The Value of Gadobenate Dimeglumine-Enhanced Delayed Phase... : Investigative Radiology (original) (raw)

Original Article

The Value of Gadobenate Dimeglumine-Enhanced Delayed Phase MR Imaging for Characterization of Hepatocellular Nodules in the Cirrhotic Liver

Kim, Jung Im MD*; Lee, Jeong Min MD*†§; Choi, Jin Young MD¶; Kim, Young Kon MD‡; Kim, Se Hyung MD*†; Lee, Jae Young MD*†; Han, Joon Koo MD*†; Choi, Byung Ihn MD*†

From the *Department of Radiology and †Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea; ‡Department of Radiology, Chonbuk National University Hospital, Cheon-Ju, Korea; §Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA; and ¶Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

Received April 21, 2007, and accepted for publication, after revision, October 6, 2007.

Reprints: Jeong Min Lee, MD, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea. E-mail: [email protected].

Abstract

Objectives:

To evaluate the value of 1-hour delayed phase imaging (DPI) of gadobenate dimeglumine (Gd-BOPTA)-enhanced MR imaging for the characterization of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in patients with cirrhosis.

Materials and Methods:

A total of 37 patients with 42 HCCs and 13 DNs were included in this study and all lesions were histopathologically confirmed except for 15 HCCs. T1-weighted 3-dimensional gradient-echo images were acquired before, immediately after (30, 60, 180 s), and 1 hour after bolus injection of gadobenate dimeglumine at a dose of 0.1 mmol/kg. The lesions were classified as isointense, hypointense, or hyperintense compared with the surrounding liver parenchyma on DPI for qualitative assessment. We performed quantitative analyses of the contrast-to-noise ratio (CNR) and of the relative contrast enhancement of the lesion on the DPI.

Results:

In the qualitative analysis, among 42 HCCs, 30 (71.4%) were hypointense on DPI, and 10 (23.8%) and 2 (4.8%) were isointense and hyperintense, respectively; only 1 of 13 DNs (7.7%) was hypointense and 10 (76.9%) and 2 (15.4%) were isointense and hyperintense, respectively. In contrast, 25 HCCs (71.4%) of 35 hypervascular HCCs were hypointense on DPI, and no hypervascular DN (0/7) was hypointense with statistical significance (P = 0.0007). When we considered the hypointensity of the hepatic lesions on delayed phase as a sign of HCC in cirrhotic liver, our results gave a sensitivity of 71.4% and a specificity of 91.7%. In the quantitative analysis, the mean CNR of the HCCs and the DNs on the 1-hour DPI was −6.32 ± 6.27 and −0.07 ± 3.28, respectively; the difference between the HCCs and the DNs was significant (P < 0.05).

Conclusions:

Delayed gadobenate dimeglumine-enhanced MR imaging allows improved characterization of HCC in cirrhotic liver. The relative hypointensity to adjacent normal liver parenchyma is a reliable predictor that this lesion favors HCC rather than DN in cirrhotic liver.