Will Gd-EOB-MRI Change the Diagnostic Algorithm in Hepatocellular Carcinoma?

Abstract

A hepatocyte-specific contrast agent, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), was approved in Japan in 2008. This contrast agent enhances the blood pool and also is hepatocyte specific: it is taken up by hepatocytes and excreted into the biliary tract. Approximately 50% of the administered dose of Gd-EOB-DTPA is taken up by normal hepatocytes and subsequently excreted into the biliary tract, while the remaining 50% is excreted via the kidney. Hepatocellular uptake is considered to represent passive diffusion mediated by organic anion transporter polypeptide 1 (OATP1), which is expressed on the hepatocyte membrane. Gd-EOB-DTPA-enhanced MRI may offer a breakthrough for the diagnosis of liver tumors, particularly early hepatocellular carcinoma (HCC). The differentiation of dysplastic nodules from early HCC has remained difficult, even for pathologists specialized in liver tumors, but Gd-EOB-DTPA MRI facilitates an objective diagnosis with accuracy close to that of HCC-specialized pathologists. In conclusion, Gd-EOB-DTPA MRI facilitates the diagnosis of hypervascular advanced HCC and the differentiation of early HCC and dysplastic nodules, which used to be difficult, even with CT during arterial portography, and offers a high accuracy rate. Thus, Gd-EOB-DTPA MRI will have a significant impact on diagnostic algorithm for HCC.

Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Guidelines Proposed by the Japan Society of Hepatology (JSH) 2010 Updated Version

“…For Gd-EOB-MRI to be used to evaluate the hepatocellular function, lesions with a decreased intense at the hepatocyte phase are regarded as HCC. The CT diagnosis rate (including CTHA and CTAP) when lesions with a decrease in portal blood flow were regarded as HCC was approximately 60–70%, whereas the diagnosis rate of HCC by EOB-MRI is approximately 90% [30]; MRI may improve the diagnostic accuracy of early HCC. However, the presence of HCC with isointense and dysplastic nodule with low intense on hepatocyte phase of Gd-EOB-MRI has been indicated.…”

“…Portal invasion and intrahepatic metastasis are more frequently seen than in simple nodular type lesions (table 6). The number of intrahepatic metastatic foci and distance from the primary nodular are greater than in simple nodular type lesions [30] (table 7). In other words, lesions with high-level biological malignancy may be macroscopically evaluated as simple nodular type with extratumor growth or multinodular confluent type lesions.…”

The clinical management of hepatocellular carcinoma worldwide: A concise review and comparison of current guidelines from 2001 to 2017

“…This new contrast agent is specifically absorbed by normal hepatocytes, resulting in contrast enhancement. Therefore, HCC nodules lacking normal hepatocytes are hypo-intense, and this difference can help distinguish tumors from non-tumorous ("normal") nodules (52,53).…”

Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI

“…The high accuracy in the identification of early HCCs will probably change the diagnostic algorithm in hepatocellular carcinoma [41] . It facilitates the diagnosis of hypervascular advanced HCC and the differentiation of early HCC and dysplastic nodules from pseudovascular lesions.…”