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Rau S, Stein T, Rau A, Faby S, Russe MF, Jost G, Doppler MC, Lang F, Bamberg F, Pietsch H, Weiss J. Use of Photon-Counting Detector CT to Visualize Liver-Specific Gadolinium-Based Contrast Agents: A Phantom Study. AJR Am J Roentgenol 2025; 224:e2432434. [PMID: 39907472 DOI: 10.2214/ajr.24.32434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
BACKGROUND. The low clinically approved doses of gadolinium-based contrast agents (GBCAs) do not generate sufficient enhancement on CT for diagnostic purposes. Photon-counting detector (PCD) CT offers improved spectral resolution and could potentially enable visualization of hepatocyte-specific GBCAs, given their associated high gadolinium concentrations within hepatocytes. OBJECTIVE. The purpose of this study was to investigate the potential of gadoxetate disodium in combination with PCD CT and low-energy virtual monoenergetic imaging (VMI) reconstructions to achieve an increase in attenuation in a phantom. METHODS. A series of solutions was prepared of diluted gadoxetate disodium (concentrations of 0.250-2.5 μmol/mL, corresponding with doses of 25-200 μmol/kg). These solutions, along with deionized water, were evaluated in an anthropomorphic abdominal phantom using a clinical PCD CT scanner; VMI reconstructions at 40, 50, 60, and 70 keV and virtual noncontrast (VNC) imaging reconstructions were generated. Attenuation measurements were obtained; a linear regression model combined these values with previously reported in vivo data to estimate hepatic enhancement and CNR across doses. RESULTS. Attenuation increased with increasing concentration at a given energy level and with decreasing energy level for a given concentration; VNC images had the lowest attenuation. The maximum attenuation reached in the abdominal phantom was 45.2 HU for a concentration of 2.5 μmol/mL at 40 keV. A concentration of 0.25 μmol/mL had attenuation at 40 keV of 13.0 HU. The model yielded estimated in vivo hepatic enhancement at 40 keV of 4.9 HU for a dose of 25 μmol/kg, 19.9 HU for 100 μmol/kg, and 30.8 HU for 200 μmol/kg; corresponding CNRs were 0.13, 0.52, and 0.81, respectively. CONCLUSION. The combination of gadoxetate disodium and PCD CT could theoretically allow appreciable hepatic enhancement at a 200-μmol/kg dose; such effect was not observed for the clinically approved 25-μmol/kg dose. CLINICAL IMPACT. PCD CT achieved attenuation increases for gadoxetate disodium at considerably lower doses than previously documented for CT of GBCAs, albeit at approximately eight times greater than clinical doses, which were thus too high for clinical use. Additional research exploiting PCD CT technology could seek to reduce further doses required for sufficient visualization into a clinically feasible range, to potentially allow CT using a liver-specific agent.
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Affiliation(s)
- Stephan Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
| | - Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Maximilian F Russe
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
| | - Gregor Jost
- MR and CT Contrast Media Research, Bayer Pharma, Berlin, Germany
| | - Michael C Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
| | - Friederike Lang
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer Pharma, Berlin, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str 55, 79106 Freiburg im Breisgau, Germany
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Hojreh A, Mulabdic A, Heilos A, Peyrl A, Lampichler K, Raudner M, Tamandl D, Ba-Ssalamah A, Szepfalusi Z. Acute adverse reactions after multiple initially well-tolerated gadolinium-based contrast-enhanced abdomen MRIs in pediatric patients. PLoS One 2024; 19:e0313495. [PMID: 39625932 PMCID: PMC11614221 DOI: 10.1371/journal.pone.0313495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 10/24/2024] [Indexed: 12/06/2024] Open
Abstract
PURPOSE Repeated gadolinium-based contrast agent (GBCA)-enhanced MRIs are crucial in the diagnosis and follow-up of oncologic and chronic disorders in pediatric patients. The aim of the study was to evaluate the frequency and severity of adverse reactions to GBCAs in children after a single vs. multiple GBCA-enhanced abdomen MRIs. MATERIAL AND METHODS All pediatric patients with at least one GBCA-enhanced abdominal MRI between 2009 and 2020 were retrospectively evaluated based on adverse reactions reports, according to the classification system of the American College of Radiology and guidelines on contrast agents of the European Society of Urogenital Radiology. A Student´s t-test analysis, a spearman ρ-correlation and a Chi-square test between the reported adverse reactions and the total number of GBCA applications, and the number of each applied GBCA was calculated. A p-value <0.05 was considered significant. RESULTS Of 623 patients with 964 GBCA-enhanced abdomen MRIs, there were 464 patients with only one and 159 patients with multiple GBCA administrations. Of 964 GBCA doses administrated, two cases with urticaria (mild allergy-like adverse reaction) and one case with vomiting (mild chemotoxic adverse reaction) were recorded (3/964 = 0.31%), but all the reports were in patients with multiple GBCA administration (3/159 = 1.89%). No adverse reactions in patients with a single GBCA administration were observed. The reported adverse reactions correlated significantly with the total number of GBCAs (p<0.001) and the number of each GBCA (p<0.001 or p = 0.002). The independent two-tailed t-tests, and the chi-square test were significant (p<0.001, p = 0.003). CONCLUSION GBCA-associated adverse reactions are rare and mostly mild, but initially well-tolerated GBCA could cause adverse reactions due to the increase likelihood of drug hypersensitivity upon repeated GBCA exposure.
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Affiliation(s)
- Azadeh Hojreh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Amra Mulabdic
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Heilos
- Division of Pediatric Nephrology and Gastroenterology Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katharina Lampichler
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Marcus Raudner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Zsolt Szepfalusi
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Wang X, Zhang S, Huang Z, Tian G, Liu X, Chen L, An L, Li X, Liu N, Ji Y, Han Y. Influence of Gadoxetate disodium to the hepatic proton density fat fraction quantified with the Dixon sequences in a rabbit model. Abdom Radiol (NY) 2024; 49:3374-3382. [PMID: 38683216 PMCID: PMC11390814 DOI: 10.1007/s00261-024-04320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To study the impact of Gx on quantification of hepatic fat contents under metabolic dysfunction-associated steatotic liver disease (MASLD) imaged on VIBE Dixon in hepatobiliary specific phase. METHODS Forty-two rabbits were randomly divided into control group (n = 10) and high-fat diet group (n = 32). Imaging was performed before enhancement (Pre-Gx) and at the 13th (Post-Gx13) and 17th (Post-Gx17) min after Gx enhancement with 2E- and 6E-VIBE Dixon to determine hepatic proton density fat fractions (PDFF). PDFFs were compared with vacuole percentage (VP) measured under histopathology. RESULTS 33 animals were evaluated and including control group (n = 11) and MASLD group (n = 22). Pre-Gx, Post-Gx13, Post-Gx17 PDFFs under 6E-VIBE Dixon had strong correlations with VPs (r2 = 0.8208-0.8536). PDFFs under 2E-VIBE Dixon were reduced significantly (P < 0.001) after enhancement (r2 = 0.7991/0.8014) compared with that before enhancement (r2 = 0.7643). There was no significant difference between PDFFs of Post-Gx13 and Post-Gx17 (P = 0.123) for which the highest consistency being found with 6E-VIBE Dixon before enhancement (r2 = 0.8536). The signal intensity of the precontrast compared with the postcontrast, water image under 2E-VIBE Dixon increased significantly (P < 0.001), fat image showed no significant difference (P = 0.754). CONCLUSION 2E- and 6E-VIBE Dixon can obtain accurate PDFFs in the hepatobiliary specific phase from 13 to 17th min after Gx enhancement. On 2E-VIBE Dixon (FA = 10°), effective minimization of T1 Bias by the Gx administration markedly improved the accuracy of the hepatic PDFF quantification.
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Affiliation(s)
- Xia Wang
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China
| | - Sheng Zhang
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China
| | - Zhe Huang
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China
| | - Gang Tian
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China
| | - Xiaofan Liu
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China
| | - Lijun Chen
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China
| | - Liang An
- Department of Clinical Laboratory, Xi'an GaoXin Hospital, Xi'an, China
| | - Xumiao Li
- Department of Pathology, Xi'an GaoXin Hospital, Xi'an, China
| | - Ningna Liu
- Department of Pathology, Xi'an GaoXin Hospital, Xi'an, China
| | - Yang Ji
- Department of Imaging Center, First Affiliated Hospital, Xi'an Medical University, Shaanxi, China.
| | - Yuedong Han
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, South Tuanjie Rd 16, Xi'an, 710075, Shaanxi, China.
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Li S, Liu B, Deng F, Xu Y, Zhou W. Image Synthesis of Hepatobiliary Phase using Contrast-Enhanced MRI and Diffusion Model. 2024 IEEE INTERNATIONAL SYMPOSIUM ON BIOMEDICAL IMAGING (ISBI) 2024:1-5. [DOI: 10.1109/isbi56570.2024.10635567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Affiliation(s)
- Shangxuan Li
- Guangzhou University of Chinese Medicine,School of Medical Information Engineering,China
| | - Baoer Liu
- Southern Medical University,Department of Medical Imaging Center, Nanfang Hospital,China
| | - Feilin Deng
- Guangzhou University of Chinese Medicine,School of Medical Information Engineering,China
| | - Yikai Xu
- Southern Medical University,Department of Medical Imaging Center, Nanfang Hospital,China
| | - Wu Zhou
- Guangzhou University of Chinese Medicine,School of Medical Information Engineering,China
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Nagata H, Ohno Y, Yoshikawa T, Yamamoto K, Shinohara M, Ikedo M, Yui M, Matsuyama T, Takahashi T, Bando S, Furuta M, Ueda T, Ozawa Y, Toyama H. Compressed sensing with deep learning reconstruction: Improving capability of gadolinium-EOB-enhanced 3D T1WI. Magn Reson Imaging 2024; 108:67-76. [PMID: 38309378 DOI: 10.1016/j.mri.2024.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE The purpose of this study was to determine the utility of compressed sensing (CS) with deep learning reconstruction (DLR) for improving spatial resolution, image quality and focal liver lesion detection on high-resolution contrast-enhanced T1-weighted imaging (HR-CE-T1WI) obtained by CS with DLR as compared with conventional CE-T1WI with parallel imaging (PI). METHODS Seventy-seven participants with focal liver lesions underwent conventional CE-T1WI with PI and HR-CE-T1WI, surgical resection, transarterial chemoembolization, and radiofrequency ablation, followed by histopathological or >2-year follow-up examinations in our hospital. Signal-to-noise ratios (SNRs) of liver, spleen and kidney were calculated for each patient, after which each SNR was compared by means of paired t-test. To compare focal lesion detection capabilities of the two methods, a 5-point visual scoring system was adopted for a per lesion basis analysis. Jackknife free-response receiver operating characteristic (JAFROC) analysis was then performed, while sensitivity and false positive rates (/data set) for consensus assessment of the two methods were also compared by using McNemar's test or the signed rank test. RESULTS Each SNR of HR-CE-T1WI was significantly higher than that of conventional CE-T1WI with PI (p < 0.05). Sensitivities for consensus assessment showed that HR-CE-MRI had significantly higher sensitivity than conventional CE-T1WI with PI (p = 0.004). Moreover, there were significantly fewer FP/cases for HR-CE-T1WI than for conventional CE-T1WI with PI (p = 0.04). CONCLUSION CS with DLR are useful for improving spatial resolution, image quality and focal liver lesion detection capability of Gd-EOB-DTPA enhanced 3D T1WI without any need for longer breath-holding time.
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Affiliation(s)
- Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiharu Ohno
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.
| | - Takeshi Yoshikawa
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan; Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, 673-0021, Japan
| | - Kaori Yamamoto
- Canon Medical Systems Corporation, Otawara, Tochigi, 324-8550, Japan
| | - Maiko Shinohara
- Canon Medical Systems Corporation, Otawara, Tochigi, 324-8550, Japan
| | - Masato Ikedo
- Canon Medical Systems Corporation, Otawara, Tochigi, 324-8550, Japan
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara, Tochigi, 324-8550, Japan
| | - Takahiro Matsuyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Tomoki Takahashi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Shuji Bando
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Minami Furuta
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Takahiro Ueda
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiyuki Ozawa
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
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Brandi N, Renzulli M. Liver Lesions at Risk of Transformation into Hepatocellular Carcinoma in Cirrhotic Patients: Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement. J Clin Transl Hepatol 2024; 12:100-112. [PMID: 38250460 PMCID: PMC10794268 DOI: 10.14218/jcth.2023.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 01/23/2024] Open
Abstract
Recent technical advances in liver imaging and surveillance for patients at high risk for developing hepatocellular carcinoma (HCC) have led to an increase in the detection of borderline hepatic nodules in the gray area of multistep carcinogenesis, particularly in those that are hypointense at the hepatobiliary phase (HBP) and do not show arterial phase hyperenhancement. Given their potential to transform and advance into hypervascular HCC, these nodules have progressively attracted the interest of the scientific community. To date, however, no shared guidelines have been established for the decision management of these borderline hepatic nodules. It is therefore extremely important to identify features that indicate the malignant potential of these nodules and the likelihood of vascularization. In fact, a more complete knowledge of their history and evolution would allow outlining shared guidelines for their clinical-surgical management, to implement early treatment programs and decide between a preventive curative treatment or a watchful follow-up. This review aims to summarize the current knowledge on hepatic borderline nodules, particularly focusing on those imaging features which are hypothetically correlated with their malignant evolution, and to discuss current guidelines and ongoing management in clinical practice.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Li S, Xu X, Li C, Xu Z, Wu K, Ye Q, Zhang Y, Jiang X, Cang C, Tian C, Wen J. In vivo labeling and quantitative imaging of neuronal populations using MRI. Neuroimage 2023; 281:120374. [PMID: 37729795 DOI: 10.1016/j.neuroimage.2023.120374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
The study of neural circuits, which underlies perception, cognition, emotion, and behavior, is essential for understanding the mammalian brain, a complex organ consisting of billions of neurons. To study the structure and function of the brain, in vivo neuronal labeling and imaging techniques are crucial as they provide true physiological information that ex vivo methods cannot offer. In this paper, we present a new strategy for in vivo neuronal labeling and quantification using MRI. We demonstrate the efficacy of this method by delivering the oatp1a1 gene to the target neurons using rAAV2-retro virus. OATP1A1 protein expression on the neuronal membrane increased the uptake of a specific MRI contrast agent (Gd-EOB-DTPA), leading to hyperintense signals on T1W images of labeled neuronal populations. We also used dynamic contrast enhancement-based methods to obtain quantitative information on labeled neuronal populations in vivo.
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Affiliation(s)
- Shana Li
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Xiang Xu
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Canjun Li
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Ziyan Xu
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Ke Wu
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Qiong Ye
- Key Laboratory of High Field Magnetic Resonance Image of Anhui Province, High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui, PR China
| | - Yan Zhang
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Xiaohua Jiang
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Chunlei Cang
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | - Changlin Tian
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China; School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China; Key Laboratory of High Field Magnetic Resonance Image of Anhui Province, High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui, PR China.
| | - Jie Wen
- The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China.
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Bouyer T, Roux M, Jacquemin S, Dioguardi Burgio M, Sutter O, Laurent-Croisé V, Lonjon J, Bricault I, Trillaud H, Rode A, Aubé C, Paisant A. Detection of arterial phase hyperenhancement of small hepatocellular carcinoma with MRI: Comparison between single arterial and multi-arterial phases and between extracellular and hepatospecific contrast agents. Diagn Interv Imaging 2023; 104:477-484. [PMID: 37211446 DOI: 10.1016/j.diii.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/21/2023] [Accepted: 04/21/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE The purpose of this study was to compare the detection rate of arterial phase hyperenhancement (APHE) in small hepatocellular carcinoma (HCC) between single arterial phase (single-AP) and triple hepatic arterial (triple-AP) phase MRI and between extracellular (ECA) and hepato-specific (HBA) contrast agents. MATERIALS AND METHODS A total of 109 cirrhotic patients with 136 HCCs from seven centers were included. There were 93 men and 16 women, with a mean age of 64.0 ± 8.9 (standard deviation) years (range: 42-82 years). Each patient underwent both ECA-MRI and HBA (gadoxetic acid)-MRI examination within one month of each other. Each MRI examination was retrospectively reviewed by two readers blinded to the second MRI examination. The sensitivities of triple- and single-AP for the detection of APHE were compared, and each phase of the triple-AP sequence was compared with the other two. RESULTS No differences in APHE detection were found between single-AP (97.2%; 69/71) and triple-AP (98.5%; 64/65) (P > 0.99) at ECA-MRI. No differences in APHE detection were found between single-AP (93%; 66/71) and triple-AP (100%; 65/65) at HBA-MRI (P = 0.12). Patient age, size of the nodules, use of automatic triggering, type of contrast agent, and type of sequence were not significantly associated with APHE detection. The reader was the single variable significantly associated with APHE detection. For triple-AP, best APHE detection rate was found for early and middle-AP images compared to late-AP images (P = 0.001 and P = 0.003). All APHEs were detected with the combination of early-AP and middle-AP images, except one that was detected on late-AP images by one reader. CONCLUSION Our study suggests that both single- and triple-AP can be used in liver MRI for the detection of small HCC especially when using ECA. Early AP and middle-AP are the most efficient phases and should be preferred for detecting APHE, regardless of the contrast agent used.
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Affiliation(s)
- Thomas Bouyer
- Department of Radiology, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France.
| | - Marine Roux
- Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, 49045 Angers, France
| | - Sarah Jacquemin
- Department of Radiology, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, APHP Nord, 92110 Clichy, France; Université de Paris, Centre de recherche sur l'inflammation, INSERM, U1149, CNRS, ERL8252, Paris, 75018, France
| | - Olivier Sutter
- Department of Radiology, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis (AP-HP), 93140 Bondy, France
| | - Valérie Laurent-Croisé
- Department of Radiology, Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, 54500 Vandœuvre-lès-Nancy, France
| | - Julie Lonjon
- Department of Radiology, Centre Hospitalier Universitaire Saint Eloi, 34090 Montpellier, France
| | - Ivan Bricault
- Université Grenoble Alpes, CNRS, 38400 Grenoble, France; Department of Radiology, Centre Hospitalier Universitaire Grenoble Alpes, 38700 Grenoble, France
| | - Hervé Trillaud
- Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France
| | - Agnès Rode
- Department of Radiology, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Centre Hospitalier Universitaire, 69317 Lyon Cedex 04, France
| | - Christophe Aubé
- Department of Radiology, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, 49045 Angers, France
| | - Anita Paisant
- Department of Radiology, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, UPRES 3859, SFR 4208, Université d'Angers, 49045 Angers, France
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Shah R, VanSyckel A, Popescu AR, Rigsby CK, Griffin LM. Guide to use of ferumoxytol for hepatic vascular assessment as part of dual contrast MRI. Pediatr Radiol 2023; 53:2180-2187. [PMID: 37599288 DOI: 10.1007/s00247-023-05737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
Magnetic resonance imaging (MRI) assessment of hepatic vasculature can be challenging in the setting of liver disease and liver lesions. The widely used hepatobiliary contrast agent gadoxetate is an extracellular contrast agent that provides excellent soft tissue characterization but has limitations as a vascular contrast agent. Ferumoxytol is an iron oxide nanoparticle with superparamagnetic properties that can be used as blood pool contrast agent to provide dedicated vascular assessment. We provide a detailed protocol for evaluation of pediatric liver vasculature using ferumoxytol, after imaging of the parenchyma with gadoxetate. We provide multiple examples and discuss practical considerations when incorporating ferumoxytol into practice.
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Affiliation(s)
- Risha Shah
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Arielle VanSyckel
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Andrada R Popescu
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsay M Griffin
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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10
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Multiarterial Phase Acquisition in Gadoxetic Acid-Enhanced Liver MRI for the Detection of Hypervascular Hepatocellular Carcinoma in High-Risk Patients: Comparison of Compressed Sensing Versus View Sharing Techniques. Invest Radiol 2023; 58:139-147. [PMID: 35976759 DOI: 10.1097/rli.0000000000000910] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aim of this study was to compare compressed sensing (CS) and view sharing (VS) techniques for single breath-hold multiarterial phase imaging with respect to image quality and focal liver observation detectability during gadoxetic acid-enhanced magnetic resonance imaging in patients at high risk for hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 385 patients who underwent gadoxetic acid-enhanced magnetic resonance imaging, including triple arterial phases using either CS (n = 224) or VS (n = 161) techniques, were retrospectively included. Among them, 117 patients had 171 focal liver observations (median diameter, 1.3 cm), which were classified according to Liver Imaging Reporting and Data System version 2018. The acquisition rate of optimally timed late arterial phase (LAP) was assessed, and image quality, including respiratory motion artifact and observation conspicuity, was rated on a 4-point scale by 3 radiologists. The Mann-Whitney U test and nonparametric test for repeated measures data were used for image quality and observation conspicuity analysis. The jackknife alternative free-response receiver operating characteristics method was used to compare the observation detectability between the 2 techniques. RESULTS The CS technique showed significantly higher acquisition rate of optimally timed LAP without transient severe motion (82.1% [184/224] vs 71.4% [115/161]; P = 0.013) than the VS technique. The CS technique also demonstrated significantly improved overall image quality (3.42 ± 0.70 vs 2.97 ± 0.61; P < 0.001) compared with the VS technique. Regarding the detection of hyperenhancing observations, there was no significant difference between the figure of merits of CS and VS techniques (0.660 vs 0.665; P = 0.890). However, the CS technique showed a higher detection rate in Liver Imaging Reporting and Data System M (LR-M, probably or definitely malignant but not HCC specific) observations than the VS technique (100.0% [9/9] vs 44.4% [8/18]; P = 0.009). CONCLUSION The CS technique tended to provide optimally timed LAP without transient severe motion and demonstrated greater detection rate of LR-M observations than the VS technique in patients at high risk of HCC.
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11
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Chavhan GB, Schooler GR, Tang ER, Squires JH, Rees MA, Nguyen HN, Morin CE, Kolbe AB, Khanna G, Infante JC, Alazraki AL, Towbin AJ. Optimizing Imaging of Pediatric Liver Lesions: Guidelines from the Pediatric LI-RADS Working Group. Radiographics 2022; 43:e220043. [DOI: 10.1148/rg.220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Wu CH, Lee YH, Liang PC, Hu RH, Shih TTF, Ho MC. Predictors of changes in preoperative tumor stage between dynamic computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging for hepatocellular carcinoma. J Formos Med Assoc 2022; 121:1550-1559. [PMID: 35033411 DOI: 10.1016/j.jfma.2021.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/27/2021] [Accepted: 12/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/PURPOSE Gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) has a higher diagnostic accuracy for hepatocellular carcinoma (HCC) than computed tomography (CT). However, indications for performing EOB-MRI after dynamic CT are not well defined. Therefore, we investigated the clinical factors associated with changes in the preoperative tumor stage between dynamic CT and EOB-MRI. METHODS A prospective cohort was conducted from January 2014 to December 2017. 156 adult patients with clinical suspicion of HCC before liver resection were enrolled and we retrospectively reviewed the images. The tumor staging was evaluated by dynamic CT and then EOB-MRI subsequently according to the TNM staging system. The changes in tumor stage between two modalities were identified, and the associated clinical factors were analyzed. RESULTS A total of 99 patients were analyzed after excluding 57 patients. 20 patients (20.2%) had changes in tumor stage between dynamic CT and EOB-MRI. The change occurred only in early stage (T1 and T2 lesions) based on dynamic CT initially. Furthermore, in univariate and multivariate analyses, albumin-bilirubin (ALBI) grade 2 and log alpha-fetoprotein (AFP) levels were associated with changes in tumor staging by EOB-MRI than those without (50% vs. 9.9%, p < 0.001 and 2.04 ± 1.35 vs. 1.40 ± 1.16, p = 0.038, respectively). Patients with changes in tumor stage also exhibited higher 1-year recurrence rate and shorter recurrence-free survival. CONCLUSION Changes in preoperative tumor stage between dynamic CT and EOB-MRI were associated with CT-defined early stage, ALBI grades, higher log AFP levels, and early recurrence.
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Affiliation(s)
- Chih-Horng Wu
- Department of Medical Imaging, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsin Lee
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rey-Heng Hu
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Radiology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; Center for Functional Image and Interventional Image, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
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13
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Usefulness of microfocus computed tomography in life science research: preliminary study using murine micro-hepatic tumor models. Surg Today 2021; 52:715-720. [PMID: 34694491 DOI: 10.1007/s00595-021-02396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Microfocus computed tomography (micro-CT) has not been widely used at high radiation intensity (industrial micro-CT) in life science fields. In this preliminary study, we investigated its potential value in the detection of micro-hepatic tumors in a mouse model. METHODS The liver with micro-hepatic tumors was surgically resected en-bloc from mice, and examined with industrial micro-CT and lower intensity micro-CT (small animal micro-CT). The number of hepatic tumors was manually counted on serial images. Then, the accuracy of each technique was determined by preparing matching liver sections and comparing the number of tumors identified in a conventional pathological examination. RESULTS The number of hepatic tumors evaluated with industrial micro-CT showed high concordance with the results of the pathological examinations (intraclass correlation coefficient [ICC]: 0.984; 95% confidence interval [CI] 0.959-0.994). On the other hand, the number of hepatic tumors evaluated with the small animal micro-CT showed low concordance with the number identified in the pathological examinations (ICC: 0.533; 95% CI 0.181-0.815). CONCLUSION Industrial micro-CT improved the detection of small structures in resected specimens, and might be a promising solution for life science research.
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14
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Effect of type 2 diabetes on Gd-EOB-DTPA uptake into liver parenchyma: replication study in human subjects. Abdom Radiol (NY) 2021; 46:4682-4688. [PMID: 34164726 DOI: 10.1007/s00261-021-03184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a contrast agent for magnetic resonance imaging (MRI), which specifically taken up by hepatocytes through organic anion-transporting polypeptides (OATPs). Previous research in mice has shown that type 2 diabetes is associated with reduced uptake of Gd-EOB-DTPA into the liver parenchyma, reflecting reduced expression of OATP. Since considerable differences in OATP expression exist between mice and humans, human studies are necessary to clarify the effect of diabetes to Gd-EOB-DTPA uptake. The purpose of this study was to validate the effect of diabetes to Gd-EOB-DTPA liver uptake by a confirmatory study in humans. METHODS Patients who underwent Gd-EOB-DTPA-enhanced MRI were retrospectively reviewed and divided into two groups: severe or uncontrolled diabetic group (patients with insulin therapy and/or HbA1c ≥ 8.4%) and the control group. Liver-to-spleen ratio (LSR) and relative enhancement of the liver (REL) were calculated to represent Gd-EOB-DTPA liver uptake. RESULTS A total of 94 patients fulfilled the criteria. The severe or uncontrolled diabetic group (n = 15) showed significantly lower LSR (1.74 ± 0.26 vs. 1.98 ± 0.31, p = 0.007) and REL (0.69 ± 0.23 vs. 0.87 ± 0.31, p = 0.005), compared to the control group (n = 79). CONCLUSION Our study revealed decreased uptake of Gd-EOB-DTPA into liver parenchyma in the severe or uncontrolled diabetic patients. Further studies to determine the impact of the reduced liver enhancement on clinical diagnostic practice will be needed.
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15
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Stocker D, Hectors S, Bane O, Vietti-Violi N, Said D, Kennedy P, Cuevas J, Cunha GM, Sirlin CB, Fowler KJ, Lewis S, Taouli B. Dynamic contrast-enhanced MRI perfusion quantification in hepatocellular carcinoma: comparison of gadoxetate disodium and gadobenate dimeglumine. Eur Radiol 2021; 31:9306-9315. [PMID: 34043055 DOI: 10.1007/s00330-021-08068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES (1) To assess the quality of the arterial input function (AIF) during dynamic contrast-enhanced (DCE) MRI of the liver and (2) to quantify perfusion parameters of hepatocellular carcinoma (HCC) and liver parenchyma during the first 3 min post-contrast injection with DCE-MRI using gadoxetate disodium compared to gadobenate dimeglumine (Gd-BOPTA) in different patient populations. METHODS In this prospective study, we evaluated 66 patients with 83 HCCs who underwent DCE-MRI, using gadoxetate disodium (group 1, n = 28) or Gd-BOPTA (group 2, n = 38). AIF qualitative and quantitative features were assessed. Perfusion parameters (based on the initial 3 min post-contrast) were extracted in tumours and liver parenchyma, including model-free parameters (time-to-peak enhancement (TTP), time-to-washout) and modelled parameters (arterial flow (Fa), portal venous flow (Fp), total flow (Ft), arterial fraction, mean transit time (MTT), distribution volume (DV)). In addition, lesion-to-liver contrast ratios (LLCRs) were measured. Fisher's exact tests and Mann-Whitney U tests were used to compare the two groups. RESULTS AIF quality, modelled and model-free perfusion parameters in HCC were similar between the 2 groups (p = 0.054-0.932). Liver parenchymal flow was lower and liver enhancement occurred later in group 1 vs group 2 (Fp, p = 0.002; Ft, p = 0.001; TTP, MTT, all p < 0.001), while there were no significant differences in tumour LLCR (max. positive LLCR, p = 0.230; max. negative LLCR, p = 0.317). CONCLUSION Gadoxetate disodium provides comparable AIF quality and HCC perfusion parameters compared to Gd-BOPTA during dynamic phases. Despite delayed and decreased liver enhancement with gadoxetate disodium, LLCRs were equivalent between contrast agents, indicating similar tumour conspicuity. KEY POINTS • Arterial input function quality, modelled, and model-free dynamic parameters measured in hepatocellular carcinoma are similar in patients receiving gadoxetate disodium or gadobenate dimeglumine during the first 3 min post injection. • Gadoxetate disodium and gadobenate dimeglumine show similar lesion-to-liver contrast ratios during dynamic phases in patients with HCC. • There is lower portal and lower total hepatic flow and longer hepatic mean transit time and time-to-peak with gadoxetate disodium compared to gadobenate dimeglumine.
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Affiliation(s)
- Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefanie Hectors
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Naik Vietti-Violi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniela Said
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Universidad de los Andes, Santiago, Chile
| | - Paul Kennedy
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Jordan Cuevas
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Guilherme M Cunha
- Liver Imaging Group, Radiology, University of California-San Diego, San Diego, CA, USA
| | - Claude B Sirlin
- Liver Imaging Group, Radiology, University of California-San Diego, San Diego, CA, USA
| | - Kathryn J Fowler
- Liver Imaging Group, Radiology, University of California-San Diego, San Diego, CA, USA
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY, 10029, USA.
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16
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Almeida MC, Netto RORF, Melo JIF, Fernandes VAR, Manfredini RC, Dutra LD. Evaluation of hepatic findings by magnetic resonance after use of gadoxetic acid. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | - Luiz Dias Dutra
- Radiology and Diagnostic Imaging Center‐CERDIL Dourados Mato Grosso do Sul Brazil
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17
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Ziemian S, Green C, Sourbron S, Jost G, Schütz G, Hines CD. Ex vivo gadoxetate relaxivities in rat liver tissue and blood at five magnetic field strengths from 1.41 to 7 T. NMR IN BIOMEDICINE 2021; 34:e4401. [PMID: 32851735 PMCID: PMC7757196 DOI: 10.1002/nbm.4401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Quantitative mapping of gadoxetate uptake and excretion rates in liver cells has shown potential to significantly improve the management of chronic liver disease and liver cancer. Unfortunately, technical and clinical validation of the technique is currently hampered by the lack of data on gadoxetate relaxivity. The aim of this study was to fill this gap by measuring gadoxetate relaxivity in liver tissue, which approximates hepatocytes, in blood, urine and bile at magnetic field strengths of 1.41, 1.5, 3, 4.7 and 7 T. Measurements were performed ex vivo in 44 female Mrp2 knockout rats and 30 female wild-type rats who had received an intravenous bolus of either 10, 25 or 40 μmol/kg gadoxetate. T1 was measured at 37 ± 3°C on NMR instruments (1.41 and 3 T), small-animal MRI (4.7 and 7 T) and clinical MRI (1.5 and 3 T). Gadolinium concentration was measured with optical emission spectrometry or mass spectrometry. The impact on measurements of gadoxetate rate constants was determined by generalizing pharmacokinetic models to tissues with different relaxivities. Relaxivity values (L mmol-1 s-1 ) showed the expected dependency on tissue/biofluid type and field strength, ranging from 15.0 ± 0.9 (1.41) to 6.0 ± 0.3 (7) T in liver tissue, from 7.5 ± 0.2 (1.41) to 6.2 ± 0.3 (7) T in blood, from 5.6 ± 0.1 (1.41) to 4.5 ± 0.1 (7) T in urine and from 5.6 ± 0.4 (1.41) to 4.3 ± 0.6 (7) T in bile. Failing to correct for the relaxivity difference between liver tissue and blood overestimates intracellular uptake rates by a factor of 2.0 at 1.41 T, 1.8 at 1.5 T, 1.5 at 3 T and 1.2 at 4.7 T. The relaxivity values derived in this study can be used retrospectively and prospectively to remove a well-known bias in gadoxetate rate constants. This will promote the clinical translation of MR-based liver function assessment by enabling direct validation against reference methods and a more effective translation between in vitro findings, animal models and patient studies.
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Affiliation(s)
| | - Claudia Green
- MR & CT Contrast Media ResearchBayer AGBerlinGermany
| | - Steven Sourbron
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Gregor Jost
- MR & CT Contrast Media ResearchBayer AGBerlinGermany
| | - Gunnar Schütz
- MR & CT Contrast Media ResearchBayer AGBerlinGermany
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Schieda N, van der Pol CB, Walker D, Tsampalieros AK, Maralani PJ, Woo S, Davenport MS. Adverse Events to the Gadolinium-based Contrast Agent Gadoxetic Acid: Systematic Review and Meta-Analysis. Radiology 2020; 297:565-572. [DOI: 10.1148/radiol.2020200073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zhou IY, Catalano OA, Caravan P. Advances in functional and molecular MRI technologies in chronic liver diseases. J Hepatol 2020; 73:1241-1254. [PMID: 32585160 PMCID: PMC7572718 DOI: 10.1016/j.jhep.2020.06.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
MRI has emerged as the most comprehensive non-invasive diagnostic tool for liver diseases. In recent years, the value of MRI in hepatology has been significantly enhanced by a wide range of contrast agents, both clinically available and under development, that add functional information to anatomically detailed morphological images, or increase the distinction between normal and pathological tissues by targeting molecular and cellular events. Several classes of contrast agents are available for contrast-enhanced hepatic MRI, including i) conventional non-specific extracellular fluid contrast agents for assessing tissue perfusion; ii) hepatobiliary-specific contrast agents that are taken up by functioning hepatocytes and excreted through the biliary system for evaluating hepatobiliary function; iii) superparamagnetic iron oxide particles that accumulate in Kupffer cells; and iv) novel molecular contrast agents that are biochemically targeted to specific molecular/cellular processes for staging liver diseases or detecting treatment responses. The use of different functional and molecular MRI methods enables the non-invasive assessment of disease burden, progression, and treatment response in a variety of liver diseases. A high diagnostic performance can be achieved with MRI by combining imaging biomarkers.
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Affiliation(s)
- Iris Y Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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Hepatobiliary phase enhancement of liver metastases on gadoxetic acid MRI: assessment of frequency and patterns. Eur Radiol 2020; 31:1359-1366. [PMID: 32886204 DOI: 10.1007/s00330-020-07228-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess for and characterize patterns of hepatobiliary phase (HBP) enhancement in hepatic metastases of various malignancies on gadoxetic acid-enhanced MRI. METHODS Eighty gadoxetic acid-enhanced MRI studies performed between July 2012 and November 2019 in patients with hepatic metastases from 13 different primary malignancies were assessed. Most (n = 60) were from colorectal cancer (CRC), pancreatic ductal adenocarcinoma (PDAC), or neuroendocrine tumor (NET) primaries. Two radiologists quantitatively evaluated the dominant lesion on each MRI. A lesion was considered enhancing when HBP enhancement relative to muscle exceeded 20%. Lesions were classified by pattern of enhancement. Quantitative enhancement metrics and patterns of enhancement were compared between CRC, PDAC, and NET using non-parametric statistical tests. RESULTS Most dominant metastatic lesions > 1 cm (77%, 54/70) demonstrated HBP enhancement. HBP enhancement was identified in hepatic metastases from 10 different primary malignancies, including CRC, PDAC, and NET. PDAC metastases demonstrated a lower degree of HBP enhancement (26%) than CRC (44%, padj = 0.04) and NET (51%, padj = 0.01) metastases. Three discrete enhancement patterns were identified: peripheral, central (target), and diffuse heterogeneous. Patterns of HBP enhancement varied between CRC, PDAC, and NET, with secondary analysis demonstrating that PDAC had the highest proportion of peripheral pattern (73%, padj < 0.001), CRC the highest proportion of diffuse heterogeneous pattern (32%, padj < 0.01), and NET the highest proportion of central pattern (89%, padj < 0.001). CONCLUSION Liver metastases from several primary malignancies, including PDAC, demonstrate mild HBP enhancement in variable patterns. Correlation with OATP1B3 expression and prognosis is required. KEY POINTS • Hepatobiliary phase (HBP) enhancement was identified in 77% of hepatic metastases in several different primary malignancies. • Discrete patterns of HBP enhancement exist (peripheral, central, diffuse heterogeneous) and varied between CRC, PDAC, and NET. CRC and PDAC metastases demonstrated mostly non-central patterns (diffuse and peripheral), and NET mostly a central pattern. • Relationship between HBP enhancement, enhancement pattern, OATP1B3 expression, and prognosis requires further dedicated exploration for each malignancy.
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21
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Yao F, Liu F. Life‐Threatening Allergic‐Like Reaction After Intravenous MRI Liver‐Specific Contrast Media Gadoxetate Disodium: A Case Report. J Magn Reson Imaging 2020; 52:958-959. [DOI: 10.1002/jmri.27055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Fei‐Fei Yao
- Department of MRI in the First Affiliated HospitalZhengzhou University Zhengzhou China
| | - Feng‐Hui Liu
- Department of Respiratory and Sleep Medicine in the First Affiliated HospitalZhengzhou University Zhengzhou China
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22
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Tanaka T, Nishida H, Mie K, Yamazaki H, Lin LS, Akiyoshi H. Assessment of hepatitis and fibrosis using Gd-EOB-DTPA MRI in dogs. Vet Rec Open 2020; 7:e000371. [PMID: 32818058 PMCID: PMC7401995 DOI: 10.1136/vetreco-2019-000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 01/27/2023] Open
Abstract
Background Gadoxetate sodium (Gd-EOB-DTPA) is taken into hepatocytes and excreted into the bile. Hepatocytes with reduced function or dysfunction due to hepatocellular carcinoma (HCC), hepatitis or hepatic fibrosis show impaired Gd-EOB-DTPA uptake. The purpose of the present retrospective case series was to assess the relationship between liver function and contrast enhancement using Gd-EOB-DTPA MRI. Methods Sixteen dogs with a histopathological diagnosis of liver disease, including six with HCC, three with nodular hyperplasia, two with hepatocellular adenoma, two with liver fibrosis and three with hepatitis were included in the study along with three dogs with suspected liver disease but no histopathological diagnosis of liver disease. Relative signal intensities (RSI) of the common bile duct and gall bladder were calculated, and their relationship with the following serum biochemical parameters was assessed: total bilirubin, alanine transaminase, alkaline phosphatase and albumin (Alb). To assess anatomical liver function, relative contrast enhancement indices (RCEI) of the liver were calculated, and differences were assessed between normal and diseased liver. Results RSI showed no significant differences between dogs without and with a histopathological diagnosis of liver disease (P=0.88) although they were significantly correlated with Alb (ρ=0.57, P=0.02) in dogs with a histopathological diagnosis of liver disease. RCEI was significantly higher in normal liver tissue than that in livers with hepatitis/fibrosis (P=0.048) and HCC (P=0.03) but not nodular hyperplasia/hepatocellular adenoma (P=0.51). Conclusions Gd-EOB-DTPA MRI may be potentially useful in the assessment of anatomical liver function in dogs with liver disease.
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Affiliation(s)
- Toshiyuki Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan.,Kinki Animal Medical Training Institute & Veterinary Clinic, Higashiosaka, Osaka, Japan
| | - Hidetaka Nishida
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Keiichiro Mie
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Hiroki Yamazaki
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Lee-Shuan Lin
- Laboratory of Veterinary Diagnostic Imaging, Department of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Hideo Akiyoshi
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
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Min JH, Kim JM, Kim YK, Cha DI, Kang TW, Kim H, Choi GS, Choi SY, Ahn S. Magnetic Resonance Imaging With Extracellular Contrast Detects Hepatocellular Carcinoma With Greater Accuracy Than With Gadoxetic Acid or Computed Tomography. Clin Gastroenterol Hepatol 2020; 18:2091-2100.e7. [PMID: 31843599 DOI: 10.1016/j.cgh.2019.12.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/13/2019] [Accepted: 12/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Computed tomography (CT) and magnetic resonance imaging (MRI) are used to detect hepatocellular carcinoma (HCC). We performed a prospective study to compare the diagnostic performance of CT, MRI with extracellular contrast agents (ECA-MRI), and MRI with hepatobiliary agents (HBA-MRI) in the detection of HCC using the liver imaging reporting and data system (LI-RADS). METHODS We studied 125 participants (102 men; mean age, 55.3 years) with chronic liver disease who underwent CT, ECA-MRI, or HBA-MRI (with gadoxetic acid) before surgery for a nodule initially detected by ultrasound at a tertiary center in Korea, from November 2016 through February 2019. We collected data on major features and assigned LI-RADS categories (v2018) from CT and MRI examinations. We then compared the diagnostic performance for LR-5 for each modality alone, and in combination. RESULTS In total, 163 observations (124 HCCs, 13 non-HCC malignancies, and 26 benign lesions; mean size, 20.7 mm) were identified. ECA-MRI detected HCC with 83.1% sensitivity and 86.6% accuracy, compared to 64.4% sensitivity and 71.8% accuracy for CT (P < .001) and 71.2% sensitivity (P = .005) and 76.5% accuracy for HBA-MRI (P = .005); all technologies detected HCC with 97.4% specificity. Adding CT to either ECA-MRI (89.2% sensitivity, 91.4% accuracy; both P < .05) or HBA-MRI (82.8% sensitivity, 86.5% accuracy; both P < .05) significantly increased its diagnostic performance in detection of HCC compared with the MRI technologies alone. ECA-MRI identified arterial phase hyperenhancement in a significantly higher proportion of patients (97.6%) than CT (81.5%; P < .001) or HBA-MRI (89.5%; P = .002). ECA-MRI identified non-peripheral washout in 79.8% of patients, vs 74.2% of patients for CT and 73.4% of patients for HBA-MRI (differences not significant). ECA-MRI identified enhancing capsules in 85.5% of patients, vs 33.9% for CT (P < .001) and 41.4% for HBA-MRI (P < .001). CONCLUSION In a prospective study of patients with chronic liver disease and a nodule detected by ultrasound, ECA-MRI detected HCC with higher levels of sensitivity and accuracy than CT or HBA-MRI, based on LI-RADS. Diagnostic performance was best when CT was used in combination with MRI compared with MRI alone.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Honsoul Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
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Hepatobiliary MRI Contrast Agents: Pattern Recognition Approach to Pediatric Focal Hepatic Lesions. AJR Am J Roentgenol 2020; 214:976-986. [DOI: 10.2214/ajr.19.22239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Paisant A, Vilgrain V, Riou J, Oberti F, Sutter O, Laurent V, Rodes A, Guiu B, Cassinotto C, Trillaud H, Bricault I, Michalak S, Bruno O, Ronot M, Aubé C. Comparison of extracellular and hepatobiliary MR contrast agents for the diagnosis of small HCCs. J Hepatol 2020; 72:937-945. [PMID: 31870951 DOI: 10.1016/j.jhep.2019.12.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The aim of this study was to use a head-to-head nodule comparison to compare the performance of extracellular contrast agent MRI (ECA-MRI) with that of hepatobiliary contrast agent MRI (HBA-MRI) for the non-invasive diagnosis of small hepatocellular carcinomas (HCCs). METHODS Between August 2014 and October 2017, 171 patients with cirrhosis, each with 1 to 3 nodules measuring 1-3 cm, were enrolled across 8 centers. All patients underwent both an ECA-MRI and an HBA-MRI within a month. A non-invasive diagnosis of HCC was made when a nodule exhibited arterial phase hyper-enhancement (APHE) with washout at the portal venous phase (PVP) and/or delayed phase (DP) for ECA-MRI, or the PVP and/or HB phase (HBP) for HBA-MRI. The gold standard was defined by using a previously published composite algorithm. RESULTS A total of 225 nodules, of which 153 were HCCs and 72 were not, were included. The sensitivites of both MRI techniques were similar. Specificity was 83.3% (95% CI 72.7-91.1) for ECA-MRI and 68.1% (95% CI 56.0-78.6) for HBA-MRI. In terms of HCC diagnosis on ECA-MRI, 138 nodules had APHE, 84 had washout at PVP, and 104 at DP; on HBA-MRI, 128 nodules had APHE, 71 had washout at PVP, and 99 at HBP. For nodules 2-3 cm in size, sensitivity and specificity were similar between the 2 approaches. For nodules 1-2 cm in size, specificity dropped to 66.1% (95% CI 52.2-78.2) for HBA-MRI vs. 85.7% (95% CI 73.8-93.6) for ECA-MRI. CONCLUSIONS HBA-MRI specificity is lower than that of ECA-MRI for diagnosing small HCCs in patients with cirrhosis. These results raise the question of the proper use of HBA-MRI in algorithms for the non-invasive diagnosis of small HCCs. LAY SUMMARY There are 2 magnetic resonance imaging (MRI)-based approaches available for the non-invasive diagnosis of hepatocellular carcinoma (HCC), using either extracellular or hepatobiliary contrast agents. The current results showed that the sensitivity of MRI with hepatobiliary contrast agents was similar to that with extracellular contrast agents, but the specificity was lower. Thus, hepatobiliary contrast agent-based MRI, although detailed in international guidelines, should be used with caution for the non-invasive diagnosis of HCC. CLINICAL TRIAL NUMBER NCT00848952.
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Affiliation(s)
- Anita Paisant
- Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France.
| | - Valérie Vilgrain
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France
| | - Jérémie Riou
- Université d'Angers, UFR Santé, 49000 Angers, France; MINT UMR INSERM 1066, CNRS 6021, Université d'Angers, 49000 Angers, France
| | - Frédéric Oberti
- Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France; Service de Gastroenterologie et Hépatologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France
| | - Olivier Sutter
- Service de Radiologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis (AP-HP), 93140 Bondy, France
| | - Valérie Laurent
- Département de Radiologie, Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, 54500 Vandoeuvre-lès-Nancy, France
| | - Agnès Rodes
- Département de Radiologie, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004 Lyon, France
| | - Boris Guiu
- Département de Radiologie, INSERM U896, CHU Saint-Eloi, Université de Montpellier, 34295 Montpellier, France
| | - Christophe Cassinotto
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France
| | - Hervé Trillaud
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France; Universitaire de Bordeaux, EA Imotion, F-33000 Bordeaux, France
| | - Ivan Bricault
- Département d'Imagerie, Radiologie et Imagerie Médicale, CHU, 38000 Grenoble, France; Laboratory of Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications, Université 38000 Grenoble Alpes, Grenoble, France
| | - Sophie Michalak
- Département d'Anatomopatologie, Centre Hospitalier Universitaire d'Angers, Université d'Angers, 49933 Angers, France
| | - Onorina Bruno
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France
| | - Maxime Ronot
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France
| | - Christophe Aubé
- Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France
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Onishi H, Theisen D, Zachoval R, Reiser MF, Zech CJ. Intrahepatic diffuse periportal enhancement patterns on hepatobiliary phase gadoxetate disodium-enhanced liver MR images: Do they correspond to periportal hyperintense patterns on T2-weighted images? Medicine (Baltimore) 2019; 98:e14784. [PMID: 30882651 PMCID: PMC6426476 DOI: 10.1097/md.0000000000014784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The purpose of this study was to investigate the findings of diffuse periportal enhancement in the liver on hepatobiliary phase gadoxetate disodium-enhanced magnetic resonance images by comparing with the finding of periportal hyperintensity on T2-weighted images and to reveal their clinical significance.Nineteen consecutive patients with diffuse periportal enhancement on hepatobiliary phase images constituted the study population. The intrahepatic diffuse periportal enhancement finding was assessed on whether it corresponded to periportal hyperintense patterns on T2-weighted images or not in the location, and the cases were classified into 2 groups according to this characteristic. Signal intensities at the periportal areas were also assessed on T1-, T2-, diffusion-weighted and dynamic images. Furthermore, possible associations between these image findings and the final diagnoses were explored.In 7 of the 19 patients, periportal enhancement area corresponded with the periportal hyperintensity area on T2-weighted images. In the remaining 12 patients, the finding of periportal T2-hyperintensity was absent or the periportal enhancement differed from the periportal T2-hyperintensity in the location. Diseases of the former group comprised autoimmune hepatitis, acute exacerbation of chronic hepatitis and acute alcoholic steatohepatitis, and those of the latter group primary sclerosing cholangitis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and liver cirrhosis with miscellaneous etiology.Diffuse periportal enhancement during the hepatobiliary phase did not always correspond to periportal hyperintensity on T2-weighted images. In the classification based on whether enhancement area corresponded or not, each enhancement pattern appeared in different groups of liver diseases. Specifically, the former (corresponding) was associated with active inflammation such as hepatitis and the latter (not corresponding) was predominantly associated with a chronic change such as cirrhosis. Appropriate recognition of these periportal enhancement patterns may contribute to the improved diagnosis of diffuse liver diseases.
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Affiliation(s)
- Hiromitsu Onishi
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daniel Theisen
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
| | - Reinhart Zachoval
- Department of Internal Medicine II, Ludwig Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F. Reiser
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
| | - Christoph J. Zech
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Munich, Germany
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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Zech CJ, Schwenke C, Endrikat J. Diagnostic Efficacy and Safety of Gadoxetate Disodium vs Gadobenate Dimeglumine in Patients With Known or Suspected Focal Liver Lesions: Results of a Clinical Phase III Study. MAGNETIC RESONANCE INSIGHTS 2019; 12:1178623X19827976. [PMID: 30799932 PMCID: PMC6379790 DOI: 10.1177/1178623x19827976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 12/15/2022]
Abstract
Purpose: The aim of this study is to evaluate the diagnostic efficacy and safety of
gadoxetate disodium vs gadobenate dimeglumine in patients with known or
suspected focal liver lesions. Methods: This was a prospective, multicenter, double-blind, randomized,
inter-individual Phase III study. The primary target—technical efficacy—was
already published. Here, secondary efficacy parameters—sensitivity and
specificity—and safety in specific patient populations are presented.
Patients with suspected or known focal liver lesions scheduled for
contrast-enhanced liver magnetic resonance imaging (MRI) were recruited and
categorized in 4 a priori specified subgroups: (1) all patients, (2)
patients with liver cancer (hepatocellular carcinoma [HCC]), (3) patients
with cirrhosis, and (4) patients with HCC + cirrhosis. Dual multi-detector
liver computed tomography (CT) served as standard of reference. Results: A total of 295 patients were included. While the overall increase in
sensitivity across all 4 patient groups was comparable for gadoxetate
disodium (increase from pre- to post-contrast ranging from 6.2% to 9.9%) and
gadobenate dimeglumine (ranging from −2.9% to 10.0%), significant
differences were seen for some of the subgroups. There was a significantly
higher increase in sensitivity for gadoxetate disodium in patients with HCC
(7%) and HCC + cirrhosis (12.8%) in comparison with gadobenate dimeglumine.
Specificity decreased for both agents: gadoxetate disodium by −2.8% to −6.3%
and gadobenate dimeglumine by −3.3% to −8.7%. Gadoxetate showed a
significantly lower loss of specificity in all subgroups. Safety was
comparable in both groups. Conclusions: Gadoxetate disodium proved to be an effective liver-specific MRI contrast
agent. Some distinct advantages over gadobenate dimeglumine were
demonstrated in patients with HCC and patients with HCC + liver cirrhosis
for sensitivity and specificity in liver lesion detection.
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Affiliation(s)
- Christoph J Zech
- Department for Radiology and Nuclear
Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Jan Endrikat
- Bayer AG, Radiology, Berlin,
Germany
- Department of Gynecology, Obstetrics and
Reproductive Medicine, University Medical School of Saarland, Homburg/Saar,
Germany
- Jan Endrikat, Bayer AG, Radiology,
Müllerstr. 178, 13353 Berlin, Germany.
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Plaikner M, Kremser C, Zoller H, Steurer M, Glodny B, Jaschke W, Henninger B. Does gadoxetate disodium affect MRE measurements in the delayed hepatobiliary phase? Eur Radiol 2019; 29:829-837. [PMID: 30027410 PMCID: PMC6302879 DOI: 10.1007/s00330-018-5616-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess if the administration of gadoxetate disodium (Gd-EOB-DTPA) significantly affects hepatic magnetic resonance elastography (MRE) measurements in the delayed hepatobiliary phase (DHBP). METHODS A total of 47 patients (15 females, 32 males; age range 23-78 years, mean 54.28 years) were assigned to standard hepatic magnetic resonance imaging (MRI) with application of Gd-EOB-DTPA and hepatic MRE. MRE was performed before injection of Gd-EOB-DTPA and after 40-50 min in the DHBP. Liver stiffness values were obtained before and after contrast media application and differences between pre- and post-Gd-EOB-DTPA values were evaluated using a Bland-Altman plot and the Mann-Whitney-Wilcoxon test. In addition, the data were compared with regard to the resulting fibrosis classification. RESULTS Mean hepatic stiffness for pre-Gd-EOB-DTPA measurements was 4.01 kPa and post-Gd-EOB-DTPA measurements yielded 3.95 kPa. We found a highly significant individual correlation between pre- and post-Gd-EOB-DTPA stiffness values (Pearson correlation coefficient of r = 0.95 (p < 0.001) with no significant difference between the two measurements (p =0.49)). Bland-Altman plot did not show a systematic effect for the difference between pre- and post-stiffness measurements (mean difference: 0.06 kPa, SD 0.81). Regarding the classification of fibrosis stages, the overall agreement was 87.23% and the intraclass correlation coefficient was 96.4%, indicating excellent agreement. CONCLUSIONS Administration of Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver in the DHBP. Therefore, MRE can be performed in the DHBP. KEY POINTS • MRE of the liver can reliably be performed in the delayed hepatobiliary phase. • Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver. • MRE performed in the delayed hepatobiliary-phase is reasonable in patients with reduced liver function.
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Affiliation(s)
- M Plaikner
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - H Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - M Steurer
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Glodny
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria
| | - B Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck, Austria.
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Lincoln JD, Parsons D, Clarke SE, Cwajna S, Robar JL. Technical Note: Evaluation of kV CBCT enhancement using a liver-specific contrast agent for stereotactic body radiation therapy image guidance. Med Phys 2019; 46:1175-1181. [PMID: 30624784 DOI: 10.1002/mp.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate possible use for cone-beam computed tomography (CBCT) guidance, this phantom study evaluated the contrast enhancement provided by Gadoxetate Disodium (Primovist® CAN/EU, or Eovist® USA, Bayer Healthcare, Leverkusen, Germany), a contrast agent that is taken up selectively by liver cells and is retained for up to an hour. Image quality from CBCT was benchmarked against helical fan-beam computed tomography for two phantom geometries. METHODS AND MATERIALS Concentrations were diluted to 0.0125-0.1 mmol per kilogram of body weight (mmol/kg) corresponding to expected physiological concentrations in the liver. Kilovoltage CBCT imaging parameters of x-ray tube potential, current, and filtration were investigated using clinically available options on a TrueBeam STx linear accelerator CBCT platform. Two phantoms were created, a cylindrical idealized imaging geometry and an ellipsoidal more realistic abdominal geometry. All parameters were optimized according to the contrast-to-noise ratio (CNR) image quality metric, as a function of concentration, following the Rose criterion for CNR. RESULTS Acceptable CNR was defined as greater than or equal to three, in accordance with the Rose criterion for CNR. These were found in a range of expected liver concentrations of 0.025-0.1 mmol/kg for a tube potential of 100 kVp, half-fan bowtie filtration and tube currents giving exposures between 2025 and 5085 mAs. Linear correlations were found for all CNR as a function of concentration, in agreement with the literature. CONCLUSION Based on this phantom study, with appropriate selection of imaging protocol, Gadoxetate Disodium may provide useful liver CBCT enhancement at physiologically achievable liver concentrations.
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Affiliation(s)
- John D Lincoln
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 4R2, Canada
| | - David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Sharon E Clarke
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 4R2, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, B3H 4R2, Canada.,Nova Scotia Health Authority, Halifax, B3H 1V8, Canada
| | - Slawa Cwajna
- Department of Radiation Oncology, Dalhousie University, Halifax, B3H 4R2, Canada.,Nova Scotia Health Authority, Halifax, B3H 1V8, Canada
| | - James L Robar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 4R2, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, B3H 4R2, Canada.,Nova Scotia Health Authority, Halifax, B3H 1V8, Canada
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Min JH, Kim JM, Kim YK, Kang TW, Lee SJ, Choi GS, Choi SY, Ahn S. Prospective Intraindividual Comparison of Magnetic Resonance Imaging With Gadoxetic Acid and Extracellular Contrast for Diagnosis of Hepatocellular Carcinomas Using the Liver Imaging Reporting and Data System. Hepatology 2018; 68:2254-2266. [PMID: 30070365 DOI: 10.1002/hep.30122] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/28/2018] [Indexed: 12/12/2022]
Abstract
We intraindividually compared the efficacy of magnetic resonance imaging (MRI) with extracellular contrast agents (ECA-MRI) and MRI with hepatobiliary agents (HBA-MRI) for the diagnosis of hepatocellular carcinoma (HCC) using the Liver Imaging Reporting and Data System (LI-RADS). Between November 2016 and November 2017, we enrolled 91 patients with chronic liver disease who underwent both ECA-MRI and HBA-MRI within a 1-month interval for a first detected hepatic nodule on ultrasound. In total, 117 observations (95 HCCs, 19 benign lesions, and 3 other malignancies; median size, 18 mm) were identified with surgical resection. Two observers assessed two MRIs based on LI-RADS v2017, with consensus by a third observer. We then compared the diagnostic performance of LR-5 according to LI-RADS and modified LI-RADS. ECA-MRI had higher sensitivity (77.9% versus 66.3%) and accuracy (82.1% versus 72.6%) than HBA-MRI in the LR-5 category (P < 0.001). When applying either modified washout on the portal venous phase (PVP)/transitional phase (TP) of HBA-MRI or isointensity with a capsule during the PVP/delayed phase of ECA-MRI (illusional washout), 13 HCCs on HBA-MRI and 11 HCCs on ECA-MRI were correctly classified as HCC, while achieving 100% specificity. One cholangiocarcinoma was accurately classified only with HBA-MRI due to its targetoid appearance in the TP and hepatobiliary phase. Conclusion: ECA-MRI showed better sensitivity and accuracy than HBA-MRI for the diagnosis of HCC with LI-RADS. We achieved better diagnostic performance when applying a modified washout on PVP/TP HBA-MRI and an illusional washout on ECA-MRI than we did with conventional criteria.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soon Jin Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyu Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, Republic of Korea
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Gadoxetic Acid-Enhanced Hepatobiliary-Phase Magnetic Resonance Imaging for Delineation of Focal Nodular Hyperplasia: Superiority of High-Flip-Angle Imaging. J Comput Assist Tomogr 2018; 42:667-674. [PMID: 30119067 DOI: 10.1097/rct.0000000000000777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether hepatobiliary-phase (HBP) flip-angle (FA) increase to 25° improves conspicuity of focal nodular hyperplasia (FNH) and enables HBP delay reduction. METHODS This was a retrospective study of 23 patients with 46 FNHs. In each patient, HBP was performed with reduced-delay high FA (early/high), standard-delay high FA (late/high), and standard-delay standard FA (standard). Relative enhancement of liver and FNH periphery, FNH periphery-to-liver contrast ratio, and FNH periphery-to-central scar contrast ratio were compared between each HBP. RESULTS Early/high, late/high, and standard HBPs were performed after 13.00 ± 2.12, 19.12 ± 3.10, and 19.68 ± 3.22 minutes, respectively. Liver and FNH periphery relative enhancement, FNH periphery-to-liver contrast ratio, and FNH periphery-to-central scar contrast ratio were higher for early/high and late/high than for standard HBP (P < 0.001 to P = 0.0048). CONCLUSIONS Increasing FA to 25° improves delineation of FNHs in HBP. Combining FA increase with delay reduction is superior to standard HBP and is sufficient for FNH characterization.
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Iwanaga T, Fukukura Y, Saito T, Sasaki M, Kumagae Y, Takumi K, Hakamada H, Fujisaki T, Saigo Y, Yoshiura T. Conspicuity of Malignant Liver Tumors on Diffusion-Weighted Imaging With Short tau Inversion Recovery After Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid Administration. J Magn Reson Imaging 2018; 49:565-573. [PMID: 30102432 DOI: 10.1002/jmri.26196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/30/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has been used for the detection and characterization of liver tumors because it has excellent contrast resolution. DWI using short tau inversion recovery (STIR) can improve tumor-to-liver contrast after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) administration that shortens the T1 relaxation of liver parenchyma. PURPOSE To quantitatively and qualitatively compare the conspicuity of malignant liver tumors on DWI after Gd-EOB-DTPA administration between STIR and chemical shift selective (CHESS) sequences. STUDY TYPE Single-institution retrospective study. SUBJECTS Fifty-seven patients with histologically confirmed malignant liver tumors were evaluated. FIELD STRENGTH/SEQUENCE Low b-value DWIs with STIR and CHESS sequences 18-20 minutes after Gd-EOB-DTPA administration were acquired at 1.5T. ASSESSMENT Tumor contrast-to-noise ratio (CNR) and visual grade of tumor conspicuity on DWI between STIR and CHESS sequences were compared. STATISTICAL TESTS Paired Student's t-test and the Wilcoxon signed rank-test were applied. P < 0.05 was considered statistically significant. RESULTS The mean tumor CNR and visual grade of tumor conspicuity on DWI were significantly higher for STIR than for CHESS (both P < 0.001). Regardless of the presence of chronic liver disease, the mean CNR (normal liver 33.5 ± 19.8 vs. 15.7 ± 12.2, P < 0.001; chronic liver disease 19.6 ± 11.0 vs. 9.2 ± 7.8, P < 0.001) and the visual conspicuity grade (normal liver 3.36 ± 0.64 vs. 2.56 ± 0.77, P < 0.001; chronic liver disease 2.94 ± 0.80 vs. 2.25 ± 0.84, P = 0.001) were significantly higher for STIR than for CHESS. Mean CNR and the visual conspicuity grade were also significantly higher for STIR than for CHESS in patients with hepatocellular carcinomas (CNR 18.1 ± 10.5 vs. 8.8 ± 7.2, P < 0.001; visual grade 2.88 ± 0.83 vs. 2.22 ± 0.87, P = 0.001) or metastases (CNR 35.0 ± 19.3 vs. 16.2 ± 13.1, P < 0.001; visual grade 3.45 ± 0.51 vs. 2.59 ± 0.73, P < 0.001). DATA CONCLUSION DWI using STIR may be more helpful for depicting malignant liver tumors after Gd-EOB-DTPA administration compared with DWI using CHESS. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:565-573.
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Affiliation(s)
- Takashi Iwanaga
- Department of Radiological Technology, Kagoshima University Hospital, Kagoshima City, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
| | - Tomonori Saito
- Department of Radiological Technology, Kagoshima University Hospital, Kagoshima City, Japan
| | - Masashi Sasaki
- Department of Radiological Technology, Kagoshima University Hospital, Kagoshima City, Japan
| | - Yuichi Kumagae
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
| | - Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
| | - Hiroto Hakamada
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
| | - Takuro Fujisaki
- Department of Radiological Technology, Kagoshima University Hospital, Kagoshima City, Japan
| | - Yasumasa Saigo
- Department of Radiological Technology, Kagoshima University Hospital, Kagoshima City, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima City, Japan
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Hepatobiliary MRI: Signal intensity based assessment of liver function correlated to 13C-Methacetin breath test. Sci Rep 2018; 8:9078. [PMID: 29899400 PMCID: PMC5998051 DOI: 10.1038/s41598-018-27401-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
Gadoxetic acid (Gd-EOB-DTPA) is a paramagnetic MRI contrast agent with raising popularity and has been used for evaluation of imaging-based liver function in recent years. In order to verify whether liver function as determined by real-time breath analysis using the intravenous administration of 13C-methacetin can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using signal intensity (SI) values. 110 patients underwent Gd-EOB-DTPA-enhanced 3-T MRI and, for the evaluation of liver function, a 13C-methacetin breath test (13C-MBT). SI values from before (SIpre) and 20 min after (SIpost) contrast media injection were acquired by T1-weighted volume-interpolated breath-hold examination (VIBE) sequences with fat suppression. The relative enhancement (RE) between the plain and contrast-enhanced SI values was calculated and evaluated in a correlation analysis of 13C-MBT values to SIpost and RE to obtain a SI-based estimation of 13C-MBT values. The simple regression model showed a log-linear correlation of 13C-MBT values with SIpost and RE (p < 0.001). Stratified by 3 different categories of 13C-MBT readouts, there was a constant significant decrease in both SIpost (p ≤ 0.002) and RE (p ≤ 0.033) with increasing liver disease progression as assessed by the 13C-MBT. Liver function as determined using real-time 13C-methacetin breath analysis can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using SI-based indices.
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Zhou ZP, Long LL, Qiu WJ, Cheng G, Huang LJ, Yang TF, Huang ZK. Comparison of 10- and 20-min hepatobiliary phase images on Gd-EOB-DTPA-enhanced MRI T1 mapping for liver function assessment in clinic. Abdom Radiol (NY) 2017; 42:2272-2278. [PMID: 28396918 DOI: 10.1007/s00261-017-1143-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare hepatobiliary phase (HBP) images obtained 10 and 20 min after Gd-EOB-DTPA-enhanced MRI for liver function assessment in clinic on 3.0 T MR imaging. METHODS 103 patients were separated into four groups: 38 patients for the normal liver function (NLF) group, 33 patients for the liver cirrhosis with Child-Pugh A (LCA) group, 21 patients for the liver cirrhosis with Child-Pugh B group, and 11 patients for a liver cirrhosis with Child-Pugh C group. T1 relaxation times (T1rt) were measured on T1 mapping and reduction rates of T1rt (rrT1rt) were calculated. HBP images were obtained at the 10- and 20-min mark after Gd-EOB-DTPA enhancement. RESULTS T1rt on pre-enhancement imaging showed no significant difference (p > 0.05) among all four groups. T1rt for both the 10-min HBP and the 20-min HBP showed a significant difference (p < 0.05) among all groups, but showed no significant difference (p > 0.05) between the NLF group and the LCA group. T1rt and rrT1rt showed no significant difference (p > 0.05) between 10-min HBP and 20-min HBP among all groups. The ROC analysis on 10-min HBP and 20-min HBP showed a lower diagnostic performance between NLF group and LCA group (AUC from 0.532 to 0.582), but high diagnostic performance (AUC from 0.788 to 1.000) among others group. CONCLUSIONS In comparing 10-min HBP and 20-min HBP T1 mapping after Gd-EOB-DTPA enhancement, our results suggest that 10-min HBP T1 mapping is a feasible option for quantitatively assessing liver function.
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Affiliation(s)
- Zhi-Peng Zhou
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China
| | - Li-Ling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Wei-Jia Qiu
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China
| | - Ge Cheng
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, People's Republic of China
| | - Li-Juan Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Teng-Fei Yang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Zhong-Kui Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China.
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Tang A, McInnes M, Hope TA, Vu KN, Amre D, Wolfson T, Roy C, Mâsse BR, Sirlin C. Magnetic resonance imaging performed with gadoxetate disodium for the diagnosis of hepatocellular carcinoma in cirrhotic and non-cirrhotic patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- An Tang
- University of Montreal; Department of Radiology, Radio-Oncology and Nuclear Medicine; 900, rue Saint-Denis, bureau R12.480 Centre de recherche du CHUM Montreal Quebec Canada H2X 0A9
| | - Matthew McInnes
- University of Ottawa; Department of Radiology; Room c159, 1053 Carling Avenue Ottawa Ontario Canada K1Y 4E9
| | - Thomas A Hope
- University of California, San Francisco; Department of Radiology and Biomedical Imaging; 505 Parnassus Avenue, M391 San Francisco CA USA 94143
| | - Kim-Nhien Vu
- University of Montreal; Department of Radiology, Radio-Oncology and Nuclear Medicine; 900, rue Saint-Denis, bureau R12.480 Centre de recherche du CHUM Montreal Quebec Canada H2X 0A9
| | - Devendra Amre
- Research Center, CHU-Sainte Justine; Division of Gastroenterology and Hepatology; 3175 Cote-Sainte-Catherine West Montréal Quebec Canada H3T1C5
| | - Tanya Wolfson
- University of California, San Diego; Computational and Applied Statistics Laboratory at the San Diego Supercomputer Center; 9500 Gilman Drive La Jolla CA USA 92093-0505
| | - Chantal Roy
- CHU Sainte-Justine; Unité de recherche clinique appliquée; 3175 Côte-Ste-Catherine Local 7122 Montreal QC Canada H3T 1C5
| | - Benoît R Mâsse
- CHU Sainte-Justine; Unité de recherche clinique appliquée; 3175 Côte-Ste-Catherine Local 7122 Montreal QC Canada H3T 1C5
- University of Montreal; School of Public Health; 3175, Côte Ste-Catherine Montreal Quebec (QC) Canada H3T 1C5
| | - Claude Sirlin
- University of California, San Diego; Department of Radiology; Altman Clinical and TranslationalResearch Institute La Lolla CA USA
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Nowicki TK, Markiet K, Szurowska E. Diagnostic Imaging of Hepatocellular Carcinoma - A Pictorial Essay. Curr Med Imaging 2017; 13:140-153. [PMID: 28553196 PMCID: PMC5427776 DOI: 10.2174/1573405612666160720123748] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, which develops mostly in the setting of chronic liver disease. European Association for the Study of the Liver (EASL) and European Organization for Research and Treatment of Cancer (EORTC) prepared guidelines for screening, follow-up and diagnosis of HCC to facilitate decision making and optimize both diagnostic and therapeutic protocols. The review briefly describes etiology, epidemiology and histopathology of HCC and presents EASL-EORTC guidelines for surveillance and diagnosis of HCC. Target population and screening algorithm is presented in the surveillance section. Ultrasound imaging of HCC and the role of contrast enhanced ultrasound are described as well as the value of laboratory tests in screening. Further, radiological features of HCC in multiphase CT and dynamic contrast enhanced MRI and diagnostic criteria are presented. Additionally, the advantages of advanced techniques in MRI such as diffusion weighed imaging and the use of hepatocyte-specific contrast agents are discussed. Lastly, the EASL-EORTC guidelines are compared with the guidelines of the American Association for the Study of Liver Diseases and the Japan Society of Hepatology. Also LI-RADS and the Barcelona Clinic Liver Cancer classification are mentioned. In the near future, due to the ongoing advances in imaging a revision of the guidelines may be expected.
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Affiliation(s)
- Tomasz K. Nowicki
- 2 Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Karolina Markiet
- 2 Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
| | - Edyta Szurowska
- 2 Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland
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Diagnosis of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI: 2016 Consensus Recommendations of the Korean Society of Abdominal Radiology. Korean J Radiol 2017; 18:427-443. [PMID: 28458595 PMCID: PMC5390612 DOI: 10.3348/kjr.2017.18.3.427] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/21/2017] [Indexed: 12/13/2022] Open
Abstract
Diagnosis of hepatocellular carcinoma (HCC) with gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) poses certain unique challenges beyond the scope of current guidelines. The regional heterogeneity of HCC in demographic characteristics, prevalence, surveillance, and socioeconomic status necessitates different treatment approaches, leading to variations in survival outcomes. Considering the medical practices in Korea, the Korean Society of Abdominal Radiology (KSAR) study group for liver diseases has developed expert consensus recommendations for diagnosis of HCC by gadoxetic acid-enhanced MRI with updated perspectives, using a modified Delphi method. During the 39th Scientific Assembly and Annual Meeting of KSAR (2016), consensus was reached on 12 of 16 statements. These recommendations might serve to ensure a more standardized diagnosis of HCC by gadoxetic acid-enhanced MRI.
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Ito T, Sugiura T, Okamura Y, Yamamoto Y, Ashida R, Aramaki T, Endo M, Uesaka K. The diagnostic advantage of EOB-MR imaging over CT in the detection of liver metastasis in patients with potentially resectable pancreatic cancer. Pancreatology 2017; 17:451-456. [PMID: 28298257 DOI: 10.1016/j.pan.2017.03.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 02/12/2017] [Accepted: 03/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver metastases (LMs) are sometimes diagnosed intraoperatively, even when multidetector-row computed tomography (MDCT) reveals no LM in the staging of pancreatic cancer (PC). Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MR imaging) may have a role to play in the detection of LM. METHODS The present study included a total of 201 patients who underwent an EOB-MR imaging examination before undergoing surgical resection for pancreatic cancer that was determined to be radiologically-resectable by MDCT. Intrahepatic lesions that were considered suspected to be liver metastases following an EOB-MR imaging examination were defined as possible lesions (PLs). All PLs were evaluated by a pathological examination or through close follow-up examinations. The diagnostic ability of EOB-MR imaging was assessed. The predictive factors for liver metastasis were evaluated. RESULTS Thirty-seven PLs were noted in 17 patients: 31 PLs were true LMs, and six were benign lesions (3 hemangiomas and 3 abscesses). Nine LMs were newly detected during surgery and were not detected by preoperative EOB-MR imaging. The diagnostic ability of EOB-MR imaging was as follows: sensitivity, 77.5%; specificity, 94.7%; positive predictive value, 83.8%; negative predictive value, 92.3%; and accuracy, 90.2%. A multivariate analysis revealed that the presence of PL on EOB-MR imaging was the only independent risk factor for intraoperative liver metastasis (P < 0.001). CONCLUSION EOB-MR imaging was useful in detecting tiny liver metastases from pancreatic cancer in cases that were determined to be radiologically resectable by MDCT.
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Affiliation(s)
- Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takeshi Aramaki
- Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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Shiozawa K, Watanabe M, Ikehara T, Matsukiyo Y, Kogame M, Kikuchi Y, Otsuka Y, Kaneko H, Igarashi Y, Sumino Y. Comparison of contrast-enhanced ultrasonograpy with Gd-EOB-DTPA-enhanced MRI in the diagnosis of liver metastasis from colorectal cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:138-144. [PMID: 27861987 PMCID: PMC5363388 DOI: 10.1002/jcu.22421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/26/2016] [Accepted: 09/23/2016] [Indexed: 05/14/2023]
Abstract
PURPOSE To compare contrast-enhanced ultrasonography (CEUS) using Sonazoid with Gd-EOB-DTPA-enhanced MRI (EOB-MRI) in the diagnosis of liver metastases in patients with colorectal cancer. METHODS A total of 69 patients diagnosed with or suspected of having liver metastasis were enrolled. These hepatic lesions were diagnosed by histopathological examination after surgical resection or based on follow-up using various imaging modalities. The diagnostic accuracies of CEUS and EOB-MRI were compared. RESULTS One hundred thirty-three lesions were detected. Of these lesions, 109 were diagnosed as liver metastases. Of the 133 lesions, 90.2% were detected on CEUS, and 98.5% on EOB-MRI. One hundred nine lesions were diagnosed as liver metastasis. The areas under the receiver operating characteristic curve for diagnosis were 0.906 and 0.851 on CEUS and EOB-MRI, respectively (p = 0.41). Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and overall accuracy were 90.8%, 84.5%, 97.1%, 67.1%, and 90.2%, respectively, for CEUS, and 95.4%, 70.8%, 93.7%, 77.3%, and 91%, respectively, for EOB-MRI. CONCLUSIONS CEUS has a higher specificity and PPV for the diagnosis of liver metastasis than EOB-MRI. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:138-144, 2017.
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Affiliation(s)
- Kazue Shiozawa
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Manabu Watanabe
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Takashi Ikehara
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Yasushi Matsukiyo
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Michio Kogame
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Yoshinori Kikuchi
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Yuichiro Otsuka
- Department of SurgeryToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Hironori Kaneko
- Department of SurgeryToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
| | - Yasukiyo Sumino
- Division of Gastroenterology and HepatologyDepartment of Internal MedicineToho University Medical CenterOmori Hospital, 6‐11‐1, OmorinishiOta‐kuTokyo143‐8541Japan
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Comparison of the Timing of Hepatic Arterial Phase and Image Quality Using Test-Bolus and Bolus-Tracking Techniques in Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced Hepatic Dynamic Magnetic Resonance Imaging. J Comput Assist Tomogr 2017; 41:638-643. [PMID: 28240635 PMCID: PMC5516670 DOI: 10.1097/rct.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives The aim of this study was to compare the image quality, the degree of artifacts and the percentage of timing of the optimal hepatic arterial phase (HAP) between test-bolus and bolus-tracking methods on gadolinium–ethoxybenzyl–diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)–enhanced magnetic resonance imaging (MRI). Methods In this prospective study, 60 patients who underwent 3-dimensional dynamic Gd-EOB-DTPA–enhanced hepatic 3-T MRI were enrolled in this study. We randomly assigned the 30 patients to the bolus-tracking method, and another 30 patients to the test-bolus method. Signal-to-noise ratios of the liver and spleen in HAP were compared in the 2 groups. Two radiologists independently assessed the ratio of optimal timing of HAP and the degree of ringing and motion artifacts of the 2 protocols. Results The signal-to-noise ratios of the liver (24.0 [SD, 6.4] vs 20.4 [SD, 4.0]) and spleen (30.0 [SD, 13.3] vs 23.6 [SD, 9.9]) were significantly higher in the test-bolus protocol than in the bolus-tracking protocol. The ratio of optimal timing was also significantly higher with the test-bolus protocol than with the bolus-tracking protocol (76.7% vs 40.0%). The degree of ringing and motion artifacts of test-bolus protocol was significantly lower than that of the bolus-tracking protocol (P < 0.01). Conclusions The test-bolus protocol in dynamic 3-T MRI can yield better qualitative image quality and more optimal timing of HAP images, while reducing the degree of artifacts compared with the bolus-tracking protocol.
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Tanpowpong N, Phewplung T. Brief communication (Original). Correlation between liver signal intensity in hepatobiliary phase of Gd-EOB-DTPA enhancement and liver function reserves. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0803.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background: Gadolinium diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA) is a developed agent with preferential uptake by hepatocytes. A rapid and specific hepatocyte uptake with biliary excretion was observed of approximately 50% of the injected dose. The amount of contrast uptake is thought to be related to reserve liver function.
Objectives: To evaluate correlation between liver signal intensity in the hepatobiliary phase of Gd-EOB-DTPA and reserved liver function by using the model score for end-stage liver disease (MELD).
Methods:All patients who underwent magnetic resonance (MR) imaging with Gd-EOB-DTPA were retrospectively collected. The patients with serum creatinine level higher than 1.5 mg/dL or patients without available data to estimate MELD score were excluded. Thirty-six patients were enrolled. A signal-to-noise ratio (SNR) in the liver parenchyma on a fat-suppressed three dimensional fast spoiled-gradient recalled echo sequence images before and 20 minutes after contrast injection were measured and calculated on PACS by two radiologists. The MELD score was determined and interobserver reliability was estimated.
Results: Among 36 patients, we found a negative relationship between the percentage enhancement and the MELD score (P < 0.01, r = 0.545). The SNR at 20 minutes after Gd-EOB-DTPA injection also had a negative relationship with the MELD score with statistical significance (P < 0.01, r = 0.460). Interobserver reliability was 0.675.
Conclusion: The percentage enhancement in hepatobiliary phase of Gd-EOB-DTPA can predict reserved liver function.
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Affiliation(s)
- Natthaporn Tanpowpong
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Tong HF, Liang HB, Mo ZK, Guan TP, Yang J, Fang CH. Quantitative analysis of gadoxetic acid-enhanced magnetic resonance imaging predicts histological grade of hepatocellular carcinoma. Clin Imaging 2017; 43:9-14. [PMID: 28153667 DOI: 10.1016/j.clinimag.2016.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To confirm the histological grade of hepatocellular carcinoma (HCC) by gadoxetic acid-enhanced MRI. METHODS Ninety-five HCC patients underwent gadoxetic acid-enhanced MRI before surgical intervention. The correlations among the signal absolute enhancement, contrast enhancement ratio (CER) and tumor histological grade were analyzed. RESULTS The correlation between CER of tumor-to-liver and the grades of tumor differentiation is the most significant negative. The k-value for the CER of tumor-to-liver and histopathologic analysis is 0.62, which gives evidence of good agreement. CONCLUSION The quantitative analysis of gadoxetic acid-enhanced MRI can predict the histological grades of small HCCs.
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Affiliation(s)
- Hong-Fei Tong
- Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510282, China.
| | - Hong-Bo Liang
- Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510282, China
| | - Zhi-Kang Mo
- Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510282, China
| | - Tian-Pei Guan
- Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510282, China
| | - Jian Yang
- Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510282, China
| | - Chi-Hua Fang
- Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510282, China.
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Gd-EOB-DTPA-enhanced MRI T1 mapping for assessment of liver function in rabbit fibrosis model: comparison of hepatobiliary phase images obtained at 10 and 20 min. Radiol Med 2017; 122:239-247. [DOI: 10.1007/s11547-016-0719-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/19/2016] [Indexed: 01/13/2023]
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Jeon I, Cho ES, Kim JH, Kim DJ, Yu JS, Chung JJ. Feasibility of 10-Minute Delayed Hepatocyte Phase Imaging Using a 30° Flip Angle in Gd-EOB-DTPA-Enhanced Liver MRI for the Detection of Hepatocellular Carcinoma in Patients with Chronic Hepatitis or Cirrhosis. PLoS One 2016; 11:e0167701. [PMID: 27936106 PMCID: PMC5147964 DOI: 10.1371/journal.pone.0167701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023] Open
Abstract
Objectives To compare 10-minute (min) delayed hepatocyte phase imaging (HPI) using a 30° flip angle (FA) (10m-FA30) and 20-min delayed HPI using a 10° FA (20m-FA10) or 30° FA (20m-FA30) in Gd-EOB-DTPA-enhanced MRI in patients with chronic hepatitis or cirrhosis, in terms of lesion-to-liver contrast-to-noise ratio (CNR) for hepatocellular carcinoma (HCC) and detection sensitivity for focal hepatic lesions (FHLs). Materials and Methods One hundred and four patients with 168 HCCs and 55 benign FHLs who underwent Gd-EOB-DTPA-enhanced MRI with 10m-FA30, 20m-FA10, and 20m-FA30 were enrolled. Patients were divided into two groups according to the Child-Pugh classification: group A with chronic hepatitis or Child-Pugh A cirrhosis and group B with Child-Pugh B or C cirrhosis. Lesion-to-liver CNR for HCCs was compared between 10m-FA30 and 20m-FA10 or 20m-FA30 for each group. The presence of FHLs was evaluated using a four-point scale by two independent reviewers, and the detection sensitivity was analyzed. Results In group A, the CNR for HCCs (n = 86) on 10m-FA30 (165.8 ± 99.7) was significantly higher than that on 20m-FA10 (113.4 ± 71.4) and lower than that of 20m-FA30 (210.2 ± 129.3). However, there was no significant difference in the sensitivity of FHL detection between 10m-FA30 (mean 95.0% for two reviewers) and 20m-FA10 (94.7%) or 20m-FA30 (94.7%). In group B, the CNR (54.0 ± 36.4) for HCCs (n = 57) and the sensitivity (94.2%) of FHL detection for 10m-FA30 were significantly higher than those for 20m-FA10 (41.8 ± 36.4 and 80.8%, respectively) and were not different from those for 20m-FA30 (62.7 ± 44.4 and 93.3%, respectively). Conclusion The diagnostic performance of 10m-FA30 was similar to or higher than 20m-FA10 or 20m-FA30 in both groups A and B. This finding indicates that 10m-FA30 could replace 20-min delayed HPI regardless of patient liver function and reduce the delay time by 10 minutes.
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Affiliation(s)
- Inhwan Jeon
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Eun-Suk Cho
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
- * E-mail:
| | - Joo Hee Kim
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Dae Jung Kim
- Department of Radiology, CHA University, CHA Bundang Medical Center, Seongnam-si, Korea
| | - Jeong-Sik Yu
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Jae-Joon Chung
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
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Kikuchi M, Hayashi N, Yarita K, Sakata K, Ujita K, Matsuda S, Teduka Y. MTF Measurement of MR Blurring in Liver Dynamic MRI with Gd-EOB-DTPA. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1169-1176. [PMID: 27867178 DOI: 10.6009/jjrt.2016_jsrt_72.11.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During the arterial phase acquisition of Gd-EOB-DTPA examinations, use of a small volume of the Gd-EOB-DTPA may make it difficult the encoding center of the k-space, and produce blurring. The previous studies revealed the encoding technique of the k-space was one of the most important reasons. However, there is no report to discuss the reasons with quantitative evaluations. The purpose of this study was to quantitatively evaluate the characteristics of the artifacts using different k-space encoding techniques (centric-view ordering (CVO) and sequential-view ordering (SVO)) for liver dynamic MRI in computer simulation study. This simulation study consists of the following steps. First of all, the creation of a time intensity curve, and original simulation images at certain points among the one phase dynamic scanning. Secondly, creation-simulated MR echo data from the created original images using FFT, and encoding simulated k-space using the simulated MR echo data. Finally, a reconstruction of simulated dynamic MR images from the simulated k-space, and to evaluate each simulated MR images, we measured modulation transfer functions (MTFs) from the bar patterns of the reconstructed images. The results of the CVO simulation indicated that the bar patterns were blurring compared to the images encoded by the SVO. The results of the SVO simulation indicated that the bar patterns were not enhanced at late scan timings. In addition, the results of MTFs indicated that there was no edge enhancement at all scan timings and both encoding techniques. In conclusion, it is possible to quantitatively evaluate the characteristics of artifacts using MTF, which was measured by the bar patterns, in liver dynamic MRI.
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Affiliation(s)
- Masashi Kikuchi
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences
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Prognostic Significance of Concurrent Hypovascular and Hypervascular Nodules in Patients with Hepatocellular Carcinoma. PLoS One 2016; 11:e0163119. [PMID: 27649084 PMCID: PMC5029907 DOI: 10.1371/journal.pone.0163119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/03/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hypovascular nodules often occur together with hypervascular hepatocellular carcinoma (HCC). However, it remains controversial whether hypovascular nodules associated with hypervascular HCC have any prognostic value. This study evaluated the prognostic impact of hypovascular nodules co-existing with hypervascular HCC as diagnosed by computed tomography during arterial portography (CTAP) and computed tomography during hepatic arteriography (CTHA), which can sensitively capture the dynamic changes in blood flow through the portal vein and hepatic artery in patients with early stage HCC. METHODS A total of 152 patients with hypervascular HCC (≤ 30 mm, ≤ 3 nodules), who underwent initial local ablation, were analyzed retrospectively. All patients received CTAP and CTHA prior to treatment. Overall survival (OS) was compared among group A (hypervascular HCC only, 107 patients) and group B (hypovascular nodules and hypervascular HCC, 45 patients). RESULTS Among all hypovascular nodules, 81% (46 of 57) developed hypervascularization within the follow-up period. The 1- and 2-year hypervascularization rates were 17% and 51%, respectively. OS was significantly longer for group A than for group B (P < 0.001). A Cox proportional-hazards model identified the presence of hypovascular nodules concurrent with hypervascular HCC as an independent poor prognostic factor. CONCLUSION The prognosis of hypervascular HCC patients with hypovascular nodules detected during CTAP and CTHA is poor. Clinical HCC categories seem to be dissimilar between patients with and without hypovascular nodules.
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Boddu S, Brylka D, Dutruel SP, Spincemaille P, Prince MR. Quantitative evaluation of gadoxetate hepatocyte phase homogeneity: potential imaging markers for detection of early cirrhosis. Clin Imaging 2016; 40:979-986. [PMID: 27288740 DOI: 10.1016/j.clinimag.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/11/2016] [Accepted: 05/19/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Does quantitative analysis of the gadoxetate hepatocyte phase homogeneity, measuring percent standard deviation of hepatocyte phase (SDHP) and liver-to-kidney enhancement ratio (LiKER) detect early hepatic fibrosis? MATERIALS AND METHODS Retrospective review of gadoxetate liver MRI plus biopsy-proven fibrosis within 6 months included 31 reversible hepatic fibrosis, 33 irreversible hepatic fibrosis, and 15 donors. Parenchymal and vascular SDHP and LiKER were measured on the 20-min hepatocyte phase using region of interest. RESULTS Parenchymal SDHP, vascular SDHP and LiKER measurements differentiate early hepatic fibrosis from controls (P<.01). CONCLUSION Quantitative analysis of gadoxetate hepatocyte phase homogeneity using SDHP and LiKER is a promising imaging biomarker for diagnosis of early liver fibrosis.
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Affiliation(s)
- Srikanth Boddu
- Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, 10065.
| | - Douglas Brylka
- Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, 10065.
| | - Silvina P Dutruel
- Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, 10065.
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, 10065.
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY, 10065.
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Greiser J, Niksch T, Weigand W, Freesmeyer M. Investigations on the Ga(III) Complex of EOB-DTPA and Its 68Ga Radiolabeled Analogue. J Vis Exp 2016. [PMID: 27584545 DOI: 10.3791/54334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We demonstrate a method for the isolation of EOB-DTPA (3,6,9-triaza-3,6,9-tris(carboxymethyl)-4-(ethoxybenzyl)-undecanedioic acid) from its Gd(III) complex and protocols for the preparation of its novel non-radioactive, i.e., natural Ga(III) as well as radioactive (68)Ga complex. The ligand as well as the Ga(III) complex were characterized by nuclear magnetic resonance (NMR) spectroscopy, mass spectrometry and elemental analysis. (68)Ga was obtained by a standard elution method from a (68)Ge/(68)Ga generator. Experiments to evaluate the (68)Ga-labeling efficiency of EOB-DTPA at pH 3.8-4.0 were performed. Established analysis techniques radio TLC (thin layer chromatography) and radio HPLC (high performance liquid chromatography) were used to determine the radiochemical purity of the tracer. As a first investigation of the (68)Ga tracers' lipophilicity the n-octanol/water distribution coefficient of (68)Ga species present in a pH 7.4 solution was determined by an extraction method. In vitro stability measurements of the tracer in various media at physiological pH were performed, revealing different rates of decomposition.
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Affiliation(s)
- Julia Greiser
- Clinic of Nuclear Medicine, University Hospital Jena
| | - Tobias Niksch
- Clinic of Nuclear Medicine, University Hospital Jena
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50
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Caschera L, Lazzara A, Piergallini L, Ricci D, Tuscano B, Vanzulli A. Contrast agents in diagnostic imaging: Present and future. Pharmacol Res 2016; 110:65-75. [PMID: 27168225 DOI: 10.1016/j.phrs.2016.04.023] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
Specific contrast agents have been developed for x ray examinations (mainly CT), sonography and Magnetic Resonance Imaging. Most of them are extracellular agents which create different enhancement on basis of different vascularization or on basis of different interstitial network in tissues, but some can be targeted to a particular cell line (e.g. hepatocyte). Microbubbles can be used as carrier for therapeutic drugs which can be released in specific targets under sonographic guidance, decreasing systemic toxicity and increasing therapeutic effect. Radiologists have to choose a particular contrast agent knowing its physical and chemical properties and the possibility of adverse reactions and balancing them with the clinical benefits of a more accurate diagnosis. As for any drug, contrast agents can cause adverse events, which are more frequent with Iodine based CA, but also with Gd based CA and even with sonographic contrast agents hypersensitivity reaction can occur.
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Affiliation(s)
- Luca Caschera
- University of Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Angelo Lazzara
- University of Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Lorenzo Piergallini
- University of Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Domenico Ricci
- University of Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Bruno Tuscano
- University of Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy
| | - Angelo Vanzulli
- Department of Biomedical and Clinical Sciences, University of Milano, ASST Grande Ospedale Metropolitano, Niguarda, Milan, Italy.
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