Detection of small hepatocellular carcinoma: comparison of conventional gadolinium-enhanced MRI with gadolinium-enhanced MRI after the administration of ferucarbotran

Abstract

We compared the diagnostic efficacy of gadolinium (Gd)-enhanced MRI with that of Gd-enhanced MRI after administration of ferucarbotran for revealing small hypervascular hepatocellular carcinomas (HCCs). 24 patients with 34 HCCs (ranging in size from 0.6-2.0 cm) underwent Gd-enhanced three-dimensional dynamic MRI followed, after an interval of 5-11 days (mean, 7 days), by Gd-enhanced three-dimensional dynamic MRI after administration of ferucarbotran. The two Gd-enhanced arterial-phase MRI scans were compared quantitatively by measuring the tumour-liver contrast-to-noise ratio (CNR) and qualitatively by evaluating the tumour-liver contrast using matched-pairs analysis. The tumour-liver CNR with Gd-enhanced arterial-phase imaging after ferucarbotran (250.3 +/- 103.7) was higher than that with Gd-enhanced arterial-phase imaging (221.1 +/- 96.1) (p < 0.001). Matched-pairs analysis indicated that, for three lesions, the relative tumour-liver contrast was slightly better with Gd-enhanced arterial-phase imaging after ferucarbotran than with conventional Gd-enhanced arterial-phase imaging; however, in the case of the remaining 31 lesions, the two images were equivalent. We concluded that, although Gd-enhanced arterial-phase imaging after ferucarbotran results in better tumour-liver CNR than Gd-enhanced arterial-phase imaging, the ability of the two techniques to reveal small hypervascular HCCs is the same.

Nanomaterials for In Vivo Imaging

“…Due to the paucity of nanomaterials in the clinic, few comparison studies have been performed between nanomaterials and small molecules aside from iron oxide nanomaterials versus small molecules using clinical MRI. Indeed, the literature is relatively rich in clinical studies performed to compare nanomaterials (iron oxides) with gadolinium chelates specifically for imaging focal liver lesions. − To help appreciate the state-of-the-art in contrast-based clinical imaging, we selected and compared several nanomaterial/small-molecule pairs that were used for identical patient indications (Table ). The agents are assessed as a function of their key differences in clinical value; nanomaterials prove heterogeneous in their benefits, displaying both advantageous and disadvantageous qualities for imaging compared with their small-molecule counterparts (Table ).…”

APASL and AASLD Consensus Guidelines on Imaging Diagnosis of Hepatocellular Carcinoma: A Review

“…However, detailed discussion of the SPIO agents will be avoided since these are currently out of production, except to say that experience with SPIO agents thus far had been promising and that it potentially improves imaging detection of HCCs [40, 53, 54]. Combined gadolinium chelate and SPIO MRI, termed “double contrast” MRI, is technically more cumbersome, even though it appears to increase the tumour to liver contrast to noise ratio, and therefore sensitivity, over multiphasic CT [55, 56] routine Gd-enhanced MRI [57], or SPIO-enhanced MRI [58, 59]. …”

Detection of Small Hepatocellular Carcinoma

“…Lastly, a Gd-first approach is not real double-contrast MRI but rather a sequential acquisition of a Gd-enhanced MRI and then a SPIOenhanced MRI because administered Gd has no influence on the successively acquired SPIO-enhanced MRI. [1][2][3]38 Nevertheless, we chose a Gd-first approach over a SPIO-first approach. A SPIO-first approach has the theoretical advantage of delineating hypervascular HCC because of a reduction in the signal intensity of the liver.…”

“…However, a previous study has shown similar diagnostic capabilities of a Gd-first approach, as compared with a SPIO-first approach for the detection of hypervascular HCC. 38 Moreover, a SPIO first approach might sacrifice the role of dynamic equilibrium phase imaging to delineate the washout of HCC or hypovascular early HCC with preserved Kupffer cells. 38 In conclusion, gadoxetic acid-enhanced MRI can replace combining gadopentetate dimeglumine-enhanced MRI and SPIOenhanced MRI for the detection of HCCs.…”

“…38 Moreover, a SPIO first approach might sacrifice the role of dynamic equilibrium phase imaging to delineate the washout of HCC or hypovascular early HCC with preserved Kupffer cells. 38 In conclusion, gadoxetic acid-enhanced MRI can replace combining gadopentetate dimeglumine-enhanced MRI and SPIOenhanced MRI for the detection of HCCs. Because most HCCs were detected on gadoxetic acid-enhanced MRI even with low confidence ratings, gadoxetic acid-enhanced MRI may be preferable to doublecontrast MRI for HCC work-up.…”