A controlled study of Gd-EOB-DTPA-enhanced MRI compared with enhanced CT in assessing lesion status after TACE for hepatocellular carcinoma

Abstract

Objective: This study aims to evaluate the diagnostic capability of Gd-EOB-DTPA-enhanced MRI in assessing lesion status following transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), in comparison to contrast-enhanced CT (CECT).

Methods: A total of 56 patients with HCC who underwent Gd-EOB-DTPA-enhanced MRI and CECT scans post-TACE were initially enrolled. The ability of both imaging modalities to differentiate between surviving, new, or necrotic lesions was assessed, using digital subtraction angiography (DSA) or interventional diagnostic results as the reference standard. Detection rates were compared using the chi-square test, while sensitivity, specificity, and accuracy were analyzed with McNemar's test.

Results: After applying inclusion and exclusion criteria, 48 patients were eventually included in the analysis. The reference standard identified 14 cases of surviving lesions, 19 of new lesions, and 15 of necrotic lesions. Gd-EOB-DTPA-enhanced MRI demonstrated a sensitivity of 93.9% (31/33), specificity of 100% (15/15), and a Youden index of 0.939, whereas CECT exhibited a sensitivity of 51.5% (17/33), specificity of 60.0% (9/15), and a Youden index of 0.115.

Conclusion: The findings indicate that Gd-EOB-DTPA-enhanced MRI possesses superior diagnostic value for evaluating lesion status in HCC post-TACE compared to CECT, as evidenced by significant differences in sensitivity and specificity (p < 0.05).

Keywords: Gd-EOB-DTPA-enhanced MRI; contrast-enhanced CT; hepatocellular carcinoma; lesion status; transcatheter arterial chemoembolization.

Figure 1

The flow chart of the study.

Figure 2

FS-T2WI and DWI: patchy high signal at the top of the right lobe of the liver: FS-T1WI: patchy high signal is seen at the top of the right lobe of the liver, and a patchy slightly low signal is seen within it. Panels (A–F) show the early arterial, late arterial, portal venous, delayed, hepatobiliary axial and coronal positions. EOB-MRI enhancement scans can accurately show the enhancement of the lesion after TACE: the necrotic area shows high signal in T1WI, low signal in T2WI and DWI, and the enhancement scans do not show any enhancement, and the hepatobiliary phase shows a low signal, which is a manifestation of coagulative necrosis.

Figure 3

FS-T2WI and DWI: rounded high signal in the right lobe of the liver, with a diameter of about 48.9 mm; FS-T1WI: rounded low signal in the right lobe of the liver. (A–F) show the early arterial, late arterial, portal venous, delayed, hepatobiliary axial and coronal positions. EOB-MRI enhancement scan can accurately show the enhancement of the lesion after TACE: the surviving area shows increased signals in T2WI and DWI, and the enhancement scan shows the characteristics of “fast-in-fast-out” enhancement, with low signals in the hepatobiliary phase. The surviving areas showed increased T2WI and DWI signals, with “fast-in-fast-out” enhancement characteristics and low signals in the hepatobiliary phase. The necrotic area showed high signal in T1WI, low signal in T2WI and DWI, no enhancement in the enhanced scan, low signal in the hepatobiliary phase, and coagulative necrosis.

Figure 4

A patient with HCC was reviewed after TACE treatment. (A–D) show the images of CT plain (A) and enhanced scans of arterial phase (B), portal vein (C), and delayed phase (D), in sequence. CT plain scan: New lesions were seen in the hepatic parenchyma, with nodular hypodensity, the large one was about 19.6 mm in diameter; enhancement scan showed insignificant enhancement in arterial phase, slightly hypodense in portal vein and delayed phase, and hyperdense in the center, which was atypical of “fast-in-fast-out” performance.

Figure 5

FS-T2WI and DWI: several round-like T2WI and DWI high-signal nodules were seen in the left and right lobes of the liver, with the largest being about 19.6 mm in diameter; FS-T1WI: several round-like low-signal nodules were seen in the left and right lobes of the liver. (A–F) show the early arterial, late arterial, portal venous, delayed, hepatobiliary axial and coronal positions. MRI dynamic scan: the lesion did not have definite enhancement in the early arterial stage, and it showed inhomogeneous and mild enhancement in the late arterial stage, with low-signal edges in the portal vein stage and the delayed stage, and high-signal in the central area; Hepatobiliary phase—axial and coronal: the lesion showed low signal, no contrast uptake was seen, suggesting that the multiple intrahepatic nodules were multiple HCC.