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.

     

Gadoxetic acid disodium-enhanced magnetic resonance imaging for biliary and vascular evaluations in preoperative living liver donors: comparison with gadobenate dimeglumine-enhanced MRI

Purpose

To compare gadoxetic acid disodium (Gd‐EOB‐DTPA)‐enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine (Gd‐BOPTA)‐enhanced MRI in preoperative living liver donors for the evaluation of vascular and biliary variations.

Materials and Methods

Sixty‐two living liver donors who underwent preoperative MRI were included in this study. Thirty‐one patients underwent MRI with Gd‐EOB‐DTPA enhancement, and the other 31 underwent MRI with Gd‐BOPTA enhancement. Two abdominal radiologists retrospectively reviewed dynamic T1‐weighted and T1‐weighted MR cholangiography images and ranked overall image qualities for the depiction of the hepatic artery, portal vein, hepatic vein, and bile duct on a 5‐point scale and determined the presence and types of normal variations in each dynamic phase. Semiquantitative analysis for bile duct visualization was also conducted by calculating bile duct‐to‐liver contrast ratios.

Results

No statistical differences were found between the two contrast media in terms of hepatic artery or bile duct image quality by the two reviewers, or in terms of portal vein image quality by one reviewer (P > 0.05). Gd‐BOPTA provided better image qualities than Gd‐EOB‐DTPA for the depiction of hepatic veins by both reviewers, and for the depiction of portal veins by one reviewer (P < 0.01). The two contrast media‐enhanced images had similar bile duct‐to‐liver contrast ratios (P > 0.05). Regarding diagnostic accuracies with hepatic vascular/biliary branching types, no significant differences were observed between the two contrast media (P > 0.05).

Conclusion

Gd‐EOB‐DTPA could be as useful as Gd‐BOPTA for the preoperative evaluation of living liver donors, and has the advantage of early hepatobiliary phase image acquisition. J. Magn. Reson. Imaging 2011;33:149–159. © 2010 Wiley‐Liss, Inc.     

Investigation using an HER‐2/neu transgenic mouse model of a newly developed MR contrast agent with the effect of an antitumor drug

Purpose

To assess whether Gd‐DTPA‐Gel‐Cis, a conjugate of gadolinium (Gd), cis diamminedichloroplatinum (Cis), diethylenetriaminepentaacetic acid (DTPA)‐dianhydride, and bovine gelatin (Gel) can be used as an intravascular contrast agent at MRI and as an antitumor cell proliferation agent in vitro.

Materials and Methods

We injected Gd‐DTPA‐Gel‐Cis (200 mg/mL) into the caudal vein of female HER‐2/neu transgenic mice with spontaneous mammary tumors. The tumor signal intensity was measured with a 0.3 Tesla MRI scanner. HER‐2/neu‐expressing NT cells were treated with Gd‐DTPA‐Gel‐Cis (5 μM cisplatin, 200 mg/mL Gel), Cis alone (5 μM cisplatin), or Gel alone (200 mg/mL gelatin). Differences of P < 0.05 were considered to be statistically significant.

Results

On T1‐weighted MRI scans of mice injected with Gd‐DTPA‐Gel‐Cis we observed a 23% increase in signal intensity. The survival rates of cells exposed to Gd‐DTPA‐Gel‐Cis or Cis were 70.9% and 58.3%, respectively, of the survival rates observed after treatment with Gel alone. Gd‐DTPA‐Gel‐Cis showed significant toxicity (P < 0.05).

Conclusion

Gd‐DTPA‐Gel‐Cis shows promise for use as an MRI contrast medium and as an antitumor agent. J. Magn. Reson. Imaging 2009;30:907–910. © 2009 Wiley‐Liss, Inc.     

Tyrosine polyethylene glycol (PEG)‐micelle magnetic resonance contrast agent for the detection of lipid rich areas in atherosclerotic plaque

Vulnerable or high‐risk atherosclerotic plaques often exhibit large lipid cores and thin fibrous caps that can lead to deadly vascular events when they rupture. In this study, polyethylene glycol (PEG)‐micelles that incorporate a gadolinium diethylenetriamine pentaacetic acid (Gd‐DTPA) amphiphile were used as an MR contrast agent. In an approach inspired by lipoproteins, the micelles were functionalized with tyrosine residues, an aromatic, lipophilic amino acid, to reach the lipid‐rich areas of atherosclerotic plaque in a highly efficient manner. These micelles were applied to apolipoprotein E^?/? (ApoE^?/?) mice as a model of atherosclerosis. The abdominal aortas of the animals were imaged using T₁‐weighted (T₁W) high‐resolution MRI at 9.4T before and up to 48 h after the administration of the micelles. PEG‐micelles modified with 15% tyrosine residues yielded a significant enhancement of the abdominal aortic wall at 6 and 24 h postinjection (pi) as compared to unmodified micelles. Fluorescence microscopy on histological sections of the abdominal aorta showed a correlation between lipid‐rich areas and the distribution of the functionalized contrast agent in plaque. Using a simple approach, we demonstrated that lipid‐rich areas in atherosclerotic plaque of ApoE^?/? mice can be detected by MRI using Gd‐DTPA micelles. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Dynamic contrast‐enhanced magnetic resonance imaging of abdominal solid organ and major vessel: Comparison of enhancement effect between Gd‐EOB‐DTPA and Gd‐DTPA

Purpose

To evaluate the differences in enhancement of the abdominal solid organ and the major vessel on dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) obtained with gadolinium ethoxybenzyldiethylenetriamine pentaacetic acid (Gd‐EOB‐DTPA: EOB) and gadolinium diethylenetriamine pentaacetic acid (Gd‐DTPA) in the same patients.

Materials and Methods

A total of 13 healthy volunteers underwent repeat assessments of abdominal MR examinations with DCE‐MRI using either Gd‐DTPA at a dose of 0.1 mmol/kg body weight or EOB at a dose of 0.025 mmol/kg body weight. DCE images were obtained at precontrast injection and in the arterial phase (AP: 25 seconds), portal phase (PP: 70 seconds), and equilibrium phase (EP: 3 minutes). The signal intensities (SIs) of liver at AP, PP, and EP; the SIs of spleen, renal cortex, renal medulla, pancreas, adrenal gland, aorta at AP; and the SIs of portal vein and inferior vena cava (IVC) at PP were defined using region‐of‐interest measurements, and were used for calculation of signal intensity ratio (SIR).

Results

The mean SIRs of liver (0.195 ± 0.140), spleen (1.35 ± 0.353), renal cortex (1.58 ± 0.517), renal medulla (0.548 ± 0.259), pancreas (0.540 ± 0.183), adrenal gland (1.04 ± 0.405), and aorta (2.44 ± 0.648) at AP as well as the mean SIRs of portal vein (1.85 ± 0.477) and IVC (1.16 ± 0.187) at PP in the EOB images were significantly lower than those (0.337 ± 0.200, 1.99 ± 0.443, 2.01 ± 0.474, 0.742 ± 0.336, 0.771 ± 0.227, 1.26 ± 0.442, 3.22 ± 1.20, 2.73 ± 0.429, and 1.68 ± 0.366, respectively) in the Gd‐DTPA images (P < 0.05 each). There was no significant difference in mean SIR of liver at PP between EOB (0.529 ± 0.124) and Gd‐DTPA (0.564 ± 0.139). Conversely, the mean SIR of liver at EP was significantly higher with EOB (0.576 ± 0.167) than with Gd‐DTPA (0.396 ± 0.093) (P < 0.001).

Conclusion

Lower arterial vascular and parenchymal enhancement with Gd‐EOB, as compared with Gd‐DTPA, may require reassessment of its dose, despite the higher late venous phase liver parenchymal enhancement. J. Magn. Reson. Imaging 2009;29:636–640. © 2009 Wiley‐Liss, Inc.     

Partition coefficients for gadolinium chelates in the normal myocardium: Comparison of gadopentetate dimeglumine and gadobenate dimeglumine

Purpose:

To evaluate the influence of contrast agents with different relaxivity on the partition coefficient (λ) and timing of equilibration using a modified Look‐Locker inversion recovery (MOLLI) sequence in cardiac magnetic resonance imaging (MRI).

Materials and Methods:

MOLLI was acquired in 20 healthy subjects (1.5T) at the mid‐ventricular short axis precontrast and 5, 10, 20, 25, and 30 minutes after administration of a bolus of 0.15 mmol/kg gadobenate dimeglumine (Gd‐BOPTA) (n = 10) or gadopentetate dimeglumine (Gd‐DTPA) (n = 10). T1 times were measured in myocardium and blood pool. λ was approximated by ΔR1_myocardium/ΔR1_blood. Values for Gd‐BOPTA and Gd‐DTPA were compared. Interobserver agreement was evaluated (intraclass correlation coefficient [ICC]).

Results:

T1 times of myocardium and blood pool (P < 0.001) and λ (0.42 ± 0.03 and 0.47 ± 0.04, respectively, P < 0.001; excluding 5 minutes for Gd‐BOPTA) were significantly lower for Gd‐BOPTA than Gd‐DTPA. The λ_(Gd‐DTPA) showed no significant variation between 5 and 30 minutes. The λ_(Gd‐BOPTA) values were significantly lower at 5 minutes compared to other times (0.38 vs. 0.42; P < 0.05). Interobserver agreement for λ values was excellent with Gd‐BOPTA (ICC = 0.818) and good for Gd‐DTPA (ICC = 0.631).

Conclusion:

The λ_(Gd‐BOPTA) values were significantly lower compared to λ_(Gd‐DTPA) at the same administered dose. Using Gd‐BOPTA, the equilibrium between myocardium and blood pool was not achieved at 5 minutes postcontrast. J. Magn. Reson. Imaging 2012;36:733–737. © 2012 Wiley Periodicals, Inc.     

In vivo MR imaging tracking of transplanted mesenchymal stem cells in a rabbit model of acute peripheral nerve traction injury

Purpose

To investigate in vivo MRI tracking mesenchymal stem cells (MSCs) in peripheral nerve injures using a clinically available paramagnetic contrast agent (Gd‐DTPA) and commercially available rhodamine‐incorporated transfection reagents (PEI‐FluoR).

Materials and Methods

After bone marrow MSCs were labeled with Gd‐DTPA and PEI‐FluoR complex, the labeling efficacy and longevity of Gd‐DTPA maintenance were measured and cell viability, proliferation, and apoptosis were assessed. Thirty‐six rabbits with acute sciatic nerve traction injury randomly received 1 × 10⁶ labeled (n = 12) or unlabeled MSCs (n = 12) or vehicle alone injection. The distribution and migration of implanted cells was followed by MRI and correlated with histology. The relative signal intensity (RSL) of the grafts was measured.

Results

The labeling efficiency was 76 ± 4.7% and the labeling procedure did not in?uence cell viability, proliferation, and apoptosis. A persistent higher RSL in grafts was found in the labeled group compared with the unlabeled and vehicle groups until 10 days after transplantation (P < 0.05). The distribution and migration of labeled cells could be tracked by MRI until 10 days after transplantation. Transplanted MSCs were not found to transdifferentiate into Schwann‐like cells within 14‐day follow‐up.

Conclusion

Labeling MSCs with the dual agents may enable cellular MRI of the engraftment in the experimental peripheral nerve injury. J. Magn. Reson. Imaging 2010;32:1076–1085. © 2010 Wiley‐Liss, Inc.

     

Interstitial MR lymphography in mice with gadopentetate dimeglumine and gadoxetate disodium

Purpose

To investigate the utility of interstitial MR lymphography with gadopentetate dimeglumine (Gd‐DTPA) or gadoxetate disodium (Gd‐EOB‐DTPA) in mice.

Materials and Methods

We performed MR lymphography after the subcutaneous injection of Gd‐DTPA or Gd‐EOB‐DTPA (0.1, 0.5, or 2.0 μmol per mouse) into the right footpad in six healthy mice, and the time courses of contrast enhancement were assessed. Additionally, the lymphatic pathways from two distinct sites were assessed in tandem by interstitial MR lymphography studies.

Results

Subcutaneous injection of Gd‐DTPA or Gd‐EOB‐DTPA caused lymph node enhancement immediately after injection, followed by a rapid decline. Dose dependency was shown for the lymph node enhancement, and a high‐dose injection caused prominent visualization of the veins. Lymph node enhancement did not differ significantly between Gd‐DTPA and Gd‐EOB‐DTPA or between Gd‐EOB‐DTPA premixed and not premixed with bovine serum albumin. The tandem assessment of two lymphatic pathways was feasible, and image fusion aided detailed comparison.

Conclusion

Interstitial MR lymphography with Gd‐DTPA or Gd‐EOB‐DTPA allowed clear visualization of the lymphatic pathway in healthy mice, and no significant difference was found between the two agents. Their rapid kinetics limits the imaging timing window, however, facilitates repeated assessment in a single imaging session. J. Magn. Reson. Imaging 2011;33:490–497. © 2011 Wiley‐Liss, Inc.     

Effect of Gd-DTPA-BMA on choline signals of HT29 tumors detected by in vivo 1H MRS

Purpose

To study the impact of Gd‐DTPA‐BMA on choline signals of HT29 colon carcinomas determined by localized ¹H MRS in vivo at 4.7T.

Materials and Methods

PRESS ¹H MR spectra (2‐second repetition time and echo times of 20–272 msec) were acquired from HT29 xenografts prior to and following intravenous administration of 0.1 or 0.2 mmol/kg Gd‐DTPA‐BMA. The magnetic resonance spectroscopy (MRS) data were analyzed by 1) normalizing choline and water peak areas to their precontrast values; and 2) estimating absolute choline concentration relative to tissue water.

Results

Changes in the T₁ and T₂ of choline and water were apparent following administration of Gd‐DTPA‐BMA. Administration of 0.1 mmol/kg Gd‐DTPA‐BMA induced significant increases in the choline peak area, concomitant with enhancements of the water peak area, whereas 0.2 mmol/kg Gd‐DTPA‐BMA induced no enhancement of choline peak area but significant increases in water peak area at short echo times.

Conclusion

The effect of Gd‐DTPA‐BMA on estimation of tumor choline concentration varied with the dose of contrast agent, the echo time, and the time after contrast agent administration. These data highlight the potential pitfalls associated with the modulation of choline and water signals post‐Gd‐DTPA‐BMA and may account for the apparently contradictory results previously reported. J. Magn. Reson. Imaging 2008;28:1201–1208. © 2008 Wiley‐Liss, Inc.     

Effect of isoflurane anesthesia and hypothermia on the hepatic kinetics of Gd-EOB-DTPA: evaluation using MRI of conscious mice

Purpose:

To develop a method for body magnetic resonance imaging (MRI) of conscious mice and investigate the effect of isoflurane anesthesia and hypothermia on the hepatic kinetics of gadoxetate disodium (Gd‐EOB‐DTPA).

Materials and Methods:

Conscious or anesthetized mice were restrained on a holder and the rectal temperature was measured serially. Serial MRI of the liver was performed after intravenous injection of Gd‐EOB‐DTPA with or without temperature control. Three mice were studied for each condition.

Results:

The temperature dropped rapidly in anesthetized mice beside the MR unit. The decline was less prominent in conscious mice. The temperature decreased less in anesthetized mice and remained constant in conscious mice in the radiofrequency (RF) coil. The washout of Gd‐EOB‐DTPA was slower in anesthetized hypothermic mice than in conscious normothermic mice. Warmed anesthetized mice showed faster washout, and cooled conscious mice showed delayed washout. Severer hypothermia in anesthetized mice resulted in weaker initial enhancement and slower washout.

Conclusion:

By separately manipulating the presence or absence of anesthesia and hypothermia, we demonstrated that washout of Gd‐EOB‐DTPA was delayed under hypothermia, regardless of anesthesia. Serial body MRI of conscious mice was feasible and allowed the evaluation of kinetics of a contrast agent, while excluding the possible effects of anesthesia. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Assessment of liver function in thioacetamide‐induced rat acute liver injury using an empirical mathematical model and dynamic contrast‐enhanced MRI with Gd‐EOB‐DTPA

Purpose:

To evaluate thioacetamide (TAA)‐induced acute liver injury in rats using an empirical mathematical model (EMM) and dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd‐EOB‐DTPA).

Materials and Methods:

Eighteen rats were divided into three groups (normal control [n = 6], TAA [140] [n = 6], and TAA [280] groups [n = 6]). The rats of the TAA (140) and TAA (280) groups were intravenously injected with 140 and 280 mg/kg body weight (BW) of TAA, respectively, while those of the normal control group were intravenously injected with the same volume of saline. DCE‐MRI studies were performed using Gd‐EOB‐DTPA (0.025 mmol Gd/kg; 0.1 mL/kg BW) as the contrast agent 48 hours after TAA or saline injection. After the DCE‐MRI study, blood was sampled and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured. We calculated the rate of contrast uptake (α), the rate of contrast washout (β), the elimination half‐life of relative enhancement (RE) (T_1/2), the maximum RE (RE_max), and the time to (RE_max) (T_max) from time‐signal intensity curves using EMM.

Results:

The RE_max values in the TAA (140) groups and TAA (280) groups were significantly smaller than that in the normal control group. The T_max value in the TAA (280) group was significantly greater than that in the normal control group. The β value in the TAA (280) group was significantly smaller than those in the normal control and TAA (140) groups, whereas there were no significant differences in β among groups. The T_1/2 value in the TAA (280) group was significantly greater than those in the normal control and TAA (140) groups. The RE_max, T_max, β, and T_1/2 values significantly correlated with AST and ALT.

Conclusion:

The EMM is useful for evaluating TAA‐induced acute liver injury using DCE‐MRI with Gd‐EOB‐DTPA. J. Magn. Reson. Imaging 2012; 36:1483–1489. © 2012 Wiley Periodicals, Inc.     

Delayed contrast enhanced MRI of meniscus with ionic and non-ionic agents

Purpose:

To evaluate the potential difference in post‐contrast T₁ relaxation time of the meniscus (T_1Gd) between osteoarthritic patients (OA) and healthy subjects (HS), and to verify if charge density has any influence on meniscal T_1Gd.

Materials and Methods:

We performed a retrospective analysis of meniscal T₁ relaxation time on data previously acquired for studying articular cartilage with both ionic and non‐ionic contrast media. MR imaging was performed in 10 OA and 8 HS at 120 min following administration of double‐dose ionic Gd‐DTPA^2? on one day and non‐ionic Gd‐DTPA‐BMA on a different day. A three‐dimensional Look‐Locker sequence with echo time of 2 ms was used for data acquisition to allow T₁ mapping of the meniscus.

Results:

Compared with HS, significantly lower meniscal T_1Gd was observed in OA with either ionic Gd‐DTPA^2? (P < 0.01) or non‐ionic Gd‐DTPA‐BMA (P < 0.001) contrast agent. There was a correlation between meniscal T₁(Gd‐DTPA^2?) versus T₁(Gd‐DTPA‐BMA). Meniscal T₁(Gd‐DTPA‐BMA) showed a larger difference and smaller overlap between OA and HS. No significant differences in either pre‐contrast T₁ or post‐contrast T_1Gd were observed between inner and outer zones of the meniscus with either agent.

Conclusion:

Significant differences in meniscal T_1Gd between OA and HS were observed with both ionic and non‐ionic contrast agents, suggesting that charge density is not responsible for the observed differences. J. Magn. Reson. Imaging 2011;33:731–735. © 2011 Wiley‐Liss, Inc.

     

Usefulness of Gd‐EOB‐DTPA‐enhanced MR imaging in the evaluation of simple steatosis and nonalcoholic steatohepatitis

Purpose:

To evaluate the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd‐EOB‐DTPA)‐enhanced MR imaging (EOB‐MRI) in differentiating between simple steatosis and nonalcoholic steatohepatitis (NASH), as compared with MR in‐phase/out‐of‐phase imaging. The correlations between the MR features and histological characteristics were preliminarily investigated.

Materials and Methods:

From April 2008 to October 2011, 25 patients (13 simple steatosis and 12 NASH) who underwent both EOB‐MRI and in‐phase/out‐of‐phase imaging were analyzed. The hepatobiliary‐phase enhancement ratio and signal intensity loss on opposed‐phase T1‐weighted images (fat fraction) were compared between the simple steatosis and NASH groups. In the simple steatosis and NASH groups, the correlations between enhancement ratio and histological grade/stage were explored. In the NASH group, fat fraction was correlated with the steatosis score.

Results:

The enhancement ratio in NASH was significantly lower than that in simple steatosis (P = 0.03). In the simple steatosis and NASH groups, the enhancement ratio was significantly correlated with the fibrosis stage (r = ?0.469, P = 0.018). Fat fraction in NASH was strongly correlated with the steatosis score (r = 0.728, P = 0.007).

Conclusion:

In simple steatosis and NASH, the hepatobiliary‐phase enhancement ratio of EOB‐MRI showed significant association with fibrosis stage, and may be a useful discriminating parameter compared with the fat fraction measured by in‐phase/out‐of‐phase imaging. J. Magn. Reson. Imaging 2012;37:1137–1143. © 2012 Wiley Periodicals, Inc.

     

Hepatocellular carcinoma in a North American population: Does hepatobiliary MR imaging with Gd‐EOB‐DTPA improve sensitivity and confidence for diagnosis?

Purpose:

To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd‐EOB‐DTPA, in a North American population.

Materials and Methods:

One hundred MRI examinations performed with the intravenous injection of Gd‐EOB‐DTPA in patients with cirrhosis were reviewed retrospectively. Nodules were classified as HCC (n = 70), indeterminate (n = 33), or benign (n = 22). Five readers independently reviewed each examination with and without hepatobiliary phase images (HBP). Lesion conspicuity scores were compared between the two readings. Lesion detection, confidence scores, and receiver operating characteristic (ROC) analysis were compared.

Results:

Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged.

Conclusion:

Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd‐EOB‐DTPA. J. Magn. Reson. Imaging 2013;37:398–406. © 2012 Wiley Periodicals, Inc.     

Liver parenchymal enhancement of hepatocyte‐phase images in Gd‐EOB‐DTPA‐enhanced MR imaging: Which biological markers of the liver function affect the enhancement?

Purpose:

To clarify the factors that predict enhancement of the liver parenchyma in hepatocyte‐phase of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd‐EOB‐DTPA)‐enhanced MR imaging.

Materials and Methods:

Gd‐EOB‐DTPA–enhanced hepatocyte‐phase MR images of 198 patients with chronic liver diseases (Child‐Pugh class A in 112 patients, class B in 74 patients, and class C in 12 patients) were retrospectively analyzed. The hepatocyte‐phase images were obtained using fat‐suppressed T1‐weighted gradient‐echo images with a 3D acquisition sequence 10 min and 20 min after IV administration of Gd‐EOB‐DTPA (0.025 mmol/kg body weight). The quantitative liver–spleen contrast ratio (Q‐LSC) was calculated using the signal intensities of the liver and spleen. Serum albumin levels, total bilirubin levels, prothrombin activity, and the results of indocyanine green clearance tests (ICGs) were recorded and correlated with the Q‐LSC. Logistic regression analysis was performed to analyze which factors predict sufficient liver enhancement using a Q‐LSC of 1.5 as a cutoff value.

Results:

Only ICGs and Child‐Pugh classifications showed a statistically significant correlation with the Q‐LSC. Logistic regression analysis showed that ICGs were the only factors that accurately predicted liver enhancement on hepatocyte‐phase images.

Conclusion:

ICGs were found to be predictors of sufficient liver enhancement on hepatocyte‐phase images. J. Magn. Reson. Imaging 2009;30:1042–1046. © 2009 Wiley‐Liss, Inc.     

Dilution method of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd‐EOB‐DTPA)‐enhanced magnetic resonance imaging (MRI)

Purpose

To elucidate whether a contrast agent dilution method (dilution method), in which gadoxetate disodium (Gd‐EOB‐DTPA) is diluted with saline, is useful for good‐quality arterial‐phase images.

Materials and Methods

In this study we observed 494 hypervascular hepatocellular carcinomas (HCCs) in 327 patients with chronic liver disease. Three Gd‐EOB‐DTPA injection methods were adopted for comparison: 1) test injection method (undiluted Gd‐EOB‐DTPA and modified scan delay), in which a test dose of 0.5 mL of Gd‐EOB‐DTPA was injected to determine scan delay; 2) conventional method (undiluted Gd‐EOB‐DTPA and fixed scan delay); and ( 3 ) dilution method (diluted Gd‐EOB‐DTPA and fixed scan delay), in which Gd‐EOB‐DTPA was diluted to 20 mL with saline. Lesion‐liver contrast was calculated. Image quality and lesion detectability were evaluated by two radiologists blinded to the injection methods.

Results

The lesion‐liver contrast of the dilution method was significantly higher than that of the other two methods. Lesion detectability of the conventional method (64%) was significantly lower than that of the other two methods (contrast agent dilution method, 95%; test injection method, 93%). The image quality of the contrast agent dilution method was significantly better than that of the other two methods.

Conclusion

The dilution method contributed to improved image quality, high lesion‐liver contrast, and high lesion detectability in the arterial‐phase images of GD‐EOB‐DTPA‐enhanced MRI. J. Magn. Reson. Imaging 2009;30:849–854. © 2009 Wiley‐Liss, Inc.     

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.     

Hypointense hepatocellular nodules on hepatobiliary phase of Gd‐EOB‐DTPA‐enhanced MRI: Can increasing the flip angle improve conspicuity of lesions?

Purpose:

To compare the conspicuity of hypointense hepatocellular nodules in patients with chronic liver disease on hepatobiliary phase (HP) of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd‐EOB‐DTPA)‐enhanced magnetic resonance imaging (MRI) acquired with low to high flip angles (FAs).

Materials and Methods:

A total of 95 patients with chronic liver disease who underwent Gd‐EOB‐DTPA‐enhanced MRI were included. HP images were obtained at 20 minutes, with 15°, 20°, and 30° FAs. For the detected hepatocellular nodule, liver‐to‐lesion contrast‐to‐phantom ratios (CPR) and lesion conspicuity (LCS) were assessed.

Results:

In all examinations, 96 hepatocellular nodules showing hypointensity on HP were identified. These lesions included 39 hypovascular nodules and 57 hypervascular nodules. Mean CPR and LCS showed the highest value on the 30° FA, followed by 20° and 15° FAs. CPR and LCS of 15° FA were significantly lower than those of 20° and 30° FAs (P < 0.001 to P = 0.007). CPR of 30° FA for hypervascular nodules was significantly greater than that of 20° FA (P < 0.001).

Conclusion:

In the evaluation of hypointense hepatocellular nodules on HP of Gd‐EOB‐DTPA‐enhanced MRI, higher FA such as 30° should be used rather than low FA such as 15°. J. Magn. Reson. Imaging 2013;37:1093–1099. © 2012 Wiley Periodicals, Inc.     

Assessing liver function using dynamic Gd‐EOB‐DTPA‐enhanced MRI with a standard 5‐phase imaging protocol

Purpose:

To evaluate liver function obtained by tracer‐kinetic modeling of dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) data acquired with a routine gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd‐EOB‐DTPA)‐enhanced protocol.

Materials and Methods:

Data were acquired from 25 cases of nonchronic liver disease and 94 cases of cirrhosis. DCE‐MRI was performed with a dose of 0.025 mmol/kg Gd‐EOB‐DTPA injected at 2 mL/sec. A 3D breath‐hold sequence acquired 5 volumes of 72 slices each: precontrast, double arterial phase, portal phase, and 4‐minute postcontrast. Regions of interest (ROIs) were selected semiautomatically in the aorta, portal vein, and whole liver on a middle slice. A constrained dual‐inlet two‐compartment uptake model was fitted to the ROI curves, producing three parameters: intracellular uptake rate (UR), extracellular volume (Ve), and arterial flow fraction (AFF).

Results:

Median UR dropped from 4.46 10^?2 min^?1 in the noncirrhosis to 3.20 in Child–Pugh A (P = 0.001), and again to 1.92 in Child–Pugh B (P < 0.0001). Median Ve dropped from 6.64 mL 100 mL^?1 in the noncirrhosis to 5.80 in Child–Pugh A (P = 0.01). Other combinations of Ve and AFF changes were not significant for any group.

Conclusion:

UR obtained from tracer kinetic analysis of a routine DCE‐MRI has the potential to become a novel index of liver function. J. Magn. Reson. Imaging 2013;37:1109–1114. © 2012 Wiley Periodicals, Inc.

     

Gd‐EOB‐DTPA‐enhanced MR imaging: Prediction of hepatic fibrosis stages using liver contrast enhancement index and liver‐to‐spleen volumetric ratio

Purpose:

To develop and evaluate a quantitative parameter for staging hepatic fibrosis by contrast enhancement signal intensity and morphological measurements from gadoxetic acid (Gd‐EOB‐DTPA)‐enhanced MR imaging.

Materials and Methods:

MR images were obtained in 93 patients; 75 patients had histopathologically proven hepatic fibrosis and 18 patients who had healthy livers were evaluated. The liver‐to‐muscle signal intensity ratio (SI_post = SIliver/SImuscle), contrast enhancement index (CEI = SIpost/SIpre), and liver‐to‐spleen volumetric ratio (VR = Vliver/Vspleen) were evaluated for staging hepatic fibrosis.

Results:

VR was most strongly correlated with fibrosis stage (7.21; r = ?0.83; P < 0.001). Sensitivity, specificity, and area under the ROC curve demonstrated by linear regression formula generated by VR and CEI in predicting fibrous scores were 100%, 73%, and 0.91, respectively, for the detection of hepatic fibrosis F1 or greater (≥ F1),100%, 87%, and 0.96 for ≥ F2, 74%, 98%, and 0.93 for ≥ F3 and 91%, 100%, and 0.97 for F4.

Conclusion:

The liver‐to‐spleen volumetric ratio and contrast enhancement index were reliable biomarkers for the staging of hepatic fibrosis on Gd‐EOB‐DTPA‐enhanced MR imaging. J. Magn. Reson. Imaging 2012;36:1148–1153. © 2012 Wiley Periodicals, Inc.