Appearance of hepatocellular carcinoma on gadoxetic acid-enhanced hepato-biliary phase MR imaging: a systematic review

Abstract

The percentage of lesions iso/hyper/iso-hyper is the same when considering well-differentiated and moderately differentiated HCC; when considering poorly differentiated HCC, the percentage of lesions iso/hyper/iso-hyper is significantly lower. Conversely, the percentage of lesions hypointense is significantly more represented in poorly differentiated HCC compared to well-differentiated and moderately differentiated HCC.

Multiparametric imaging for detection and characterization of hepatocellular carcinoma using gadoxetic acid-enhanced MRI and perfusion-CT: which parameters work best?

“…Based on the same principle, the currently used enhancement patterns like the presence of wash-in and wash-out proved to be less sensitive for lesion identification based on differences in the contribution of arterial and portal-venous dual blood supply to the liver and tumor and seem to be in part subjective. For improved detectability of these patterns, enhancement ratios have been proposed for both the arterial and portal-venous perfusion phases [12]. At this point, our data is in line with that of previous reports validating the benefit of using these ratios [12].…”

“…For improved detectability of these patterns, enhancement ratios have been proposed for both the arterial and portal-venous perfusion phases [12]. At this point, our data is in line with that of previous reports validating the benefit of using these ratios [12]. Nonetheless, even the use of enhancement ratios could not entirely enforce their weighting as unfaultable perfusion parameters.…”

“…After i.v. injection of gadoxetic acid, the following quantitative parameters were evaluated: the enhancement ratio (ER) equivalent to (post-contrast signal intensity (SI) – pre-contrast SI/pre-contrast SI) × 100 in the arterial post-contrast phase (ERa) and portal-venous phase (ERv) [12]. …”

“…The relative intensity ratio (RIR) between lesion and liver parenchyma was calculated on pre-contrast T1w-images (RIR T1 ) and T2w-images (RIR T2 ) equivalent to SInod/SIpar, where SInod is the SI of the nodule, and SIpar is the SI of the liver parenchyma [12]. Additionally, the RIR was calculated for the hepatobiliary phase (RIR HB ) using the same formula.…”

Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid–enhanced MRI

“…Unlike SPIO, gadoxetic acid, which we used in this study, is an MRI contrast agent that enters hepatocytes via organic anionic transporting polypeptides receptors; these transporter molecules are expressed only in “functioning” hepatocytes. According to a previous report on the appearance of hepatocellular nodules on hepatobiliary phase of gadoxetic acid MRI, approximately one‐third of high‐grade DNs can show hypointensity with decreased organic anionic transporting polypeptides expression, and another study reported that 86% of well‐differentiated HCCs and 88% of moderately differentiated HCCs showed hypointensity on hepatobiliary‐phase images, although without statistical significance . Inferring from these results, discrepancy between Kupffer‐phase defects on CEUS and hepatobiliary‐phase defects on MRI is expected in cases of DNs and well‐differentiated HCCs.…”