Published online Jul 27, 2022. doi: 10.4254/wjh.v14.i7.1459
Peer-review started: February 23, 2022
First decision: April 17, 2022
Revised: April 20, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 27, 2022
Processing time: 153 Days and 21.1 Hours
Challenging lesions, difficult to diagnose through non-invasive methods, constitute an important emotional burden for each patient regarding a still uncertain diagnosis (malignant x benign). In addition, from a therapeutic and prognostic point of view, delay in a definitive diagnosis can lead to worse outcomes. One of the main innovative trends currently is the use of molecular and functional methods to diagnosis. Numerous liver-specific contrast agents have been developed and studied in recent years to improve the performance of liver magnetic resonance imaging (MRI). More recently, one of the contrast agents introduced in clinical practice is gadoxetic acid (gadoxetate disodium).
To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions (FLL) in clinical practice.
Overall, 302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL. Two radiologists independently reviewed the MRI exams using four stages, and categorized them on a 6-point scale, from 0 (lesion not detected) to 5 (definitely malignant). The stages were: stage 1- images without contrast, stage 2- addition of dynamic phases after contrast (analogous to usual extracellular contrasts), stage 3- addition of hepatobiliary phase after 10 min (HBP 10’), stage 4- hepatobiliary phase after 20 min (HBP 20’) in addition to stage 2.
The interobserver agreement was high (weighted Kappa coefficient: 0.81- 1) at all stages in the characterization of benign and malignant FLL. The diagnostic weighted accuracy (Az) was 0.80 in stage 1 and was increased to 0.90 in stage 2. Addition of the hepatobiliary phase increased Az to 0.98 in stage 3, which was also 0.98 in stage 4.
The hepatobiliary sequences improve diagnostic accuracy. With growing potential in the era of precision medicine, the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.
Core Tip: The translational objective was to determine the value of hepatobiliary phases using gadoxetic acid as a liver-specific agent in magnetic resonance imaging (MRI) in the characterization of benign and malignant focal liver lesions (FLL) in clinical practice. Morphofunctional MRI with gadoxetic acid in addition to the usual dynamic phases after contrast medium (arterial, portal and transitional/ equilibrium) increased the proportion of hits for differentiation between benign and malignant FLL in relation to the definitive diagnosis. The results suggest a relevant impact on the definition of strategies for the approach of focal hepatic lesions, as well as in the assessment of the treatment employed.