Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging is more effective than enhanced 64-slice CT for the detection of small lesions in patients with hepatocellular carcinoma

Li, Jiangfa; Li, Xiaoqing; Weng, Jun; Lei, Liping; Gong, Jianhua; Wang, Junyi; Zhenghang, LI; Zhang, Longmiao; He, Songqing

doi:10.1097/md.0000000000013964

Cited by 16 publications

(11 citation statements)

References 22 publications

(33 reference statements)

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“…Therefore, the theoretical disadvantage of GA-MRI for the detection of PVTT, if it existed at all, may have been overcome by the better delineation of “PVTT showing continuity with the tumor in the adjacent liver parenchyma” or by the additional parameters of T2- and diffusion-weighted imaging. Furthermore, previous studies have demonstrated that GA-MRI also better detects small (≤2 cm) HCCs than CECT in patients who underwent surgery for HCC [18, 37], presumably due to the excellent lesion-to-liver contrast at hepatobiliary phase imaging [38]. Considering this high sensitivity of GA-MRI for the detection of PVTT as well as for small HCCs, GA-MRI can additionally be performed in HCC patients meeting the Milan criteria on CECT for more accurate staging and allocation of treatment.…”

Section: Discussionmentioning

confidence: 99%

How to Best Detect Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Meeting the Milan Criteria: Gadoxetic Acid-Enhanced MRI versus Contrast-Enhanced CT

et al. 2020

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Introduction: The detection of portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC) meeting the Milan criteria is of critical importance as PVTT is known to be a contraindication to transplantation and an indicator of a dismal prognosis. Objective: To determine which modality may best detect PVTT, we compared the diagnostic performance of gadoxetic acid-enhanced MRI (GA-MRI) and contrast-enhanced CT (CECT) in HCC patients meeting the Milan criteria. Methods: We retrospectively enrolled 310 patients with HCCs meeting the Milan criteria who underwent both GA-MRI and CECT between June 2007 and May 2017. Among them, 44 patients were demonstrated to have PVTT while 266 patients had no PVTT. Two radiologists then assessed GA-MRI and CECT images for the presence of PVTT on a 5-point scale as well as vessel expansion, continuity with tumors, and enhancement on both modalities, as well as T2 hyperintensity and diffusion restriction on GA-MRI. The McNemar test was used to compare sensitivity and specificity of GA-MRI and CECT for the detection of PVTT, and Fisher's exact test was used to compare their imaging features.

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Section: Discussionmentioning

confidence: 99%

How to Best Detect Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Meeting the Milan Criteria: Gadoxetic Acid-Enhanced MRI versus Contrast-Enhanced CT

et al. 2020

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“…Contrast-enhanced US has emerged as a promising method to diagnose small HCCs (25); however, additional studies are required to confirm its clinical value (23). Multiple meta-analyses have found that contrast-enhanced MRI outperforms contrast enhanced CT in the diagnosis of small HCCs with higher sensitivity and overall accuracy (26,27). Previous meta-analysis indicated that contrast-enhanced MRI had moderately high sensitivity and high specificity in the diagnosis of small HCC (28).…”

Section: Discussionmentioning

confidence: 99%

A meta‑analysis of the added value of diffusion weighted imaging in combination with contrast‑enhanced magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma lesser or equal to 2 cm

Lan¹,

Lin

Zhong³

2020

Oncol Lett

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Diffusion weighted imaging (DWI) has been found to increase the sensitivity in the diagnosis of small hepatocellular carcinoma (HCC), although additional studies are required to confirm its value. The aim of the present study was to explore the diagnostic performance of DWI combined with contrast-enhanced magnetic resonance imaging (MRI) for small HCC by performing a meta-analysis. Literature databases (PubMed, Embase, Web of Science and Cochrane Library databases) were searched to identify studies reporting the sensitivity and specificity of MRI with DWI for the diagnosis of small HCCs. Pooled sensitivity and specificity were generated using a bivariate random effect model. Multilevel mixed-effects logistic regression analysis was used to examine the value of DWI combined with conventional MRI. A total of 837 small HCCs and 545 benign liver lesions from 10 studies were included. The overall sensitivity and specificity of DWI combined with contrast-enhanced MRI was 0.88 (95% CI, 0.80-0.93) and 0.90 (95% CI, 0.81-0.95), respectively. Compared with that in contrast-enhanced MRI, DWI with contrast-enhanced MRI had a significantly higher sensitivity for the diagnosis of small HCC (P= 0.01) while there was no significant difference in the specificity (P= 0.603). The present meta-analysis suggests that DWI combined with contrast-enhanced MRI may increase the sensitivity, whilst maintaining high specificity for the diagnosis of small HCCs with a diameter ≤2 cm.

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“…Gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) has been shown to have promising applications in the assessment of liver function [1][2][3][4][5][6] and diagnosis of various pathologies in the liver. [7][8][9][10][11][12] Gadoxetic acid provides utility as a hepatobiliary contrast, allowing interrogation of the uptake of contrast into the hepatocytes as well as liver perfusion parameters. Various pharmacokinetic parameters have been used as a measure of regional liver function 1,[13][14][15] with gadoxetic acid uptake rate being among the most direct due to its correspondence with the number of functioning hepatocytes, making it a reasonable quantitative measure of regional liver function.…”

Section: Introductionmentioning

confidence: 99%

“…Gadoxetic acid–enhanced dynamic magnetic resonance imaging (MRI) has been shown to have promising applications in the assessment of liver function and diagnosis of various pathologies in the liver . Gadoxetic acid provides utility as a hepatobiliary contrast, allowing interrogation of the uptake of contrast into the hepatocytes as well as liver perfusion parameters.…”

Section: Introductionmentioning

confidence: 99%

GAN and dual‐input two‐compartment model‐based training of a neural network for robust quantification of contrast uptake rate in gadoxetic acid‐enhanced MRI

Simeth

Cao

2020

Medical Physics

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Purpose: Gadoxetic acid uptake rate (k 1 ) obtained from dynamic, contrast-enhanced (DCE) magnetic resonance imaging (MRI) is a promising measure of regional liver function. Clinical exams are typically poorly temporally characterized, as seen in a low temporal resolution (LTR) compared to high temporal resolution (HTR) experimental acquisitions. Meanwhile, clinical demands incentivize shortening these exams. This study develops a neural network-based approach to quantitation of k 1 , for increased robustness over current models such as the linearized single-input, two-compartment (LSITC) model. Methods: Thirty Liver HTR DCE MRI exams were acquired in 22 patients with at least 16 min of postcontrast data sampled at least every 13 s. A simple neural network (NN) with four hidden layers was trained on voxel-wise LTR data to predict k 1 . Low temporal resolution data were created by subsampling HTR data to contain six time points, replicating the characteristics of clinical LTR data. Both the total length and the placement of points in the training data were varied considerably to encourage robustness to variation. A generative adversarial network (GAN) was used to generate arterial and portal venous inputs for use in data augmentation based on the dual-input, two-compartment, pharmacokinetic model of gadoxetic acid in the liver. The performance of the NN was compared to direct application of LSITC on both LTR and HTR data. The error was assessed when subsampling lengths from 16 to 4 min, enabling assessment of robustness to acquisition length. Results: For acquisition lengths of 16 min NRMSE (Normalized Root-Mean-Squared Error) in k 1 was 0.60, 1.77, and 1.21, for LSITC applied to HTR data, LSITC applied to LTR data, and GAN-augmented NN applied to LTR data, respectively. As the acquisition length was shortened, errors greatly increased for LSITC approaches by several folds. For acquisitions shorter than 12 min the GAN-augmented NN approach outperformed the LSITC approach to a statistically significant extent, even with HTR data. Conclusions: The study indicates that data length is significant for LSITC analysis as applied to DCE data for standard temporal sampling, and that machine learning methods, such as the implemented NN, have potential for much greater resilience to shortened acquisition time than directly fitting to the LSITC model.

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Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging is more effective than enhanced 64-slice CT for the detection of small lesions in patients with hepatocellular carcinoma

Cited by 16 publications

References 22 publications

How to Best Detect Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Meeting the Milan Criteria: Gadoxetic Acid-Enhanced MRI versus Contrast-Enhanced CT

How to Best Detect Portal Vein Tumor Thrombosis in Patients with Hepatocellular Carcinoma Meeting the Milan Criteria: Gadoxetic Acid-Enhanced MRI versus Contrast-Enhanced CT

A meta‑analysis of the added value of diffusion weighted imaging in combination with contrast‑enhanced magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma lesser or equal to 2 cm

GAN and dual‐input two‐compartment model‐based training of a neural network for robust quantification of contrast uptake rate in gadoxetic acid‐enhanced MRI

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