Biliary and reticuloendothelial impairment in hepatocarcinogenesis: the diagnostic role of tissue-specific MR contrast media

Abstract

The development and progression of a hepatocellular carcinoma (HCC) in a chronically diseased liver, i.e., the carcinogenesis, comprise a multistep and long-term process. Morphologically, this process is associated with the presence of distinct nodular lesions in the liver that are called 'preneoplastic lesions.' These preneoplastic lesions are associated with and can precede the growth and progression of well-differentiated HCCs . The characterization of nodular lesions and demonstration of the multistep development of HCC in the cirrhotic liver by imaging modalities represent a challenging issue. The arterial hypervascular supply, depicted by different dynamic studies, represents a fundamental radiological criterion for the diagnosis of HCC in cirrhosis. Magnetic resonance (MR) imaging performed with tissue-specific contrast media can help to investigate the "grey area" of carcinogenesis, in which significant histological changes are already present without any imaging evidence of neoangiogenesis. The purpose of this review is to provide information on the properties of tissue-specific MR contrast agents and on their usefulness in the demonstration of the pathologic changes that take place at the level of the biliary and reticuloendothelial systems during the carcinogenetic process in liver cirrhosis.

Comparison between areas with Gd‐EOB‐DTPA uptake and without in hepatocellular carcinomas on Gd‐EOB‐DTPA‐enhanced hepatobiliary‐phase MR imaging: Pathological correlation

“…THE LIVER-SPECIFIC MR contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) (gadoxetic acid disodium, Primovist, Bayer Schering, Berlin, Germany) produces both dynamic and liver-specific hepatobiliary MR images (1)(2)(3)(4)(5)(6). This contrast agent is highly liver-specific; approximately 50% of the injected dose is taken up by functioning hepatocytes and is excreted in bile, as compared to an uptake of 3-5% for gadobenate dimeglumine (4).…”

“…This contrast agent is highly liver-specific; approximately 50% of the injected dose is taken up by functioning hepatocytes and is excreted in bile, as compared to an uptake of 3-5% for gadobenate dimeglumine (4). A bolus injection of gadoxetic acid provides a dual mode of action that allows imaging in the early dynamic phase (as with standard gadolinium chelates) and in the delayed phase (hepatobiliary phase) that is obtained 10 to 20 min after injection and lasts until 90 min after injection (7,8).…”

Differentiating Focal Eosinophilic Infiltration from Metastasis in the Liver with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging

“…The recently developed hepatobiliary agent, gadoxetic acid (Gadolinium-ethoxybezyl [Gd-EOB]-DTPA, Primovist, Bayer Schering Pharma, Berlin), is taken up preferentially by hepatocytes and evidences prolonged persistence in the liver, owing to the fact that approximately 50% of the injected dose is taken up by functioning hepatocytes and excreted in the bile, as compared with an uptake of 3-5% for gadobenate dimeglumine and hepatocyte-specific phase imaging after the injection of gadoxetic acid, which can be obtained earlier than gadobenate dimeglumine (13)(14)(15). Some investigators (16,17) have previously reported that gadoxetic acid-enhanced MRI allows for the accurate detection and characterization of focal liver lesions.…”

Detection of Hepatocellular Carcinoma: Comparison of Gadoxetic Acid-Enhanced MRI, Diffusion-Weighted Imaging, and Combined Interpretation at 3 T MRI

“…Gadoxetic acid (Eovist or Primovist, Bayer Schering: Berlin, Germany) has been approved for hepatic imaging and is being widely used (9)(10)(11)(12). It is a liver-specific hepatobiliary contrast agent which can also be used extracellularly.…”

“…It is a liver-specific hepatobiliary contrast agent which can also be used extracellularly. It is taken up by functioning hepatocytes and up to 50% is excreted into the bile (9,13). There have ) and dynamic gadoxetic acid-enhanced MRI as well as hepatobiliary phase were performed.…”