Hepatocellular Carcinoma: Detection with Gadolinium- and Ferumoxides-enhanced MR Imaging of the Liver

Pauleit, Dirk; Textor, J.; Bachmann, R.; Conrad, Rudi; Flacke, Sebastian; Layer, G.; Kreft, Burkhard; Schild, Hans H.

doi:10.1148/radiol.2221001599

Cited by 92 publications

(53 citation statements)

References 23 publications

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“…A 3D gradient-echo sequence and parallel acquisition techniques facilitate dynamic contrast-enhanced imaging of HCC [7][8][9][10][11][12]. Gadobenate dimeglumine has been found useful for liver MRI.…”

Section: Choi Et Almentioning

confidence: 99%

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Choi

Lee

et al. 2008

American Journal of Roentgenology

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529sis determines patient eligibility for and the potential success of curative treatments. Therefore, CT and MRI aided by technologic advances that afford improved spatial, temporal, and contrast resolution are regarded as promising alternative surveillance tools for detecting HCC [4,5]. Contrast-enhanced dynamic multiphasic imaging has substantial performance benefits because most HCCs are hypervascular lesions that typically become enhanced during the hepatic arterydominant phase of imaging [6]. OBJECTIVE. The purpose of this study was to retrospectively evaluate the diagnostic performance of dynamic gadobenate dimeglumine-enhanced MRI with explant pathologic correlation in the detection of hepatocellular carcinoma (HCC) in patients undergoing liver transplantation. Hepatocellular Carcinoma in H e p a t o b i l i a r y I m ag i ng • O r ig i n a l R e s e a rc hMATERIALS AND METHODS. Forty-seven patients (28 men, 19 women; mean age, 49 years) underwent dynamic gadobenate dimeglumine-enhanced MRI within 3 months before primary liver transplantation. Dynamic imaging was performed before (unenhanced) and after (hepatic arterial, portal venous, equilibrium, and 1-hour delayed phases) IV bolus administration of gadobenate dimeglumine at 0.1 mmol/kg body weight. Retrospective image analysis to detect HCC nodules was performed independently by two abdominal radiologists who had no pathologic information. On a per-nodule basis, the sensitivity and positive predictive value were calculated for the two observers. Sensitivity and specificity in the diagnosis of HCC also were evaluated. Fisher's exact test was performed to determine whether there was a detection difference between HCC nodules 1 cm in diameter or larger and nodules smaller than 1 cm and to evaluate the differences in causes of false-positive MRI findings based on lesion size (≥ 1 cm vs < 1 cm).RESULTS. Twenty-seven patients had 41 HCCs. In HCC detection, gadobenate dimeglumine-enhanced MRI had a sensitivity of 85% (35 of 41 HCCs) and a positive predictive value of 66% (35 of 53 readings) for observer 1 and a sensitivity of 80% (33 of 41 HCCs) and a positive predictive value of 65% (34 of 52 readings) for observer 2. For both observers, sensitivity in the detection of HCCs 1 cm in diameter and larger (91-94%) was significantly different (p < 0.05) from that in detection of HCCs smaller than 1 cm (29-43%). Nonneoplastic arterial hypervascular lesions more often caused false-positive diagnoses of lesions smaller than 1 cm in diameter (80-86%) on MR images than of those 1 cm in diameter and larger (0-25%). The difference was statistically significant (p < 0.05) for both observers. In diagnosis, gadobenate dimeglumine-enhanced MRI had a sensitivity of 87% (20 of 23 patients) and a specificity of 79% (19 of 24 patients) for both observers.CONCLUSION. Dynamic gadobenate dimeglumine-enhanced MRI has a sensitivity of 80-85% and a positive predictive value of 65-66% in the detection of HCC. The technique, however, is of limited value for detecting and characterizi...

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Section: Choi Et Almentioning

confidence: 99%

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Choi

Lee

et al. 2008

American Journal of Roentgenology

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“…Difficulties can be observed in distinguishing well differentiated HCC from regenerative and dysplastic nodules, because small HCCs can have an identical appearance as dysplastic nodules, in up to 13% [26]. HCCs show variable enhancement with superparamagnetic iron oxide (SPIO) particles, therefore in the context of cirrhosis and small tumors, gadolinium enhanced imaging or a combination of the two types of contrast agent are preferred [27,28]. In our study, the incapacity of MRI to distinguish HCC depended on enhancement patterns and grading.…”

Section: Discussionmentioning

confidence: 99%

Contrast enhanced ultrasound and magnetic resonance imaging in hepatocellular carcinoma diagnosis

Dumitrescu

Gheonea²,

Săndulescu

et al. 2013

Med Ultrason

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Background: The new developments in imaging technology, including contrast enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI), allow a better diagnosis of both malignant and benign liver lesions. Material and methods: A retrospective trial of 126 patients was conducted in the Gastroenterology and Imaging Departments of the University of Medicine and Pharmacy Craiova, Romania. CEUS and MRI were the imaging techniques used for diagnosis of focal liver lesions (FLL), especially for hepatocellular carcinoma (HCC). Histopathology was used only in 15 cases. For each method of investigation we calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratio (+LR, -LR), accuracy and we compared the ROC curves. Statistical analysis also included the Chi-square and Kappa tests. Results: Seventy six cases were diagnosed as HCC, with average size of 5.2±3.3 cm in diameter. The sensitivity and specificity were 71.4% and 95.6% for CEUS and 91.4%, 98.9% respectively, for MRI. When comparing the ROC curves, we found a higher area under curve for MRI (0.952) then for CEUS (0.835) (p=0.005), and 95% confidence interval of 0.0343 to 0.199. No statistically significant difference in diagnosis of FLL was found between CEUS and MRI (p > 0.05) and the agreement between the two imaging techniques was good (k = 0.78). Conclusions: CEUS can be used as the first step in the diagnosis of liver lesions, but MRI remains the gold standard diagnostic method for liver tumors.

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“…Pauleit et al reported that the detection of small HCC (Å15 mm) in SPIO-enhanced MRI was inferior to that of large HCC. 8 The following reasons might have contributed to the non-detection of small HCCs in SPIO-enhanced MRI. In cirrhotic liver parenchyma, the accumulation of SPIO particles in KupŠer cells decreases because of the decreasing activity of KupŠer cells.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Dynamic MRI with Superparamagnetic Iron Oxide (SH U 555A): Vascularity Evaluation in Hepatocellular Carcinoma

et al. 2002

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Purpose: A study was conducted to determine the possibility of evaluating the blood ‰ow in cases of hypervascular hepatocellular carcinoma (HCC) by employing dynamic MRI with superparamagnetic iron oxide (SH U 555 A), which can be rapidly injected via an intravenous route.Methods: Six patients with hypervascular HCC (23 nodules) served as the subjects. Dynamic MRI includes images obtained at precontrast and at 10 (perfusion phase), 60, 120, 180, 240, 300 and 600 s after the start of injection of SH U 555 A. CT hepatic arteriography (CTHA) and CT during arterial portography (CTAP) were used as the standards of reference, and these were performed in all patients three days after dynamic MRI. The signal changes were evaluated at each phase, especially at the perfusion phase from the viewpoints of a lesion-to-liver contrast-to-noise ratio (CNR) and visual examination.Results: A total of 23 hypervascular HCC were detected on CTHA and CTAP. Of the 23 lesions, 17 were detected on SH U 555 A enhanced MRI. Incorrect timing during acquisition of the perfusion phase was considered in two cases with three lesions. Of 14 lesions, excluding two cases with incorrect timing, a reduction in the transient signal in the lesions at the perfusion phase was visually recognized in 10 lesions (71z). Signiˆcant diŠerences were seen in tumor size between visible and non-visible tumors involving transient signal reduction (pº0.05). CNR gradually increased after rapidly decreasing in the perfusion phase.Conclusion: SH U 555 A enhanced MRI is valuable in limited cases. Evaluation of tumor blood ‰ow employing dynamic MRI with SH U 555 A is aŠected by tumor size and requires optimal timing of the perfusion phase.

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Hepatocellular Carcinoma: Detection with Gadolinium- and Ferumoxides-enhanced MR Imaging of the Liver

Abstract: For the detection of early HCC, gadolinium-enhanced MR imaging is preferred to ferumoxides-enhanced MR imaging because the former demonstrated significantly greater accuracy in the detection of small HCCs.

Cited by 92 publications

References 23 publications

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Hepatocellular Carcinoma in Liver Transplantation Candidates: Detection with Gadobenate Dimeglumine–Enhanced MRI

Contrast enhanced ultrasound and magnetic resonance imaging in hepatocellular carcinoma diagnosis

Efficacy of Dynamic MRI with Superparamagnetic Iron Oxide (SH U 555A): Vascularity Evaluation in Hepatocellular Carcinoma

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