Preliminary Study of Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging for Cirrhosis-Related Nodules_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Xijiao , TANG Hehan , ZHONG Huanhuan , HUANG Zixing ,  SONG Bin

Department of Radiology， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

SONG Bin, Email: ajr.songbin@vip.163.com

Keywords：

Medical imaging; Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid; Magnetic resonanceimaging; Cirrhosis; Nodule; Hepatocelluar carcinoma

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Objective 　To explore the clinical value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid （Gd-EOB-DTPA） enhanced magnetic resonance （MR） imaging for cirrhosis-related nodules.　
Methods 　Nineteen patients who were suspected cirrhosis with lesions of liver were prospectively included for Gd-EOB-DTPA enhanced MR imaging test between Nov. 2011 and Jan. 2013. The hepatobiliary phase （HBP） images were taken in 20 minutes after agents’ injection. The images were diagnosed independently in two groups： group A， including the plain phase and dynamic phase images； group B， including plain phase， dynamic phase， and HBP phase images. The signal intensity （SI） of lesions in HBP images， background liver SI， and background noise standard deviation were measured by using a circular region of interest， then the lesion signal to noise ratio （SNR） and contrast signal to noise ratio （CNR） were calculated.
Results 　Nineteen patients had 25 tumors in all， including 18 hepatocelluar carcinoma （HCC） and 7 regenerative nodule （RN） or dysplastic nodule （DN）， with the diameter ranged from 0.6 cm to 3.2 cm （average 1.3 cm） . Sixteen HCC manifested hypo SI relative to the normal liver， while 2 HCC manifested hyper SI at HBP. Five HCC had cystic necrosis with the necrotic area， and there were no enhancement in artery phase， while performed flocculent enhancement at HBP. Six RN or DN showed hyper SI while another 1 showed iso SI to background liver at HBP. The diagnostic accuracy rates of group A and group B were 80.0% （20/25） and 92.0% （23/25）. SNR of RN or DN at HBP was 132.90±17.21， and of HCC was 114.35±19.27， while the CNR of RN or DN was 19.47±8.20， and of HCC was 112.15±33.52.
Conclusion 　Gd-EOB-DTPA enhanced MR imaging can improve the diagnosis capacity of cirrhosis-related nodules， so as to develop more accurate and reasonable treatment options.

Citation： LIU Xijiao,TANG Hehan,ZHONG Huanhuan,HUANG Zixing,SONG Bin,.. Preliminary Study of Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging for Cirrhosis-Related Nodules. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(3): 328-333. doi: Copy

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14.	Reimer P， Rummeny EJ， Shamsi K， et al. PhaseⅡclinical evalu-ation of Gd-EOB-DTPA：dose， safety aspects， and pulse sequence[J]. Radiology， 1996， 199(1)：177-183.
15.	Weinmann HJ， Ebert W， Misselwitz B， et al. Tissue-specific MR contrast agents[J]. Eur J Radiol， 2003， 46(1)：33-44.
16.	Bollow M， Taupitz M， Hamm B， et al. Gadolinium-ethoxybenzyl-DTPA as a hepatobiliary contrast agent for use in MR cholangiography：results of an in vivo phase-Ⅰclinical evaluation[J]. Eur Radiol， 1997， 7(1)：126-132.
17.	Seale MK， Catalano OA， Saini S， et al. Hepatobiliary-specific MR contrast agents：role in imaging the liver and biliary tree[J]. Radiographics， 2009， 29(6)：1725-1748.
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19.	Ahn SS， Kim MJ， Lim JS， et al. Added value of gadoxetic acid-en-hanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma[J]. Radiology， 2010， 255(2)：459-466.
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21.	Sun HY， Lee JM， Shin CI， et al. Gadoxetic acid-enhanced magn-etic resonance imaging for differentiating small hepatocellular carcinomas (≤2cm in diameter) from arterial enhancing pseudolesions：special emphasis on hepatobiliary phase imaging[J]. Invest Radiol， 2010， 45(2)：96-103.
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1. Parkin DM， Bray F， Ferlay J， et al. Global cancer statistics， 2002[J]. CA Cancer J Clin， 2005， 55(2)：74-108.
2. Llovet JM， Burroughs A， Bruix J. Hepatocellular carcinoma[J]. Lancet，2003，362(9399)：1907-1917.
3. Kudo M. Diagnostic imaging of hepatocellular carcinoma：recent progress[J]. Oncology， 2011， 81 Suppl 1：73-85.
4. Huppertz A， Balzer T， Blakeborough A， et al. Improved detectionof focal liver lesions at MR imaging：multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings[J]. Radiology， 2004， 230(1)：266-275.
5. Park MJ， Kim YK， Lee MW， et al. Small hepatocellular carcino-mas：improved sensitivity by combining gadoxetic acid-enhanced and diffusion-weighted MR imaging patterns[J]. Radiology， 2012， 264(3)：761-770.
6. Krinsky G. Terminology of hepatocellular nodules in cirrhosis：plea for consistency[J]. Radiology， 2002， 224(3)：638.
7. Kudo M. Multistep human hepatocarcinogenesis：correlation of imaging with pathology[J]. J Gastroenterol， 2009， 44 Suppl 19：112-118.
8. Nascimento C， Bottino A， Nogueira C， et al. Analysis of morph-ological variables and arterialization in the differential diagnosisof hepatic nodules in explanted cirrhotic livers[J]. Diagn Pathol，.
9. Bruix J， Sherman M. Management of hepatocellular carcinoma[J]. Hepatology， 2005， 42(5)：1208-1236.
10. Debruyne EN， Delanghe JR. Diagnosing and monitoring hepato-cellular carcinoma with alpha-fetoprotein：new aspects and applications[J]. Clin Chim Acta， 2008， 395(1-2)：19-26.
11. Di Martino M， Marin D， Guerrisi A. Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the detection of hepatocellular carcinoma in patients with cirrhosis[J]. Radiology， 2010， 256(3)：806-816.
12. Ichikawa T， Saito K， Yoshioke N， et al. Detection and characterization of focal liver lesions：a Japanese phase Ⅲ， multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease[J]. Invest Radiol， 2010， 45(3)：133-141.
13. Hamm B， Staks T， Mühler A， et al. Phase Ⅰ clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent：safety， pharmacokinetics， and MR imaging[J]. Radiology， 1995， 195(3)：785-792.
14. Reimer P， Rummeny EJ， Shamsi K， et al. PhaseⅡclinical evalu-ation of Gd-EOB-DTPA：dose， safety aspects， and pulse sequence[J]. Radiology， 1996， 199(1)：177-183.
15. Weinmann HJ， Ebert W， Misselwitz B， et al. Tissue-specific MR contrast agents[J]. Eur J Radiol， 2003， 46(1)：33-44.
16. Bollow M， Taupitz M， Hamm B， et al. Gadolinium-ethoxybenzyl-DTPA as a hepatobiliary contrast agent for use in MR cholangiography：results of an in vivo phase-Ⅰclinical evaluation[J]. Eur Radiol， 1997， 7(1)：126-132.
17. Seale MK， Catalano OA， Saini S， et al. Hepatobiliary-specific MR contrast agents：role in imaging the liver and biliary tree[J]. Radiographics， 2009， 29(6)：1725-1748.
18. Goodwin MD， Dobson JE， Sirlin CB， et al. Diagnostic challengesand pitfalls in MR imaging with hepatocyte-specific contrast agents[J]. Radiographics， 2011， 31(6)：1547-1568.
19. Ahn SS， Kim MJ， Lim JS， et al. Added value of gadoxetic acid-en-hanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma[J]. Radiology， 2010， 255(2)：459-466.
20. Golfieri R， Renzulli M， Lucidi V， et al. Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to dynamic MRI in the detection of hypovascular small (≤2cm) HCC incirrhosis[J]. Eur Radiol， 2011， 21(6)：1233-1242.
21. Sun HY， Lee JM， Shin CI， et al. Gadoxetic acid-enhanced magn-etic resonance imaging for differentiating small hepatocellular carcinomas (≤2cm in diameter) from arterial enhancing pseudolesions：special emphasis on hepatobiliary phase imaging[J]. Invest Radiol， 2010， 45(2)：96-103.
22. Motosugi U， Ichikawa T， Sou H， et al. Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging[J].Radiology， 2010， 256(1)：151-158.
23. ， 2：51.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary Study of Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging for Cirrhosis-Related Nodules

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