Impact of gadoxetic acid (Gd‐EOB‐DTPA)‐enhanced magnetic resonance on the non‐invasive diagnosis of small hepatocellular carcinoma: a prospective study. Issue 3 (2nd December 2012)

• Record Type: Journal Article
• Authors: Granito, A.; Galassi, M.; Piscaglia, F.; Romanini, L.; Lucidi, V.; Renzulli, M.; Borghi, A.; Grazioli, L.; Golfieri, R.; Bolondi, L.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 37:Issue 3(2013)
• Page Start: 355
• Page End: 363
• Publication Date: 2012-12-02
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12166
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12166-abs-0001"> <title>Summary</title> <sec id="apt12166-sec-0001" sec-type="section"> <title>Background</title> <p>Gadoxetic acid (Gd‐EOB‐DTPA) is a 'hepatocyte‐specific' contrast agent for magnetic resonance (MR) in both the vascular and the hepatobiliary phases.</p> </sec> <sec id="apt12166-sec-0002" sec-type="section"> <title>Aim</title> <p>To evaluate the contribution of the hepatobiliary phase of Gd‐EOB‐DTPA MR in the diagnosis of small hepatocellular carcinoma (HCC) in cirrhotic patients under surveillance.</p> </sec> <sec id="apt12166-sec-0003" sec-type="section"> <title>Methods</title> <p>Between 2008 and 2011, 48 consecutive small (10–30 mm) liver nodules were detected in 33 patients, who prospectively underwent contrast‐enhanced ultrasound (CEUS), Gd‐EOB‐DTPA‐enhanced MR and helical‐computed tomography (CT) in a blind study. The diagnosis of HCC was established according to AASLD 2005 criteria.</p> </sec> <sec id="apt12166-sec-0004" sec-type="section"> <title>Results</title> <p>Of the 48 nodules, 38 (79%) were diagnosed as HCC, 24 (63%) of them based on AASLD non‐invasive criteria, 11 diagnosed at histology and 3 during follow‐up. The typical vascular pattern (arterial hypervascularisation and venous/late washout) was detected in 30 (79%) HCC nodules by MR, in 22 (58%) by CT and in 17 (45%) by CEUS. Hypointensity during the MR hepatobiliary phase was observed in all HCC nodules and in 3 nonmalignant nodules (sensitivity 100%, specificity 70%, positive predictive value 93%, negative predictive value 100%, positive likelihood ratio 3.33, negative likelihood ratio 0). Eight (21%) of the 38 HCC nodules, 7 of which lacked the typical vascular features at any of the imaging modalities, showed washout in the portal/venous phase and hypointensity in the hepatobiliary phase at MRI, while this pattern was not detected in any nonmalignant lesion.</p> </sec> <sec id="apt12166-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Gadoxetic acid magnetic resonance may enhance the sensitivity of the non‐invasive diagnosis of small hepatocellular carcinoma nodules in cirrhotic patients under surveillance. Double hypointensity in the portal/venous and hepatobiliary phases could be considered a new magnetic resonance pattern, highly suggestive of hypovascular hepatocellular carcinoma.</p> </sec> </abstract>