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. 2024 Aug 2;14(15):1676.
doi: 10.3390/diagnostics14151676.

Differentiating Well-Differentiated from Poorly-Differentiated HCC: The Potential and the Limitation of Gd-EOB-DTPA in the Presence of Liver Cirrhosis

Andrea Goetz  1 , Niklas Verloh  2 , Kirsten Utpatel  3 , Claudia Fellner  1 , Janine Rennert  1 , Ingo Einspieler  1 , Michael Doppler  2 , Lukas Luerken  4 , Leona S Alizadeh  5 , Wibke Uller  2 , Christian Stroszczynski  1 , Michael Haimerl  4
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Differentiating Well-Differentiated from Poorly-Differentiated HCC: The Potential and the Limitation of Gd-EOB-DTPA in the Presence of Liver Cirrhosis

Andrea Goetz et al. Diagnostics (Basel). .

Abstract

This study uses magnetic resonance imaging (MRI) to investigate the potential of the hepatospecific contrast agent gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) in distinguishing G1- from G2/G3-differentiated hepatocellular carcinoma (HCC). Our approach involved analyzing the dynamic behavior of the contrast agent in different phases of imaging by signal intensity (SI) and lesion contrast (C), to surrounding liver parenchyma, and comparing it across distinct groups of patients differentiated based on the histopathological grading of their HCC lesions and the presence of liver cirrhosis. Our results highlighted a significant contrast between well- and poorly-differentiated lesions regarding the lesion contrast in the arterial and late arterial phases. Furthermore, the hepatobiliary phase showed limited diagnostic value in cirrhotic liver parenchyma due to altered pharmacokinetics. Ultimately, our findings underscore the potential of Gd-EOB-DTPA-enhanced MRI as a tool for improving preoperative diagnosis and treatment selection for HCC while emphasizing the need for continued research to overcome the diagnostic complexities posed by the disease.

Keywords: gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA); hepatocellular carcinoma (HCC); liver cirrhosis; magnetic resonance imaging (MRI); tumor differentiation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Contrast response of the liver lesions for the plain, arterial (AP), late atrial (LAP), portal venous (PVP), and hepatobiliary phase (HBP). (a) absolute signal intensities (b) contrast (C). *, p = 0.040; **, p = 0.010.
Figure 2
Figure 2
Contrast of HCC lesions in relation to cirrhotic (red) and non-cirrhotic (black) liver parenchyma for the plain, arterial (AP), late atrial (LAP), portal venous (PVP), and hepatobiliary phase (HBP). (a) G1. (b) G2/G3.
Figure 3
Figure 3
Comparison of well-differentiated and poorly-differentiated HCCs in the presence of liver cirrhosis (ISHAK Score 6) in T1 weighted VIBE sequences (phases as indicated): (A) well-differentiated HCC (G1) in liver fibrosis (ISHAK 2), (B) well-differentiated HCC (G1) in liver cirrhosis (ISHAK 6), (C) poorly-differentiated HCC (G2) in normal liver parenchyma (ISHAK 0), (D) poorly-differentiated HCC (G2) in in liver cirrhosis (ISHAK 6).
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