Learning objectives
To illustrate typical and atypical findings of various focal hepatic nodules that may show paradoxical uptake or unusual defect in the HBP of Gd-EOB-DTPA-enhanced liver MRI.
To provide tips of differentiation of various focal hepatic nodules in Gd-EOB-DTPA-enhanced MRI.
Background
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA,
also known as gadoxetic acid or gadoxetate disodium) is a newly developed MRI contrast agent that was first approved in Europe in 2004 and then by Food and Drug Administration (FDA) in the United States in 2008 for the detection and characterization of focal liver lesion.
Gd-EOB-DTPA has not only conventional extracellular properties but also hepatocyte-selective properties.
These combined properties make Gd-EOB-DTPA taken by hepatocyte via the organic anion trasporter proteins (OATPs) and excreted into the biliary canaliculivia the multidrug resistance-associated...
Findings and procedure details
I.
Hepatocellular carcinoma (HCC)
1) Typical finding
Hepatocellular carcinoma (HCC),
the most common primary malignant tumor of the liver is a hypervascular tumor,
usually arising in the cirrhotic liver.
The usual findings of HCC are rapid enhancement in the arterial phase,
decreased signal intensity (“washout”) from the portal phase to the equilibrium phase,
and low signal intensity (“defect”) in the hepatobiliary phase (HBP) (Figure 1,
2).
Rapid enhancement in the arterial phase reflects the fact that HCC receive most of blood supply from the hepatic...
Conclusion
Gd-EOB-DTPA improved the detection and characterization of focalhepatic lesions.
In clinical practice,
focalhepatic lesions sometimes show paradoxical uptake or unusual defect in the HBP of gadoxetic acid-enhanced liver MRI.
- HCC : paradoxical uptake in the HBP.
- "Hyervascular" MICC : rapid arterial enhancement and "defect" in the HBP.
- Metastasis : some metastasis may show "target" appearance in the HBP.
However,
"target appearance" is not unusual finding in the hepatic metastasis from the breast cancer.
- "High flow" hemangioma : rapid arterial enhancement and...
References
1.
SA Lee,
CH Lee,
et al,
Paradoxical high signal intensity of hepatocellular carcinoma in the hepatobiliary phase of Gd-EOB-DTPA enhanced MRI: initial experienceMagn Reson Imaging,
2011; 29(1):83-90
2.
Kitao A,
et al,
Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR Imaging--correlation with molecular transporters and histopathologic featuresRadiology 2010; 256(3):817-826
3.
Tsuboyama T,
et al,
Hepatocellular carcinoma: hepatocyte-selective enhancement at gadoxetic acid-enhanced MR imaging--correlation with expression of sinusoidal and canalicular transporters and bile accumulationRadiology 2010;255(3):824-833
4.
Chung YE,
et al,
Varying appearances of cholangiocarcinoma: radiologic-pathologic...