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Agarwal S, Gordon J, Bok RA, von Morze C, Vigneron DB, Kurhanewicz J, Ohliger MA. Distinguishing metabolic signals of liver tumors from surrounding liver cells using hyperpolarized 13 C MRI and gadoxetate. Magn Reson Med 2024; 91:2114-2125. [PMID: 38270193 DOI: 10.1002/mrm.29918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To use the hepatocyte-specific gadolinium-based contrast agent gadoxetate combined with hyperpolarized (HP) [1-13 C]pyruvate MRI to selectively suppress metabolic signals from normal hepatocytes while preserving the signals arising from tumors. METHODS Simulations were performed to determine the expected changes in HP 13 C MR signal in liver and tumor under the influence of gadoxetate. CC531 colon cancer cells were implanted into the livers of five Wag/Rij rats. Liver and tumor metabolism were imaged at 3 T using HP [1-13 C] pyruvate chemical shift imaging before and 15 min after injection of gadoxetate. Area under the curve for pyruvate and lactate were measured from voxels containing at least 75% of normal-appearing liver or tumor. RESULTS Numerical simulations predicted a 36% decrease in lactate-to-pyruvate (L/P) ratio in liver and 16% decrease in tumor. In vivo, baseline L/P ratio was 0.44 ± 0.25 in tumors versus 0.21 ± 0.08 in liver (p = 0.09). Following administration of gadoxetate, mean L/P ratio decreased by an average of 0.11 ± 0.06 (p < 0.01) in normal-appearing liver. In tumors, mean L/P ratio post-gadoxetate did not show a statistically significant change from baseline. Compared to baseline levels, the relative decrease in L/P ratio was significantly greater in liver than in tumors (-0.52 ± 0.16 vs. -0.19 ± 0.25, p < 0.05). CONCLUSIONS The intracellular hepatobiliary contrast agent showed a greater effect suppressing HP 13 C MRI metabolic signals (through T1 shortening) in normal-appearing liver when compared to tumors. The combined use of HP MRI with selective gadolinium contrast agents may allow more selective imaging in HP 13 C MRI.
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Affiliation(s)
- Shubhangi Agarwal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Cornelius von Morze
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Attiyeh MA, Malhotra GK, Li D, Manoukian SB, Motarjem PM, Singh G. Defining MRI Superiority over CT for Colorectal and Neuroendocrine Liver Metastases. Cancers (Basel) 2023; 15:5109. [PMID: 37894475 PMCID: PMC10605771 DOI: 10.3390/cancers15205109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND We compared CT and MRI for staging metastatic colorectal or neuroendocrine liver metastases (CRLMs and NELMs, respectively) to assess their impact on tumor burden. METHODS A prospectively maintained database was queried for patients who underwent both imaging modalities within 3 months, with two blinded radiologists (R1 and R2) independently assessing the images for liver lesions. To minimize recall bias, studies were grouped by modality, and were randomized and evaluated separately. RESULTS Our query yielded 76 patients (42 CRLMs; 34 NELMs) with low interrater variability (intraclass correlation coefficients: CT = 0.941, MRI = 0.975). For CRLMs, there were no significant differences in lesion number or size between CT and MRI. However, in NELMs, Eovist®-enhanced MRI detected more lesions (R1: 14.3 vs. 12.1, p = 0.02; R2: 14.4 vs. 12.4, p = 0.01) and smaller lesions (R1: 5.7 vs. 4.4, p = 0.03; R2: 4.8 vs. 2.9, p = 0.02) than CT. CONCLUSIONS CT and MRI are equivalent for CRLMs, but for NELMs, MRI outperforms CT in detecting more and smaller lesions, potentially influencing treatment planning and surgery.
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Affiliation(s)
- Marc A. Attiyeh
- Department of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Gautam K. Malhotra
- Department of Surgery, USC, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Saro B. Manoukian
- Department of Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Pejman M. Motarjem
- Department of Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
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Caton MT Jr, Shinagare AB, Lee B, Tirumani SH. Optimization of timing of hepatocellular phase imaging after gadoxetate disodium injection for evaluation of patients with neuroendocrine tumor. Abdom Radiol (NY) 2020; 45:2358-69. [PMID: 32270259 DOI: 10.1007/s00261-020-02515-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Zember J, Loomis J, Vyas P, Badalyan V, Shet N. Advances in Diagnostic Imaging in Pediatric Gastroenterology. Curr Gastroenterol Rep 2020; 22:22. [PMID: 32193706 DOI: 10.1007/s11894-020-00762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The purpose is to provide a review of cross-sectional imaging updates in the assessment of gastrointestinal diseases, relevant to clinical practice and research. RECENT FINDINGS New magnetic resonance imaging contrast agents (Eovist) are taken up by hepatocytes and excreted via the biliary tree. As such, a lesion will retain contrast only if hepatocytes are present, which aids in refining the differential diagnosis. Magnetic resonance enterography is a method for non-invasively diagnosing and following various GI conditions, predominantly inflammatory bowel disease. Contrast-enhanced ultrasound uses gas-filled microbubbles providing superb temporal resolution most notably in the arterial phase, which aids in differentiating lesions. Elastography is a new technique which assesses stiffness of liver for evaluating fibrosis. These new techniques provide more accurate diagnoses and information, often limiting ionizing radiation exposure from other modalities. While ultrasound will still remain the initial imaging modality, familiarity with these other options is valuable for appropriate pathology workup.
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Affiliation(s)
- Jonathan Zember
- Department of Radiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, USA.
| | - Judyta Loomis
- Department of Radiology, Children's National Hospital, Washington, DC, USA
| | - Pranav Vyas
- Department of Radiology, Children's National Hospital, Washington, DC, USA
| | - Vahe Badalyan
- Department of Gastroenterology, Hepatology and Nutrition, Children's National Hospital, Washington, DC, USA
| | - Narendra Shet
- Department of Radiology, Children's National Hospital, Washington, DC, USA
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Lanier H, Wallace A, Khanna G. Rate of gadoxetate disodium ( Eovist®) induced transient respiratory motion in children and young adults. Abdom Radiol (NY) 2020; 45:101-6. [PMID: 31701191 DOI: 10.1007/s00261-019-02296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gadoxetate disodium (Eovist®, Bayer Healthcare, Wayne, NJ) is the preferred MR contrast agent for pediatric hepatobiliary imaging. A known limitation of this contrast agent is transient severe respiratory artifacts during arterial phase imaging, and some adult studies have raised caution against its use for evaluation of arterial enhancing lesions. The reported rate of transient severe breathing motion is 5-22% in adult studies. This study seeks to evaluate the frequency of transient severe respiratory motion secondary to gadoxetate disodium in a pediatric cohort. MATERIALS AND METHODS This is a retrospective, IRB-approved study with informed consent waiver. The radiology information system of a children's hospital was searched to identify all MRI studies performed with gadoxetate disodium during January 2016-June 2018. Two readers independently evaluated all phases of a dynamic liver protocol for respiratory motion artifact on a 5-point scale (1 none, 2 mild, 3 moderate, 4 severe-still diagnostic, 5 extreme-not diagnostic). Average scores of the 2 readers for each phase were used for analyses. Transient severe respiratory motion was defined as an increase in artifact score of ≥ 1.5 from pre-contrast to arterial phase that returned to < 3 in equilibrium phase of imaging. RESULTS The study cohort consisted of 140 cases (60% female), age range: 1 month-23 years (median 13 years). 102/140 scans were performed non-sedated. Mean respiratory motion score for each phase of scan for the entire cohort were pre-contrast: 2.23, arterial: 2.56, portal venous: 2.39, and equilibrium: 2.31. Transient severe respiratory motion was seen in 8 non-sedated cases and in 0 sedated cases. The rate of transient severe respiratory motion in a non-sedated pediatric cohort was estimated at 7.84% (8/102 cases). CONCLUSION The rate of transient severe respiratory motion in the non-sedated pediatric population is in the lower end of the range reported in adults. Transient severe respiratory motion is not observed in sedated patients.
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Abstract
Magnetic resonance imaging (MRI) is the modality of choice for liver imaging due to its superior contrast resolution in comparison with computer tomography and the ability to provide both morphologic and physiologic information. The physics of MR are complex, and a detailed understanding is not required to appreciate findings on an MRI exam. Here, we attempt to introduce the basic principles of MRI with respect to hepatic imaging focusing on various commonly encountered hepatic diseases. The purpose is to facilitate an appreciation of the various diagnostic capabilities of MR among hepatic oncologists and surgeons and to foster an understanding of when MR studies may be appropriate in the care of their patients.
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Affiliation(s)
- Lan N Vu
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John N Morelli
- Department of Radiology, St. John's Medical Center, Tulsa, OK, USA
| | - Janio Szklaruk
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Park CC, Hamilton G, Desai A, Zand KA, Wolfson T, Hooker JC, Costa E, Heba E, Clark L, Gamst A, Loomba R, Middleton MS, Sirlin CB. Effect of intravenous gadoxetate disodium and flip angle on hepatic proton density fat fraction estimation with six-echo, gradient-recalled-echo, magnitude-based MR imaging at 3T. Abdom Radiol (NY) 2017; 42:1189-1198. [PMID: 28028556 DOI: 10.1007/s00261-016-0992-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of the study was to determine in patients undergoing gadoxetate disodium (Gx)-enhanced MR exams whether proton density fat fraction (PDFF) estimation accuracy of magnitude-based multi-gradient-echo MRI (MRI-M) could be improved by using high flip angle (FA) on post-contrast images. MATERIALS AND METHODS Thirty-one adults with known or suspected hepatic steatosis undergoing 3T clinical Gx-enhanced liver MRI were enrolled prospectively. MR spectroscopy (MRS), the reference standard, was performed before Gx to measure MRS-PDFF. Low (10°)- and high (50°)-flip angle (FA) MRI-M sequences were acquired before and during the hepatobiliary phase after Gx administration; MRI-PDFF was estimated in the MRS-PDFF voxel location. Linear regression parameters (slope, intercept, average bias, R 2) were calculated for MRS-PDFF as a function of MRI-PDFF for each MRI-M sequence (pre-Gx low-FA, pre-Gx high-FA, post-Gx low-FA, post-Gx high-FA) for all patients and for patients with MRS-PDFF <10%. Regression parameters were compared (Bonferroni-adjusted bootstrap-based tests). RESULTS Three of the four MRI-M sequences (pre-Gx low-FA, post-Gx low-FA, post-Gx high-FA) provided relatively unbiased PDFF estimates overall and in the low-PDFF range, with regression slopes close to 1 and intercepts and biases close to zero. Pre-Gx high-FA MRI overestimated PDFF in proportion to MRS-PDFF, with slopes of 0.72 (overall) and 0.63 (low-PDFF range). Based on regression bias closest to 0, the post-Gx high-FA sequence was the most accurate overall and in the low-PDFF range. This sequence provided statistically significant improvements in at least two regression parameters compared to every other sequence. CONCLUSION In patients undergoing Gx-enhanced MR exams, PDFF estimation accuracy of MRI-M can be improved by using high-FA on post-contrast images.
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Affiliation(s)
- Charlie C Park
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Gavin Hamilton
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Ajinkya Desai
- Department of Diagnostic and Interventional Radiology, Rochester General Hospital, Rochester, NY, USA
| | - Kevin A Zand
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center (SDSC), University of California, San Diego, La Jolla, CA, USA
| | - Jonathan C Hooker
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Eduardo Costa
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Elhamy Heba
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Lisa Clark
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Anthony Gamst
- Computational and Applied Statistics Laboratory (CASL), San Diego Supercomputer Center (SDSC), University of California, San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- Division of Epidemiology, Department of Family Medicine and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Michael S Middleton
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA
| | - Claude B Sirlin
- MR3T Bydder Laboratory, Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, MC 8226, San Diego, CA, 92103-8226, USA.
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Constant C, Hecht S, Craig LE, Lux CN, Cannon CM, Conklin GA. GADOXETATE DISODIUM (GD-EOB-DTPA) CONTRAST ENHANCED MAGNETIC RESONANCE IMAGING CHARACTERISTICS OF HEPATOCELLULAR CARCINOMA IN DOGS. Vet Radiol Ultrasound 2016; 57:594-600. [PMID: 27633531 DOI: 10.1111/vru.12419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma is the most common primary hepatic tumor in dogs and is amenable to surgical resection in many cases. Unfortunately, overlap of sonographic findings between benign and malignant hepatic lesions typically requires more invasive diagnostic tests to be performed (e.g., biopsy for histopathology). The availability of a noninvasive diagnostic test to identify hepatocellular carcinoma would be beneficial. The use of a liver-specific magnetic resonance imaging (MRI) contrast agent such as gadoxetate disodium (Gd-EOB-DTPA; Eovist® or Primovist®) has improved lesion detection in human patients. In this descriptive study, gadoxetate disodium contrast-enhanced MRI characteristics in dogs were evaluated in seven dogs (total of eight lesions). The imaging characteristics were variable with the exception of all lesions being hypointense to surrounding normal hepatic parenchyma on 3D T1-weighted gradient recalled echo images at all postcontrast time points. All lesions displayed signal intensity ratios less than 1, consistent with retained but impaired hepatocyte function. Hepatic lesions not identified on previous imaging were found in 3/7 patients which may affect surgical planning. In two patients, several hepatic nodules were identified during surgery which had not been visualized on MRI and were found to be benign on histopathology. This descriptive study reports the MRI characteristics of hepatocellular carcinoma in dogs using the liver-specific contrast agent gadoxetate disodium.
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Affiliation(s)
- Chase Constant
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542.
| | - Linden E Craig
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
| | - Cassie N Lux
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
| | - Claire M Cannon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
| | - Gordon A Conklin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
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Pahade JK, Juice D, Staib L, Israel G, Cornfeld D, Mitchell K, Weinreb J. Is there an added value of a hepatobiliary phase with gadoxetate disodium following conventional MRI with an extracellular gadolinium agent in a single imaging session for detection of primary hepatic malignancies? Abdom Radiol (NY) 2016; 41:1270-84. [PMID: 26800701 DOI: 10.1007/s00261-016-0635-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To determine added value of hepatobiliary phase (HBP) using gadoxetate disodium compared to MRI with extracellular gadolinium-based contrast agent (GBCA) for detection of primary hepatic malignancies in a single imaging session. MATERIALS AND METHODS IRB approved this HIPAA compliant retrospective study. Within 90 days of resection or liver transplant, thirty patients underwent MRI with extracellular GBCA followed by separate injection of gadoxetate for HBP. Two sets of images were reviewed: Set #1-unenhanced and enhanced images with an extracellular GBCA and set #2-with addition of HBP. Data were analyzed in two groups, cases with hepatocellular carcinoma (HCC) only and cases with either HCC and/or cholangiocarcinoma. Observer diagnostic accuracy (Az), sensitivity, and specificity were calculated. RESULTS 14/30 subjects had HCC (46%, CI 28-66%), 2/30 (2%, CI 1-22%) cholangiocarcinoma, and 14/30 (46%, CI 28-66%) no malignancy. There was no significant change in A z value with addition of gadoxetate in the detection of HCC (range 0.84-0.97 set #1 and 0.85-0.97 set #2, p > 0.05). Sensitivity and specificity showed no significant differences (p > 0.05) between the image sets for all readers. When stratified by lesion size, there was no significant difference in accuracy, sensitivity, or specificity for any reader (p > 0.05). CONCLUSION When compared to extracellular GBCA, gadoxetate HBP imaging does not result in a significant difference in accuracy or sensitivity in diagnosis of HCC or cholangiocarcinoma and may result in a decrease in specificity.
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Affiliation(s)
- Jay K Pahade
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - David Juice
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Department of Radiology, UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Lawrence Staib
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Gary Israel
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Dan Cornfeld
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Kisha Mitchell
- Department of Pathology, Yale School of Medicine, 310 Cedar Street, PO Box 208023, New Haven, CT, 06520-8023, USA
| | - Jeffrey Weinreb
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
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Becker-Weidman DJS, Hope TA, Doshi PH, Patel A, Mitchell DG. Transient washout of hepatic hemangiomas: Potential pitfall mimicking malignancy. Radiol Case Rep 2016; 11:62-6. [PMID: 27257451 PMCID: PMC4878935 DOI: 10.1016/j.radcr.2016.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/28/2016] [Indexed: 12/22/2022] Open
Abstract
Hemangiomas are the most common tumor of the liver and distinguishing them from malignancy is important. This is a report of 3 hemangiomas in 2 patients that exhibit transient washout of gadoxetate disodium (Eovist), relative to blood pool and liver parenchyma, a characteristic that is used to diagnose hepatocellular carcinoma in at-risk patients. It is important to recognize that high-flow hemangiomas can exhibit transient washout when using a small volume of injected contrast agent. This finding is unlikely to be present on CT examinations because of the larger volume of contrast administered.
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Affiliation(s)
- David J S Becker-Weidman
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, 10 Main Building, Philadelphia, PA 19107, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143, USA
| | - Pooja H Doshi
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27103, USA
| | - Anuj Patel
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, 10 Main Building, Philadelphia, PA 19107, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, 132 S 10th St, 10 Main Building, Philadelphia, PA 19107, USA
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Ngu S, Lebron-Zapata L, Pomeranz C, Katz S, Gerst S, Zheng J, Moskowitz C, Do RK. Inter-observer agreement on the assessment of relative liver lesion signal intensity on hepatobiliary phase imaging with gadoxetate (Gd-EOB-DTPA). Abdom Radiol (NY) 2016; 41:50-5. [PMID: 26830611 DOI: 10.1007/s00261-015-0609-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The purpose of the study was to assess the inter-observer agreement on the qualitative and quantitative evaluation of relative signal intensity of liver lesions on delayed hepatobiliary phase (HBP) MRI with gadoxetate (Gd-EOB-DTPA). METHODS 105 patients with liver lesions, who had delayed HPB MRI using gadoxetate were reviewed retrospectively. For each patient, four readers (two fellows in training and two attending radiologists) qualitatively assessed the relative SI of the largest representative lesion on a five point scale, and quantitatively measured the relative SI of the lesion to adjacent liver parenchyma using region of interests (ROI). Intra-class correlation (ICC) and kappa statistics with quadratic weights (k) analysis, and maximally selected rank statistic were performed. RESULTS Substantial agreement between fellows (k = 0.719; ICC = 0.705) and almost perfect agreement between attending radiologists (k = 0.853; ICC = 0.849) were found for both qualitative and quantitative assessments of relative SI on delayed HPB imaging. A cut-off ratio to differentiate between hypointense and iso- to hyperintense lesions by ROI was calculated to be 0.90. CONCLUSION Inter-observer agreement of liver lesion relative SI on delayed HBP imaging is high and may improve with radiologist experience. A cut-off ratio of relative SI at 0.90 may be useful to quantitatively distinguish hypointense from iso- to hyperintense liver lesions.
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Wang YXJ. Current status of superparamagnetic iron oxide contrast agents for liver magnetic resonance imaging. World J Gastroenterol 2015; 21:13400-13402. [PMID: 26715826 PMCID: PMC4679775 DOI: 10.3748/wjg.v21.i47.13400] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/09/2015] [Indexed: 02/07/2023] Open
Abstract
Five types of superparamagnetic iron oxide (SPIO), i.e. Ferumoxides (Feridex® IV, Berlex Laboratories), Ferucarbotran (Resovist®, Bayer Healthcare), Ferumoxtran-10 (AMI-227 or Code-7227, Combidex®, AMAG Pharma; Sinerem®, Guerbet), NC100150 (Clariscan®, Nycomed,) and (VSOP C184, Ferropharm) have been designed and clinically tested as magnetic resonance contrast agents. However, until now Resovist® is current available in only a few countries. The other four agents have been stopped for further development or withdrawn from the market. Another SPIO agent Ferumoxytol (Feraheme®) is approved for the treatment of iron deficiency in adult chronic kidney disease patients. Ferumoxytol is comprised of iron oxide particles surrounded by a carbohydrate coat, and it is being explored as a potential imaging approach for evaluating lymph nodes and certain liver tumors.
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Jhaveri K, Cleary S, Audet P, Balaa F, Bhayana D, Burak K, Chang S, Dixon E, Haider M, Molinari M, Reinhold C, Sherman M. 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] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Karam AR, Kim YH, Corwin MT. Gadoxetate disodium-enhanced liver MRI: gallbladder opacification patterns during hepatobiliary phase. Clin Imaging 2013; 38:42-9. [PMID: 24139834 DOI: 10.1016/j.clinimag.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 08/14/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE(S) To describe the different patterns of gallbladder lumen opacification on gadoxetate disodium-enhanced liver magnetic resonance imaging (MRI). METHODS One hundred eighty-seven MRI examinations were reviewed by two abdominal imaging radiologists who described the different patterns of gallbladder opacification, based on comparing the post-contrast to the pre-contrast images. RESULTS Four patterns of gallbladder opacification were identified, all based on the anti-dependent distribution of the excreted biliary contrast inside the gallbladder lumen. Contrast was identified at the level of the gallbladder neck, anti-dependant wall, and gallbladder fundus. One gallbladder completely filled with contrast. CONCLUSION(S) The opacification of the gallbladder lumen follows a distinctive anti-dependent distribution.
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Affiliation(s)
- Adib R Karam
- University of Massachusetts Medical School, Radiology Department, 55 Lake Avenue North, Worcester, MA01655.
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