Gd-EOB-DTPA-enhanced magnetic resonance imaging combined with T1 mapping predicts the degree of differentiation in hepatocellular carcinoma

Abstract

Background: Variable degrees of differentiation in hepatocellular carcinoma(HCC)under Edmondson-Steiner grading system has been proven to be an independent prognostic indicator for HCC. Up till now, there has been no effective radiological method that can reveal the degree of differentiation in HCC before surgery. This paper aims to evaluate the use of Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging combined with T1 mapping for the diagnosis of HCC and assessing its degree of differentiation.

Methods: Forty-four patients with 53 pathologically proven HCC had undergone Gd-EOB-DTPA enhanced MRI with T1 mapping before surgery. Out of the 53 lesions,13 were grade I, 27 were gradeII, and 13 were grade III. The T1 values of each lesion were measured before and at 20 min after Gd-EOB-DTPA administration (T1p and T1e). The absolute reduction in T1 value (T1d) and the percentage reduction (T1d %) were calculated. The one-way ANOVA and Pearson correlation were used for comparisons between the T1 mapping values.

Results: The T1d and T1d % of grade I, II and III of HCC was 660.5 ± 422.8ms、295.0 ± 99.6ms、276.2 ± 95.0ms and 54.0 ± 12.2 %、31.5 ± 6.9 %、27.7 ± 6.7 % respectively. The differences between grade Iand II, grade Iand III were statistically significant (p < 0.05), but there was no statically significant difference between grade II and III. The T1d % was the best marker for grading of HCC, with a Spearman correlation coefficient of -0.676.

Conclusions: T1 mapping before and after Gd-EOB-DTPA administration can predict degree of differentiation in HCC.

Keywords: Differentiated degrees; Edmondson-Steiner grade; Gd-EOB-DTPA; Hepatocellular Carcinoma; T1 mapping.

Fig. 1

a, b T1 values in T1 mapping images was measured before (T1p) and after (T1e) administration of the contrast medium. The two ROIs were chosen at the same place in the same lesions

Fig. 2

Row a: T1 weightedimages, Row b: T2 weightedI image, Row c: arterial phase image, Row d: potal venous phase image, Row e: hepatobiliary phase images; Row f: and Row g: T1 mapping of T1WI and hepatobiliary phase images; row h: corresponding pathological pictures. 1a-h, HCC (Edmondson-Steiner grade I). Lesion appeared hyperintense on routine sequences and hypointense in hepatobiliary-phase; T1p 892ms, T1e 388 ms, T1d = 504 ms, T1d % = 56.50 %; cells showed abundant cytoplasm and minimal nuclear irregularity. 2a-h, HCC (Edmondson-Steiner grade II), hypointense on T1WI and hepatobiliary phase images, “wash in and wash out”; T1p 1696 ms, T1e 1444 ms, T1d = 252 ms, T1d % = 14.90 %. 3a-h, HCC (Edmondson-Steiner grade III), hyperintense on T2WI images, hypointense on T1WI and hepatobiliary phase images; T1p 2134 ms, T1e 1494 ms,T1d = 640 ms,T1d % = 30.00 %. 2-h and 3-h, nuclear pleomorphism increased with increase in Edmondson-Steiner grade

Fig. 3

Values of T1p, T1e, T1d, T1d % in different groups and all of the studied lesions

Fig. 4

The average value of T1d and T1d % in HCC of different Edmondson-Steiner grades. Box-and-whisker plots showed that there was statistical significance of T1d and T1d % between grade I and the other two groups, but no statistically significant difference between grade II and grade III lesions