐msec TE was optimal of the four TEs used in this study at 3.0T. J. Magn. Reson. Imaging 2009;29:595–600. © 2009 Wiley‐Liss, Inc.     

Comparison of ferucarbotran‐enhanced fluid‐attenuated inversion‐recovery echo‐planar,T2‐weighted turbo spin‐echo,T2*‐weighted gradient‐echo,and diffusion‐weighted echo‐planar imaging for detection of malignant liver lesions

Purpose:

To compare the diagnostic accuracy of superparamagnetic iron oxide (SPIO)‐enhanced fluid‐attenuated inversion‐recovery echo‐planar imaging (FLAIR EPI) for malignant liver tumors with that of T2‐weighted turbo spin‐echo (TSE), T2*‐weighted gradient‐echo (GRE), and diffusion‐weighted echo‐planar imaging (DW EPI).

Materials and Methods:

SPIO‐enhanced magnetic resonance imaging (MRI) that included FLAIR EPI, T2‐weighted TSE, T2*‐weighted GRE, and DW EPI sequences was performed using a 3 T system in 54 consecutive patients who underwent surgical exploration with intraoperative ultrasonography. A total of 88 malignant liver tumors were evaluated. Images were reviewed independently by two blinded observers who used a 5‐point confidence scale to identify lesions. Results were correlated with results of histopathologic findings and surgical exploration with intraoperative ultrasonography. The accuracy of each MRI sequence was measured with jackknife alternative free‐response receiver operating characteristic analysis. The sensitivity of each observer with each MRI sequence was compared with McNemar's test.

Results:

Accuracy values were significantly higher with FLAIR EPI sequence (0.93) than with T2*‐weighted GRE (0.80) or DW EPI sequences (0.80) (P < 0.05). Sensitivity was significantly higher with the FLAIR EPI sequence than with any of the other sequences.

Conclusion:

SPIO‐enhanced FLAIR EPI sequence was more accurate in the diagnosis of malignant liver tumors than T2*‐weighted GRE and DW EPI sequences. SPIO‐enhanced FLAIR EPI sequence is helpful for the detection of malignant liver tumors. J. Magn. Reson. Imaging 2010;31:607–616. ©2010 Wiley‐Liss, Inc.     

Characterization of hyperintense nodules on precontrast T1-weighted MRI: utility of gadoxetic acid-enhanced hepatocyte-phase imaging

Purpose:

To evaluate the utility of gadoxetic acid‐enhanced hepatocyte‐phase magnetic resonance imaging (MRI) in characterization of T1‐weighted hyperintense nodules within cirrhotic liver.

Materials and Methods:

This retrospective study was approved by our Institutional Review Board. Thirty‐four nodules hyperintense in unenhanced T1‐weighted MRI with histopathological confirmation from a collection of 19 patients were included. Tumor size, signal intensity on T1‐weighted, and T2‐weighted imaging as well as enhancement patterns on contrast‐enhanced dynamic/hepatocyte‐phase imaging were recorded. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of hepatocyte‐phase imaging.

Results:

Evaluation of the nodules with standard of reference revealed 15 dysplastic nodules (DN), seven well‐differentiated hepatocellular carcinomas (wHCC), and 12 moderately differentiated HCCs (mHCC). The mean size of dysplastic nodules was smaller than that of HCCs (P < 0.001). Using the HCC criteria (T2W or arterial enhancement followed with portal venous washout), 11/19 HCC were correctly characterized. Using solely hypointensity (compared to the surrounding liver parenchyma) during the hepatocyte phase as the criterion, 18/19 HCC were correctly characterized. There were seven additional HCCs diagnosed with hepatocyte‐phase imaging (P = 0.02).

Conclusion:

Gadoxetic acid‐enhanced MRI with hepatocyte‐phase imaging is superior to gadoxetic acid‐enhanced MRI with conventional criteria alone in characterization of T1W hyperintense nodules. J. Magn. Reson. Imaging 2011;33:625–632. © 2011 Wiley‐Liss, Inc.     

Hepatocellular carcinoma with marginal superparamagnetic iron oxide uptake on T2*-weighted magnetic resonance imaging: histopathologic correlation

Purpose

To evaluate the characteristics of hepatocellular carcinomas (HCCs) with marginal superparamagnetic iron oxide (SPIO) uptake on T2*-weighted MRI.

Materials and methods

The study group consisted of 73 patients with 83 surgically resected HCCs. Preoperative SPIO-enhanced MRI studies were retrospectively reviewed. Marginal SPIO uptake was considered positive if a rim-like or band-like low intensity area was present on SPIO-enhanced T2*-weighted images. The prevalence of marginal SPIO uptake was evaluated. Pathological specimens with hematoxylin and eosin staining and immunohistochemical staining of CD68 were reviewed in HCCs with marginal SPIO uptake and 33 HCCs without marginal SPIO uptake (control group).

Results

Ten of 83 (12%) HCCs showed marginal SPIO uptake. All HCCs were hypervascular, and only one nodule showed a nodule-in-nodule appearance on imaging findings. The pathology specimens suggested possible causes of marginal SPIO uptake, including marginal macrophage infiltration in moderately or poorly differentiated HCC (n = 4), residual normal hepatic tissue at the marginal area of confluent multinodular or single nodular with extranodular growth type HCC (n = 3), and a well-differentiated HCC component in nodule-in-nodule type HCC (n = 3). Marginal macrophage infiltration was not seen in the control group.

Conclusion

SPIO-enhanced MRI may be able to demonstrate marginal macrophage infiltration in HCC.     

Magnetic resonance imaging enhanced by superparamagnetic iron oxide particles: Usefulness for distinguishing between focused ultrasound‐induced blood–brain barrier disruption and brain hemorrhage

Purpose

To investigate the usefulness of a fully flow‐compensated heavy T2*‐weighted imaging enhanced by superparamagnetic iron oxide (SPIO) particles for distinguishing between focused ultrasound‐induced disruption of blood–brain barrier (BBB) and brain hemorrhage.

Materials and Methods

Focused ultrasound (frequency: 1.5 MHz) was used to induce disruption of the BBB in 39 rats. Two T2*‐weighted images were obtained before and after SPIO administration. Preenhanced T2*‐weighted images were used to detect hemorrhage. Detection of BBB disruption was performed on SPIO‐enhanced images. Thirty‐four rats were sacrificed after magnetic resonance (MR) scanning for histological confirmation of brain lesions. Theremaining five animals were followed up for 35 days. Prussian blue staining was performed on histological sections to detect SPIO particles in the brain.

Results

After SPIO injection the areas of BBB disruption in rat brain were significantly enlarged. The area of mismatch between the T2*‐weighted images indicated a safe region where BBB opening occurred without hemorrhagic complications. In the longitudinal study, removal of SPIO occurred at a faster rate in hemorrhagic areas, albeit being closer to that occurring in the liver. The presence of SPIO was confirmed by Prussian blue staining in brain parenchyma and capillary endothelial cells in areas of BBB disruption.

Conclusion

T2*‐weighted images—either with and without SPIO enhancement—may differentiate focused ultrasound‐induced BBB disruption from brain hemorrhage. J. Magn. Reson. Imaging 2009;29:31–38. © 2008 Wiley‐Liss, Inc.     

Detectability of hepatocellular carcinoma by gadoxetate disodium‐enhanced hepatic MRI: Tumor‐by‐tumor analysis in explant livers

Purpose:

To investigate the detectability of hepatocellular carcinoma (HCC) on Gd‐EOB‐enhanced MR images (Gd‐EOB‐MRI), we performed tumor‐by‐tumor analysis of pathologically confirmed tumors using explants from cirrhotic patients who had undergone liver transplantation.

Materials and Methods:

We studied 11 explanted livers and classified the tumor intensity during the arterial phase (AP) and the hepatobiliary phase (HBP) as low in HBP with early enhancement (EE) in AP (A), as high in HBP with EE in AP (B), as low in HBP without EE in AP (C), as high in HBP without EE in AP (D), and as iso‐intense in HBP with EE in AP (E). The diagnostic criteria for HCC were (i) pattern A and C, (ii) pattern A and E, (iii) pattern C and E, and (iv) patterns A, C, and E.

Results:

Of the 71 HCCs, 22 were not detected at MRI; of these, 9 were moderately differentiated and 13 were well‐differentiated HCCs. The sensitivity of Gd‐EOB‐MRI for diagnostic criteria 1, 2, 3, and 4 was 63.4%, 52.1%, 22.5%, and 69.0%.

Conclusion:

The maximum sensitivity of Gd‐EOB‐MRI for HCC was only 69.0% even when diagnostic criteria that included all previously reported HCC patterns were adopted. J. Magn. Reson. Imaging 2013;37:684—691. © 2012 Wiley Perioidicals, Inc.     

Gadoxetic acid-enhanced MRI findings of early hepatocellular carcinoma as defined by new histologic criteria

Purpose:

To describe the imaging features of early hepatocellular carcinoma (HCC) on gadoxetic acid‐enhanced MRI (Gd‐EOB‐MRI) in comparison with multidetector computed tomography (MDCT) examinations.

Materials and Methods:

We analyzed imaging findings of 19 pathologically proven early HCC lesions in 15 patients who underwent both MDCT and Gd‐EOB‐MRI at 3.0 Tesla (T) units before surgery. MRI included in‐phase and out‐of‐phase T1‐weighted dual‐echo gradient‐recalled‐echo sequences, dynamic T1‐weighted images before and after bolus injection of gadoxetic acid disodium, fat‐saturated T2‐weighted fast spin‐echo sequences, and T1‐weighted hepatobiliary phase images 20 min after contrast injection. Two radiologists retrospectively evaluated the signal intensities and enhancement features on MRI and MDCT.

Results:

None of the lesions displayed arterial enhancement and washout on MDCT. On Gd‐EOB‐MRI, six (32%) lesions showed T2‐hyperintensity, five (26%) lesions showed signal drop on opposed‐phase. Three lesions (16%) showed arterial enhancement and washout. Twelve (63%), 13 (68%), and 15 (79%) lesions were hypointense on hepatic venous, equilibrium, and hepatobiliary phase, respectively.

Conclusion:

Most early HCCs did not show arterial enhancement and washout pattern on both MDCT and Gd‐EOB‐MRI. Gd‐EOB‐MRI may provide several ancillary findings for diagnosis of early HCC such as decreased hepatobiliary uptake, T2 hyperintensity and signal drop in opposed phase. J. Magn. Reson. Imaging 2012;393‐398. © 2011 Wiley Periodicals, Inc.     

Added value of breathhold diffusion‐weighted MRI in detection of small hepatocellular carcinoma lesions compared with dynamic contrast‐enhanced MRI alone using receiver operating characteristic curve analysis

Purpose

To evaluate the added value of single‐breathhold diffusion‐weighted MRI (DWI) in detection of small hepatocellular carcinoma (HCC) lesions (≤2 cm) in patients with chronic liver disease, by comparing the detection sensitivity of combined DWI/conventional dynamic contrast‐enhanced (DCE)‐MRI to that of conventional DCE‐MRI alone.

Materials and Methods

A total of 37 patients with chronic liver diseases underwent abdominal MRI at 1.5T, including T1‐weighted imaging (T1WI), T2‐weighted imaging (T2WI), and 2D conventional DCE. For each patient study, axial DWI was performed with a single‐shot echo‐planar imaging (EPI) sequence using a modified sensitivity‐encoding (mSENSE) technique with b‐value of 500 seconds/mm². A total of 20–24 slices were obtained during a 15–17‐second breathhold. Two observers independently interpreted the combined DWI/conventional DCE‐MRI images and the conventional DCE‐MRI images alone in random order. For all small HCC lesions, the diagnostic performance using each imaging set was evaluated by receiver operating characteristic (ROC) curve analysis. Sensitivity and positive predictive values were also calculated and analyzed.

Results

A total of 47 small HCCs were confirmed as final result. The area under the ROC curve (Az) of combined DWI/conventional DCE‐MRI images (observer 1, 0.922; observer 2, 0.918) were statistically higher than those of conventional DCE‐MRI alone (observer 1, 0.809; observer 2, 0.778) for all small HCC lesions (P < 0.01). The lesion detection sensitivities using the combined technique for both observers were significantly higher than those using conventional DCE‐MRI alone (P < 0.01). The sensitivity values for two observers using the combined technique were 97.87% and those using conventional DCE‐MRI alone were 85.11% to 82.98%. The positive predictive values for two observers using the combined imaging technique (97.87%) were slightly higher than those using conventional DCE‐MRI alone (92.86–93.02%), but there was no significant difference between the two imaging sets.

Conclusion

Combined use of breathhold DWI with conventional DCE‐MRI helped to provide higher sensitivities than conventional DCE‐MRI alone in the detection of small HCC lesions in patients with chronic liver disease. J. Magn. Reson. Imaging 2009;29:341–349. © 2009 Wiley‐Liss, Inc.     

Different signal intensity at Gd-EOB-DTPA compared with Gd-DTPA-enhanced MRI in hepatocellular carcinoma transgenic mouse model in delayed phase hepatobiliary imaging

Purpose:

To evaluate hyperintense Gd‐DTPA‐ compared with hyper‐ and hypointense Gd‐EOB‐DTPA‐enhanced magnet resonance imaging (MRI) in c‐myc/TGFα transgenic mice for detecting hepatocellular carcinoma (HCC).

Materials And Methods:

Twenty HCC‐bearing transgenic mice with overexpression of the protooncogene c‐myc and transforming growth factor‐alpha (TGF‐α) were analyzed. MRI was performed using a 3‐T MRI scanner and an MRI coil. The imaging protocol included Gd‐DTPA‐ and Gd‐EOB‐DTPA‐enhanced T1‐weighted images. The statistically evaluated parameters are signal intensity (SI), signal intensity ratio (SIR), contrast‐to‐noise ratio (CNR), percentage enhancement (PE), and signal‐to‐noise ratio (SNR).

Results:

On Gd‐DTPA‐enhanced MRI compared with Gd‐EOB‐DTPA‐enhanced MRI, the SI of liver was 265.02 to 573.02 and of HCC 350.84 to either hyperintense with 757.1 or hypointense with 372.55 enhancement. Evaluated parameters were SNR of HCC 50.1 to 56.5/111.5 and SNR of liver parenchyma 37.8 to 85.8, SIR 1.32 to 1.31/0.64, CNR 12.2 to 26.1/?30.08 and PE 42.08% to 80.5/?98.2%, (P < 0.05).

Conclusion:

Gd‐EOB‐DTPA is superior to Gd‐DTPA for detecting HCC in contrast agent‐enhanced MRI in the c‐myc/TGFα transgenic mouse model and there was no difference between the hyperintense or hypointense appearance of HCC. Either way, HCCs can easily be distinguished from liver parenchyma in mice. J. Magn. Reson. Imaging 2012;35:1397–1402. © 2012 Wiley Periodicals, Inc.

     

Added value of diffusion‐weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas

Purpose

To investigate the additional value of diffusion‐weighted imaging (DWI) in the MRI assessment of perilesionally recurrent hepatocellular carcinomas (HCCs) after transcatheter arterial chemoembolization (TACE).

Materials and Methods

For gadopentetate dimeglumine‐enhanced multiphasic dynamic images with precontrast T1‐ and T2‐weighted images of 23 patients treated with TACE, two radiologists independently sorted the confidence levels for the presence of a viable tumor in the vicinity of the treated lesions into five grades. In another session, images from DWI (b factor = 50, 400, and 800 s/mm²) were added to the previously reviewed images and the same radiologists sorted the confidence levels.

Results

A total of 26 lesions (0.7–3.5 cm) from 16 patients were confirmed to be perilesional recurrences of HCC. The area under the receiver operating characteristic curve (A_z) for the second interpretation session (0.826) was not significantly different (P = 0.299) from that of the first session (0.859). The overall sensitivity was increased from 85% to 92%, but the specificity decreased from 65% to 50% after adding DWI.

Conclusion

The addition of DWI has the potential to improve sensitivity, but not the overall diagnostic accuracy, in the assessment of perilesional recurrence of HCCs after chemoembolization. J. Magn. Reson. Imaging 2009;30:153–160. © 2009 Wiley‐Liss, Inc.     

Arterial enhancing‐only nodules less than 2 cm in diameter in patients with liver cirrhosis: Predictors of hepatocellular carcinoma diagnosis on gadobenate dimeglumine‐enhanced mr imaging

Purpose:

To assess whether gadobenate dimeglumine (Gd‐BOPTA)‐enhanced MR imaging could predict hepatocellular carcinoma (HCC) diagnosis in small arterial enhancing‐only nodules detected by contrast‐enhanced computed tomography (CT) in patients with liver cirrhosis.

Materials and Methods:

We prospectively recruited 125 cirrhotic patients (67 males, and 58 females; age: 68 ± 12.36 years) with 151 small (<2 cm in diameter) arterial enhancing‐only nodules identified by contrast‐enhanced CT. All patients were scanned by MR imaging before and after Gd‐BOPTA injection during the hepatic arterial phase (HAP), portal venous phase (PVP), equilibrium phase (EP), and hepatobiliary phase (HP). Nodule characterization was based on reference imaging criteria (n = 29 nodules), follow‐up (n = 105), or histology (n = 17). Two radiologists (5 and 10 years experience) analyzed the MR images, and logistic regression was conducted to assess how well MR imaging findings could predict HCC diagnosis.

Results:

Final diagnoses included 115 benign nodules and 36 HCCs. Nodule T2 hyperintensity, T1 hypointensity, PVP‐EP hypointensity, and HP hypointensity were the best predictors of HCC on univariate analysis. Nodule T2 hyperintensity, T1 hypointensity, and HP hypointensity, were independent predictors of HCC on multivariate analysis.

Conclusion:

Gd‐BOPTA‐enhanced MR imaging provides imaging findings which may predict a diagnosis of HCC in small arterial enhancing‐only nodules in cirrhotic patients. J. Magn. Reson. Imaging 2013;37:892–902. © 2012 Wiley Periodicals, Inc.     

Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow

Objective:

To retrospectively investigate enhancement patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI in relation to histological grading and portal blood flow.

Methods:

Sixty-nine consecutive patients with 83 histologically proven HCCs and DNs were studied. To assess Gd-EOB-DTPA uptake, we calculated the EOB enhancement ratio, which is the ratio of the relative intensity of tumorous lesion to surrounding nontumorous area on hepatobiliary phase images (post-contrast EOB ratio) to that on unenhanced images (pre-contrast EOB ratio). Portal blood flow was evaluated by CT during arterial portography.

Results:

Post-contrast EOB ratios significantly decreased as the degree of differentiation declined in DNs (1.00?±?0.14) and well, moderately and poorly differentiated HCCs (0.79?±?0.19, 0.60?±?0.27, 0.49?±?0.10 respectively). Gd-EOB-DTPA uptake, assessed by EOB enhancement ratios, deceased slightly in DNs and still more in HCCs, while there was no statistical difference in the decrease between different histological grades of HCC. Reductions in portal blood flow were observed less frequently than decreases in Gd-EOB-DTPA uptake in DNs and well-differentiated HCCs.

Conclusions:

Reduced Gd-EOB-DTPA uptake might be an early event of hepatocarcinogenesis, preceding portal blood flow reduction. The hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help estimate histological grading, although difficulties exist in differentiating HCCs from DNs.     

Perfusion-weighted MRI in evaluating the intranodular hemodynamic characteristics of dysplastic nodules and hepatocellular carcinomas in an experimental rat model

PURPOSE: To investigate the value of perfusion-weighted MRI in the evaluation of the intranodular hemodynamic characteristics of dysplastic nodules (DNs) and hepatocellular carcinomas (HCCs) in an experimental rat model. MATERIALS AND METHODS: A total of 40 rats with chemically-induced DNs and HCCs were investigated. Single-slice gadolinium-enhanced perfusion-weighted MRI was performed to evaluate the nodules. Time to peak (Tp), maximal relative signal enhancement (REmax), and the initial slope of signal intensity (SI) vs. time curves of the nodules and cirrhotic liver were evaluated. Nodules precisely corresponding to MRI were examined histologically. Paired Student's t-tests were used to compare the difference between nodules and cirrhotic liver. RESULTS: A total of 20 HCCs and 14 DNs were evaluated. HCCs showed a significantly higher REmax, shorter Tp, and higher slope than adjacent cirrhotic liver. The REmax and slope of DNs were significantly lower than adjacent cirrhotic liver parenchyma. Although the Tp of DNs was delayed two to three seconds compared to adjacent cirrhotic liver, there was no significant difference between them. CONCLUSION: Perfusion-weighted MRI detected the intranodular hemodynamic characteristics of DNs and HCCs in an experimental rat model. DNs were hypovascular compared to cirrhotic liver, while HCCs were markedly hypervascular.     

Enhancement patterns of hepatocellular carcinomas on multiphasicmultidetector row CT: comparison with pathological differentiation

Objective The objective of this study was to determine the incidence of typical and atypical enhancement patterns of hepatocellular carcinomas (HCCs) on multiphasic multidetector row CT (MDCT) and to correlate the enhancement patterns and morphological image findings of HCC with the degree of tumour differentiation. Methods MDCT images of 217 patients with 243 surgically proven HCCs were evaluated through consensus reading by two radiologists. Our MDCT protocol was composed of precontrast, arterial, portal and delayed phases. The reviewers analysed the CT images for degree of attenuation; relative timing of washout; presence of dysmorphic intratumoral vessels, aneurysms and necrosis; tumour size; tumour margin; presence of pseudocapsule; intratumoral heterogeneity; and determined enhancement pattern. The imaging features were correlated with tumour differentiation using Fisher's exact test or the χ(2) test. Results Among 243 HCCs, 137 (56.4%) showed the typical enhancement pattern of HCC, which is arterial enhancement and washout on portal or equilibrium phase images. In the arterial phase, 190 of 243 (78.2%) HCCs showed hypervascularity, with approximately three quarters of poorly differentiated (PD) (34 of 45, 75.6%) and moderately differentiated (MD) HCCs (92 of 123, 74.8%) showing washout during the portal or delayed phases, vs only 50% of well-differentiated (WD) HCCs (11 of 22; p<0.048). The presence of intratumoral vessels and aneurysms, tumour necrosis, attenuation of precontrast, the relative timing of washout, intratumoral attenuation heterogeneity, tumour margin and tumour size were correlated with the pathological differentiation of HCCs (p<0.05). Conclusion A typical enhancement of HCCs on MDCT was not unusual (43.6%) and WD and PD HCCs account for most of the atypical enhancement patterns. Early washout favoured MD and PD HCCs rather than WD HCCs, whereas in our study the presence of intratumoral aneurysm was a highly specific finding for PD HCC.     

High‐risk nodules detected in the hepatobiliary phase of Gd‐EOB‐DTPA‐enhanced mr imaging in cirrhosis or chronic hepatitis: Incidence and predictive factors for hypervascular transformation,preliminary results

Purpose:

To evaluate the incidence and predictive factors of hypervascular transformation during follow‐up of “high‐risk nodules” detected in the hepatobiliary phase of initial Gd‐EOB‐DTPA‐enhanced MRI in chronic liver disease patients.

Materials and Methods:

A total of 109 patients with chronic liver disease who underwent Gd‐EOB‐DTPA‐enhanced MRI several times were investigated. Of these, 43 patients had 76 high‐risk nodules with both hypointensity in the hepatobiliary phase and hypovascularity in the arterial phase of initial MRI. These nodules were observed until hypervascularity was detected. MRI and clinical findings were compared to assess the incidence and potential predictive factors for hypervascular transformation between the group showing hypervascular transformation and the group not showing hypervascularization.

Results:

The median observation period was 242.5 ± 203.2 days (range, 47–802 days). Overall, 24 of 76 high‐risk nodules (31.6%) showed hypervascular transformation during follow‐up (median observation period, 186.0 ± 190.3 days). The growth rate of the nodules (P < 0.001), the presence of fat within nodules (P = 0.037), and hyperintensity on T1‐weighted images (P = 0.018) were significantly correlated with hypervascularization.

Conclusion:

Subsets of high‐risk nodules tended to show hypervascular transformation during follow‐up, with an increased growth rate, the presence of fat, and hyperintensity on T1‐weighted images as predictive factors. J. Magn. Reson. Imaging 2013;37:1377–1383. © 2013 Wiley Periodicals, Inc.     

Additional value of gadoxetic acid-DTPA-enhanced hepatobiliary phase MR imaging in the diagnosis of early-stage hepatocellular carcinoma: comparison with dynamic triple-phase multidetector CT imaging

Purpose:

To assess the value of hepatobiliary phase gadoxetic acid (EOB)‐enhanced magnetic resonance imaging (MRI) for the diagnosis of early stage hepatocellular carcinoma (HCC) (<3 cm) compared to triple‐phase dynamic multidetector computed tomography (MDCT).

Materials and Methods:

In all, 52 patients with 60 pathologically proven HCCs underwent both EOB‐enhanced MRI and triple‐phase dynamic MDCT. Two radiologists independently and blindly reviewed three image sets: 1) MDCT, 2) dynamic MRI (unenhanced and EOB‐enhanced dynamic MR images), and 3) combined MRI (dynamic MRI + hepatobiliary phase images) using a five‐point rating scale on a lesion‐by‐lesion basis. Receiver operating characteristics (ROC) analysis was performed, and sensitivity and specificity were calculated.

Results:

The area under the ROC curve (Az) of dynamic MRI was equivalent to that of MDCT for both readers. For both readers, Az and sensitivity of combined MRI for smaller lesions (<1.5 cm) were significantly higher than that of dynamic MRI and MDCT (P < 0.0166). The majority of false‐negative nodules on dynamic MRI or MDCT (75% and 62%, respectively) were due to a lack of identified washout findings.

Conclusion:

Hepatobiliary phase images can increase the value of EOB‐enhanced MRI in the diagnosis of early stage HCC. The sensitivity and accuracy were significantly superior to MDCT for the diagnosis of lesions less than 1.5 cm. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

How to detect hepatocellular carcinoma in cirrhosis

Cirrhosis predisposes to hepatocellular carcinoma (HCC) which develops by sequential steps of de-differentiation of hepatocytes from regenerative nodules via borderline (dysplastic) nodules to frankly malignant HCC. Effective treatment depends on early recognition of HCC, so the key tasks for imaging are firstly recognising the presence of a suspicious lesion, and secondly differentiating between benign, borderline and malignant nodules. Screening of high-risk cirrhotic patients with sonography and measurement of alpha fetoprotein (AFP) is helpful but will not reliably differentiate small HCC from benign or dysplastic nodules. Large HCCs can usually be recognised by their characteristic morphology on imaging, but the appearances of smaller benign and malignant nodules show considerable overlap on unenhanced sonography, CT and MRI. Increasing degrees of histological malignancy are associated with increasing arterialisation and loss of portal blood supply, so the recognition of HCC requires the use of dynamic imaging with contrast-enhanced CT or T1-weighted MRI with gadolinium enhancement. Sonography with microbubble contrast media now offers another method for detecting arterialised nodules; however, some non-malignant nodules show arterial hypervascularity and a minority of HCCs are hypovascular, so the assessment of perfusion does not conclusively distinguish benign from malignant lesions. Kupffer cell function is another attribute of liver tissue which can be explored using MRI with superparamagnetic iron oxide particles (SPIO). Experience thus far suggests that uptake of SPIO is an effective discriminator between benign and malignant nodules. The combination of SPIO with gadolinium-enhanced MRI offers the opportunity for imaging characterisation of cirrhotic nodules by cellular function as well as by blood supply, and this approach is now proposed as the examination of choice for detecting HCC in cirrhosis.     

Method for simultaneous voxel-based morphometry of the brain and cervical spinal cord area measurements using 3D-MDEFT

Purpose:

To develop a quantitative multiparametric PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction) magnetic resonance imaging (MRI) approach and its application in a diethylnitrosamine (DEN) chemically induced rodent model of hepatocarcinogenesis for lesion characterization.

Materials and Methods:

In nine rats with 33 cirrhosis‐associated hepatic nodules including regenerative nodule (RN), dysplastic nodule (DN), hepatocellular carcinoma (HCC), and cyst, multiparametric PROPELLER MRI (diffusion‐weighted, T2/M0 (proton density) mapping and T1‐weighted) were performed. Apparent diffusion coefficient (ADC) maps, T2 and M0 maps of each tumor were generated. We compared ADC, T2, and M0 measurements for each type of hepatic nodule, confirmed at histopathology.

Results:

PROPELLER images and resultant parametric maps were inherently coregistered without image distortion or motion artifacts. All types of hepatic nodules demonstrated complex imaging characteristics within conventional T1‐ and T2‐weighted images. Quantitatively, cysts were distinguished from RN, DN, and HCC with significantly higher ADC and T2; however, there was no significant difference of ADC and T2 between HCC, DN, and RN. Mean tumor M0 values of HCC were significantly higher than those of DN, RN, and cysts.

Conclusion:

This study exploited quantitative PROPELLER MRI and multidimensional analysis approaches in an attempt to differentiate hepatic nodules in the DEN rodent model of hepatocarcinogenesis. This method offers great potential for parallel parameterization during noninvasive interrogation of hepatic tissue properties. J. Magn. Reson. Imaging 2010;31:1242–1251. © 2010 Wiley‐Liss, Inc.