Fate of hypointense lesions on Gd-EOB-DTPA-enhanced magnetic resonance imaging
ABSTRACT To investigate the natural outcome and clinical implication of hypointense lesions in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.
Forty patients underwent Gd-EOB-DTPA-enhanced MRI for preoperative evaluation of HCC. Hypointense lesions in the hepatobiliary phase that were hypovascular 5mm of more were extracted for follow-up. We performed a longitudinal study retrospectively for these lesions regardless of whether classical HCC developed or emerged in a different area from that of the lesions being followed.
Thirty one patients displayed 130 hypointense lesions on MRI and only nine showed no hypointense lesions. In total, 17 (13.1%) of 130 hypointense lesions on MRI developed into classical HCC. The cumulative rates for these lesions to develop into classical HCC were 3.2% at 1 year, 11.1% at 2 years and 15.9% at 3 years. The total occurrence rates of classical HCC (25.8% at 1 year, 52.6% at 2 years and 76.4% at 3 years) were higher compared to those regarding only occurrence of classical HCC from hypointense lesions on MRI (10.0% at 1 year, 35.6% at 2 years and 44.6% at 3 years), although no significant difference was observed (p=0.073).
Hypointense lesions that are detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI have some malignant potential, although treating these lesions aggressively in patients who already have HCC may be too severe.
- SourceAvailable from: sciencedirect.com
[Show abstract] [Hide abstract]
- "Particularly, some early hypovascular HCC are only observed as hypointense nodules during the hepatobiliary phase at gadoxetate-enhanced MR imaging without being readily seen during dynamic imaging. The subgroup of lesions showing both absence of enhancement during the arterial phase and hypointensity during the hepatobiliary phase is challenging because not all of these lesions correspond to HCC or will evolve into HCC  . In this setting, hyperintensity on DW MR images increases the likelihood of early HCC or progression to hypervascular HCC  . "
ABSTRACT: Newly developed or advanced methods at ultrasonography and MR imaging provide combined anatomical and quantitative functional information regarding diffuse and focal liver diseases. Dynamic contrast-enhanced ultrasonography may improve tumor characterization and ultrasound elastography has a central role for staging liver fibrosis and an increasing role in grading portal hypertension. In clinical practice, MR imaging examinations currently include diffusion-weighted and dynamic MR imaging enhanced with extracellular or hepatobiliary contrast agents. Moreover, quantitative parameters obtained at diffusion-weighted MR imaging, dynamic contrast-enhanced MR imaging and MR elastography have the potential to further characterize diffuse and focal liver diseases by adding information about tissue cellularity, perfusion, hepatocyte transport function and visco-elasticity. The multiparametric capability of ultrasonography and more markedly of MR imaging gives the opportunity of high diagnostic performance by combining imaging biomarkers. The image acquisition and post-processing methods should be further standardized and validated in multicenter trials.Journal of Hepatology 10/2014; 62(3). DOI:10.1016/j.jhep.2014.10.014 · 10.40 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: A preparation method for hollow particles composed of silica shell containing gadolinium compound (GdC) is proposed. GdC nanoparticles with an average size of 40.5 ± 6.2 nm were prepared with a homogeneous precipitation method at 80°C using 1.0 × 10−3 M Gd(NO3)3 and 0.5 M urea in the presence of 2.0 × 10−4 M ethylenediaminetetraacetic acid disodium salt dihydrate. Silica-coated GdC (GdC/SiO2) nanoparticles with an average size of 100.9 ± 9.9 nm were fabricated with a sol-gel method at 35°C using 5.0 × 10−3 M tetraethylorthosilicate, 11 M H2O, and 1.5 × 10−3 M NaOH in ethanol in the presence of 1.0 × 10−3 M GdC nanoparticles. The GdC/SiO2 particles were aged at 80°C in water after replacement of solvent of the as-prepared GdC/SiO2 particle colloid solution with water, which provided diffusion of GdC into the silica shell and then formation of a hollow structure. The hollow particle colloid solution revealed good MRI properties. A relaxivity value for longitudinal relaxation time-weighted imaging was as high as 3.38 mM−1 · s−1 that attained 80% of that for a commercial Gd complex contrast agent.01/2013; 3(1). DOI:10.1186/2193-8865-3-11
- [Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study is to evaluate the correlation between the intranodular blood supply revealed by CT during intraarterial injection of contrast medium, mainly using helical CT, and the grade of malignancy of hepatocellular nodules associated with liver cirrhosis as classified by the International Working Party of the World Congress of Gastroenterology. We studied 201 histologically proven nodules (101 resected and 100 biopsied nodules), including 47 low-grade dysplastic nodules (low-DNs), 56 high-grade dysplastic nodules (high-DNs), 24 well-differentiated hepatocellular carcinomas (wd-HCCs), and 74 moderately or poorly differentiated HCCs (mp-HCCs), in 139 cirrhotic patients. Findings on CT during arterial portography (n = 201) and CT during hepatic arteriography (n = 74) were reviewed and compared with the histologic diagnosis. CT findings were classified into four types relative to the surrounding liver: type A (isodense), type B (slightly hypodense), type C (partially hypodense), and type D (markedly hypodense) on CT during arterial portography and type I (isodense), type II (hypodense), type III (partially hyperdense), and type IV (hyperdense) on CT during hepatic arteriography. On CT during arterial portography, the distributions of each type were low-DN (n = 47 [A, n = 36; B, n = 8; C, n = 3]), high-DN (n = 56 [A, n = 18; B, n = 20; C, n = 10; D, n = 8]), wd-HCC (n = 24; [B, n = 4; C, n = 13; D, n = 7]), and mp-HCC (n = 74 [D, n = 74]). On CT during hepatic arteriography, the distributions were low-DN (n = 26 [I, n = 18; II, n = 7; III, n = 1]), high-DN (n = 19 [I, n = 6; II, n = 7; III, n = 4; IV, n = 2]), wd-HCC (n = 15 [I, n = 1; III, n = 8; IV, n = 6]), and mp-HCC (n = 14 [IV, n = 14]). We found a statistically significant correlation between the four types and the grade of malignancy of these nodules. Findings on CT during arterial portography and CT during hepatic arteriography correlated positively with histologic grading when overlap in appearance between dysplastic nodules and HCCs occurred. The concept revealed in this study can apply to diagnoses made on the basis of Doppler sonography, dynamic CT, and MR imaging.American Journal of Roentgenology 05/1999; 172(4):969-76. DOI:10.2214/ajr.172.4.10587130 · 2.74 Impact Factor