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.
"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  . "
[Show abstract][Hide abstract] 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 · 11.34 Impact Factor
"However, atypical HCCs carry the risk to be overlooked in dynamic phase images and Gd-EOB-DTPA-enhanced hepatobiliary phase images have been shown to improve both detection and characterization of those lesions . Only recently the malignant potential of hypointense lesions detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI has been shown emphasizing its clinical benefit . "
[Show abstract][Hide abstract] ABSTRACT: Correct characterization of focal solid hepatic lesions has always been a challenge and is of great diagnostic and therapeutic relevance. The purpose of this study was to determine the added value of hepatobiliary phase images in Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for differentiating focal solid hepatic lesions.
In this retrospective trial 84 consecutive patients underwent Gd-EOB-DTPA-enhanced MR examinations. MRI was conducted for 64 patients with malignant focal hepatic lesions (34 hepatocellular carcinoma (HCC), 30 metastases) and for 20 patients with benign hepatic lesions (14 focal nodular hyperplasia (FNH), 3 adenoma, 3 hemangioma). Five radiologists independently reviewed three sets of MR images by means of a 5-point confidence scale from score 1 (definitely benign) to score 5 (definitely malignant): set 1: unenhanced images; set 2: unenhanced and Gd-EOB-DTPA-enhanced dynamic images; set 3: hepatobiliary phase images in addition to set 2. Accuracy was assessed by the alternative free-response receiver operating characteristic curve (Az) and the index of diagnostic performance was calculated.
Diagnostic accuracy was significantly improved by the addition of Gd-EOB-DTPA-enhanced dynamic images: Az in set 1 was 0.708 and 0.833 in set 2 (P = 0.0002). The addition of hepatobiliary phase images increased the Az value to 0.941 in set 3 (set 3 vs set 2, P < 0.0001; set 3 vs set 1, P < 0.0001). The index of diagnostic performance was lowest in set 1 (45%), improved in set 2 (71%), and highest in set 3 (94%).
Hepatobiliary phase images obtained after Gd-EOB-DTPA-enhanced dynamic MRI improve the differentiation of focal solid hepatic lesions.
BMC Medical Imaging 12/2013; 13(1):41. DOI:10.1186/1471-2342-13-41 · 1.31 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.
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