MRI in the Evaluation of Hepatocellular Nodules: Role of Pulse Sequences and Contrast Agents

Abstract

Magnetic resonance (MR) imaging is more useful than computed tomography (CT) in the evaluation of hepatocellular nodules based on the excellent soft-tissue image contrast of MR imaging. In addition, recent MR units have allowed various fast MR imaging techniques (i.e., parallel imaging or echo-planar imaging) to dramatically improve image quality and image contrast. A variety of liver-specific MR contrast agents are also currently available or have been evaluated in clinical trials to improve the contrast between the liver parenchyma and hepatocellular nodules.

Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

“…First, the low signal intensity on in-phase and isosignal intensity on opposed-phase T1-weighted MRI may have reflected iron deposits in the FNH-like nodule, since similar phase-shift imaging has been reported to reflect hemosiderin deposits in regenerative nodules in liver cirrhosis (16). In contrast, the isointensity to slightly high intensity on inphase and the low signal intensity on opposed-phase T1-weighted MRI are known to reflect hepatocellular nodules with fatty degeneration (8). Thus, the combined findings from the in-phase and opposed-phase may facilitate discrimination between FNH-like nodules and welldifferentiated HCC, since the former frequently have iron deposits and the latter has fatty degeneration.…”

“…On the other hand, gadolinium-ethoxybenzyldiethylenetriamine pentaacetic acid ( Gd-EOB-DTPA ) - enhanced MRI has enabled us to detect focal liver lesions because of its hepatocyte-specific properties (5-7), and it might be the most useful imaging modality for the diagnosis of HCC at present (8,9). However, the image findings of FNH-like nodules in Gd-EOB-DTPA-enhanced MRI are not well known, and it remains unclear if FNH-like nodules can be distinguished from HCC in Gd-EOB-DTPA-enhanced MRI.…”

Gadoxetate Disodium–Enhanced MRI of the Liver: Part 2, Protocol Optimization and Lesion Appearance in the Cirrhotic Liver

“…Because regenerative nodules, dysplastic nodules, and HCCs constitute a spectrum with gradual dedifferentiation [17], it may be difficult to distinguish among these entities on the basis of vascular imaging features [26]. The hepatocyte phase of Gd-EOB-DTPA may help differentiate benign (regenerative and dysplastic) nodules from HCC because benign nodules usually show Gd-EOB-DTPA uptake unlike HCC [43], a distinction that is of clinical importance. In addition, Gd-EOB may allow a more confident evaluation and characterization of pseudolesions and peritumoral areas of arterial hyperenhancement.…”

Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma

“…A differential diagnosis of a dysplastic nodule and welldifferentiated HCC can be based on findings with or without uptake of Gd-EOB-DTPA [6]. However, some HCCs may show paradoxical uptake of Gd-EOB-DTPA and are recognized as iso-or hyperintense lesions in the hepatobiliary phase, compared with normal parenchyma [7,8].…”