Detection of malignant primary hepatic neoplasms with gadobenate dimeglumine (Gd-BOPTA) enhanced T1-weighted hepatocyte phase MR imaging: results of off-site blinded review in a phase-II multicenter trial

Abstract

Objective: To investigate the efficacy of gadobenate dimeglumine (Gd-BOPTA) enhanced MR imaging for the detection of liver lesions in patients with primary malignant hepatic neoplasms.

Materials and methods: Thirty-one patients with histologically proven primary malignancy of the liver were evaluated before and after administration of Gd-BOPTA at dose 0.05 or 0.10 mmol/kg. T1-weighted spin echo (T1W-SE) and gradient echo (T1W-GRE) images were evaluated for lesion number, location, size and confidence by three off-site independent reviewers and the findings were compared to reference standard imaging (intraoperative ultrasound, computed tomography during arterial portography or lipiodol computed tomography). Results were analyzed for significance using a two-sided McNemar's test.

Results: More lesions were identified on Gd-BOPTA enhanced images than on unenhanced images and there was no significant difference in lesion detection between either concentration. The largest benefit was in detection of lesions under 1 cm in size (7 to 21, 9 to 15, 16 to 18 for reviewers A, B, C respectively). In 68% of the patients with more than one lesion, Gd-BOPTA increased the number of lesions detected.

Conclusion: Liver MR imaging after Gd-BOPTA increases the detection of liver lesions in patients with primary malignant hepatic neoplasm.

Fig. 1

61 year-old man with hepatocellular carcinoma. A. T1-weighted GRE image without contrast demonstrates a small segment 8 lesion (arrow). B. T1-weighted GRE image after injection of 0.1 mmol/kg of gadobenate dimeglumine shows increased conspicuity of the segment 8 lesion (arrow).

Fig. 2

72 year-old woman with hepatocellular carcinoma. A. T1-weighted SE image before contrast demonstrates a large lesion within segment 2-3. B. T1-weighted SE image performed 90 minutes after injection of 0.05 mmol/kg of gadobenate dimeglumine better delineates a second lesion within segment 4 (arrow). Note even though there is enhancement of the tumor, the lesion to liver contrast still increases.

Fig. 3

35 year-old woman with hepatocellular carcinoma. A. T1-weighted GRE image before contrast demonstrates large primary lesion. B. T1-weighted GRE image performed 90 minutes after injection of 0.05 mmol/kg of gadobenate dimeglumine better identifies the large primary tumor but also of smaller lesions within the right lobe.