Evaluation of combined Gd-EOB-DTPA and gadobutrol magnetic resonance imaging for the prediction of hepatocellular carcinoma grading

Abstract

Background

Tumor biopsy is not essential for the diagnosis of hepatocellular carcinoma (HCC); however, grading remains important for the prognosis.

Purpose

To investigate whether combined Gd-EOB-DTPA and gadobutrol liver magnetic resonance imaging (MRI) can predict HCC grading.

Material and Methods

Thirty patients (66.6 ± 7.3 years) with histologically confirmed HCC (grade 1, n = 5; grade 1–2, n = 6; grade 2, n = 13; grade 2–3, n = 2; grade 3, n = 4) underwent two liver MRIs, one with gadobutrol and one with Gd-EOB-DTPA, on consecutive days. Blinded to grading, two radiologists reviewed the gadobutrol and Gd-EOB-DTPA images in consensus with respect to: (i) HCC hyper-/iso-/hypointensity in the arterial, portal-venous/delayed, and Gd-EOB-DTPA hepatocellular phase; and (ii) morphologic tumor features (encapsulated growth, vessel invasion, heterogeneity, liver capsule infiltration, satellite metastases).

Results

A significant correlation with grading was not found for either the combined dynamic information of all gadobutrol phases (r = −0.187, P = 0.331) or all the Gd-EOB-DTPA phases (r = 0.052, P = 0.802). No correlation with grading was found for a combination of arterial and hepatocellular phase in Gd-EOB-DTPA MRI (r = 0.209, P = 0.305), a combination of both arterial phases (gadobutrol and Gd-EOB-DTPA) with the Gd-EOB-DTPA hepatocellular phase (r = 0.240, P = 0.248), or a combination of all available gadobutrol and Gd-EOB-DTPA phases (r = 0.086, P = 0.691). For all gadobutrol information (dynamic phases and morphology; r = 0.049, P = 0.801) and for all Gd-EOB-DTPA information (r = 0.040, P = 0.845), no correlation with grading was found. Hepatocellular Gd-EOB-DTPA phase iso-/hyperintensity never occurred in grade 3 HCCs.

Conclusion

Histological HCC grading cannot be predicted by combined Gd-EOB-DTPA/gadobutrol MRI. However, Gd-EOB-DTPA hepatocellular phase iso-/hyperintensity was never detected in grade 3 HCCs.

Keywords

Hepatocellular carcinoma grading magnetic resonance imaging (MRI)Gd-EOB-DTPA gadoxetate gadobutrol

Get full access to this article

View all access options for this article.

References

Altekruse

McGlynn

Reichman

. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol 2009; 27: 1485–1491.

European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: Management of hepatocellular carcinoma. J Hepatol 2012; 56: 908–943.

Wayne

Lauwers

Ikai

. Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg 2002; 235: 722,30:730–731.

Van Beers

Pastor

Hussain

. Primovist, eovist: What to expect? J Hepatol 2012; 57: 421–429.

Hammerstingl

Huppertz

Breuer

. Diagnostic efficacy of gadoxetic acid (primovist)-enhanced MRI and spiral CT for a therapeutic strategy: Comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2008; 18: 457–467.

Huppertz

Balzer

Blakeborough

. Improved detection of focal liver lesions at MR imaging: Multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 2004; 230: 266–275.

Ichikawa

Saito

Yoshioka

. 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. Invest Radiol 2010; 45: 133–141.

Bottcher

Hansch

Pfeil

. Detection and classification of different liver lesions: Comparison of gd-EOB-DTPA-enhanced MRI versus multiphasic spiral CT in a clinical single centre investigation. Eur J Radiol 2013; 82: 1860–1869.

Reimer

Schneider

Schima

. Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: Properties, clinical development and applications. Eur Radiol 2004; 14: 559–578.

10.

Kim

Choi

Kim

. Changes in the signal- and contrast-to-noise ratios of hepatocellular carcinomas on gadoxetic acid-enhanced dynamic MR imaging. Eur J Radiol 2013; 82: 62–68.

11.

Choi

Lee

Kim

. Hepatocellular carcinoma: Imaging patterns on gadoxetic acid-enhanced MR images and their value as an imaging biomarker. Radiology 2013; 267: 776–786.

12.

Park

Jeon

. Prediction of the histopathological grade of hepatocellular carcinoma using qualitative diffusion-weighted, dynamic, and hepatobiliary phase MRI. Eur Radiol 2012; 22: 1701–1708.

13.

Davenport

Viglianti

Al-Hawary

. Comparison of acute transient dyspnea after intravenous administration of gadoxetate disodium and gadobenate dimeglumine: Effect on arterial phase image quality. Radiology 2013; 266: 452–461.

14.

Zizka

Klzo

Ferda

. Dynamic and delayed contrast enhancement in upper abdominal MRI studies: Comparison of gadoxetic acid and gadobutrol. Eur J Radiol 2007; 62: 186–191.

15.

Kuhn

Hegenscheid

Siegmund

. Normal dynamic MRI enhancement patterns of the upper abdominal organs: Gadoxetic acid compared with gadobutrol. Am J Roentgenol 2009; 193: 1318–1323.

16.

Theise

Hepatocellular carcinoma. In: Bosman

Carneiro

Hruban

(eds). WHO Classification of Tumours of the Digestive System, 4th ed. Lyon: International Agency for Research on Cancer (IARC), 2010, pp. 205–216.

17.

Huppertz

Haraida

Kraus

. Enhancement of focal liver lesions at gadoxetic acid-enhanced MR imaging: Correlation with histopathologic findings and spiral CT–initial observations. Radiology 2005; 234: 468–478.

18.

Lee

Jung

. Paradoxical high signal intensity of hepatocellular carcinoma in the hepatobiliary phase of gd-EOB-DTPA enhanced MRI: Initial experience. Magn Reson Imaging 2011; 29: 83–90.

19.

Choi

Kim

Park

. Gadoxetate disodium-enhanced hepatobiliary phase MRI of hepatocellular carcinoma: Correlation with histological characteristics. Am J Roentgenol 2011; 197: 399–405.