Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma

Background  Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is an MRI contrast agent with perfusion and hepatoselective properties. The purpose of the study was to examine uptake of Gd-EOB-DTPA in the hepatobiliary phase in hepatocellular carcinoma (HCC). Methods  A retrospective analysis of 22 patients with HCC who underwent preoperative Gd-EOB-DTPA-enhanced MRI was performed. Enhancement ratios (ERs) and expression levels of the organic anion transporter (OATP) 1B3 protein were examined. Results  Gd-EOB-DTPA accumulated in the hepatobiliary phase in 6 of the 22 cases. All 6 Gd-EOB-DTPA-positive cases were moderately differentiated HCC, but 11 other moderately differentiated HCCs did not show Gd-EOB-DTPA uptake. Histopathologically, 4 Gd-EOB-DTPA-positive HCCs and 5 Gd-EOB-DTPA-negative HCCs produced bile. HCCs with Gd-EOB-DTPA uptake overexpressed OATP1B3 compared with HCCs without Gd-EOB-DTPA uptake, and OATP1B3 levels were significantly correlated with ERs (r = 0.91, P < 0.0001). Conclusions  Uptake of Gd-EOB-DTPA in HCC is determined by expression of OATP1B3 rather than by tumor differentiation or bile production.     

Case report of a focal nodular hyperplasia-like nodule present in cirrhotic liver

An 81-year-old female was referred to Sapporo Medical University Hospital because of a nodular lesion 20 mm in diameter found in the liver S8 during follow-up for type C liver cirrhosis. Abdominal ultrasonography showed a capsule-like structure, and contrast computed tomography revealed hypervascularity at the early phase and inner pooling of the contrast medium with ring enhancement at the late phase. Magnetic resonance T2-weighted imaging (T2WI) demonstrated a hyperintensity nodule with further hyperintensity signals in some parts of the nodule, and the signal pattern differed from that of typical fibrosis. SPIO-magnetic resonance imaging showed partial hypointensity signals by T2WI, which indicated the presence of Kupffer cells. Angiography did not show a spoke-wheel pattern. The results by imaging modalities indicated that the nodule was atypical for hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH), and liver nodule biopsy was performed for histological diagnosis. Compared with the background liver, the nodule revealed high cellular density, cellular dysplasia at the periphery, a pseudo-crypt structure and irregular hepatic cord arrangement in some parts of the nodule. Among them, there was immature fibrous tissue containing arterioles with muscular hypertrophy. There has been no report of well-differentiated HCC with a central scar, and this case was presumed to be an FNH-like nodule with dysplasia physically associated with cirrhotic tissue.     

Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI

Background

Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC.

Methods

Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively.

Results

On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P < 0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P < 0.001).

Conclusions

In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.     

Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI

Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid(Gd-EOB-DTPA) properties. Following contrast injection, it provides dynamic vascular phases(arterial, portal and equilibrium phases) and hepatobiliary phase, the latter due to its uptake by functional hepatocytes. The main advantages of Gd-EOB-DTPA of focal liver lesion detection and characterization are discussed in this paper. Namely, we focus on the possibility of distinguishing focal nodular hyperplasia(FNH) from hepatic adenoma(HA), the identification of early hepatocellular carcinoma(HCC) and the pre-operative assessment of metastasis in liver parenchyma. Regarding the differentiation between FNH and HA, adenoma typically appears hypointense in hepatobiliary phase, whereas FNH is isointense or hyperintense to the surrounding hepatic parenchyma. As for the identification of early HCCs, many papers recently published in literature have emphasized the contribution of hepatobiliary phase in the characterization of nodules without a typical hallmark of HCC. Atypical nodules(no hypervascularizaton observed on arterial phase and/or no hypovascular appearance on portal phase) with low signal intensity in the hepatobiliary phase, have a high probability of malignancy. Finally, regarding the evaluation of focal hepatic metastases, magnetic resonance pre-operative assessment using gadoxetic acid allows for more accurate diagnosis.     

Serum amyloid A and C‐reactive protein positive nodule in alcoholic liver cirrhosis,hard to make definite diagnosis

We describe a case of serum amyloid A (SAA) and C‐reactive protein (CRP) positive nodule detected by immunohistochemical analysis in a 37‐year‐old woman with alcohol‐related cirrhosis. Imaging studies at first admission pointed to hepatocellular carcinoma (HCC), a dysplastic nodule, an inflammatory pseudotumor or focal nodular hyperplasia (FNH). Ultrasonography‐guided biopsy in Segment 2 showed minimal atypical changes, except for a slight increase in cell density and micronodular cirrhosis in the non‐nodular portion. gadolinium‐ethoxybenzyl‐diethylenetriamine pentaacetic acid‐enhanced magnetic resonance imaging carried out after a year and a half revealed hypervascularity in the arterial phase and isointensity in the hepatobiliary phase. Three years thereafter, however, the imaging displayed a change from isointensity to a defect in the hepatobiliary phase, and the nodule demonstrated minimal histological atypia. Immunohistochemical staining of the nodule was positive for SAA, CRP, liver fatty acid‐binding protein and glutamine synthetase, but negative for β‐catenin, heat shock protein 70 and Glypican 3. Organic anion transporter (OATP)8 staining was weaker in the nodule than in the non‐nodular portion of the alcohol‐related micronodular cirrhosis. The nodule was diagnosed as an SAA and CRP positive nodule, and HCC was ruled out. Despite the change from isointensity to a defect in the hepatobiliary phase, no evidence of HCC was found in the biopsy specimen. The change may be explained more by the weak OATP8 staining compared with that of alcohol‐related liver cirrhosis than by malignant transformation into HCC.     

Imaging of focal nodular hyperplastic-like nodules in alcoholic liver cirrhosis patients using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging

We report on two patients with a history of alcohol abuse who presented with multiple hepatic nodules. Dynamic computed tomography revealed multiple nodular lesions, which were enhanced at the early contrast phase and washed out at the portal phase. In the hepatobiliary phase using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA MRI), these tumors did not show any uptake, thus suggesting the presence of hepatocellular carcinoma. An ultrasound-guided biopsy revealed a slight increase in cell density, sinusoidal dilatation, and contained unpaired small arteries. According to immunohistochemical analyses, these arteries were positive for CD34 and alpha-smooth muscle actin. From these findings, the nodules were diagnosed to be focal nodular hyperplastic (FNH)-like nodules arising in alcoholic-cirrhosed livers. The differential diagnosis of FNH-like nodules arising in alcoholic liver cirrhosis and hepatocellular carcinoma is difficult with Gd-EOB-DTPA MRI, and therefore histological confirmation is necessary.     

Contrast uptake in primary hepatic angiosarcoma on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging in the hepatobiliary phase

Primary hepatic angiosarcoma is the most common malignant mesenchymal tumor of the liver. It has a poor prognosis and various appearances on magnetic resonance(MR) images. We report a case of hepatic angiosarcoma with a characteristic appearance on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MR imaging in the hepatobiliary phase. A 72-year-old man was admitted with a complaint of abdominal pain. Gd-EOBDTPA-enhanced MR imaging revealed a liver tumor that showed slight hyperintensity in the hepatobiliary phase. These findings suggested Gd-EOB-DTPA uptake in the tumor. An autopsy revealed the solid proliferation and sinusoidal spreading of hepatic angiosarcoma cells. Immunohistochemistry indicated that the tumor was negative for OATP1B3. Gd-EOB-DTPA uptake in the liver tumor in the hepatobiliary phase suggested sinusoidal tumor invasion with residual normal hepatocytes.     

Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies

We describe a 15-mm scirrhous hepatocellular carcinoma （HCC） in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not diffuse, hypervascularity in the early phase and a defect in the Kupffer phase.Contrast-enhanced computed tomography （CT） revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase.Magnetic resonance imaging （MRI） revealed iso- to hypointensity at T1 and high intensity at T2-weighted sequences. Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase. Super-paramagnetic iron oxide-MRI revealed a hvoerintense nodule. CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect, respectively. Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC.Histologically, the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis. Immunohistochemically,the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin, and negative for cytokeratin 19. From the above findings, the nodule was diagnosed as scirrhous HCC. Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings, as shown in our case on the basis of chronic liver disease.     

原发性肝癌的MRI增强表现临床分析

目的分析肝胆期表现为乏血管低信号结节有可能转变为富血管原发性肝癌（PLC）的MRI增强影像表现。方法 135例乙型肝炎合并肝硬化患者的肝胆期增强MRI中,发现214个乏血管低信号结节灶。分析每一个结节的大小,在肝胆期的低信号程度（分为4度）,有无脂肪成分,在T1加权、T2加权及弥散成像序列的信号强度。将这些变量进行多变量单变量回归分析,来确认再生结节转变为PLC最有价值的影像特征。结果在135例214个结节的MRI随访系列图像上,139个结节（65.0%）无PLC形成的迹象（稳定组,平均随访522天）,转变组75个结节（35.0%）则最终转变为富血管高信号PLC结节。单变量回归分析显示与PLC形成明显相关的为在MRI增强肝胆期结节灶的低信号程度（P=0.001）,T2加权高信号（P=0.001）与弥散成像高信号（P=0.0001）。多变量回归分析显示首次MRI弥散成像结节高信号为PLC形成最有价值的影像特征（危害比7.44;95%CI 4.28,12.94）。结论肝硬化患者MRI增强肝胆期结节灶信号最低而在弥散成像序列表现为高信号,强烈提示富血管PLC已经形成。     

Primovist, Eovist: what to expect?

Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA, Primovist in Europe and Eovist in the USA) is a liver-specific magnetic resonance imaging contrast agent that has up to 50% hepatobiliary excretion in the normal liver. After intravenous injection, Gd-EOB-DTPA distributes into the vascular and extravascular spaces during the arterial, portal venous and late dynamic phases, and progressively into the hepatocytes and bile ducts during the hepatobiliary phase. The hepatocyte uptake of Gd-EOB-DTPA mainly occurs via the organic anion transporter polypeptides OATP1B1 and B3 located at the sinusoidal membrane and biliary excretion via the multidrug resistance-associated proteins MRP2 at the canalicular membrane. Because of these characteristics, Gd-EOB-DTPA behaves similarly to non-specific gadolinium chelates during the dynamic phases, and adds substantial information during the hepatobiliary phase, improving the detection and characterization of focal liver lesions and diffuse liver disease. This information is particularly relevant for the detection of metastases, and for the detection and characterization of nodular lesions in liver cirrhosis, including early hepatocellular carcinomas. Finally, GD-EOB-DTPA-enhanced magnetic resonance imaging may provide quantitative assessment regarding liver perfusion and hepatocyte function in diffuse liver diseases. The full potential of GD-EOB-DTPA-enhanced magnetic resonance imaging has to be established further. It is already clear that GD-EOB-DTPA-enhanced magnetic resonance imaging provides anatomic and functional information in the setting of focal and diffuse liver disease that is unattainable with magnetic resonance imaging enhanced with non-specific contrast agents.     

增强MRI扫描在乙型肝炎肝硬化背景下对原发性肝癌的诊断价值分析*

目的 研究采用钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)对乙型肝炎肝硬化背景下原发性肝癌(PLC)的诊断价值。方法 2018年12月～2020年12月我院收治的乙型肝炎肝硬化背景下肝脏局灶性病变患者147例,均行Gd-EOB-DTPA肝脏增强MRI扫描,观察病灶强化特点和各序列信号强度,包括T1加权像(T₁WI)、T2加权像(T₂WI)及动脉期、门脉期、肝胆特异期和磁共振弥散加权成像(DWI)病灶的信号强度。采用受试者工作特征(ROC)曲线下面积(AUC)分析上述信号特征对PLC的诊断效能。结果 在147例患者中,发现PLC者102例,病灶大小为0.9～2.9 cm,平均为(1.8±0.6)cm,肝脏异型性增生结节45例,病灶大小为0.8～2.5 cm,平均为(1.4±0.2)cm;增强MRI扫描显示,84例表现为动脉期病灶呈低或等强化,门静脉期或延迟期呈低强化,63例表现为动脉期明显强化,门静脉期或延迟期未廓清;PLC组病灶T₁WI低信号、T₂WI高信号、DWI高信号、动脉期高强化和肝胆期低信号表现占比分别为50.0%、79.4%、82.4%、52.9%和94.1%,显著高于非PLC组(20.0%、20.0%、26.7%、20.0%和20.0%,P＜0.05);ROC分析结果显示病灶T₁WI低信号(AUC=0.670,敏感度=0.451)、T₂WI高信号(AUC=0.817,敏感度=0.745)、DWI高信号(AUC=0.754,敏感度=0.863)、动脉期高强化(AUC=0.693,敏感度=0.520)和肝胆期低信号(AUC=0.891,敏感度=0.892)对PLC具有一定的诊断效能(P＜0.05)。结论 增强MRI扫描在乙型肝炎肝硬化背景下早期发现PLC具有重要的诊断价值,临床应不断总结其特点变化,提高早期诊断率。     

增强MRI T1 mapping定量评估慢性乙型肝炎患者肝纤维化程度效能分析

目的 应用钆塞酸二钠增强MRI T1 mapping技术定量评估慢性乙型肝炎(CHB)患者肝纤维化程度。方法 2018年1月～2020年6月我院诊治的CHB患者74例,接受肝活检和钆塞酸二钠增强MR扫描,测量肝胆期信号强度(SI)、肝胆期T1值、相对增强(RE)和T1值变化率,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),采用Z检验,分析MRI指标评估CHB患者显著性肝纤维化的效能。结果 在74例CHB患者中,组织病理学诊断肝纤维化F0期22例,F1期12例,F2期15例,F3期9例,F4期16例;40例显著性肝纤维化患者肝胆期SI、肝胆期T1值、RE和T1值变化率分别为(362.5±29.8)、(418.5±41.2)、(0.52±0.07)和(50.8±4.8)%,与34例非显著性肝纤维化组比,差异显著【分别为(472.6±50.6)、(284.0±35.9)、(0.80±0.09)和(76.2±5.4)%,P<0.05】;在评估显著性肝纤维化的效能方面,T1值变化率诊断的敏感度和特异度分别达到77.6%和93.2%,显著高于其他指标(P<0.05)。结论 应用钆塞酸二钠增强MRI T1 mapping技术定量评价CHB患者显著性肝纤维化有一定的价值,值得进一步验证。     

钆塞酸二钠增强磁共振成像肝胆期对比剂摄取相关参数评估药物性肝损伤的价值

目的探讨钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）肝胆期对比剂摄取相关参数评估药物性肝损伤（DILI）患者肝损伤程度的价值。 方法选择2020年1月至2021年6月扬州大学附属苏北人民医院收治的55例DILI患者,其中轻症DILI组29例,重症DILI组26例。选择同期30例肝功能正常患者（非DILI组）作为对照。回顾性分析患者Gd-EOB-DTPA增强MRI图像,测量增强前及增强后肝胆期肝脏、门静脉与脾脏信号强度,计算肝脏相对强化程度（RE）、肝脏相对于门静脉强化程度比（LPC）、肝脏相对于脾脏强化程度比（LSC）,同时评价功能性肝脏影像评分（FLIS）。比较非DILI组、轻症DILI组、重症DILI组患者各参数差异。采用Pearson相关分析Gd-EOB-DTPA增强MRI肝胆期对比剂摄取相关参数与肝功能指标的相关性。绘制受试者操作特征（ROC）曲线分析Gd-EOB-DTPA增强MRI肝胆期对比剂摄取相关参数鉴别轻症DILI组与重症DILI组的效能。 结果DILI组患者RE、LPC、LSC均低于非DILI组患者,且随着肝损伤程度的加重而降低,且差异均有统计学意义（P均<0.05）。RE、LPC与DILI患者总胆红素水平呈中度负相关（r=-0.53、-0.51,P<0.05）,与DILI患者总蛋白水平呈中度正相关（r=0.54、0.53,P<0.05）。ROC曲线显示,RE、LPC、LSC、FLIS区分轻症DILI组与重症DILI组患者的曲线下面积（AUC）分别为0.74、0.81、0.74、0.78。 结论Gd-EOB-DTPA增强MRI肝胆期对比剂摄取相关参数可评估DILI患者肝损伤程度,为临床定量评估DILI严重程度提供了新的辅助方法。     

肝细胞癌癌前结节影像学特征的研究进展

肝细胞癌(HCC)发生是一个多步骤过程,在其发展中检测出HCC癌前病变和进展期HCC,对预测肿瘤行为、判断病变程度、采用最佳治疗策略、改善患者生存至关重要。肝脏成像技术的快速进展和广泛应用,尤其是肝细胞特异性对比剂钆塞酸二钠MRI(Gd-EOB-DTPA MRI)可提供肝结节血管变化、肝细胞功能信息,能够精确区分肝硬化再生结节、低度异型增生结节、高度异型增生结节、早期HCC(early HCC)和HCC,从而进行恶性进展的风险度分层。现综述Gd-EOB-DTPA MRI在HCC早期诊断中的价值,分析HCC多步发展过程中的关键概念,以及癌前病变最终可能转化成典型HCC的影像学表现。     

钆塞酸二钠增强磁共振扫描诊断肝脏局灶性病变研究*

目的 通过与手术后组织病理学诊断结果比较,观察钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）对肝脏局灶性病变（FLL）的诊断价值。方法 我院收治的FLL患者68例,接受Gd-EOB-DTPA增强MRI检查,与术后组织病理学诊断比较检查结果的正确性。结果 68例FLL患者经术后组织病理学检查诊断为肝细胞癌36例,肝内胆管细胞癌6例,混合型肝癌8例,肝局灶性结节性增生12例,肝血管平滑肌脂肪瘤4例,非FLL 2例,而Gd-EOB-DTPA增强MRI诊断FLL 64例,其中肝细胞癌37例,肝内胆管细胞癌7例,混合型肝癌4例,肝局灶性结节性增生14例,肝血管平滑肌脂肪瘤2例,非FLL 4例。增强MRI诊断FLL的Kappa值为0.7,其灵敏度为97.1%,特异度为100.0%,阳性预测值为100.0%,阴性预测值为50.0%。结论 采取Gd-EOB-DTPA增强MRI检查对FLL诊断具有较高的灵敏度和特异度,临床应重视其诊断价值。     

Management of sub-centimeter recurrent hepatocellular carcinoma after curative treatment: Current status and future

Hepatocellular carcinomas (HCCs) frequently recur despite initial successful surgical resection or local ablation therapy. Diagnostic methods for small HCCs have improved with the introduction of gadoxetic acid-enhanced liver magnetic resonance imaging and diffusion-weighted imaging (DWI). Currently, sub-centimeter recurrent nodules showing typical hallmark imaging findings of HCC are frequently detected in patients with a treatment history for HCC. With five typical magnetic resonance findings, including arterial enhancement, washout on portal or transitional phase, high signal intensity on both T2-weighted image and DWI, and low signal intensity on hepatobiliary phase, sub-centimeter recurrent HCC can be diagnosed with high accuracy. Although more information is needed to determine the treatment of choice, local ablation therapy under fusion imaging and/or contrast-enhanced ultrasound guidance or cone-beam computed tomography-guided chemoembolization seem to be promising as they are effective and safe for the management of sub-centimeter recurrent HCCs.     

MR with Gd-EOB-DTPA in assessment of liver nodules in cirrhotic patients

To date the imaging diagnosis of liver lesions is based mainly on the identification of vascular features, which are typical of overt hepatocellular carcinoma(HCC), but the hepatocarcinogenesis is a complex and multistep event during which, a spectrum of nodules develop within the liver parenchyma, including benign small and large regenerative nodule(RN), low-grade dysplastic nodule(LGDN), high-grade dysplastic nodule(HGDN), early HCC, and well differentiated HCC. These nodules may be characterised not only on the basis of their respective different blood supplies, but also on their different hepatocyte function. Recently, in liver imaging the introduction of hepatobiliary magnetic resonance imaging contrast agent offered the clinicians the possibility to obtain, at once, information not only related to the vascular changes of liver nodules but also information on hepatocyte function. For this reasons this new approach becomes the most relevant diagnostic clue for differentiating low-risk nodules(LGDN-RN) from highrisk nodules(HGDN/early HCC or overt HCC) and consequently new diagnostic algorithms for HCC have been proposed. The use of hepatobiliary contrast agents is constantly increasing and gradually changing the standard of diagnosis of HCC. The main purpose of this review is to underline the added value of Gd-EOB-DTPA in early-stage diagnoses of HCC. We also analyse the guidelines for the diagnosis and management of HCC, the key concepts of HCC development, growth and spread and the imaging appearance of precursor nodules that eventually may transform into overt HCC.     

The value of the signal intensity of peritumoral tissue on Gd-EOB-DTPA dynamic enhanced MRI in assessment of microvascular invasion and pathological grade of hepatocellular carcinoma

The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan–Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.SI ratio of peritumoral tissue to normal liver in arterial phase (SI_Ap/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867–5.198] and pathological grades (OR = 1.437, 95% CI: 1.042–1.981). The area under the curve (AUC) of SI_Ap/Al was equivalent to the SI of tumor parenchyma on arterial phase (SI_At) in distinguishing low and high pathological grades. However, the AUC of SI_Ap/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SI_Ap/Al<1.1 was higher than HCC with SI_Ap/Al≥1.1(P = .025).The SI_Ap/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SI_Ap/Al may predict the poor prognosis of HCC after surgery.     

Unique hypervascular nodules in alcoholic liver cirrhosis: identical to focal nodular hyperplasia-like nodules?

BACKGROUND/AIMS: Currently, focal nodular hyperplasia (FNH)-like nodules in cirrhotic liver is spotlighted. Unique hypervascular nodules mimicking FNH-like nodule in alcoholic liver cirrhosis were clinicopathologically clarified. METHODS: Six resected and six biopsy cases of small hypervascular nodules found in alcoholic cirrhosis were studied clinicopathologically. RESULTS: All cases were male and consumed 90-150 g/day of ethanol for longer than 20 years, and hepatitis virus markers were negative. The nodules, 9-21 mm in diameter, were detected by ultrasonography during follow-up of alcoholic cirrhosis, and showed hypervascularity on angiography. Six patients were diagnosed as hepatocellular carcinoma and six were as hyperplastic nodule by biopsy, and the former six cases received partial hepatectomy. All of the resected nodules were completely or incompletely encapsulated. Histologically, all resected and biopsy nodules showed moderate increase of cell-density with an irregular trabecular pattern, and scar-like fibrosis with anomalous blood vessels, and unpaired arteries. All nodules showed marked or mild iron deposits in hepatocytes and/or kupffer cells, and a diffuse capillarization of the sinusoids. CONCLUSIONS: The nodules in the present series seem to fall in the same category as FNH-like nodules in cirrhotic liver, and should be taken account in screening programs including patients with alcoholic cirrhosis.     

Gd-EOB-DTPA-enhanced magnetic resonance imaging for bile duct intraductal papillary mucinous neoplasms

AIM: To investigate gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) of intraductal papillary mucinous neoplasms of the bile duct (IPMN-B).METHODS: The imaging findings of five cases of IPMN-B which were pathologically confirmed at our hospital between March 2012 and May 2013 were retrospectively analyzed. Three of these cases were diagnosed by duodenal endoscopy and biopsy pathology, and two cases were diagnosed by surgical pathology. All five patients underwent enhanced and non-enhanced computed tomography (CT), magnetic resonance cholangiopancreatography, and Gd-EOB-DTPA-enhanced MRI; one case underwent both Gd-EOB-DTPA-enhanced MRI and positron emission tomography-CT. The clinical data and imaging results for these cases were compared and are presented.RESULTS: Conventional imaging showed diffuse dilatation of bile ducts and multiple intraductal polypoid and papillary neoplasms or serrated changes along the bile ducts. In two cases, Gd-EOB-DTPA-enhanced MRI revealed dilated biliary ducts and intraductal tumors, as well as filling defects caused by mucin in the dilated bile ducts in the hepatobiliary phase. Gd-EOB-DTPA-enhanced MRI in one case clearly showed a low-signal tumor in the hepatobiliary phase, similar to what was seen by positron emission tomography-CT. In two patients, routine inspection was unable to discern whether the lesions were inflammation or tumors. However, Gd-EOB-DTPA-enhanced MRI revealed a pattern of gradual enhancement during the hepatobiliary phase, and the signal intensity of the lesions was lower than the surrounding liver parenchyma, suggesting tissue inflammation in both cases, which were confirmed by surgical pathology.CONCLUSION: Gd-EOB-DTPA-enhanced MRI reveals the intraductal mucin component of IPMN-B in some cases and the extent of tumor infiltration beyond the bile ducts in invasive cases.