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.