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Kobayashi T, Kozaka K, Matsubara T, Yokka A, Igarashi S, Kitao A, Yoneda N, Okuda M, Gabata T, Matsui O, Kobayashi S. Super delayed phase imaging in gadoxetic acid-enhanced MRI: investigating factors contributing to improved liver contrast. Eur Radiol 2025; 35:3195-3205. [PMID: 39613959 PMCID: PMC12081474 DOI: 10.1007/s00330-024-11227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/23/2024] [Accepted: 10/23/2024] [Indexed: 12/01/2024]
Abstract
OBJECTIVES To assess whether extended delayed phase imaging, performed after gadoxetic acid administration for 60-120 min (termed as super delayed phase [SDP]), improves liver contrast and nodule visibility in patients with chronic liver disease and to identify predictors for contrast enhancement. METHODS In this retrospective study, 116 patients with chronic liver disease were selected from 6933 gadoxetic acid-enhanced MRI examinations, which included SDP images. The liver-to-spleen contrast (LSC) was quantitatively evaluated, and factors influencing the improvement of LSC were analyzed. By comparing the standard hepatobiliary phase images at 20 min post-contrast (HBP20) with SDP images, nodule visibility was evaluated by two readers who were blinded to the study. RESULTS SDP significantly enhanced LSC (SDP: 1.81 ± 0.48 vs HBP20: 1.50 ± 0.34, p < 0.001) and improved nodule visibility in patients with initially poor LSC. Total bilirubin levels and visible biliary excretion during HBP20 are predictors of LSC enhancement. Furthermore, nodule visibility scores significantly increased in the group with poor initial contrast (Reader 1: from 2.92 ± 1.57 to 3.79 ± 1.44; Reader 2: from 2.34 ± 1.42 to 3.36 ± 1.57, p < 0.001). CONCLUSION SDP enhanced liver contrast and nodule detection in patients with chronic liver disease, particularly in those with impaired liver function. Total bilirubin levels and visible biliary excretion during HBP20 are useful predictors of improvement. This technique may improve the diagnostic utility of MRI for hepatocarcinogenesis in cirrhotic nodules, specifically for detecting precursors of hepatocellular carcinoma, in cirrhotic patients with compromised liver function. KEY POINTS Question In gadoxetic acid-enhanced MRI, inadequate liver contrast can occur in patients with impaired liver function, potentially limiting the diagnostic value of the examination. Findings SDP images improved liver parenchymal signal intensity and visibility of hepatocellular carcinoma, even in cases with impaired liver function. Clinical relevance The addition of SDP imaging in gadoxetic acid-enhanced MRI improves liver contrast and early detection of hepatocellular carcinoma, especially in patients with impaired liver function, such as Child-Pugh B or C, aiding in making appropriate treatment decisions.
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Affiliation(s)
- Tomohiro Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
| | - Takashi Matsubara
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Akira Yokka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Saya Igarashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Azusa Kitao
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Miho Okuda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Jang W, Cho HR, Ha GW, Song JS. Quantitative and qualitative evaluation of high-quality hepatobiliary phase imaging with shortened timing and utility in patients with compromised liver function. Abdom Radiol (NY) 2024; 49:2659-2671. [PMID: 39009896 DOI: 10.1007/s00261-024-04495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To compare high flip angle (FA) hepatobiliary-phase (hHBP) imaging with variable time intervals to conventional HBP (cHBP) to assess the impact of increased FA on image quality in shortened HBP imaging. METHODS Data from 218 patients, divided into normal liver group (n = 184) and decompensated liver group (n = 34), who underwent liver magnetic resonance imaging (MRI) including 10-min, 15-min, 20-min hHBP, and cHBP were analyzed. Signal-to-noise ratio (SNR), contrast-ratio (CR), contrast-to-noise ratio (CNR), signal intensity ratios (SIRs), and relative enhancement (RE) of the liver were calculated for quantitative analysis. Sharpness, noise, and artifacts of the image, contrast media visibility, overall image quality, and lesion conspicuity were evaluated by two abdominal radiologists. RESULTS Quantitative analysis showed that SNR, RE, SIR for liver/muscle, liver/spleen, and CR of all hHBP images demonstrated a significantly higher value compared to cHBP images in the normal liver group (p < 0.001). These values were also superior in the normal liver group compared to the decompensated liver group (p < 0.01). In qualitative analysis, both normal and decompensated liver groups exhibited significantly superior image sharpness in all hHBP images compared to cHBP images and the overall image quality of the 15-min and 20-min hHBP did not show significant difference compared to cHBP. All values tended to be better in the normal liver group than the decompensated liver group with statistical significance except for lesion conspicuity (p < 0.01). CONCLUSION High-FA HBP has proven to be a valuable image acquisition method, potentially shortening liver MR imaging time while maintaining acceptable image quality.
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Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
| | - Hyeong Ryun Cho
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
| | - Gi Won Ha
- Department of Surgery, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea.
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea.
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Wang C, Yuan XD, Wu N, Sun WR, Tian Y. Optimization of hepatobiliary phase imaging in gadoxetic acid-enhanced magnetic resonance imaging: a narrative review. Quant Imaging Med Surg 2023; 13:1972-1982. [PMID: 36915322 PMCID: PMC10006143 DOI: 10.21037/qims-22-916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/04/2023] [Indexed: 02/25/2023]
Abstract
Background and Objective Gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) is widely used in clinical practice. Its unique hepatobiliary phase (HBP) has been used to improve the detection and identification of hepatic lesions and has also been used to evaluate hepatic function and fibrosis. At the early stage of its clinical practice, the HBP was typically collected empirically with a delay of 20 minutes after intravenous administration to image the liver with sufficient enhancement for diagnosis. However, numerous methods and consensus statements for optimizing HBP acquisition have been proposed. This review details the methods and consensus statements on optimizing HBP collection. Methods The electronic literature search was performed using the databases PubMed, MEDLINE, Cochrane, and Embase without limit on publication period to identify published reports on optimizing HBP imaging in Gd-EOB-DTPA-enhanced MRI. Articles with low relevance to the topics were excluded. Key Content and Findings Recently, an increasing number of investigations suggest that collecting HBP after 20 min is too drawn-out for patients with normal liver function but is too short for patients with cirrhosis. Previous studies demonstrated that liver enhancement is closely related to liver function in Gd-EOB-DTPA-enhanced MRI. Therefore several reports have proposed various HBP delay times at different liver function levels. These delay times could be evaluated by laboratory indicators, such as prothrombin (PT) activity, total bilirubin, direct bilirubin, and the model for end-stage liver disease. Other investigations have found that the initial visualization time of the intrahepatic bile duct (IHD) in Gd-EOB-DTPA-enhanced MRI to also be related to liver enhancement and function. Therefore, initial visualization of the IHD is considered necessary for adequate HBP and has been employed in HBP acquisition in recent reports. Conclusions Optimizing HBP acquisition according to individual hepatic function is a good strategy and was followed in most of the investigations included in our review. Obtaining adequate HBP in the shortest possible time is the target condition in Gd-EOB-DTPA-enhanced MRI. However, a more concise and efficient HBP acquisition strategy is still expected to be developed in the future.
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Affiliation(s)
- Chao Wang
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China
| | - Xiao-Dong Yuan
- Department of Radiology, the 8th Medical Center of PLA General Hospital, Beijing, China
| | - Ning Wu
- Department of Radiology, the 8th Medical Center of PLA General Hospital, Beijing, China
| | - Wei-Rong Sun
- Department of Radiology, the 8th Medical Center of PLA General Hospital, Beijing, China
| | - Yuan Tian
- Department of Radiology, the 8th Medical Center of PLA General Hospital, Beijing, China
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Ghorra C, Pommier R, Piveteau A, Rubbia-Brandt L, Vilgrain V, Terraz S, Ronot M. The diagnostic performance of a simulated "short" gadoxetic acid-enhanced MRI protocol is similar to that of a conventional protocol for the detection of colorectal liver metastases. Eur Radiol 2020; 31:2451-2460. [PMID: 33025173 DOI: 10.1007/s00330-020-07344-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the performance of standard and simulated short gadoxetic acid-enhanced MRI protocols for the detection of colorectal liver metastases (CRLM). METHODS From 2008 to 2017, 67 patients (44 men (66%); mean age 65 ± 11 years old) who underwent gadoxetic acid-enhanced MRI during the initial work-up for colorectal cancer were included. Exams were independently reviewed by two readers blinded to clinical data in two reading sessions: (1) all acquired sequences (standard "long" protocol) and (2) only T2-weighted, diffusion-weighted, and hepatobiliary phase images (simulated "short" protocol). Readers characterized detected lesions using a 5-point scale (1-certainly benign to 5-certainly malignant). A lesion was considered a CRLM when the score was ≥ 3. The reference standard was histopathology or 12-month imaging follow-up. Chi-square, Student's t, and McNemar tests were used for comparisons. RESULTS A total of 486 lesions including 331 metastases (68%) were analyzed. The metastasis detection rate was 86.1% (95% CI 82-89.4)-86.7% (82.6-90) and 85.8% (81.6-89.2)-87% (82.9-90.2) with the short and long protocols, respectively (p > 0.99). Among detected lesions, 92.1% (89.1-94.4)-94.8% (92.2-96.6) and 84.6% (80.8-87.7)-88.8% (85.4-91.5) were correctly classified with the short and long protocols, respectively (p = 0.13 and p = 0.10). The results remained unchanged when lesions scored ≥ 4 were considered as CRLM. CONCLUSION The diagnostic performance of a simulated short gadoxetic enhanced-MR protocol including T2-weighted, diffusion-weighted, and hepatobiliary phase appears similar to that of a standard long protocol including dynamic phase images. Since this protocol shortens the duration of MR examination, it could facilitate the evaluation of patients with colorectal liver metastases. KEY POINTS • The detection rate of colorectal metastases with a simulated, short, MRI protocol was similar to that of a standard protocol. • The performance of both protocols for the differentiation of metastases and benign lesions appears to be similar. • A short MR imaging protocol could facilitate the evaluation of patients with colorectal liver metastases.
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Affiliation(s)
- Camille Ghorra
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Romain Pommier
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
| | - Arthur Piveteau
- Department of Radiology, University Hospitals of Geneva - HUG, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Department of Pathology, University Hospitals of Geneva - HUG, Geneva, Switzerland
| | - Valérie Vilgrain
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva - HUG, Geneva, Switzerland
| | - Maxime Ronot
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,Université de Paris, Paris, France. .,INSERM U1149, CRI, Paris, France.
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Optimization of timing of hepatocellular phase imaging after gadoxetate disodium injection for evaluation of patients with neuroendocrine tumor. Abdom Radiol (NY) 2020; 45:2358-2369. [PMID: 32270259 DOI: 10.1007/s00261-020-02515-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Metastatic gastroenteropancreatic neuroendocrine neoplasms (mGEP-NEN) are indolent malignancies which undergo frequent imaging follow-up. Hepatocellular phase (HCP) MR with hepatocellular-specific contrast agent is widely used to evaluate mGEP-NEN liver metastases but is commonly performed after a 20-min delay which prolongs scan time. The purpose of this study was to evaluate if HCP MR at 15 min offers comparable performance to 20-min delay for patients with mGEP-NEN undergoing routine imaging surveillance. MATERIALS AND METHODS In this IRB-approved retrospective study, we evaluated 52 patients with mGEP-NEN who were imaged for routine surveillance with gadoxetate disodium (Eovist®)-enhanced MR including 15- and 20-min delayed HCP. Two readers (R1, R2), blinded to HCP timing, independently reviewed each set of images in random order at least 1 month apart. Readers assessed presence and conspicuity of metastases, and subjective image quality using 5-point scales. Readers quantified the number of metastases and diameter of the largest lesion. Statistical analysis was performed to determine individual-reader and inter-reader differences for qualitative and quantitative data. RESULTS No differences were observed for subjective image quality (R1 p = 0.86, R2 p = 0.17) or lesion conspicuity (R1 p = 0.56, R2 p = 0.74) at 15 min and 20 min for either reader. Individual-reader concordance correlation coefficient between 15 and 20 min was high for number of metastases detected (R1 = 0.9842, R2 = 0.9579) and diameter of largest metastasis (R1 = 0.9629, R2 = 0.8859). CONCLUSION HCP imaging at 15 min provides similar diagnostic yield to standard 20-min delay, which may help reduce the scan time and costs, and improve throughput and patient satisfaction.
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Lesion detection performance of an abbreviated gadoxetic acid–enhanced MRI protocol for colorectal liver metastasis surveillance. Eur Radiol 2019; 29:5852-5860. [DOI: 10.1007/s00330-019-06113-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
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Jeon I, Cho ES, Kim JH, Kim DJ, Yu JS, Chung JJ. Feasibility of 10-Minute Delayed Hepatocyte Phase Imaging Using a 30° Flip Angle in Gd-EOB-DTPA-Enhanced Liver MRI for the Detection of Hepatocellular Carcinoma in Patients with Chronic Hepatitis or Cirrhosis. PLoS One 2016; 11:e0167701. [PMID: 27936106 PMCID: PMC5147964 DOI: 10.1371/journal.pone.0167701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023] Open
Abstract
Objectives To compare 10-minute (min) delayed hepatocyte phase imaging (HPI) using a 30° flip angle (FA) (10m-FA30) and 20-min delayed HPI using a 10° FA (20m-FA10) or 30° FA (20m-FA30) in Gd-EOB-DTPA-enhanced MRI in patients with chronic hepatitis or cirrhosis, in terms of lesion-to-liver contrast-to-noise ratio (CNR) for hepatocellular carcinoma (HCC) and detection sensitivity for focal hepatic lesions (FHLs). Materials and Methods One hundred and four patients with 168 HCCs and 55 benign FHLs who underwent Gd-EOB-DTPA-enhanced MRI with 10m-FA30, 20m-FA10, and 20m-FA30 were enrolled. Patients were divided into two groups according to the Child-Pugh classification: group A with chronic hepatitis or Child-Pugh A cirrhosis and group B with Child-Pugh B or C cirrhosis. Lesion-to-liver CNR for HCCs was compared between 10m-FA30 and 20m-FA10 or 20m-FA30 for each group. The presence of FHLs was evaluated using a four-point scale by two independent reviewers, and the detection sensitivity was analyzed. Results In group A, the CNR for HCCs (n = 86) on 10m-FA30 (165.8 ± 99.7) was significantly higher than that on 20m-FA10 (113.4 ± 71.4) and lower than that of 20m-FA30 (210.2 ± 129.3). However, there was no significant difference in the sensitivity of FHL detection between 10m-FA30 (mean 95.0% for two reviewers) and 20m-FA10 (94.7%) or 20m-FA30 (94.7%). In group B, the CNR (54.0 ± 36.4) for HCCs (n = 57) and the sensitivity (94.2%) of FHL detection for 10m-FA30 were significantly higher than those for 20m-FA10 (41.8 ± 36.4 and 80.8%, respectively) and were not different from those for 20m-FA30 (62.7 ± 44.4 and 93.3%, respectively). Conclusion The diagnostic performance of 10m-FA30 was similar to or higher than 20m-FA10 or 20m-FA30 in both groups A and B. This finding indicates that 10m-FA30 could replace 20-min delayed HPI regardless of patient liver function and reduce the delay time by 10 minutes.
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Affiliation(s)
- Inhwan Jeon
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Eun-Suk Cho
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
- * E-mail:
| | - Joo Hee Kim
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Dae Jung Kim
- Department of Radiology, CHA University, CHA Bundang Medical Center, Seongnam-si, Korea
| | - Jeong-Sik Yu
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Jae-Joon Chung
- Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
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