Aims and objectives
Gd-EOB-DTPA-enhanced MRI(EOB-MRI)
Gd-EOB-DTPA (gadolinium ethoxy- benzyl diethylenetriamine pentaacetic acid)
Liver-specific contrast agent that is taken up specifically by hepatocytes
Also provides information about vascularity
EOB-MRI improves the detectability of hepatocellular carcinoma (HCC) and the characterization of arterial enhancing lesion in the liver.
Transcatheter arterial chemoembolization (TACE)/ lipiodol-transcatheter arterial infusion (lip-TAI)
Established treatment procedure along with surgical resection and percutaneous treatment for HCC
Less invasiveness
Effective against multiple lesions
Dynamic contrast-enhanced CT is a standard modality to detect hypervascular HCCs that are candidates for TACE/lip-TAI.
However,...
Methods and materials
Study population:
44 patients with clinically suspected HCCs who underwent TACE/lip-TAI
Contrast-enhanced CT and EOB-MRI were performed within 2 months before TACE/lip-TAI.
・Duration： 1/2011 to 6/2012
・Gender： male 30, female 14
・Age： 58‒88 years (median 71)
MRI
1.5T: Intera Achieva Nova,
Philips Medical Systems,
Netherlands
3T: Achieva TX,
Philips Medical Systems,
Netherlands
・Fat-suppressed T1-weighted gradient-echo images with a three-dimensional acquisition sequence
・1.5T: TR 3.6,
TE 1.8,
flip angle 18,
FOV 360x252,
slice thickness 3.0 mm,
number of excitations 1
・3T: TR 3.0,
TE 1.4,
flip...
Results
Change of target lesions by adding MRI findings
Case
Presence
27 (61.4 %)
Absence
17 (38.6%)
Total
44
Final target lesions after adding MRI findings
Lesion
Case
Confirmed lesion
26
16 (36.4 %)
Excluded lesion
34
9 (20.5 %)
Additional lesion
17
8 (18.2 %)
Therapeutic effects on confirmed and additional lesions
Effective
Ineffective
Total
Confirmed lesion
20
(76.9%)
6
26
Additional lesion
6
(35.3%)
11
17
(p=0.01,
Fisher’s test )
Observation of excluded lesion
HCC
Not HCC
Total
Excluded lesion
0
(0%)
34
34...
Conclusion
Discussion
・In more than half of the cases,
the target lesions changed by adding EOB-MRI findings to contrast-enhanced CT findings before TACE/lip-TAI.
・None of the excluded target lesions was clinically diagnosed as an HCC by observation.
→EOB-MRI enables us to select appropriate target lesions for TACE/lip-TAI.
・Confirmed target lesions showed a relatively high therapeutic effect of TACE/lip-TAI.
・Additional target lesions showed a low therapeutic effect of TACE/lip-TAI.
→Additional target lesions,
such as well-differentiated or early advanced HCC,
are often small or less hypervascular.
・Such lesions...
References
1.
Hamm B,
Staks T,
Mühler A et al.
(1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety,
pharmacokinetics,
and MR imaging Radiology,
195: 785–792
2.
Golfieri R,
Renzulli M,
Lucidi V,
Corcioni B,
Trevisani F,
Bolondi L.
(2011) Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to Dynamic MRI in the detection of hypovascular small (≤ 2 cm) HCC in cirrhosis.
Eur Radiol 21:1233-1242.
Epub 2011 Feb 5.
3.
Murakami T,
Okada M,
Hyodo T.
(2012) CT versus MR...
