nach oben

European Radiology

Erschienen in:

01.06.2011 | Magnetic Resonance

Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis

verfasst von: Rita Golfieri, Matteo Renzulli, Vincenzo Lucidi, Beniamino Corcioni, Franco Trevisani, Luigi Bolondi

Erschienen in: European Radiology | Ausgabe 6/2011

Einloggen, um Zugang zu erhalten

Abstract

Objective

To prospectively assess the additional value of the hepatobiliary (HB) phase of Gd-EOB-DTPA-MRI in identifying and characterising small (≤2 cm) hepatocellular carcinomas (HCCs) undetermined in dynamic phases alone because of their atypical features, according to the AASLD criteria.

Methods

127 cirrhotic patients were evaluated with Gd-EOB-DTPA-MRI in two sets: unenhanced and dynamic phases; unenhanced, dynamic and HB phases. Sixty-two out of 215 nodules (29%) were atypical in 42 patients (33%).

Results

62 atypical nodules were reported at histology: high-grade dysplastic nodules (HGDN)/early HCC (n = 20), low-grade DN (LGDN) (n = 21), regenerative nodules (n = 17) and nodular regenerative hyperplasia (n = 4). The sensitivity, specificity, accuracy, positive and negative predictive value (PPV, NPV) were increased by the addition of the HB phase: 88.4–99.4%, 88–95%, 88–98.5%, 97–99%, and 65–97.5%, respectively. Twenty atypical nodules were malignant (32%), 19 of which were characterised only during the HB phase.

Conclusions

The HB phase is 11% more sensitive in the classification of HGDN/early HCC than dynamic MRI, with an added value of 32.5% in the NPV. The high incidence (33%) of atypical nodules and their frequent malignancy (32%) suggest the widespread employment of Gd-EOB-DTPA-MRI in the follow-up of small nodules (≤2 cm) in cirrhosis.

Sherman M (2010) Epidemiology of hepatocellular carcinoma. Oncology 78(Suppl 1):7–10PubMedCrossRef

Roayaie S, Llovet JM (2005) Liver transplantation for hepatocellular carcinoma: is expansion of criteria justified? Clin Liver Dis 9:315–28PubMedCrossRef

Shibuya K, Yano E (2005) Regression analysis of trends in mortality from hepatocellular carcinoma in Japan, 1972–2001. Int J Epidemiol 34:397–402PubMedCrossRef

El-Serag HB (2004) Hepatocellular carcinoma: recent trends in the United States. Gastroenterology 127:S27–34PubMedCrossRef

El-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 11:745–750CrossRef

Hayashi M, Matsui O, Ueda K, Kawamori Y, Gabata T, Kadoya M (2002) Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intrarterial injection of contrast material. Radiology 225:143–149PubMedCrossRef

Hayashi M, Matsui O, Ueda K, Kawamori Y, Kadoya M, Yoshikawa J, Gabata T, Takashima T, Nonomura A, Nakanuma Y (1999) Correlation between the blood supply and grade of malignancy of hepatocellular nodules associated with liver cirrhosis: evaluation by CT during intraarterial injection of contrast medium. AJR Am J Roentgenol 172:969–976PubMed

Leoni S, Piscaglia F, Golfieri R, Camaggi V, Vidili G, Pini P, Bolondi L (2010) The impact of vascular and non vascular findings on the non invasive diagnosis of small hepatocellular carcinoma based on EASL and AASLD criteria. Am J Gastroenterol 105:599–609PubMedCrossRef

Colli A, Fraquelli M, Casazza G, Massironi S, Colucci A, Conte D, Duca P (2006) Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol 101:513–523PubMedCrossRef

10.

Hecht EM, Holland AE, Israel GM, Hahn WY, Kim DC, West AB, Babb JS, Taouli B, Lee VS, Krinsky GA (2006) Hepatocellular carcinoma in the cirrhotic liver: gadolinium-enhanced 3D T1-weighted MR imaging as a stand-alone sequence for diagnosis. Radiology 239:438–447PubMedCrossRef

11.

Rode A, Bancel B, Douek P, Chevallier M, Vilgrain V, Picaud G, Henry L, Berger F, Bizollon T, Gaudin JL, Ducerf C (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25:327–336PubMedCrossRef

12.

Snowberger N, Chinnakotla S, Lepe RM, Peattie J, Goldstein R, Klintmalm GB, Davis GL (2007) Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis. Aliment Pharmacol Ther 26:1187–1194PubMedCrossRef

13.

Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. AASLD PRACTICE GUIDELINE. Hepatology 42:1208–1235PubMedCrossRef

14.

Marrero JA, Hussain HK, Nghiem HV, Umar R, Fontana RJ, Lok AS (2005) Improving the prediction of hepatocellular carcinoma in cirrhotic patients with an arterially-enhancing liver mass. Liver Transpl 11:281–289PubMedCrossRef

15.

Bruix J, Sherman M (2010) Management of hepatocellular carcinoma: an update. AASLD PRACTICE GUIDELINE. Hepatology July, published online by American Association for the Study of Liver Diseases.http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/HCCUpdate2010.pdf

16.

Mion F, Grozel L, Boillot O, Paliard P, Berger F (1996) Adult cirrhotic liver explants: precancerous lesions and undetected small hepatocellular carcinomas. Gastroenterology 111:1587–1592PubMedCrossRef

17.

Bolondi L, Gaiani S, Celli N, Golfieri R, Grigioni WF, Leoni S, Venturi AM, Piscaglia F (2005) Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42:27–34PubMedCrossRef

18.

International Consensus Group for Hepatocellular Neoplasia (2009) Pathologic diagnosis of early hepatocellular carcinoma: a report of the International Consensus Group for Hepatocellular Neoplasia. Hepatology 49:658–664CrossRef

19.

Spinazzi A, Lorusso V, Pirovano G, Kirchin M (1999) Safety, tolerance, biodistribution, and MR imaging enhancement of the liver with gadobenate dimeglumine: results of clinical pharmacologic and pilot imaging studies in nonpatient and patient volunteers. Acad Radiol 6:282–291PubMedCrossRef

20.

Kirchin MA, Pirovano GP, Spinazzi A (1998) Gadobenate dimeglumine (Gd-BOPTA). An overview. Invest Radiol 33:798–809PubMedCrossRef

21.

Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV (2009) Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. RadioGraphics 29:1725–1748PubMedCrossRef

22.

Reimer P, Rummeny EJ, Shamsi K, Balzer T, Daldrup HE, Tombach B, Hesse T, Berns T, Peters PE (1996) Phase II clinical evaluation of Gd-EOB-DTPA: dose, safety aspects, and pulse sequence. Radiology 199:177–183PubMed

23.

Vogl TJ, Kümmel S, Hammerstingl R, Schellenbeck M, Schumacher G, Balzer T, Schwarz W, Müller PK, Bechstein WO, Mack MG, Söllner O, Felix R (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67PubMed

24.

Saito K, Kotake F, Ito N, Ozuki T, Mikami R, Abe K, Shimazaki Y (2005) Gd-EOB-DTPA enhanced MRI for hepatocellular carcinoma: quantitative evaluation of tumor enhancement in hepatobiliary phase. Magn Reson Med Sci 4:1–9PubMedCrossRef

25.

Kim JI, Lee JM, Choi JY, Kim YK, Kim SH, Lee JY, Han JK, Choi BI (2008) The value of gadobenate dimeglumine-enhanced delayed phase MR imaging for characterization of hepatocellular nodules in the cirrhotic liver. Invest Radiol 43:202–210PubMedCrossRef

26.

Kogita S, Imai Y, Okada M, Kim T, Onishi H, Takamura M, Fukuda K, Igura T, Sawai Y, Morimoto O, Hori M, Nagano H, Wakasa K, Hayashi N, Murakami T (2010) Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol 20:2405–2413PubMedCrossRef

27.

Ahn SS, Kim MJ, Lim JS, Hong HS, Chung YE, Choi JY (2010) Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma. Radiology 255:459–466PubMedCrossRef

28.

Forty-first World Medical Assembly (1990) Declaration of Helsinki: recommendations guiding physicians in biomedical research involving human subjects. Bull Pan Am Health Organ 24:606–609

29.

International Working Party (1995) Terminology of nodular hepatocellular lesions. Hepatology 22:983–993

30.

Stevens WR, Gulino SP, Batts KP, Stephens DH, Johnson CD (1996) Mosaic pattern of hepatocellular carcinoma: histologic basis for a characteristic CT appearance. J Comput Assist Tomogr 20:337–342PubMedCrossRef

31.

Choi SH, Lee JM, Yu NC, Suh KS, Jang JJ, Kim SH, Choi BI (2008) Hepatocellular carcinoma in liver transplantation candidates: detection with gadobenate dimeglumine-enhanced MRI. AJR Am J Roentgenol 191:529–536PubMedCrossRef

32.

Kim YK, Kwak HS, Han YM, Kim CS (2007) Usefulness of combining sequentially acquired gadobenate dimeglumine-enhanced magnetic resonance imaging and Resovist enhanced magnetic resonance imaging for the detection of hepatocellular carcinoma: comparison with computed tomography hepatic arteriography and computed tomography arterioportography using 16-slice multidetector computed tomography. J Comput Assist Tomogr 31:702–711PubMedCrossRef

33.

Willatt JM, Hussain HK, Adusumilli S, Marrero JA (2008) MR Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and controversies. Radiology 247:311–330PubMedCrossRef

34.

Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002) Large regenerative nodules in Budd-Chiari Syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation. AJR Am J Roentgenol 178:877–883PubMed

35.

Amesa JT, Federle MP, Chopra K (2009) Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver. Clin Radiol 64:1190–1195CrossRef

36.

Kitao A, Zen Y, Matsui O, Gabata T, Kobayashi S, Koda W, Kozaka K, Yoneda N, Yamashita T, Kaneko S, Nakanuma Y (2010) Hepatocellular carcinoma: signal intensity at gadoxetic acid–enhanced MR imaging—correlation with molecular transporters and histopathologic features. Radiology 256:817–826PubMedCrossRef

37.

Narita M, Hatano E, Arizono S, Miyagawa-Hayashino A, Isoda H, Kitamura K, Taura K, Yasuchika K, Nitta T, Ikai I, Uemoto S (2009) Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol 44:793–798PubMedCrossRef

38.

Pascolo L, Petrovic S, Cupelli F, Bruschi CV, Anelli PL, Lorusso V, Visigalli M, Uggeri F, Tiribelli C (2001) Abc protein transport of MRI contrast agents in canalicular rat liver plasma vesicles and yeast vacuoles. Biochem Biophys Res Commun 282:60–66PubMedCrossRef

39.

Hamm B, Staks T, Mühler A, Bollow M, Taupitz M, Frenzel T, Wolf KJ, Weinmann HJ, Lange L (1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 195:785–792PubMed

40.

Kudo M (2008) Hepatocellular carcinoma 2009 and beyond: from the surveillance to molecular targeted therapy. Oncology 75(suppl 1):1–12. doi:10.1159/000181865 PubMedCrossRef

41.

Hammerstingl R, Huppertz A, Breuer J, Balzer T, Blakeborough A, Carter R, Fusté LC, Heinz-Peer G, Judmaier W, Laniado M, Manfredi RM, Mathieu DG, Müller D, Mortelè K, Reimer P, Reiser MF, Robinson PJ, Shamsi K, Strotzer M, Taupitz M, Tombach B, Valeri G, van Beers BE, Vogl TJ, European EOB-study group (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18(3):457–467. doi:10.1007/s00330-007-0716-9 PubMedCrossRef

42.

Tajima T, Honda H, Taguchi K, Asayama Y, Kuroiwa T, Yoshimitsu K, Irie H, Aibe H, Shimada M, Masuda K (2002) Sequential hemodynamic change in hepatocellular carcinoma and dysplastic nodules: CT angiography and pathologic correlation. AJR Am J Roentgenol 178:885–897PubMed

43.

Kojiro M (2007) Diagnostic discrepancy of early hepatocellular carcinoma between Japan and West. Hepatology Res 37:S249–S252CrossRef

44.

Gabata T, Matsui O, Kadoya M, Yoshikawa J, Ueda K, Kawamori Y, Takashima T, Nonomura A (1998) Delayed MR imaging of the liver: correlation of delayed enhancement of hepatic tumors and pathologic appearance. Abdom Imaging 23:309–313PubMedCrossRef

45.

Grazioli L, Morana G, Caudana R, Benetti A, Portolani N, Talamini G, Colombari R, Pirovano G, Kirchin MA, Spinazzi A (2000) Hepatocellular carcinoma: correlation between gadobenate dimeglumine-enhanced MRI and pathologic findings. Invest Radiol 35:25–34PubMedCrossRef

46.

Manfredi R, Maresca G, Baron RL, Cotroneo AR, De Gaetano AM, De Franco A, Pirovano G, Spinazzi A, Marano P (1999) Delayed MR imaging of hepatocellular carcinoma enhanced by gadobenate dimeglumine (Gd-BOPTA). J Magn Reson Imaging 9:704–710PubMedCrossRef

47.

Nakashima Y, Nakashima O, Hsia CC, Kojiro M, Tabor E (1999) Vascularization of small hepatocellular carcinomas: correlation with differentiation. Liver 19:12–18PubMedCrossRef

48.

Takayasu K, Furukawa H, Wakao F, Muramatsu Y, Abe H, Terauchi T, Winter TC 3rd, Sakamoto M, Hirohashi S (1995) CT diagnosis of early hepatocellular carcinoma: sensitivity, findings, and CT-pathologic correlation. AJR Am J Roentgenol 164:885–890PubMed

49.

Lim JH, Choi D, Kim SH, Lee SJ, Lee WJ, Lim HK, Kim S (2002) Detection of hepatocellular carcinoma: value of adding delayed phase imaging to dual-phase helical CT. AJR Am J Roentgenol 179:67–73PubMed

50.

Marin D, Di Martino M, Guerrisi A, De Filippis G, Rossi M, Ginanni Corradini S, Masciangelo R, Catalano C, Passariello R (2009) Hepatocellular carcinoma in patients with cirrhosis: qualitative comparison of gadobenate dimeglumine-enhanced MR imaging and multiphasic 64-section CT. Radiology 251:85–95PubMedCrossRef

51.

Kim SH, Kim SH, Lee J, Kim MJ, Jeon YH, Park Y, Choi D, Lee WJ, Lim HK (2009) Gadoxetic acid-enhanced MRI versus triple-phase MDCT for the preoperative detection of hepatocellular carcinoma. AJR Am J Roentgenol 192:1675–1681PubMedCrossRef

52.

Ransohoff DF, Feinstein AR (1978) Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med 299:926–930PubMedCrossRef

53.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG (2003) Standards for reporting of diagnostic accuracy. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 138:W1–12PubMed

54.

Kojiro M (2004) Focus on dysplastic nodules and early hepatocellular carcinoma: an Eastern point of view. Liver Transpl 10:S3–S8PubMedCrossRef

55.

Kojiro M, Roskams T (2005) Early hepatocellular carcinoma and dysplastic nodules. Semin Liver Dis 25:133–142PubMedCrossRef

56.

Kudo M (2009) Multistep human hepatocarcinogenesis: correlation of imaging with pathology. J Gastroenterol 44:112–118PubMedCrossRef

57.

Inoue K, Takayama T, Higaki T, Watanabe Y, Makuuchi M (2004) Clinical significance of early hepatocellular carcinoma. Liver Transpl 10:S16–S19PubMedCrossRef

58.

Yamamoto M, Takasaki K, Otsubo T, Katsuragawa H, Katagiri S, Yoshitoshi K, Ariizumi S, Saito A, Nakano M (2004) Favorable surgical outcomes in patients with early hepatocellular carcinoma. Ann Surg 239:395–399PubMedCrossRef

Titel: Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis
verfasst von: Rita Golfieri
Matteo Renzulli
Vincenzo Lucidi
Beniamino Corcioni
Franco Trevisani
Luigi Bolondi
Publikationsdatum: 01.06.2011
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 6/2011
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-010-2030-1

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis