Use of gadobenate dimeglumine dynamic MRI for detection of early hepatocellular carcinoma in atypical hepatic focal lesions

Abstract

Aim: Gadobenate dimeglumine (multihance) is a contrast medium which can be used not only as an extracellular contrast agent for dynamic imaging of the liver, but also as a liver specific agent for the acquisition of hepatobiliary-phase images which are more helpful in evaluation of small atypical hepatic focal lesions equal or less than 3 cm. The authors tried to evaluate multihance dynamic magnetic resonance imaging (MRI) as a new modality in early detection of hepatocellular carcinoma (HCC).

Methods: Thirty cirrhotic patients with small hepatic focal lesions (less than 3 cm in diameter), detected by imaging (ultrasound and triphasic computed tomography) were subjected to dynamic MRI with multihance contrast. All patients had a liver biopsy stained with heat shock protein 70, glypican 3, and glutamine synthetase to confirm the diagnosis of HCC.

Results: Eight out of 30 patients (26.6%) with atypical focal lesions proved to have HCC by histology, whereas 7 out of 8 histologically proven HCC patients (87.5%) were shown to have typical criteria on Multihance imaging.

Conclusion: Multihance dynamic MRI is a promising diagnostic modality for detection of early HCC, however, future studies on large numbers of patients are warranted to precisely detect the sensitivity and specificity of this new modality.

Keywords

Dynamic magnetic resonance imaging / multihance / gadobenate dimeglumine / early detection / hepatocellular carcinoma

References

[1] Bruix J.Management of hepatocellular carcinoma: an update..Hepatology2011;53:1020-2

[2] Shen YC,Cheng CC,Cheng AL.A critical evaluation of the preventive effect of antiviral therapy on the development of HCC in patients with chronic hepatitis C or B..Oncology2012;82:275-89

[3] Stangovanni A,Fasani P,Romeo R,Del Ninno E,Colombo M.The natural history of compensated cirrhosis due to hepatitis C virus: a 17-year cohort study of 214 patients..Hepatology2006;34:1303-10

[4] Matsui O,Sanada J,Ryu Y,Kitao A,Gabata T.Hepatocellular nodules in liver cirrhosis: hemodynamic evaluation (angiography-assisted CT) with special reference to multi-step hepatocarcinogenesis..Abdom Imaging2011;3:264-72 PMCID:PMC3102849

[5] Kudo M.Early hepatocellular carcinoma: definition and diagnosis..Liver Cancer2013;2:69-72 PMCID:PMC3740734

[6] Llovet JM.Novel advancement in management of hepatocellular carcinoma in 2008..J Hepatol2008;48:S20-37

[7] Ricke J,Mohnike K.Noninvasive diagnosis of HCC in cirrhotic liver: current guidelines and future prospects for radiological imaging..Liver Cancer2012;1:51-8 PMCID:PMC3747541

[8] Bolondi L,Celli N,Grigioni WF,Venturi AM.Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma..Hepatology2005;42:27-34

[9] Kim I.Histological characteristics of HCC showing atypical en-hancement pattern on 4-phase MDCT examination..Korean J Radiol2012;13:586-93 PMCID:PMC3435856

[10] Bartolozzi C,Lenicioni R,Della Pina C.Biliary and reticuloendothelial impairment in hepatocarcinogenesis: the diagnostic role of tissue-specific MR contrast media..Eur Radiol2007;17:2519-30

[11] Kim JI,Choi JY,Kim SH,Han JK.The value of gadobenate dimeglumine-enhanced delayed phase MRI for characterization of hepatocellular nodules in the cirrhotic liver..Invest Radiol2008;43:202-10

[12] Kudo M,Izumi N,Kadoya M.Liver cancer study group of Japan surveillance and diagnostic algorithm for hepatocellular carcinoma proposed by the liver cancer study group of Japan: 2014 update..Oncology2014;87 Suppl 1:7-21

[13] Lee JM,Choi BI.2014 KLCSG-NCC Korea practice guidelines for the management of hepatocellular carcinoma: HCC diagnostic algorithm..Dig Dis2014;32:764-77

[14] Mitchell DG,Sherman M.LI-RADS (liver imaging reporting and data system): summary, discussion, and consensus of the LI-RADS management working group and future directions..Hepatology2015;61:1056-65

[15] Kudo M,Izumi N,Kadoya M,Okusaka T,Tsuchiya K,Hiraoka A,Ogasawara S,Minami T.JSH Consensus-Based Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma: 2014 Update by the Liver Cancer Study Group of Japan..Liver Cancer2014;3:458-68 PMCID:PMC4531423

[16] Bota S,Marinelli S,Terzi E.Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma..Liver Cancer2012;1:190-200

[17] Sanz-Cameno P,Chaparro M,Moreno-Otero R.Angiogenesis: from chronic liver inflammation to hepatocellular carcinoma..J Oncol2010;2010:272170 PMCID:PMC2878677

[18] Kim YK,Han YM.Detection of small hepatocellular carcinoma: can gadoxetic acid-enhanced magnetic resonance imaging replace combining gadopentetatedimeglumine-enhanced and superparamagnetic iron oxide-enhanced magnetic resonance imaging?.Invest Radiol2010;45:740-6

[19] Ahn SS,Lim JS,Chung YE.Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma..Radiology2010;255:459-66

[20] Inoue T,Komuta M,Ueda T,Kitai S,Yada N,Chung H,Ueshima K,Maenishi O,Okada M,Murakami T.Assessment of Gd-EOB-DTPA-enhanced MRI for HCC and dysplastic nodules and comparison of detection sensitivity versus MDCT..J Gastroenterol2012;47:1036-47

[21] Kim TK,Jang HJ,Menesez RJ,Yazdi L,Khalil K.Analysis of gadobenatedimenglumine-enhanced MR findings for characterizing small (1-2) hepatic nodules inpatients at high risk for hepatocellular carcinoma..Radiology2011;259:730-8

[22] Kim YK,Kwak HS,Han YM.Clinical implication of small (< 20 mm) enhancing hepatic nodules observed only during three-dimensional gadobenatedimenglumine-enhanced arterial-phase MRI of the hepatitis B virus-induced mild cirrhosis..Clin Imaging2008;32:453-9

[23] Quaia E,De Paoli L,Ukmar M.Arterial enhancing-only nodules less than 2 cm in diameter in patients with liver cirrhosis: predictors of hepatocellular carcinoma diagnosis on gadobenatedimenglumine-enhanced MR imaging..J Mag Reson Imaging2013;37:892-902