The Quantitative Evaluation of Primary Liver Lesions on Hepatocyte Specific Contrast Enhanced Magnetic Resonance Imaging

Öz

Introduction: Most of the previous researchers evaluated contrast-noise ratio, SI lesion/SI liver parenchyma, and DWI in their studies for quantitative analysis of liver lesions. We aimed to investigate the diagnostic value of the quantitative measurements with new formulas calculated on Gd-EOB-DTPA enhanced DCE-MR images with 30° and 10° FA at the hepatobiliary phase and DWI.

Material-Methods: There was a total of 54 primary liver lesions; n=23 HCC in the malignant group and n=19 hemangioma, n=6 FNH, n=3 hepatic adenoma, n=3 dysplastic nodule in the benign group. Relative contrast enhancement  [RCE= (HBP-Pre)/Pre], absolute contrast enhancement [ACE= (SI lesion- SI liver)/ SI paravertebral muscle], absolute washout [AW=(AP-HBP)/(AP-Pre)], relative washout (RW=AP-HBP/AP) and ADC values were calculated.

Results: There was a significant difference in the quantitative measurements among the liver lesion groups. HCC demonstrated significantly higher AW and RW, lower ACE and RCE values than the benign group. The ICC values between the two FA measurements were good for RCE and RW, but not for ACE and AW. HCC demonstrated significantly lower ADC values than the benign group. According to ROC analysis, cut-off values for HCC were calculated [ACE; -3.5 (sensitivity 100%, specificity 45.6%, accuracy 68.5 %), AW; 0.53 (sensitivity 87%, specificity 51.6%, accuracy 66.7%), RW; 0.105 (sensitivity 95.7%, specificity 48.4%, accuracy 68.5%), RCE; -0,03 (sensitivity 73.9%, specificity 67.7%, accuracy 70.4%), ADC; 1.09 (sensitivity 73.9%, specificity 74.2%, accuracy 74.1%)].

Conclusion: We suggest that our quantitative measurements and DWI can be useful in differentiation between HCC and other benign lesions in conflicting cases.

Anahtar Kelimeler

• liver,hepatocellular carcinoma,contrast,quantitative

The Quantitative Evaluation of Primary Liver Lesions on Hepatocyte Specific Contrast Enhanced Magnetic Resonance Imaging

Öz

Giriş: Daha önce araştırmacılar kontrast-gürültü oranı, SI lezyon/SI karaciğer parankimi ve DAG’yi karaciğer lezyonlarının kantitatif değerlendirmesi için kullanmışlardır. Biz çalışmamızda Gd-EOB-DTPA kontrast ajanlı DCE-MRG’de 30° ve 10° FA ile çekilmiş hepatobiliyer faz görüntülerde yeni oluşturduğumuz formülleri kullanarak ve DAG inceleme ile yapılan kantitatif değerlendirmenin primer karaciğer lezyonları için tanısal değerini araştırmayı amaçladık.

Gereç ve Yöntem: 54 primer karaciğer lezyonu; malign grupta n=23 HCC, benign grupta n=19 hemangioma, n=6 FNH, n=3 hepatik adenom, n=3 displastik nodül çalışmaya dahil edildi. Relatif kontrastlanma [RCE= (HBP-Pre)/Pre],  mutlak kontrastlanma [ACE= (SI lezyon- SI karaciğer)/ SI paravertebral kas], mutlak yıkanma [AW=(AP-HBP)/(AP-Pre)], relatif yıkanma (RW=AP-HBP/AP) ve ADC değerleri hesaplandı. 

Bulgular: Karaciğer lezyon grupları arasında kantitatif ölçümlerde anlamlı farklılık bulundu. HCC benign gruba göre daha yüksek AW and RW, düşük ACE ve RCE değerleri gösterdi. İki FA ölçümleri arasında ICC değerleri RCE ve RW ölçümleri için iyi iken, ACE ve AW değerleri için değildi. HCC benign gruba göre daha düşük ADC değerleri gösterdi. ROC analizine göre; HCC için hesaplanan kesme değerleri şu şekildedir; [ACE; -3.5 (duyarlılık %100, özgüllük %45.6, doğruluk %68.5), AW; 0.53 (duyarlılık %87, özgüllük %51.6, doğruluk %66.7), RW; 0.105 (duyarlılık %95.7, özgüllük %48.4, doğruluk %68.5), RCE; -0,03 (duyarlılık %73.9, özgüllük %67.7, doğruluk %70.4), ADC; 1.09 (duyarlılık %73.9, özgüllük %74.2, doğruluk %74.1)].

Sonuç: Kantitatif ölçüm ve DAG’nin arada kalınılan olgularda HCC ve benign karaciğer lezyon ayrımında yararlı olacağını düşünmekteyiz. 

Anahtar Kelimeler

• hepatoselüler karsinom,kantitatif,karaciğer,kontrast

Kaynakça

1. 1. Chandarana H, Taouli B. Diffusion and perfusion imaging of the liver. European journal of radiology. 2010;76(3):348-58.
2. 2. Low RN. Abdominal MRI advances in the detection of liver tumours and characterisation. The Lancet Oncology. 2007;8(6):525-35.
3. 3. Pirasteh A, Clark HR, Sorra EA, Pedrosa I, Yokoo T. Effect of steatosis on liver signal and enhancement on multiphasic contrast-enhanced magnetic resonance imaging. Abdominal Radiology. 2016;41(9):1744-50.
4. 4. Jeong WK, Kim YK, Song KD, Choi D, Lim HK. The MR imaging diagnosis of liver diseases using gadoxetic acid: emphasis on hepatobiliary phase. Clinical and molecular hepatology. 2013;19(4):360.
5. 5. Lee NK, Kim S, Lee JW, Lee SH, Kang DH, Kim GH, et al. Biliary MR imaging with Gd-EOB-DTPA and its clinical applications. Radiographics. 2009;29(6):1707-24.
6. 6. Reimer P, Schneider G, Schima W. Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. European radiology. 2004;14(4):559-78.
7. 7. Evelhoch JL. Key factors in the acquisition of contrast kinetic data for oncology. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 1999;10(3):254-9.
8. 8. Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology. 1999;211(1):101-10.

9. 9. Cho E-S, Yu J-S, Park AY, Woo S, Kim JH, Chung J-J. Feasibility of 5-minute delayed transition phase imaging with 30° flip angle in gadoxetic acid–enhanced 3D gradient-echo MRI of liver, compared with 20-minute delayed hepatocyte phase MRI with standard 10° flip angle. American Journal of Roentgenology. 2015;204(1):69-75.
10. 10. Frericks BB, Loddenkemper C, Huppertz A, Valdeig S, Stroux A, Seja M, et al. Qualitative and quantitative evaluation of hepatocellular carcinoma and cirrhotic liver enhancement using Gd-EOB-DTPA. American Journal of Roentgenology. 2009;193(4):1053-60.
11. 11. Kim AW, Kim YK, Park HJ, Park MJ, Lee WJ, Choi D. Diagnosis of focal liver lesions with gadoxetic acid‐enhanced MRI: Is a shortened delay time possible by adding diffusion‐weighted imaging? Journal of Magnetic Resonance Imaging. 2014;39(1):31-41.
12. 12. Morelli JN, Michaely HJ, Meyer MM, Rustemeyer T, Schoenberg SO, Attenberger UI. Comparison of dynamic and liver-specific gadoxetic acid contrast-enhanced MRI versus apparent diffusion coefficients. PloS one. 2013;8(6):e61898.
13. 13. Jeon I, Cho E-S, Kim JH, Kim DJ, Yu J-S, Chung J-J. 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(12):e0167701.
14. 14. Lee D, Cho E-S, Kim DJ, Kim JH, Yu J-S, Chung J-J. Validation of 10-Minute Delayed Hepatocyte Phase Imaging with 30 Flip Angle in Gadoxetic Acid-Enhanced MRI for the Detection of Liver Metastasis. PloS one. 2015;10(10):e0139863.
15. 15. Kitao A, Zen Y, Matsui O, Gabata T, Kobayashi S, Koda W, et al. Hepatocellular carcinoma: signal intensity at gadoxetic acid–enhanced MR imaging—correlation with molecular transporters and histopathologic features. Radiology. 2010;256(3):817-26.
16. 16. Tsuboyama T, Onishi H, Kim T, Akita H, Hori M, Tatsumi M, et al. Hepatocellular carcinoma: hepatocyte-selective enhancement at gadoxetic acid–enhanced MR imaging—correlation with expression of sinusoidal and canalicular transporters and bile accumulation. Radiology. 2010;255(3):824-33.
17. 17. Gandhi SN, Brown MA, Wong JG, Aguirre DA, Sirlin CB. MR contrast agents for liver imaging: what, when, how. Radiographics. 2006;26(6):1621-36.
18. 18. Seale ACE, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics. 2009;29(6):1725-48.
19. 19. Campos JT, Sirlin CB, Choi J-Y. Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas. Insights into imaging. 2012;3(5):451-74.
20. 20. Cruite I, Schroeder M, Merkle EM, Sirlin CB. Gadoxetate disodium–enhanced MRI of the liver: part 2, protocol optimization and lesion appearance in the cirrhotic liver. American Journal of Roentgenology. 2010;195(1):29-41.
21. 21. Roncalli M, Roz E, Coggi G, Di Rocco MG, Bossi P, Minola E, et al. The vascular profile of regenerative and dysplastic nodules of the cirrhotic liver: implications for diagnosis and classification. Hepatology. 1999;30(5):1174-8.
22. 22. Tajima T, Honda H, Taguchi K, Asayama Y, Kuroiwa T, Yoshimitsu K, et al. Sequential hemodynamic change in hepatocellular carcinoma and dysplastic nodules: CT angiography and pathologic correlation. American Journal of Roentgenology. 2002;178(4):885-97.
23. 23. Hanna RF, Aguirre DA, Kased N, Emery SC, Peterson MR, Sirlin CB. Cirrhosis-associated hepatocellular nodules: correlation of histopathologic and MR imaging features. Radiographics. 2008;28(3):747-69.
24. 24. Fujita M, Yamamoto R, Fritz‐Zieroth B, Yamanaka T, Takahashi M, Miyazawa T, et al. Contrast enhancement with GD‐EOB‐DTPA in MR imaging of hepatocellular carcinoma in mice: A comparison with superparamagnetic iron oxide. Journal of Magnetic Resonance Imaging. 1996;6(3):472-7.
25. 25. Huppertz A, Haraida S, Kraus A, Zech CJ, Scheidler J, Breuer J, et al. Enhancement of focal liver lesions at gadoxetic acid–enhanced MR imaging: correlation with histopathologic findings and spiral CT—initial observations. Radiology. 2005;234(2):468-78.
26. 26. Kim SH, Kim SH, Lee J, Kim MJ, Jeon YH, Park Y, et al. Gadoxetic acid–enhanced MRI versus triple-phase MDCT for the preoperative detection of hepatocellular carcinoma. American Journal of Roentgenology. 2009;192(6):1675-81.
27. 27. Shimofusa R, Ueda T, Kishimoto T, Nakajima M, Yoshikawa M, Kondo F, et al. Magnetic resonance imaging of hepatocellular carcinoma: a pictorial review of novel insights into pathophysiological features revealed by magnetic resonance imaging. Journal of hepato-biliary-pancreatic sciences. 2010;17(5):583-9.
28. 28. Doo KW, Lee CH, Choi JW, Lee J, Kim KA, Park CM. “Pseudo washout” sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. American Journal of Roentgenology. 2009;193(6):W490-W6.
29. 29. Kamel IR, Liapi E, Fishman EK. Focal nodular hyperplasia: lesion evaluation using 16-MDCT and 3D CT angiography. American Journal of Roentgenology. 2006;186(6):1587-96.
30. 30. Wanless IR, Mawdsley C, Adams R. On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology. 1985;5(6):1194-200.
31. 31. Grazioli L, Morana G, Federle MP, Brancatelli G, Testoni M, Kirchin MA, et al. Focal nodular hyperplasia: morphologic and functional information from MR imaging with gadobenate dimeglumine. Radiology. 2001;221(3):731-9.
32. 32. Zech CJ, Grazioli L, Breuer J, Reiser MF, Schoenberg SO. Diagnostic performance and description of morphological features of focal nodular hyperplasia in Gd-EOB-DTPA-enhanced liver magnetic resonance imaging: results of a multicenter trial. Investigative radiology. 2008;43(7):504-11.
33. 33. Chen B-B, Shih TT-F. DCE-MRI in hepatocellular carcinoma-clinical and therapeutic image biomarker. World journal of gastroenterology: WJG. 2014;20(12):3125.
34. 34. Kloeckner R, dos Santos DP, Kreitner K-F, Leicher-Düber A, Weinmann A, Mittler J, et al. Quantitative assessment of washout in hepatocellular carcinoma using MRI. BMC cancer. 2016;16(1):758.
35. 35. Goshima S, Kanematsu M, Kondo H, Yokoyama R, Kajita K, Tsuge Y, et al. Diffusion‐weighted imaging of the liver: optimizing b value for the detection and characterization of benign and malignant hepatic lesions. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2008;28(3):691-7.
36. 36. Kele PG, van der Jagt EJ. Diffusion weighted imaging in the liver. World journal of gastroenterology: WJG. 2010;16(13):1567.
37. 37. Feuerlein S, Pauls S, Juchems MS, Stuber T, Hoffmann MH, Brambs H-J, et al. Pitfalls in abdominal diffusion-weighted imaging: how predictive is restricted water diffusion for malignancy. American Journal of Roentgenology. 2009;193(4):1070-6.
38. 38. Lichy MP, Aschoff P, Plathow C, Stemmer A, Horger W, Mueller-Horvat C, et al. Tumor detection by diffusion-weighted MRI and ADC-mapping—initial clinical experiences in comparison to PET-CT. Investigative radiology. 2007;42(9):605-13.
39. 39. Sandrasegaran K, Akisik FM, Lin C, Tahir B, Rajan J, Aisen AM. The value of diffusion-weighted imaging in characterizing focal liver masses. Academic radiology. 2009;16(10):1208-14.