Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid(Gd-EOB-DTPA) properties. Following contrast injection, it ...Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid(Gd-EOB-DTPA) properties. Following contrast injection, it provides dynamic vascular phases(arterial, portal and equilibrium phases) and hepatobiliary phase, the latter due to its uptake by functional hepatocytes. The main advantages of Gd-EOB-DTPA of focal liver lesion detection and characterization are discussed in this paper. Namely, we focus on the possibility of distinguishing focal nodular hyperplasia(FNH) from hepatic adenoma(HA), the identification of early hepatocellular carcinoma(HCC) and the pre-operative assessment of metastasis in liver parenchyma. Regarding the differentiation between FNH and HA, adenoma typically appears hypointense in hepatobiliary phase, whereas FNH is isointense or hyperintense to the surrounding hepatic parenchyma. As for the identification of early HCCs, many papers recently published in literature have emphasized the contribution of hepatobiliary phase in the characterization of nodules without a typical hallmark of HCC. Atypical nodules(no hypervascularizaton observed on arterial phase and/or no hypovascular appearance on portal phase) with low signal intensity in the hepatobiliary phase, have a high probability of malignancy. Finally, regarding the evaluation of focal hepatic metastases, magnetic resonance pre-operative assessment using gadoxetic acid allows for more accurate diagnosis.展开更多
BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) usi...BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypoi展开更多
目的比较两种注射速度(1、1.5 m L/s)钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA)增强磁共振(magnetic resonance,MR)肝脏动态增强动脉期图像质量的优劣性。方法回顾性评估本院2012年12月至2...目的比较两种注射速度(1、1.5 m L/s)钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA)增强磁共振(magnetic resonance,MR)肝脏动态增强动脉期图像质量的优劣性。方法回顾性评估本院2012年12月至2013年9月接受Gd-EOB-DTPA肝脏MR动态增强检查的患者106例,包括注射速度为1 m L/s患者52例,1.5 m L/s患者54例,对动脉期增强图像进行评估。由2名副高以上诊断医师定量评估所有患者肝脏动脉期腹主动脉、肝总动脉、肝脏实质的信噪比(signal noise ratio,SNR)和强化率(contrast-enhancement ratio,CER)的差异性,定性评估腹主动脉、肝总动脉、肝脏实质、门静脉和图像伪影5个项目得分和总分的差异性。结果 Gd-EOB-DTPA注射速度为1 m L/s组和1.5 m L/s组各部分SNR和CER差异无统计学意义(P>0.05),1 m L/s组腹主动脉、肝总动脉强化评分和总分均高于1.5 m L/s组(P<0.05)。结论 Gd-EOB-DTPA注射速度为1 m L/s的肝脏动脉期图像质量优于注射速度为1.5 m L/s的肝脏动脉期图像质量。展开更多
文摘Since its clinical introduction, several studies in literature have investigated gadolinium ethoxybenzhyl diethylenetriaminepentaacetic acid or gadoxetic acid(Gd-EOB-DTPA) properties. Following contrast injection, it provides dynamic vascular phases(arterial, portal and equilibrium phases) and hepatobiliary phase, the latter due to its uptake by functional hepatocytes. The main advantages of Gd-EOB-DTPA of focal liver lesion detection and characterization are discussed in this paper. Namely, we focus on the possibility of distinguishing focal nodular hyperplasia(FNH) from hepatic adenoma(HA), the identification of early hepatocellular carcinoma(HCC) and the pre-operative assessment of metastasis in liver parenchyma. Regarding the differentiation between FNH and HA, adenoma typically appears hypointense in hepatobiliary phase, whereas FNH is isointense or hyperintense to the surrounding hepatic parenchyma. As for the identification of early HCCs, many papers recently published in literature have emphasized the contribution of hepatobiliary phase in the characterization of nodules without a typical hallmark of HCC. Atypical nodules(no hypervascularizaton observed on arterial phase and/or no hypovascular appearance on portal phase) with low signal intensity in the hepatobiliary phase, have a high probability of malignancy. Finally, regarding the evaluation of focal hepatic metastases, magnetic resonance pre-operative assessment using gadoxetic acid allows for more accurate diagnosis.
文摘BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2. AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1). METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusionweighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules. RESULTS There were 39 (34.2%;39 of 114) and 75 (65.8%;75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67;95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203;95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypoi
文摘目的比较两种注射速度(1、1.5 m L/s)钆塞酸二钠(Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA)增强磁共振(magnetic resonance,MR)肝脏动态增强动脉期图像质量的优劣性。方法回顾性评估本院2012年12月至2013年9月接受Gd-EOB-DTPA肝脏MR动态增强检查的患者106例,包括注射速度为1 m L/s患者52例,1.5 m L/s患者54例,对动脉期增强图像进行评估。由2名副高以上诊断医师定量评估所有患者肝脏动脉期腹主动脉、肝总动脉、肝脏实质的信噪比(signal noise ratio,SNR)和强化率(contrast-enhancement ratio,CER)的差异性,定性评估腹主动脉、肝总动脉、肝脏实质、门静脉和图像伪影5个项目得分和总分的差异性。结果 Gd-EOB-DTPA注射速度为1 m L/s组和1.5 m L/s组各部分SNR和CER差异无统计学意义(P>0.05),1 m L/s组腹主动脉、肝总动脉强化评分和总分均高于1.5 m L/s组(P<0.05)。结论 Gd-EOB-DTPA注射速度为1 m L/s的肝脏动脉期图像质量优于注射速度为1.5 m L/s的肝脏动脉期图像质量。
