The value of Gd-EOB-DTPA-enhanced MR imaging in characterizing cirrhotic nodules with atypical enhancement on Gd-DTPA-enhanced MR images

Abstract

Purpose: To evaluate the utility of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in characterizing atypically enhanced cirrhotic nodules detected on conventional Gd-DTPA-enhanced MR images.

Materials and methods: We enrolled 61 consecutive patients with 88 atypical nodules seen on conventional Gd-DTPA-enhanced MR images who underwent Gd-EOB-DTPA-enhanced MRI within a 3-month period. Using a reference standard, we determined that 58 of the nodules were hepatocellular carcinoma (HCC) and 30 were dysplastic nodules (DNs). Tumor size, signal intensity on precontrast T1-weighted images (T1WI), T2-weighted images (T2WI) and diffusion-weighted images (DWI), and the enhancement patterns seen on dynamic phase and hepatocyte phase images were determined.

Results: There were significant differences between DNs and HCC in hyperintensity on T2WI, hypointensity on T1WI, hypervascularity on arterial phase images, typical HCC enhancement patterns on dynamic MR images, hypointensity on hepatocyte phase images, and hyperintensity on DWI. The sensitivity and specificity were 79.3% and 83.3% for T2WI, 50.0% and 80.0% for T1WI, 82.8% and 76.7% for DWI, 17.2% and 100% for dynamic MR imaging, 93.1% and 83.3% for hepatocyte phase imaging, and 46.8% and 100% when arterial hypervascularity was combined with hypointensity on hepatocyte-phase imaging.

Conclusion: Gd-EOB-DTPA-enhanced hepatocyte phase imaging is recommended for patients at high risk for HCC who present with atypical lesions on conventional Gd-DTPA-enhanced MR images.

Fig 1. Flowchart showing patient selection.

Fig 2. A 50-year-old female with moderately differentiated HCC (arrow) at S4 of the liver underwent gadoxetic acid-enhanced MRI and hepatectomy.

(a) The tumor showed hypointensity on the T1-weighted image. (b) The tumor was isointense to the adjacent liver parenchyma on the T2-weighted image. (c) The tumor showed hyperintensity on diffusion-weighted imaging. (d) Hypervascularity was found in the tumor in the atrial phase, but was isointense to the adjacent liver parenchyma in the venous phase of dynamic MRI study. (e) The tumor was hypointense on the Gd-EOB-DTPA-enhanced hepatobiliary phase T1-weighted image.

Fig 3. A 63-year-old male with a well-differentiated HCC (arrow) at S3 of the liver underwent gadoxetic acid-enhanced MR imaging and hepatectomy.

(a) The tumor was hypointense on the T1-weighted image. (b) The tumor depicted hyperintensity on the T2-weighted image. (c) The tumor depicted hyperintensity on the diffusion-weighted image. (d)The tumor was isointense to the adjacent liver parenchyma in the arterial phase, but was hypointense in the venous phase of the dynamic MRI study. (e) The tumor was hypointense on the Gd-EOB-DTPA-enhanced hepatobiliary phase T1-weighted image.