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Froehlich JM, Moussa L, Guirguis N, Gutzeit A, Wu D, Sartoretti-Schefer S, Koh DM, Kolokythas O, Matoori S. Comparison of gadolinium-based contrast agents for MR cholangiography in saline, blood and bile: a phantom study. Eur Radiol Exp 2023; 7:21. [PMID: 37093398 PMCID: PMC10126166 DOI: 10.1186/s41747-023-00331-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/15/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND We compared T1- and T2-weighted signal intensities of liver-specific (gadoxetate, gadobenate) and non-specific (gadoterate) gadolinium contrast agents (CAs) in a bile phantom. METHODS In a phantom study, gadoxetate, gadobenate, and gadoterate were diluted in saline, blood, and bile at different concentrations (0, 0.25, 0.5. 1, 2.5, 5, 10, and 25 mM) and imaged in a 3-T magnetic resonance imaging (MRI) system using T1- and T2-weighted sequences. The maximum signal intensities of CAs were compared for each sequence separately and across all T1-weighted sequences using one-way ANOVA. RESULTS Using T1-weighted sequences, CA concentration-dependent signal intensity increase was followed by decrease due to T2* effects. Comparing CAs for each sequence in bile yielded higher maximum signal intensities with gadobenate than gadoxetate and gadoterate using T1-weighted spin-echo (p < 0.010), multiecho gradient- and spin-echo (p < 0.001), and T1-weighted high-resolution isotropic volume excitation (eTHRIVE) sequences (p < 0.010). Comparing across all T1-weighted sequences in the bile phantom, gadobenate imaged using T1-weighted turbo field-echo (TFE) sequence showed the highest signal intensity, significantly higher than that using other CAs agents or sequences (p < 0.004) except for gadobenate and gadoxetate evaluated with three-dimensional multiecho fast field-echo (3D-mFFE) and gadoxetate with T1-weighted TFE sequence (p > 0.141). Signal reduction with CA concentration-dependent decrease was observed on T2-weighted images. CONCLUSION In this bile phantom study of gadolinium-based CA, gadobenate and gadoxetate showed high signal intensity with T1-weighted TFE and 3D-mFFE sequences, which supports their potential utility for contrast-enhanced hepatobiliary MRI. KEY POINTS • Contrast-enhanced magnetic resonance (MR) cholangiography depends on contrast agent type, kinetics, and concentration in bile, • We compared signal intensities of three contrast agents in a bile phantom study. • Gadobenate, gadoxetate, and gadoterate demonstrated different signal intensities at identical concentrations. • Gadoxetate and gadobenate showed high signal intensities on T1-weighted MR sequences.
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Affiliation(s)
| | - Leen Moussa
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Natalie Guirguis
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Andreas Gutzeit
- Institute of Radiology and Nuclear Medicine and Breast Center St. Anna, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- Department of Health Sciences and Medicine, Universität Luzern, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - David Wu
- Laboratory for Cell and Tissue Engineering, Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, 02115, USA
| | | | - Dow-Mu Koh
- Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK
| | - Orpheus Kolokythas
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
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Heo S, Choi SH, Hong S, Kim DW. Visualization Score of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging: The Effect on the Diagnostic Accuracy for Hepatocellular Carcinoma. J Magn Reson Imaging 2023; 57:941-949. [PMID: 35849038 DOI: 10.1002/jmri.28357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The visualization score of hepatobiliary-phase (HBP) images has been introduced as an image quality index for gadoxetic acid-enhanced MRI. It may be associated with hepatic function and could have an implication on the diagnostic accuracy for hepatocellular carcinoma (HCC). PURPOSE To investigate the association between the visualization score of gadoxetic acid-enhanced MRI and clinical factors and to evaluate its effect on the diagnostic accuracy for HCC ≤ 3.0 cm. STUDY TYPE Retrospective. POPULATION A total of 493 focal lesions from 397 patients. FIELD STRENGTH/SEQUENCE A 5-T or 3.0 -T with pre/postcontrast T1-weighted 3D gradient echo sequence, and T2-weighted fast spin-echo sequence ASSESSMENT: Child-Pugh classification and albumin-bilirubin (ALBI) score were assessed. Three readers evaluated the visualization score of each MRI examination (A, no or minimal; B, moderate; and C, severe limitations), and major features (arterial-phase hyperenhancement, washout, enhancing capsule, threshold growth) and ancillary features of each focal lesion. STATISTICAL TESTS Univariable and multivariable logistic regression analyses were performed to determine significant clinical factors associated with a suboptimal visualization score (B or C). Generalized estimating equations were used to compare the sensitivity and specificity for diagnosing HCC between the two group (visualization score A vs. B or C). A P value < 0.05 was considered statistically significant. RESULTS Of the 397 MRI examinations, the incidence of suboptimal visualization score was 13%. A suboptimal visualization score was significantly associated with Child-Pugh classification B or C (adjusted odds ratio [OR] = 15.2) and ALBI grade 2 or 3 (OR = 4.7). Compared with the visualization score A group, the suboptimal visualization score group showed significantly lower sensitivity (56.8% vs. 75.2%) and less frequent washout in HCC (62.2% vs. 84.0%). DATA CONCLUSION The visualization score on gadoxetic acid-enhanced MRI can be an important image quality index and the diagnostic accuracy for HCC ≤ 3.0 cm may not be sufficient in the suboptimal visualization score group. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sun Hong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Clinic-radiological features and radiomics signatures based on Gd-BOPTA-enhanced MRI for predicting advanced liver fibrosis. Eur Radiol 2022; 33:633-644. [DOI: 10.1007/s00330-022-08992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Recomendaciones de expertos sobre el uso de ácido gadoxético en pacientes con metástasis hepáticas en España. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain. RADIOLOGIA 2022; 64:300-309. [DOI: 10.1016/j.rxeng.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/03/2021] [Indexed: 10/15/2022]
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Armbruster M, Guba M, Andrassy J, Rentsch M, Schwarze V, Rübenthaler J, Knösel T, Ricke J, Kramer H. Measuring HCC Tumor Size in MRI-The Sequence Matters! Diagnostics (Basel) 2021; 11:diagnostics11112002. [PMID: 34829348 PMCID: PMC8623118 DOI: 10.3390/diagnostics11112002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this paper was to assess and compare the accuracy of common magnetic resonance imaging (MRI) pulse sequences in measuring the lesion sizes of hepatocellular carcinomas (HCCs) with respect to the Milan criteria and histopathology as a standard of reference. METHODS We included 45 patients with known HCC who underwent contrast-enhanced MRI of the liver prior to liver transplantation or tumor resection. Tumor size was assessed pathologically for all patients. The MRI protocol contained axial T2-weighted images as well as T1-weighted imaging sequences before and after application of Gd-EOB-DTPA. Tumor diameters, the sharpness of lesions, and the presence of artifacts were evaluated visually on all available MRI sequences. MRI measurements and pathologically assessed tumor dimensions were correlated using Pearson's correlation coefficient and Bland-Altman plots. The rate of misclassifications following Milan criteria was assessed. RESULTS The mean absolute error (in cm) of MRI size measurements in comparison to pathology was the smallest for the hepatobiliary phase T1-weighted acquisition (0.71 ± 0.70 cm, r = 0.96) and largest for the T2w turbo-spin-echo (TSE) sequence (0.85 ± 0.78 cm, r = 0.94). The misclassification rate regarding tumor size under the Milan criteria was lowest for the T2w half-Fourier acquisition single-shot turbo spin-echo sequence and the hepatobiliary phase T1w acquisition (each 8.6%). The highest rate of misclassification occurred in the portal venous phase T1w acquisition and T2w TSE sequence (each 14.3%). CONCLUSIONS The hepatobiliary phase T1-weighted acquisition seems to be most accurate among commonly used MRI sequences for measuring HCC tumor size, resulting in low rates of misclassification with respect to the Milan criteria.
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Affiliation(s)
- Marco Armbruster
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (V.S.); (J.R.); (J.R.); (H.K.)
- Correspondence:
| | - Markus Guba
- Department of General, Visceral, Vascular, and Transplant Surgery, Medical Center of the University of Munich, 81377 Munich, Germany; (M.G.); (J.A.)
| | - Joachim Andrassy
- Department of General, Visceral, Vascular, and Transplant Surgery, Medical Center of the University of Munich, 81377 Munich, Germany; (M.G.); (J.A.)
| | - Markus Rentsch
- Department of General, Visceral and Thoracic Surgery, Klinikum Ingolstadt, 85049 Ingolstadt, Germany;
| | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (V.S.); (J.R.); (J.R.); (H.K.)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (V.S.); (J.R.); (J.R.); (H.K.)
| | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University, 81377 Munich, Germany;
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (V.S.); (J.R.); (J.R.); (H.K.)
| | - Harald Kramer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (V.S.); (J.R.); (J.R.); (H.K.)
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Chang SD, Cunha GM, Chernyak V. MR Imaging Contrast Agents: Role in Imaging of Chronic Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:329-345. [PMID: 34243921 DOI: 10.1016/j.mric.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Contrast-enhanced MR imaging plays an important role in the evaluation of patients with chronic liver disease, particularly for detection and characterization of liver lesions. The two most commonly used contrast agents for liver MR imaging are extracellular agents (ECAs) and hepatobiliary agents (HBAs). In patients with liver disease, the main advantage of ECA-enhanced MR imaging is its high specificity for the diagnosis of progressed HCCs. Conversely, HBAs have an additional contrast mechanism, which results in high liver-to-lesion contrast and highest sensitivity for lesion detection in the hepatobiliary phase. Emerging data suggest that features depicted on contrast-enhanced MR imaging scans are related to tumor biology and are predictive of patients' prognosis, likely to further expand the role of contrast-enhanced MR imaging in the clinical care of patients with chronic liver disease.
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Affiliation(s)
- Silvia D Chang
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, British Columbia V5Z 1M9, Canada. https://twitter.com/SilviaChangMD
| | - Guilherme Moura Cunha
- Department of Radiology, University of Washington, 1959 NE Pacific Street 2nd Floor, Seattle, WA 98195, USA
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Feng Z, Zhao H, Guan S, Wang W, Rong P. Diagnostic performance of MRI using extracellular contrast agents versus gadoxetic acid for hepatocellular carcinoma: A systematic review and meta-analysis. Liver Int 2021; 41:1117-1128. [PMID: 33647177 DOI: 10.1111/liv.14850] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/31/2021] [Accepted: 02/13/2021] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Magnetic resonance imaging (MRI) is the first-line tool for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We performed a meta-analysis to compare the performance of MRI using extracellular contrast agents (ECA-MRI) with that using gadoxetic acid (EOB-MRI) for diagnosing HCC. METHODS We searched multiple databases for studies comparing the diagnostic performance of ECA-MRI with that of EOB-MRI in patients with suspected HCC until 31 May 2020. The bivariate random-effects model was used to pool the performance and further subgroup analysis was performed. RESULTS Eight studies were included evaluating a total of 1002 patients. ECA-MRI revealed significantly higher per-lesion sensitivity in the diagnosis of HCC than EOB-MRI did (0.76 vs 0.63, P = .002). For modified EOB-MRI (mEOB-MRI) using extended washout to the transitional phase (TP) or hepatobiliary phase (HBP), the sensitivity increased compared with that of EOB-MRI using restrictive washout in the portal venous phase (PVP) (0.74 vs 0.63, P = .07). No significant difference among the specificities of ECA-MRI, EOB-MRI, and mEOB-MRI (0.96, 0.98, and 0.93, respectively) was found. The sensitivity for lesions < 20 mm was significantly lower than that for lesions ≥ 20mm (0.66 vs 0.87, P = .01) only for ECA-MRI, which achieved higher sensitivity in Asian patients or with a 3.0 T scanner. CONCLUSIONS ECA-MRI outperforms EOB-MRI in per-lesion sensitivity for diagnosing HCC, whereas mEOB-MRI shows a trend towards improved sensitivity compared with EOB-MRI with slightly decreased specificity. Registration: Prospero CRD42020189680.
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Affiliation(s)
- Zhichao Feng
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Huafei Zhao
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shiwei Guan
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Wang
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengfei Rong
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha, China
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Shao YY, Wang SY, Lin SM. Management consensus guideline for hepatocellular carcinoma: 2020 update on surveillance, diagnosis, and systemic treatment by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2021; 120:1051-1060. [PMID: 33199101 DOI: 10.1016/j.jfma.2020.10.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan had established a management consensus guideline in 2016. The current recommendations focus on updating critical issues regarding the management of HCC, including surveillance, diagnosis, and systemic treatment. For surveillance, the updated guideline suggests the role of dynamic computed tomography or magnetic resonance imaging and contrast-enhanced ultrasound (CEUS) in selected patients. For diagnosis, this update incorporates CEUS and recognizes the role of gadoxetic acid-enhanced magnetic resonance imaging. For systemic therapy, the updated guideline summarizes the multiple choices of targeted therapy, immune checkpoint inhibitors, and the combination of both. Through this update of the management consensus guideline, patients with HCC can benefit from receiving optimal diagnostic and therapeutic modalities.
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Affiliation(s)
- Yu-Yun Shao
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shen-Yung Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shi-Ming Lin
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
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Baek SE, Ul-Haq A, Kim DH, Choi HW, Kim MJ, Choi HJ, Kim H. Human Organic Anion Transporting Polypeptide 1B3 Applied as an MRI-Based Reporter Gene. Korean J Radiol 2020; 21:726-735. [PMID: 32410411 PMCID: PMC7231618 DOI: 10.3348/kjr.2019.0903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/10/2020] [Accepted: 01/19/2020] [Indexed: 12/22/2022] Open
Abstract
Objective Recent innovations in biology are boosting gene and cell therapy, but monitoring the response to these treatments is difficult. The purpose of this study was to find an MRI-reporter gene that can be used to monitor gene or cell therapy and that can be delivered without a viral vector, as viral vector delivery methods can result in long-term complications. Materials and Methods CMV promoter-human organic anion transporting polypeptide 1B3 (CMV-hOATP1B3) cDNA or CMV-blank DNA (control) was transfected into HEK293 cells using Lipofectamine. OATP1B3 expression was confirmed by western blotting and confocal microscopy. In vitro cell phantoms were made using transfected HEK293 cells cultured in various concentrations of gadoxetic acid for 24 hours, and images of the phantoms were made with a 9.4T micro-MRI. In vivo xenograft tumors were made by implanting HEK293 cells transfected with CMV-hOATP1B3 (n = 4) or CMV-blank (n = 4) in 8-week-old male nude mice, and MRI was performed before and after intravenous injection of gadoxetic acid (1.2 µL/g). Results Western blot and confocal microscopy after immunofluorescence staining revealed that only CMV-hOATP1B3-transfected HEK293 cells produced abundant OATP1B3, which localized at the cell membrane. OATP1B3 expression levels remained high through the 25th subculture cycle, but decreased substantially by the 50th subculture cycle. MRI of cell phantoms showed that only the CMV-hOATP1B3-transfected cells produced a significant contrast enhancement effect. In vivo MRI of xenograft tumors revealed that only CMV-hOATP1B3-transfected HEK293 tumors demonstrated a T1 contrast effect, which lasted for at least 5 hours. Conclusion The human endogenous OATP1B3 gene can be non-virally delivered into cells to induce transient OATP1B3 expression, leading to gadoxetic acid-mediated enhancement on MRI. These results indicate that hOATP1B3 can serve as an MRI-reporter gene while minimizing the risk of long-term complications.
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Affiliation(s)
- Song Ee Baek
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Asad Ul-Haq
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Hee Kim
- Yonsei University College of Medicine, Seoul, Korea
| | | | - Myeong Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jin Choi
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Honsoul Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Vernuccio F, Cannella R, Gozzo C, Greco V, Midiri M, Furlan A, Tang A, Brancatelli G. Hepatic enhancement in cirrhosis in the portal venous phase: what are the differences between gadoxetate disodium and gadobenate dimeglumine? Abdom Radiol (NY) 2020; 45:2409-2417. [PMID: 32435849 DOI: 10.1007/s00261-020-02578-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare the level of parenchymal and portal venous enhancement in the portal venous phase (PVP) in cirrhotic patients undergoing gadoxetate disodium- and gadobenate dimeglumine-enhanced MRI. METHODS In this retrospective study, 84 cirrhotic patients (mean age ± SD: 66 ± 13 years) who underwent contrast-enhanced MRI with both gadoxetate disodium and gadobenate dimeglumine between 2012 and 2018 were included. Two readers measured signal intensities of hepatic parenchyma, portal vein and psoas muscle on precontrast and PVP. Relative enhancement (RE), image contrast, and portal vein-to-liver contrast difference were calculated. Intraindividual differences were compared with the Wilcoxon signed rank-sum test and inter-reader differences with the intraclass correlation coefficient (ICC). RESULTS In PVP, gadoxetate disodium provided lower RE than gadobenate dimeglumine (Reader 1: 42.4 ± 44.6 vs. 56.1 ± 58.8, p = 0.044; Reader 2: 42.4 ± 42.9 vs. 57.7 ± 60.5, p = 0.027;), lower image contrast (Reader 1: 0.27 ± 0.11 vs. 0.35 ± 0.11, respectively; p < 0.001; Reader 2: 0.29 ± 0.10 vs. 0.37 ± 0.07, respectively; p < 0.001), and lower portal vein-to-liver contrast difference (Reader 1: 0.89 ± 0.39 vs. 1.42 ± 0.90, p < 0.001; Reader 2: 0.95 ± 0.40 vs. 1.28 ± 0.37, p < 0.001). ICC was 0.94, 0.79, and 0.69 for RE, image contrast, and portal vein-to-liver contrast difference, respectively. CONCLUSION In cirrhotic patients, gadoxetate disodium yielded lower enhancement of the hepatic parenchyma and lower contrast of the portal vein than gadobenate dimeglumine in PVP.
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Paisant A, Vilgrain V, Riou J, Oberti F, Sutter O, Laurent V, Rodes A, Guiu B, Cassinotto C, Trillaud H, Bricault I, Michalak S, Bruno O, Ronot M, Aubé C. Comparison of extracellular and hepatobiliary MR contrast agents for the diagnosis of small HCCs. J Hepatol 2020; 72:937-945. [PMID: 31870951 DOI: 10.1016/j.jhep.2019.12.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The aim of this study was to use a head-to-head nodule comparison to compare the performance of extracellular contrast agent MRI (ECA-MRI) with that of hepatobiliary contrast agent MRI (HBA-MRI) for the non-invasive diagnosis of small hepatocellular carcinomas (HCCs). METHODS Between August 2014 and October 2017, 171 patients with cirrhosis, each with 1 to 3 nodules measuring 1-3 cm, were enrolled across 8 centers. All patients underwent both an ECA-MRI and an HBA-MRI within a month. A non-invasive diagnosis of HCC was made when a nodule exhibited arterial phase hyper-enhancement (APHE) with washout at the portal venous phase (PVP) and/or delayed phase (DP) for ECA-MRI, or the PVP and/or HB phase (HBP) for HBA-MRI. The gold standard was defined by using a previously published composite algorithm. RESULTS A total of 225 nodules, of which 153 were HCCs and 72 were not, were included. The sensitivites of both MRI techniques were similar. Specificity was 83.3% (95% CI 72.7-91.1) for ECA-MRI and 68.1% (95% CI 56.0-78.6) for HBA-MRI. In terms of HCC diagnosis on ECA-MRI, 138 nodules had APHE, 84 had washout at PVP, and 104 at DP; on HBA-MRI, 128 nodules had APHE, 71 had washout at PVP, and 99 at HBP. For nodules 2-3 cm in size, sensitivity and specificity were similar between the 2 approaches. For nodules 1-2 cm in size, specificity dropped to 66.1% (95% CI 52.2-78.2) for HBA-MRI vs. 85.7% (95% CI 73.8-93.6) for ECA-MRI. CONCLUSIONS HBA-MRI specificity is lower than that of ECA-MRI for diagnosing small HCCs in patients with cirrhosis. These results raise the question of the proper use of HBA-MRI in algorithms for the non-invasive diagnosis of small HCCs. LAY SUMMARY There are 2 magnetic resonance imaging (MRI)-based approaches available for the non-invasive diagnosis of hepatocellular carcinoma (HCC), using either extracellular or hepatobiliary contrast agents. The current results showed that the sensitivity of MRI with hepatobiliary contrast agents was similar to that with extracellular contrast agents, but the specificity was lower. Thus, hepatobiliary contrast agent-based MRI, although detailed in international guidelines, should be used with caution for the non-invasive diagnosis of HCC. CLINICAL TRIAL NUMBER NCT00848952.
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Affiliation(s)
- Anita Paisant
- Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France.
| | - Valérie Vilgrain
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France
| | - Jérémie Riou
- Université d'Angers, UFR Santé, 49000 Angers, France; MINT UMR INSERM 1066, CNRS 6021, Université d'Angers, 49000 Angers, France
| | - Frédéric Oberti
- Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France; Service de Gastroenterologie et Hépatologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France
| | - Olivier Sutter
- Service de Radiologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis (AP-HP), 93140 Bondy, France
| | - Valérie Laurent
- Département de Radiologie, Centre Hospitalier Universitaire de Nancy, Hôpital de Brabois, 54500 Vandoeuvre-lès-Nancy, France
| | - Agnès Rodes
- Département de Radiologie, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004 Lyon, France
| | - Boris Guiu
- Département de Radiologie, INSERM U896, CHU Saint-Eloi, Université de Montpellier, 34295 Montpellier, France
| | - Christophe Cassinotto
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France
| | - Hervé Trillaud
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, F-33000 Bordeaux, France; Universitaire de Bordeaux, EA Imotion, F-33000 Bordeaux, France
| | - Ivan Bricault
- Département d'Imagerie, Radiologie et Imagerie Médicale, CHU, 38000 Grenoble, France; Laboratory of Techniques for Biomedical Engineering and Complexity Management - Informatics, Mathematics and Applications, Université 38000 Grenoble Alpes, Grenoble, France
| | - Sophie Michalak
- Département d'Anatomopatologie, Centre Hospitalier Universitaire d'Angers, Université d'Angers, 49933 Angers, France
| | - Onorina Bruno
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France
| | - Maxime Ronot
- Département de Radiologie, Hôpital Beaujon, Hôpitaux Paris Nord Val de Seine (AP-HP) 92110, Clichy, France; Université Paris Diderot, Sorbonne Paris Cité, CRI, U1149, 75000 Paris, France
| | - Christophe Aubé
- Département de Radiologie, Centre Hospitalier Universitaire d'Angers, 49933 Angers, France; Laboratoire HIFIH, EA 3859, Universitaire d'Angers, 49045 Angers, France
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13
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Granata V, Fusco R, Maio F, Avallone A, Nasti G, Palaia R, Albino V, Grassi R, Izzo F, Petrillo A. Qualitative assessment of EOB-GD-DTPA and Gd-BT-DO3A MR contrast studies in HCC patients and colorectal liver metastases. Infect Agent Cancer 2019; 14:40. [PMID: 31798677 PMCID: PMC6882051 DOI: 10.1186/s13027-019-0264-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022] Open
Abstract
Aim To compare liver-specific EOB-GD-DTPA and liver-non-specific Gd-BT-DO3A MR, in hepatocellular carcinoma (HCC) and liver colorectal metastases. Material and methods Seventy HCC patients with 158 nodules and 90 colorectal liver metastases (mCRC) with 370 lesions were included in the retrospective analysis. HCC patients underwent MR at 0 time (MR0), after 3 (MR3) and 6 months (MR6) using two different CM; 69 mCRC patients underwent MR with Gd-EOB-BTPA and 21 mCRC patients with Gd-BT-DO3A. We evaluated arterial phase hyperenhancement, lesion-to-liver contrast during portal phase, hepatobiliary phase parenchymal hyperenhancement. Results In HCC patients arterial phase hyperenhancement degree was statistically higher (p = 0.03) with Gd-BT-DO3A (mean 4) than GD-EOB-DTPA (mean 2.6), while we found no significant statistical differences among mean (2.6) values at MR0 and MR6 using GD-EOB-DTPA. For all 209 patients underwent Gd-EOB-DTPA, we found that lesion-to-liver contrast during portal phase mean value was 4 while for patients underwent MR with Gd-BT-DO3A was 3 (p = 0.04). For HCC hepatobiliary phase parenchymal hyperenhancement mean value was 2.4. For mCRC patients: among 63 patients underwent previous chemotherapy hepatobiliary phase parenchymal hyperenhancement mean value was 3.1 while for 6 patients no underwent previous chemotherapy was 4 (p = 0.05). Conclusions Gd-EOB-DTPA should be chosen in pre surgical setting in patients with colorectal liver metastases.
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Affiliation(s)
- Vincenza Granata
- Division of Radiology, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Roberta Fusco
- Division of Radiology, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Francesca Maio
- 2Division of Radiology, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Antonio Avallone
- Division of Abdominal Oncology, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Guglielmo Nasti
- Division of Abdominal Oncology, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Raffaele Palaia
- Division of Abdominal Surgical Oncology, Hepatobiliary, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Vittorio Albino
- Division of Abdominal Surgical Oncology, Hepatobiliary, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Roberto Grassi
- 5Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Izzo
- Division of Abdominal Surgical Oncology, Hepatobiliary, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
| | - Antonella Petrillo
- Division of Radiology, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, NAPOLI, ITALIA, Naples, Italy
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14
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Ayuso C, Forner A, Darnell A, Rimola J, García-Criado Á, Bianchi L, Vilana R, Oliveira R, Llarch N, Bruix J. Prospective evaluation of gadoxetic acid magnetic resonance for the diagnosis of hepatocellular carcinoma in newly detected nodules ≤2 cm in cirrhosis. Liver Int 2019; 39:1281-1291. [PMID: 31077539 DOI: 10.1111/liv.14133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS Most of the published studies about the diagnostic accuracy of gadoxetic acid-enhanced magnetic resonance (EOB-MR) for the non-invasive diagnosis of hepatocellular carcinoma (HCC) have had a retrospective design. Thus, we aimed to prospectively evaluate the diagnostic accuracy of EOB-MR for the non-invasive diagnosis of HCC in nodules ≤2 cm detected by screening ultrasound (US) in patients with cirrhosis. METHODS Between July 2012 and October 2015, 62 consecutive asymptomatic Child-Pugh A-B cirrhotic patients with newly US-detected solitary nodules between 1 and 2 cm were prospectively included in the study. Hepatic extracellular contrast-enhanced MR (ECCE-MR) followed by EOB-MR were obtained in less than 1-month interval. Two independent radiologists blindly reviewed the EOB-MR studies, and the diagnosis of HCC was assigned when the lesion showed arterial enhancement followed by portal venous phase washout and/or hypointensity on the hepatobiliary phase (HBP). The final HCC diagnosis was made by ECCE-MR according to the accepted non-invasive criteria, or by biopsy in lesions with atypical vascular profile. RESULTS Final diagnoses were as follows: HCC (n = 41), intrahepatic cholangiocarcinoma (n = 2), colorectal metastases (n = 1) and benign conditions (n = 18). The sensitivity and specificity of EOB-MR for HCC diagnosis were 56.1% (95% CI: 39.7-71.5) and 90.5% (95% CI: 69.6-98.8), respectively, while sensitivity of ECCE-MR was 63.4% (95% CI: 46.9-77.9). The low rate of hypointense HCCs in the HBP and suboptimal liver uptake of contrast agent justify the low sensitivity of EOB-MR for HCC diagnosis. CONCLUSION EOB-MR does not surpass the diagnostic accuracy of ECCE-MR for non-invasive diagnosis of HCC in nodules ≤2 cm in cirrhotic patients.
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Affiliation(s)
- Carmen Ayuso
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Alejandro Forner
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Darnell
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Ángeles García-Criado
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Luis Bianchi
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ramón Vilana
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Rafael Oliveira
- Radiology Department, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Neus Llarch
- Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Bruix
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Liver Unit, Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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15
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Zech CJ, Schwenke C, Endrikat J. Diagnostic Efficacy and Safety of Gadoxetate Disodium vs Gadobenate Dimeglumine in Patients With Known or Suspected Focal Liver Lesions: Results of a Clinical Phase III Study. MAGNETIC RESONANCE INSIGHTS 2019; 12:1178623X19827976. [PMID: 30799932 PMCID: PMC6379790 DOI: 10.1177/1178623x19827976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 12/15/2022]
Abstract
Purpose: The aim of this study is to evaluate the diagnostic efficacy and safety of
gadoxetate disodium vs gadobenate dimeglumine in patients with known or
suspected focal liver lesions. Methods: This was a prospective, multicenter, double-blind, randomized,
inter-individual Phase III study. The primary target—technical efficacy—was
already published. Here, secondary efficacy parameters—sensitivity and
specificity—and safety in specific patient populations are presented.
Patients with suspected or known focal liver lesions scheduled for
contrast-enhanced liver magnetic resonance imaging (MRI) were recruited and
categorized in 4 a priori specified subgroups: (1) all patients, (2)
patients with liver cancer (hepatocellular carcinoma [HCC]), (3) patients
with cirrhosis, and (4) patients with HCC + cirrhosis. Dual multi-detector
liver computed tomography (CT) served as standard of reference. Results: A total of 295 patients were included. While the overall increase in
sensitivity across all 4 patient groups was comparable for gadoxetate
disodium (increase from pre- to post-contrast ranging from 6.2% to 9.9%) and
gadobenate dimeglumine (ranging from −2.9% to 10.0%), significant
differences were seen for some of the subgroups. There was a significantly
higher increase in sensitivity for gadoxetate disodium in patients with HCC
(7%) and HCC + cirrhosis (12.8%) in comparison with gadobenate dimeglumine.
Specificity decreased for both agents: gadoxetate disodium by −2.8% to −6.3%
and gadobenate dimeglumine by −3.3% to −8.7%. Gadoxetate showed a
significantly lower loss of specificity in all subgroups. Safety was
comparable in both groups. Conclusions: Gadoxetate disodium proved to be an effective liver-specific MRI contrast
agent. Some distinct advantages over gadobenate dimeglumine were
demonstrated in patients with HCC and patients with HCC + liver cirrhosis
for sensitivity and specificity in liver lesion detection.
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Affiliation(s)
- Christoph J Zech
- Department for Radiology and Nuclear
Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Jan Endrikat
- Bayer AG, Radiology, Berlin,
Germany
- Department of Gynecology, Obstetrics and
Reproductive Medicine, University Medical School of Saarland, Homburg/Saar,
Germany
- Jan Endrikat, Bayer AG, Radiology,
Müllerstr. 178, 13353 Berlin, Germany.
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16
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Chernyak V, Fowler KJ, Heiken JP, Sirlin CB. Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI-RADS). J Magn Reson Imaging 2019; 49:1236-1252. [DOI: 10.1002/jmri.26540] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Victoria Chernyak
- Department of Radiology, Montefiore Medical Center; Bronx New York USA
| | - Kathryn J. Fowler
- Liver Imaging Group, Department of Radiology; University of California - San Diego; California USA
| | - Jay P. Heiken
- Department of Radiology; Mayo Clinic; Rochester Minnesota USA
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology; University of California - San Diego; California USA
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17
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Hepatobiliary phase in cirrhotic patients with different Model for End-stage Liver Disease score: comparison of the performance of gadoxetic acid to gadobenate dimeglumine. Eur Radiol 2018; 29:3090-3099. [PMID: 30547205 DOI: 10.1007/s00330-018-5884-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/22/2018] [Accepted: 11/09/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The purpose of this study was to compare the performance of gadobenate dimeglumine-enhanced MRI and gadoxetic acid-enhanced MRI in the hepatobiliary phase (HBP) in cirrhotic patients with different degrees of liver dysfunction. METHODS In this retrospective cross-sectional study, we analyzed the unenhanced phase and the HBP of 131 gadobenate dimeglumine-enhanced MRI examinations (gadobenate dimeglumine group) and 127 gadoxetic acid-enhanced MRI examinations (gadoxetic acid group) performed in 249 cirrhotic patients (181 men and 68 women; mean age, 64.8 years) from August 2011 to April 2017. For each MRI, the contrast enhancement index of the liver parenchyma was calculated and correlated to the Model For End-Stage Liver Disease (MELD) score (multiple linear regression analysis). A qualitative analysis of the adequacy of the HBP, adjusted for the MELD score (logistic regression analysis), was performed. RESULTS The contrast enhancement index was inversely related (r = - 0.013) with MELD score in both gadoxetic acid and gadobenate dimeglumine group. At the same MELD score, the contrast enhancement index in the gadoxetic acid group was increased by a factor of 0.23 compared to the gadobenate dimeglumine group (p < 0.001), and the mean odds ratio to have an adequate HBP with gadoxetic acid compared to gadobenate dimeglumine was 3.64 (p < 0.001). The adequacy of the HBP in the gadoxetic acid group compared to the gadobenate dimeglumine group increased with the increase of the MELD score (exp(b)interaction = 1.233; p = 0.011). CONCLUSION In cirrhotic patients, the hepatobiliary phase obtained with gadoxetic acid-enhanced MRI is of better quality in comparison to gadobenate dimeglumine-enhanced MRI, mainly in patients with high MELD score. KEY POINTS • In cirrhotic patients, the adequacy of the hepatobiliary phase with gadoxetic acid-enhanced MRI is better compared to gadobenate dimeglumine-enhanced MRI. • Gadoxetic acid-enhanced MRI should be preferred to gadobenate dimeglumine-enhanced MRI in cirrhotic patients with MELD score > 10, if the hepatobiliary phase is clinically indicated. • In patients with high MELD score (> 15), the administration of the hepatobiliary agent could be useless; even though, if it is clinically indicated, we recommend to use gadoxetic acid given the higher probability of obtaining clinically relevant information.
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18
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How Do Different Indices of Hepatic Enhancement With Gadoxetic Acid Compare in Predicting Liver Failure and Other Major Complications After Hepatectomy? J Comput Assist Tomogr 2018; 42:380-386. [DOI: 10.1097/rct.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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19
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Tang A, McInnes M, Hope TA, Vu KN, Amre D, Wolfson T, Roy C, Mâsse BR, Sirlin C. Magnetic resonance imaging performed with gadoxetate disodium for the diagnosis of hepatocellular carcinoma in cirrhotic and non-cirrhotic patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- An Tang
- University of Montreal; Department of Radiology, Radio-Oncology and Nuclear Medicine; 900, rue Saint-Denis, bureau R12.480 Centre de recherche du CHUM Montreal Quebec Canada H2X 0A9
| | - Matthew McInnes
- University of Ottawa; Department of Radiology; Room c159, 1053 Carling Avenue Ottawa Ontario Canada K1Y 4E9
| | - Thomas A Hope
- University of California, San Francisco; Department of Radiology and Biomedical Imaging; 505 Parnassus Avenue, M391 San Francisco CA USA 94143
| | - Kim-Nhien Vu
- University of Montreal; Department of Radiology, Radio-Oncology and Nuclear Medicine; 900, rue Saint-Denis, bureau R12.480 Centre de recherche du CHUM Montreal Quebec Canada H2X 0A9
| | - Devendra Amre
- Research Center, CHU-Sainte Justine; Division of Gastroenterology and Hepatology; 3175 Cote-Sainte-Catherine West Montréal Quebec Canada H3T1C5
| | - Tanya Wolfson
- University of California, San Diego; Computational and Applied Statistics Laboratory at the San Diego Supercomputer Center; 9500 Gilman Drive La Jolla CA USA 92093-0505
| | - Chantal Roy
- CHU Sainte-Justine; Unité de recherche clinique appliquée; 3175 Côte-Ste-Catherine Local 7122 Montreal QC Canada H3T 1C5
| | - Benoît R Mâsse
- CHU Sainte-Justine; Unité de recherche clinique appliquée; 3175 Côte-Ste-Catherine Local 7122 Montreal QC Canada H3T 1C5
- University of Montreal; School of Public Health; 3175, Côte Ste-Catherine Montreal Quebec (QC) Canada H3T 1C5
| | - Claude Sirlin
- University of California, San Diego; Department of Radiology; Altman Clinical and TranslationalResearch Institute La Lolla CA USA
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20
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Abstract
There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
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21
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Gotra A, Sivakumaran L, Chartrand G, Vu KN, Vandenbroucke-Menu F, Kauffmann C, Kadoury S, Gallix B, de Guise JA, Tang A. Liver segmentation: indications, techniques and future directions. Insights Imaging 2017; 8:377-392. [PMID: 28616760 PMCID: PMC5519497 DOI: 10.1007/s13244-017-0558-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/03/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Liver volumetry has emerged as an important tool in clinical practice. Liver volume is assessed primarily via organ segmentation of computed tomography (CT) and magnetic resonance imaging (MRI) images. The goal of this paper is to provide an accessible overview of liver segmentation targeted at radiologists and other healthcare professionals. METHODS Using images from CT and MRI, this paper reviews the indications for liver segmentation, technical approaches used in segmentation software and the developing roles of liver segmentation in clinical practice. RESULTS Liver segmentation for volumetric assessment is indicated prior to major hepatectomy, portal vein embolisation, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transplant. Segmentation software can be categorised according to amount of user input involved: manual, semi-automated and fully automated. Manual segmentation is considered the "gold standard" in clinical practice and research, but is tedious and time-consuming. Increasingly automated segmentation approaches are more robust, but may suffer from certain segmentation pitfalls. Emerging applications of segmentation include surgical planning and integration with MRI-based biomarkers. CONCLUSIONS Liver segmentation has multiple clinical applications and is expanding in scope. Clinicians can employ semi-automated or fully automated segmentation options to more efficiently integrate volumetry into clinical practice. TEACHING POINTS • Liver volume is assessed via organ segmentation on CT and MRI examinations. • Liver segmentation is used for volume assessment prior to major hepatic procedures. • Segmentation approaches may be categorised according to the amount of user input involved. • Emerging applications include surgical planning and integration with MRI-based biomarkers.
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Affiliation(s)
- Akshat Gotra
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada.,Department of Radiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Lojan Sivakumaran
- University of Montreal, 2900 boulevard Eduoard-Montpetit, Montreal, QC, H3T 1J4, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Gabriel Chartrand
- Imaging and Orthopaedics Research Laboratory (LIO), École de technologie supérieure, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Kim-Nhien Vu
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Franck Vandenbroucke-Menu
- Department of Hepato-biliary and Pancreatic Surgery, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Claude Kauffmann
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada
| | - Samuel Kadoury
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.,École Polytechnique de Montréal, University of Montreal, 2500 chemin de Polytechnique Montréal, Montreal, QC, H3T 1J4, Canada
| | - Benoît Gallix
- Department of Radiology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Jacques A de Guise
- Imaging and Orthopaedics Research Laboratory (LIO), École de technologie supérieure, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Saint-Luc Hospital, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
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22
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Costa AF, Tremblay St-Germain A, Abdolell M, Smoot RL, Cleary S, Jhaveri KS. Can contrast-enhanced MRI with gadoxetic acid predict liver failure and other complications after major hepatic resection? Clin Radiol 2017; 72:598-605. [PMID: 28274510 DOI: 10.1016/j.crad.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/09/2017] [Accepted: 02/06/2017] [Indexed: 12/17/2022]
Abstract
AIM To determine whether a combination of clinical factors, the future liver remnant (FLR) ratio, and hepatic uptake of gadoxetic acid can be used to predict post-hepatectomy liver failure (PHLF) and other major complications (OMC). MATERIALS AND METHODS Sixty-five consecutive patients who underwent pre-hepatectomy gadoxetic acid-enhanced magnetic resonance imaging (MRI) between October 2010 and December 2013 were included. The relative liver enhancement (RLE) of gadoxetic acid was calculated from regions of interest on MRI, and FLR ratios were obtained from computed tomography (CT). PHLF and OMC were defined by the International Study Group of Liver Surgery criteria and Clavien-Dindo grade of ≥3, respectively. Multivariate logistic regression modelling was performed to identify predictors of PHLF and OMC, including RLE, FLR ratio, age, sex, chemotherapy history, intra-operative blood loss, and intra-operative transfusion. RESULTS Nine patients experienced PHLF and another nine patients experienced OMC. RLE was comparable to the FLR ratio in predicting PHLF (areas under the receiver operating characteristic [AUROC] curves, 0.665 and 0.705), but performed poorly in predicting OMCs (AUROCs, 0.556 and 0.702). Combining all clinical and imaging parameters as predictors yielded the best performing predictive models (AUROCs, 0.875 and 0.742 for PHLF and OMC, respectively). CONCLUSION A model based on clinical parameters, the FLR ratio, and RLE of gadoxetic acid may improve pre-hepatectomy risk assessment.
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Affiliation(s)
- A F Costa
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Canada.
| | - A Tremblay St-Germain
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - M Abdolell
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - R L Smoot
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - S Cleary
- Department of Surgery, Division of Hepatobiliary Surgery, University Health Network, University of Toronto, Canada
| | - K S Jhaveri
- Joint Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Canada
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23
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Lu Y, Liu P, Fu P, Chen Y, Nan D, Yang X. Comparison of the DWI and Gd-EOB-DTPA-enhanced MRI on assessing the hepatic ischemia and reperfusion injury after partial hepatectomy. Biomed Pharmacother 2016; 86:118-126. [PMID: 27951418 DOI: 10.1016/j.biopha.2016.11.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/09/2016] [Accepted: 11/27/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare two different imaging media, diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) and Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) with perfusion parameters Ktrans, Kep, and relative contrast enhancement index (RCEI), in assessing the liver function via ischemia/perfusion injury (IRI) + partial hepatectomy rat model. METHODS Rats underwent 0, 30 and 60min of ischemia/reperfusion with 30% of hepatectomy before subjected to Gd-EOB-DTPA-enhanced MRI in addition to 99mTc-GSA scintigraphy. For 99mTc-GSA scintigraphy test, the receptor index LHL15, modified receptor index and the blood clearance index HH15 were recorded. Apparent diffusion coefficient (ADC) was evaluated by using both mono- and bi-exponential models, and perfusion parameters Ktrans, Kep, and RCEI were measured. Liver function is tested by measuring activity of serum ALT, AST and PT. Histological analysis was performed by H&E and Ki-67 staining. RESULTS 99mTc-GSA dynamic imaging analysis demonstrated that LHL15 was increased and HH15 was decreased as the extension of ischemia/reperfusion time. ADC value estimated by MRI was significantly increased (P<0.05) in 30min IRI group compared with 0min and 60min IRI groups, respectively. Ktrans value was gradually and significantly decreased (P<0.05) as the extension of IRI time, but there was no significant difference (P>0.05) in Kep value between at 30min and 60min IRI, and RCEI value was significantly higher (P<0.05) in 30min IR compared with 0min and 60min IRI group. Serum level of ALT, AST and PT were gradually and significantly (P<0.05) increased as the extension of IRI time. Histological analysis showed that there was a remarkable difference between 30min and 60min IRI, as protein expression of Ki-67 was significantly higher (P<0.05) in 30min IRI group. CONCLUSION Fast ADC bi-exponential model in DWI and RCEI in Gd-EOB-DTPA-enhanced MRI showed the good correlation in assessment of liver function after partial hepatectomy, showing consistency with our histological findings. The Ktrans in Gd-EOB-DTPA-enhanced MRI could be a potent parameter for assessing the early ischemic injury, but not the severity of the hepatic injury, in accordance with the correlation with our biochemical findings.
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Affiliation(s)
- Yu Lu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Pengfei Liu
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Peng Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yaodong Chen
- Department of Abdomen Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Dong Nan
- Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xiuhua Yang
- Department of Abdomen Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
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Di Pietropaolo M, Briani C, Pilozzi E, Carbonetti F, David V, Iannicelli E. Gd-EOB-DTPA-Enhanced Magnetic Resonance Findings of a Giant Inflammatory Hepatocellular Adenoma: a Case Report and Review of the Literature. J Gastrointest Cancer 2016; 46:421-5. [PMID: 25894634 DOI: 10.1007/s12029-015-9715-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marco Di Pietropaolo
- Department of Radiology, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Chiara Briani
- Department of Radiology, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Emanuela Pilozzi
- Department of Clinical and Molecular Sciences, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Francesco Carbonetti
- Department of Radiology, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Vincenzo David
- Department of Radiology, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Elsa Iannicelli
- Department of Radiology, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy
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Pastor CM. How transfer rates generate Gd-BOPTA concentrations in rat liver compartments: implications for clinical liver imaging with hepatobiliary contrast agents. CONTRAST MEDIA & MOLECULAR IMAGING 2016; 11:291-8. [DOI: 10.1002/cmmi.1691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/08/2016] [Accepted: 02/17/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Catherine M. Pastor
- Centre de Recherche sur l'Inflammation U1149 INSERM and University Paris-Diderot; Paris France
- Département de Radiologie; Hôpitaux Universitaires de Genève; Switzerland
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Cieszanowski A, Podgórska J, Rosiak G, Maj E, Grudziński IP, Kaczyński B, Szeszkowski W, Milczarek K, Rowiński O. Gd-EOB-DTPA-Enhanced MR Imaging of the Liver: The Effect on T2 Relaxation Times and Apparent Diffusion Coefficient (ADC). Pol J Radiol 2016; 81:103-9. [PMID: 27026795 PMCID: PMC4792226 DOI: 10.12659/pjr.895701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/11/2015] [Indexed: 01/02/2023] Open
Abstract
Background To investigate the effect of gadoxetic acid disodium (Gd-EOB-DTPA) on T2 relaxation times and apparent diffusion coefficient (ADC) values of the liver and focal liver lesions on a 1.5-T system. Material/Methods Magnetic resonance (MR) studies of 50 patients with 35 liver lesions were retrospectively analyzed. All examinations were performed at 1.5T and included T2-weighted turbo spin-echo (TSE) and diffusion-weighted (DW) images acquired before and after intravenous administration of Gd-EOB-DTPA. To assess the effect of this hepatobiliary contrast agent on T2-weighted TSE images and DW images T2 relaxation times and ADC values of the liver and FLLs were calculated and compared pre- and post-injection. Results The mean T2 relaxation times of the liver and focal hepatic lesions were lower on enhanced than on unenhanced T2-weighted TSE images (decrease of 2.7% and 3.6% respectively), although these differences were not statistically significant. The mean ADC values of the liver showed statistically significant decrease (of 4.6%) on contrast-enhanced DW images, compared to unenhanced images (P>0.05). The mean ADC value of liver lesions was lower on enhanced than on unenhanced DW images, but this difference (of 2.9%) did not reach statistical significance. Conclusions The mean T2 relaxation times of the liver and focal liver lesions as well as the mean ADC values of liver lesions were not significantly different before and after administration of Gd-EOB-DTPA. Therefore, acquisition of T2-weighted and DW images between the dynamic contrast-enhanced examination and hepatobiliary phase is feasible and time-saving.
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Affiliation(s)
- Andrzej Cieszanowski
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland; Department of Radiology I, Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
| | - Joanna Podgórska
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Rosiak
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Maj
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Ireneusz P Grudziński
- Department of Toxicology, Medical University of Warsaw, Faculty of Pharmacy, Warsaw, Poland
| | - Bartosz Kaczyński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Szeszkowski
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Milczarek
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- 2 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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Vilgrain V, Van Beers BE, Pastor CM. Insights into the diagnosis of hepatocellular carcinomas with hepatobiliary MRI. J Hepatol 2016; 64:708-16. [PMID: 26632635 DOI: 10.1016/j.jhep.2015.11.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 12/12/2022]
Abstract
The incidence of hepatocellular carcinomas (HCCs) has increased worldwide in line with an improved screening by high-resolution imaging of cirrhotic livers. Besides abdominal ultrasonography and computerised tomography, magnetic resonance imaging (MRI) is an important tool to detect HCCs. With commercialisation of MR hepatobiliary contrast agents that cross membrane transporters in hepatocytes or tumour cells, MRI adds new information to detect and characterise HCCs. When tumour cells lose organic anion transporting polypeptides (OATP1B1/B3) in cell membranes facing sinusoidal blood, tumours appear hypointense (decreased contrast agent concentrations) in comparison to surrounding normal or cirrhotic liver that retains OATP1B1/B3 expression. However, expression, regulation, and prognostic significance of transporter evolution along carcinogenesis are not completely known. Moreover, understanding signal intensities in focal lesions also relies on transport functions of cellular efflux transporters. This manuscript reviews all the publications that associate liver imaging with hepatobiliary contrast agents and expression of transporters. The regulation of transporters along carcinogenesis to anticipate the prognosis of focal lesions is also included.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val-de-Seine, Beaujon, 100 Boulevard du Général Leclerc, 92118 Clichy, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Bernard E Van Beers
- Department of Radiology, University Hospitals Paris Nord Val-de-Seine, Beaujon, 100 Boulevard du Général Leclerc, 92118 Clichy, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; Inserm U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Catherine M Pastor
- University Paris Diderot, Sorbonne Paris Cité, Paris, France; Département d'imagerie et des sciences de l'information médicale, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
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Agnello F, Dioguardi Burgio M, Picone D, Vernuccio F, Cabibbo G, Giannitrapani L, Taibbi A, Agrusa A, Bartolotta TV, Galia M, Lagalla R, Midiri M, Brancatelli G. Magnetic resonance imaging of the cirrhotic liver in the era of gadoxetic acid. World J Gastroenterol 2016; 22:103-111. [PMID: 26755863 PMCID: PMC4698478 DOI: 10.3748/wjg.v22.i1.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/22/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Gadoxetic acid improves detection and characterization of focal liver lesions in cirrhotic patients and can estimate liver function in patients undergoing liver resection. The purpose of this article is to describe the optimal gadoxetic acid study protocol for the liver, the unique characteristics of gadoxetic acid, the differences between gadoxetic acid and extra-cellular gadolium chelates, and the differences in phases of enhancement between cirrhotic and normal liver using gadoxetic acid. We also discuss how to obtain and recognize an adequate hepatobiliary phase.
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Yoon JH, Park JW, Lee JM. Noninvasive Diagnosis of Hepatocellular Carcinoma: Elaboration on Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guidelines Compared with Other Guidelines and Remaining Issues. Korean J Radiol 2016; 17:7-24. [PMID: 26798212 PMCID: PMC4720815 DOI: 10.3348/kjr.2016.17.1.7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular carcinoma (HCC) can be diagnosed based on characteristic findings of arterial-phase enhancement and portal/delayed "washout" in cirrhotic patients. Several countries and major academic societies have proposed varying specific diagnostic criteria for HCC, largely reflecting the variable HCC prevalence in different regions and ethnic groups, as well as different practice patterns. In 2014, a new version of Korean practice guidelines for management of HCC was released by the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC). According to the KLCSG-NCC Korea practice guidelines, if the typical hallmark of HCC (i.e., hypervascularity in the arterial phase with washout in the portal or 3 min-delayed phases) is identified in a nodule ≥ 1 cm in diameter on either dynamic CT, dynamic MRI, or MRI using hepatocyte-specific contrast agent in high-risk groups, a diagnosis of HCC is established. In addition, the KLCSG-NCC Korea practice guidelines provide criteria to diagnose HCC for subcentimeter hepatic nodules according to imaging findings and tumor marker, which has not been addressed in other guidelines such as Association for the Study of Liver Diseases and European Association for the Study of the Liver. In this review, we briefly review the new HCC diagnostic criteria endorsed by the 2014 KLCSG-NCC Korea practice guidelines, in comparison with other recent guidelines; we furthermore address several remaining issues in noninvasive diagnosis of HCC, including prerequisite of sonographic demonstration of nodules, discrepancy between transitional phase and delayed phase, and implementation of ancillary features for HCC diagnosis.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Joong-Won Park
- Center for Liver Cancer, National Cancer Center, Goyang 10408, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
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You MW, Kim SY, Kim KW, Lee SJ, Shin YM, Kim JH, Lee MG. Recent advances in the imaging of hepatocellular carcinoma. Clin Mol Hepatol 2015; 21:95-103. [PMID: 25834808 PMCID: PMC4379204 DOI: 10.3350/cmh.2015.21.1.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The role of imaging is crucial for the surveillance, diagnosis, staging and treatment monitoring of hepatocellular carcinoma (HCC). Over the past few years, considerable technical advances were made in imaging of HCCs. New imaging technology, however, has introduced new challenges in our clinical practice. In this article, the current status of clinical imaging techniques for HCC is addressed. The diagnostic performance of imaging techniques in the context of recent clinical guidelines is also presented.
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Affiliation(s)
- Myung-Won You
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Asan Liver Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Asan Liver Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Asan Liver Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Asan Liver Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Asan Liver Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Asan Liver Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Imaging of HCC-Current State of the Art. Diagnostics (Basel) 2015; 5:513-45. [PMID: 26854169 PMCID: PMC4728473 DOI: 10.3390/diagnostics5040513] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
Abstract
Early diagnosis of hepatocellular carcinoma (HCC) is crucial for optimizing treatment outcome. Ongoing advances are being made in imaging of HCC regarding detection, grading, staging, and also treatment monitoring. This review gives an overview of the current international guidelines for diagnosing HCC and their discrepancies as well as critically summarizes the role of magnetic resonance imaging (MRI) and computed tomography (CT) techniques for imaging in HCC. The diagnostic performance of MRI with nonspecific and hepatobililiary contrast agents and the role of functional imaging with diffusion-weighted imaging will be discussed. On the other hand, CT as a fast, cheap and easily accessible imaging modality plays a major role in the clinical routine work-up of HCC. Technical advances in CT, such as dual energy CT and volume perfusion CT, are currently being explored for improving detection, characterization and staging of HCC with promising results. Cone beam CT can provide a three-dimensional analysis of the liver with tumor and vessel characterization comparable to cross-sectional imaging so that this technique is gaining an increasing role in the peri-procedural imaging of HCC treated with interventional techniques.
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Predictors of intrahepatic cholangiocarcinoma in cirrhotic patients scanned by gadobenate dimeglumine-enhanced magnetic resonance imaging: diagnostic accuracy and confidence. Clin Imaging 2015; 39:1032-8. [DOI: 10.1016/j.clinimag.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 05/28/2015] [Accepted: 06/22/2015] [Indexed: 12/22/2022]
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Validation of 10-Minute Delayed Hepatocyte Phase Imaging with 30° Flip Angle in Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastasis. PLoS One 2015; 10:e0139863. [PMID: 26444677 PMCID: PMC4596879 DOI: 10.1371/journal.pone.0139863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/16/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives To compare 10-minute delayed hepatocyte phase imaging using a 30° flip angle (10min-FA30) and 20-minute hepatocyte phase imaging using a 10° FA (20min-FA10) in gadoxetic acid-enhanced MRI of patients with possible liver metastases, regarding lesion-to-liver contrast-to-noise ratio (CNR) and focal hepatic lesion (FHL) detection to evaluate whether 10min-FA30 would be superior to 20min-FA10. Materials and Methods Eighty-three patients with 248 liver metastases and 78 benign FHLs who underwent gadoxetic acid-enhanced MRI with 10min-FA30 and 20min-FA10 were enrolled. Lesion-to-liver CNRs were compared between the two image groups. Two radiologists independently assessed the presence of FHLs using a four-point scale and detection sensitivity was calculated. Results The mean CNR for liver metastases on the 10min-FA30 (248.5 ± 101.6) were significantly higher than that of the 20min-FA10 (187.4 ± 77.4) (p < 0.001). The mean CNR difference between the two image groups was 61.2 ± 56.8. There was no significant difference in detection sensitivity of FHLs for two readers between 10min-FA30 (mean 97.7%) and 20min-FA10 (mean 97.9%), irrespective of the lesion size or malignancy. Conclusion 10min-FA30 yielded higher CNR with similar sensitivity compared to 20min-FA10. This finding indicates that 10min-FA30 can potentially replace 20min-FA10 with higher diagnostic performance and save 10 minutes of time.
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Consensus Statements From a Multidisciplinary Expert Panel on the Utilization and Application of a Liver-Specific MRI Contrast Agent (Gadoxetic Acid). AJR Am J Roentgenol 2015; 204:498-509. [PMID: 25714278 DOI: 10.2214/ajr.13.12399] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Feasibility of 5-minute delayed transition phase imaging with 30° flip angle in gadoxetic acid-enhanced 3D gradient-echo MRI of liver, compared with 20-minute delayed hepatocyte phase MRI with standard 10° flip angle. AJR Am J Roentgenol 2015; 204:69-75. [PMID: 25539239 DOI: 10.2214/ajr.13.11903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The purpose of this study was to compare 5-minute delayed transitional phase imaging using a 30° flip angle (hereafter, 5 min-FA30) and 20-minute hepatocyte phase imaging using a 10° flip angle (hereafter, 20 min-FA10) in gadoxetic acid-enhanced MRI for focal hepatic lesion detection and lesion-to-liver contrast-to-noise ratio (CNR), and to determine whether 5 min-FA30 could replace 20 min-FA10 with a 15-minute time saving. MATERIALS AND METHODS One hundred sixteen patients with 282 focal hepatic lesions (size range, 0.2-12.5 cm; malignant, n = 146; benign, n = 136) underwent gadoxetic acid-enhanced MRI with 5 min-FA30 and 20 min-FA10 with a 3D T1-weighted gradient-echo sequence. Three radiologists independently assessed the presence of focal hepatic lesions using a 4-point scale, and detection sensitivity of focal hepatic lesions was calculated. Lesion-to-liver CNRs were calculated and compared in two image groups. RESULTS There was no significant difference in detection sensitivity of focal hepatic lesions for all three readers between 5 min-FA30 (mean, 95.4%) and 20 min-FA10 (mean, 95.6%), irrespective of lesion size or malignancy. The mean CNR on 5 min-FA30 (167.9 ± 84.1) was significantly higher than that on 20 min-FA10 (160.2 ± 79.5). However, the mean CNR difference between the two image groups was relatively small (7.8 ± 41.9). CONCLUSION Compared with 20 min-FA10, 5 min-FA30 provided higher CNR and similar sensitivity. These findings indicate that 5 min-FA30 could replace 20-min delayed hepatocyte phase imaging using a 10° flip angle with similar diagnostic performance and 15 minutes of time saving.
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Feng ST, Wu L, Cai H, Chan T, Luo Y, Dong Z, Zheng K, Li ZP. Cholangiocarcinoma: spectrum of appearances on Gd-EOB-DTPA-enhanced MR imaging and the effect of biliary function on signal intensity. BMC Cancer 2015; 15:38. [PMID: 25655565 PMCID: PMC4324426 DOI: 10.1186/s12885-015-1039-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/23/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To describe the Gd-EOB-DTPA-enhanced MRI appearances of cholangiocarcinoma, and evaluate the relative signal intensities (RSIs) changes of major abdominal organs, and investigate the effect of total bilirubin (TB) levels on the RSI. METHODS 25 patients with pathologically-proven cholangiocarcinoma underwent Gd-EOB-DTPA-enhanced MRI. The visualization of the biliary system during biliary phase (BP) was observed. RSIs of the abdominal aorta (A), portal vein (V), liver (L), and spleen (S) were measured. RESULTS On hepatocellular phase (HP), exophytic tumors (n =10) and infiltrative tumors (n =10) were hypointense, polypoid tumors (n = 2) were hypointense, and combined type tumors (n = 3) had mixed appearances. While patients with normal TB levels (≤22 μmol/L, n = 12) had clear visualization of the biliary tree during BP, those with elevated TB levels (>22 μmol/L, n = 13) had obscured or no visualization. In addition, patients with normal TB levels had higher RSIA, RSIV and RSIS than those with elevated TB levels on all dynamic phases (P <0.001), and lower RSIA, RSIV and RSIS on HP and BP (P <0.001). Patients with normal TB levels had higher RSIL than those with elevated TB levels on all phases (P <0.001). CONCLUSIONS RSIs of major abdominal organs reflected underlying biliary function. Cholangiocarcinoma patients with elevated TB levels had delayed excretion of Gd-EOB-DTPA compared with patients with normal TB levels.
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Affiliation(s)
- Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Ling Wu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Tao Chan
- Medical Imaging Department, Union Hospital, Hong Kong, 18 Fu Kin Street, Tai Wai, Shatin, NT, Hong Kong.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Keguo Zheng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
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Endrikat JS, Dohanish S, Balzer T, Breuer JAM. Safety of gadoxetate disodium: Results from the clinical phase II-III development program and postmarketing surveillance. J Magn Reson Imaging 2015; 42:634-43. [PMID: 25643844 DOI: 10.1002/jmri.24838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/13/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To summarize the safety data of gadoxetate disodium, reported in 12 Phase II and III clinical development studies and in the postmarketing surveillance database. MATERIALS AND METHODS Patients with liver lesions received gadoxetate disodium-enhanced liver magnetic resonance imaging (MRI). Adverse events (AEs) were recorded and evaluated with regard to a potential drug relationship. Subgroup analyses were run on patients with special medical history. Worldwide spontaneous AEs and adverse drug reactions (ADRs) from postmarketing safety surveillance were analyzed. RESULTS A total of 1989 patients were included in the clinical development program. A total of 1581/1989 (79.5%) patients received the finally approved dose of 0.025 mmol/kg body weight. 10.1% of patients reported AEs, 4.1% were classified as related AEs. Nausea and headache were the most frequently reported related AEs, with 1.1% each. Age, history of contrast media allergy, liver cirrhosis, or impaired liver or renal function did not significantly impact the frequency and type of AEs. The postmarketing safety surveillance database encompassed more than 2.2 million patients. Nausea was the most frequent ADR, with a reporting rate of 0.00652%; all other symptoms were below 0.004%. CONCLUSION Gadoxetate disodium for liver MRI has an excellent safety profile.
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Affiliation(s)
- Jan S Endrikat
- Bayer HealthCare Pharmaceuticals, Medical Care, Global Medical and Clinical Affairs, Radiology & Interventional, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | - Susan Dohanish
- Bayer HealthCare Pharmaceuticals, Global Pharmacovigilance and Risk Management, Whippany, New Jersey, USA
| | - Thomas Balzer
- Bayer HealthCare Pharmaceuticals, Medical Care, Medical and Clinical Affairs, Radiology & Interventional, Whippany, New Jersey, USA
| | - Josy A M Breuer
- Bayer HealthCare Pharmaceuticals, Medical Care, Global Medical and Clinical Affairs, Radiology & Interventional, Berlin, Germany
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Rosenberg C, Jahn A, Pickartz T, Wahnschaffe U, Patrzyk M, Hosten N. Gd-EOB-DTPA-enhanced MR guidance in thermal ablation of liver malignancies. PLoS One 2014; 9:e109217. [PMID: 25541950 PMCID: PMC4277266 DOI: 10.1371/journal.pone.0109217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/30/2014] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate the potency of Gd-EOB-DTPA to support hepatic catheter placement in laser ablation procedures by quantifying time-dependent delineation effects for instrumentation and target tumor within liver parenchyma. Monitoring potential influence on online MR thermometry during the ablation procedure is a secondary aim. MATERIALS AND METHODS 30 cases of MR-guided laser ablation were performed after i.v. bolus injection of gadoxetic acid (0.025 mmol/Kg Gd-EOB-DTPA; Bayer Healthcare, Berlin, Germany). T1-weighted GRE sequences were used for applicator guidance (FLASH 3D) in the catheter placement phase and for therapy monitoring (FLASH 2D) in the therapy phase. SNR and consecutive CNR values were measured for elements of interest plotted over time both for catheter placement and therapy phase and compared with a non-contrast control group of 19 earlier cases. Statistical analysis was realized using the paired Wilcoxon test. RESULTS Sustainable signal elevation of liver parenchyma in the contrast-enhanced group was sufficient to silhouette both target tumor and applicator against the liver. Differences in time dependent CNR alteration were highly significant between contrast-enhanced and non-contrast interventions for parenchyma and target on the one hand (p = 0.020) and parenchyma and instrument on the other hand (p = 0.002). Effects lasted for the whole procedure (monitoring up to 60 min) and were specific for the contrast-enhanced group. Contrasting maxima were seen after median 30 (applicator) and 38 (tumor) minutes, in the potential core time of a multineedle procedure. Contrast influence on T1 thermometry for real-time monitoring of thermal impact was not significant (p = 0.068-0.715). CONCLUSION Results strongly support anticipated promotive effects of Gd-EOB-DTPA for MR-guided percutaneous liver interventions by proving and quantifying the delineating effects for therapy-relevant elements in the procedure. Time benefit, cost effectiveness and oncologic outcome of the described beneficiary effects will have to be part of further investigations.
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Affiliation(s)
- Christian Rosenberg
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Andrea Jahn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Tilman Pickartz
- Clinic of Internal Medicine, Division of Gastroenterology, Endocrinology and Nutritive Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Ulrich Wahnschaffe
- Clinic of Internal Medicine, Division of Gastroenterology, Endocrinology and Nutritive Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Maciej Patrzyk
- Clinic of General Surgery, Visceral, Thoracic and Vascular Surgery, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014; 272:635-54. [PMID: 25153274 PMCID: PMC4263631 DOI: 10.1148/radiol.14132361] [Citation(s) in RCA: 318] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The first article of this two-part review discusses key concepts of HCC development, growth, and spread, emphasizing those features with imaging correlates and hence most relevant to radiologists; state-of-the-art CT and MR imaging technique with extracellular and hepatobiliary contrast agents; and the imaging appearance of precursor nodules that eventually may transform into overt HCC.
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Affiliation(s)
- Jin-Young Choi
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
| | - Jeong-Min Lee
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
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Sirlin CB, Hussain HK, Jonas E, Kanematsu M, Min Lee J, Merkle EM, Peck-Radosavljevic M, Reeder SB, Ricke J, Sakamoto M. Consensus report from the 6th International forum for liver MRI using gadoxetic acid. J Magn Reson Imaging 2013; 40:516-29. [PMID: 24923695 DOI: 10.1002/jmri.24419] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/21/2013] [Indexed: 02/06/2023] Open
Abstract
As the utility of liver-specific magnetic resonance imaging (MRI) increases, it is pertinent to optimize and expand protocols to improve accuracy and foster evolution of techniques; in turn, positive impacts should be seen in patient management. This article reports on the latest expert thinking and current evidence in the field of liver-specific MRI, as discussed at the 6(th) International Forum for Liver MRI, which was held in Vancouver, Canada in September 2012. Topics discussed at this forum described the use of gadoxetic acid-enhanced MRI for the assessment of liver function at the segmental level; to increase accuracy in the diagnosis of liver metastases; to overcome current challenges in patients with cirrhosis, including management of arterial hypo-/isovascular, hepatobiliary phase hypointense nodules; and the data which would be required in order to recommend the use of this modality in hepatocellular carcinoma management guidelines. Growing evidence suggests that gadoxetic acid-enhanced MRI can help to improve the management of patients with a number of different liver disorders; however, more data are needed in some areas, and there may be a case for developing an interpretation guideline for gadoxetic acid-enhanced MRI findings to aid standardization.
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Affiliation(s)
- Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, California, USA
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Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A. Liver Failure after Major Liver Resection: Risk Assessment by Using Preoperative Gadoxetic Acid–enhanced 3-T MR Imaging. Radiology 2013. [DOI: 10.1148/radiology.13130210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A. Liver failure after major liver resection: risk assessment by using preoperative Gadoxetic acid-enhanced 3-T MR imaging. Radiology 2013; 269:777-86. [PMID: 23942606 DOI: 10.1148/radiol.13130210] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine if gadoxetic acid-enhanced magnetic resonance (MR) imaging with measurement of relative liver enhancement (RLE) on hepatobiliary phase images can allow preoperative assessment of the risk of liver failure after major liver resection. MATERIALS AND METHODS The local institutional review committee approved this retrospective analysis and waived written informed consent. The study included 73 patients (39 men; median age, 64.4 years) who underwent gadoxetic acid-enhanced 3-T MR imaging before resection of three or more liver segments. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid. RLE was assessed in each liver segment and the mean value of all segments was used for analysis. Posthepatectomy liver failure was defined according to the "50-50 criteria" (ie, prothrombin time <50% and serum bilirubin >50 µmol/L on postoperative day 5) and the International Study Group of Liver Surgery (ISGLS) classification. The association of RLE and liver failure was tested with univariate and multivariate logistic regression analysis. In addition to RLE, the latter also included demographic, clinical, operative, and histologic variables. RESULTS Patients with liver failure according to the 50-50 criteria (n = 3) had significantly lower RLE (54.5%) than those without (125.6%) (P = .009). According to ISGLS criteria, RLE was 112.5% in patients with grade A liver failure (n = 20), 88.4% in patients with grade B (n = 7), 41.7% (n = 2) in patients with grade C, and 136.5% (P < .001) in those without liver failure. In a logistic regression analysis, RLE was inversely related to the probability of liver failure according to the 50-50 (P = .02) and ISGLS (P < .001) criteria. In a multivariate analysis, RLE was independently associated with a higher probability of liver failure according to ISGLS classification (P = .003). CONCLUSION Gadoxetic acid-enhanced MR imaging can help with the assessment of the risk for liver failure after major liver resection.
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Affiliation(s)
- Andreas Wibmer
- From the Departments of Radiology (A.W., R.N., A.B.S.) and Surgery (A.M.P., T.G., M.S.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Ulloa JL, Stahl S, Yates J, Woodhouse N, Kenna JG, Jones HB, Waterton JC, Hockings PD. Assessment of gadoxetate DCE-MRI as a biomarker of hepatobiliary transporter inhibition. NMR IN BIOMEDICINE 2013; 26:1258-1270. [PMID: 23564602 PMCID: PMC3817526 DOI: 10.1002/nbm.2946] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 06/02/2023]
Abstract
Drug-induced liver injury (DILI) is a clinically important adverse drug reaction, which prevents the development of many otherwise safe and effective new drugs. Currently, there is a lack of sensitive and specific biomarkers that can be used to predict, assess and manage this toxicity. The aim of this work was to evaluate gadoxetate-enhanced MRI as a potential novel biomarker of hepatobiliary transporter inhibition in the rat. Initially, the volume fraction of extracellular space in the liver was determined using gadopentetate to enable an estimation of the gadoxetate concentration in hepatocytes. Using this information, a compartmental model was developed to characterise the pharmacokinetics of hepatic uptake and biliary excretion of gadoxetate. Subsequently, we explored the impact of an investigational hepatobiliary transporter inhibitor on the parameters of the model in vivo in rats. The investigational hepatobiliary transporter inhibitor reduced both the rate of uptake of gadoxetate into the hepatocyte, k1 , and the Michaelis-Menten constant, Vmax , characterising its excretion into bile, whereas KM values for biliary efflux were increased. These effects were dose dependent and correlated with effects on plasma chemistry markers of liver dysfunction, in particular bilirubin and bile acids. These results indicate that gadoxetate-enhanced MRI provides a novel functional biomarker of inhibition of transporter-mediated hepatic uptake and clearance in the rat. Since gadoxetate is used clinically, the technology has the potential to provide a translatable biomarker of drug-induced perturbation of hepatic transporters that may also be useful in humans to explore deleterious functional alterations caused by transporter inhibition.
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Affiliation(s)
- Jose L Ulloa
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Macclesfield, UK
| | - Simone Stahl
- Molecular Toxicology, Safety Assessment UKAstraZeneca, Macclesfield, UK
| | - James Yates
- DMPK, Oncology iMedAstraZeneca, Macclesfield, UK
| | - Neil Woodhouse
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Macclesfield, UK
| | - J Gerry Kenna
- Molecular Toxicology, Safety Assessment UKAstraZeneca, Macclesfield, UK
| | - Huw B Jones
- Pathology, Safety Assessment UKAstraZeneca, Macclesfield, UK
| | - John C Waterton
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Macclesfield, UK
| | - Paul D Hockings
- Science and Validation, Personalised Healthcare and BiomarkersAstraZeneca, Mölndal, Sweden
- MedTech West, Chalmers University of TechnologyGothenburg, Sweden
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Bergmann K, Agris J, Balzer T. Does Intravenous Administration of Gadoxetate Disodium Have Any Effect on Breath-hold Times. Radiology 2013; 268:926-7. [DOI: 10.1148/radiol.13130785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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45
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Gadoxetic acid disodium-enhanced magnetic resonance imaging for the detection of hepatocellular carcinoma: a meta-analysis. PLoS One 2013. [PMID: 23967130 DOI: 10.1371/journal.pone.0070896.ecolletion] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To determine the accuracy of MR imaging with gadoxetic acid disodium (Gd-EOB-DTPA) for the detection of hepatocelluar carcinoma (HCC). MATERIALS AND METHODS A systematic search was performed in PUBMED, EMBASE, Web of Science, Cochrane Library and the Chinese Biomedical Literature Database up to March 2013 to identify studies about evaluation of Gd-EOB-DTPA enhanced MR imaging in patients suspected of having HCC. The data were extracted to perform heterogeneity test and threshold effect test and to calculate sensitivity, specificity, diagnostic odds ratio, predictive value, and areas under summary receiver operating characteristic curve (AUC). RESULTS From 601 citations, 10 were included in the meta-analysis. The methodological quality of the 10 studies was good. Overall HCC: There was significant heterogeneity in the pooled analysis (I(2) = 69.4%, P = 0.0005), and the pooled weighted values were determined to be sensitivity: 0.91 (95% confidence interval (CI): 0.89, 0. 93); specificity: 0.95 (95% CI: 0.94, 0.96); diagnostic odds ratio: 169.94 (95% CI: 108.84, 265.36); positive likelihood ratio: 15.75 (95% CI: 7.45, 33.31); negative likelihood ratio: 0.10 (95% CI: 0.06, 0.15). The AUC was 0.9778. HCC in cirrhosis: The estimates were to be sensitivity: 0.91 (95% CI: 0.88, 0.93); specificity: 0.93 (95% CI: 0.89, 0.95); diagnostic odds ratio: 234.24 (95% CI: 33.47, 1639.25); positive likelihood ratio: 15.08 (95% CI: 2.20, 103.40); negative likelihood ratio: 0.08 (95% CI: 0.03, 0.21). The AUC was 0.9814. ≤20 mm HCC: The AUC was 0.9936. There was no notable publication bias. CONCLUSIONS This meta-analysis suggests that MR imaging with Gd-EOB-DTPA has high diagnostic accuracy for the detection of HCC, especially for ≤20 mm HCC. This technique shows good prospect in diagnosis of HCC.
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Early hepatocellular carcinomas showing isointensity or hyperintensity in gadoxetic acid-enhanced, hepatocyte-phase magnetic resonance images. J Comput Assist Tomogr 2013; 37:466-9. [PMID: 23674023 DOI: 10.1097/rct.0b013e3182873799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hypointensity in the hepatocyte phase is believed to be a key feature of hypovascular early hepatocellular carcinoma, which indicates malignancy. The 3 cases we present suggest that the converse is not true. Three small hepatocellular lesions showed isointensity/hyperintensity on gadoxetic acid-enhanced, hepatocyte-phase magnetic resonance images and were pathologically confirmed as early hepatocellular carcinomas. We conclude that isointensity or hyperintensity in the hepatocyte phase does not always represent benignity of hepatocellular lesions in the cirrhotic liver.
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Newly developed hypervascular hepatocellular carcinoma during follow-up periods in patients with chronic liver disease: observation in serial gadoxetic acid-enhanced MRI. AJR Am J Roentgenol 2013; 200:1254-60. [PMID: 23701061 DOI: 10.2214/ajr.12.9136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the process and frequency of newly developed hypervascular hepatocellular carcinoma (HCC) in serial gadoxetic acid-enhanced MRI examinations in patients with chronic liver disease during clinical follow-up periods. MATERIALS AND METHODS After review of 341 MRI examinations in 100 patients with chronic liver diseases who underwent gadoxetic acid-enhanced MRI at least twice during the observation period, 32 newly developed hypervascular HCCs in 14 patients were retrospectively evaluated. Serial MRI examinations before detecting hypervascular HCC were evaluated to determine whether hypervascular HCC showed the presence of a hypointense nodule on the hepatobiliary phase and hypovascularity (high-risk nodule) before hyper-vascularization. The size of newly developed hypervascular HCCs and the duration of hyper-vascularization from initial detection of a high-risk nodule were compared between HCCs with and without the presence of a high-risk nodule. RESULTS Eleven (34.4%) of 32 newly developed hypervascular HCCs had the presence of high-risk nodule before hypervascularization. The size of newly developed hypervascular HCCs was significantly smaller in HCC with high-risk nodule presence (mean, 9.5 mm) than in HCC without the presence of high-risk nodule (mean, 16.4 mm) (p = 0.004). In hypervascular HCCs with high-risk nodule presence, the mean duration of hypervascularization from initial high-risk nodule was 330.7 days, with mean size change from 5.4 mm of high-risk nodules to 9.5 mm of hypervascular HCCs. CONCLUSION Approximately one third of newly developed hypervascular HCCs had the presence of high-risk nodule before hypervascularization in the serial gadoxetic acid-enhanced MRI examinations. High-risk nodule tended to develop into hypervascular HCC after having almost doubled in size during 1 year of high-risk nodule presence.
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Burke C, Alexander Grant L, Goh V, Griffin N. The role of hepatocyte-specific contrast agents in hepatobiliary magnetic resonance imaging. Semin Ultrasound CT MR 2013; 34:44-53. [PMID: 23395317 DOI: 10.1053/j.sult.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatocyte-specific contrast agents have been made available in the last 15 years for magnetic resonance imaging of the liver. These agents are differentially taken up by functioning hepatocytes and excreted in the biliary system. They can help distinguish focal liver lesions of hepatocellular origin from lesions of nonhepatocellular origin, and can also be used in the evaluation of the biliary tree. The purpose of this review is to summarize the different types of hepatocyte-specific contrast agents presently available, their use in the characterization of focal liver lesions, their role in the evaluation of biliary pathology, and their potential future applications.
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Affiliation(s)
- Chistopher Burke
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
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Yeom SK, Byun JH, Kim HJ, Park SH, Kim N, Shin YM, Kim PN. Focal fat deposition at liver MRI with gadobenate dimeglumine and gadoxetic acid: Quantitative and qualitative analysis. Magn Reson Imaging 2013; 31:911-7. [DOI: 10.1016/j.mri.2013.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/23/2013] [Accepted: 02/20/2013] [Indexed: 12/14/2022]
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Kim MJ, Kim SH, Kim HJ, Kim BS, Hernandes M, Semelka RC. Enhancement of liver and pancreas on late hepatic arterial phase Imaging: Quantitative comparison among multiple gadolinium-based contrast agents at 1.5 tesla MRI. J Magn Reson Imaging 2013; 38:102-8. [DOI: 10.1002/jmri.23934] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 10/01/2012] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | | | | | - Mateus Hernandes
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill; North Carolina; USA
| | - Richard C. Semelka
- Department of Radiology; University of North Carolina at Chapel Hill; Chapel Hill; North Carolina; USA
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