Portal hypertension may influence the registration of hypointensity of small hepatocellular carcinoma in the hepatobiliary phase in gadoxetic acid MR.
hepatocellular carcinoma
liver cirrhosis
magnetic resonance imaging
Journal
Radiology and oncology
ISSN: 1581-3207
Titre abrégé: Radiol Oncol
Pays: Poland
ID NLM: 9317213
Informations de publication
Date de publication:
14 08 2022
14 08 2022
Historique:
received:
04
02
2022
accepted:
24
04
2022
pubmed:
2
7
2022
medline:
17
8
2022
entrez:
1
7
2022
Statut:
epublish
Résumé
The aim of the study was to analyze the association between the liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the hepatobiliary phase (HBP) in cirrhotic patients and the presence of clinically significant portal hypertension (CSPH), and how these features impact on hepatocellular carcinoma (HCC) detection in the HBP. Post-hoc analysis of a prospective cohort of 62 cirrhotic patients with newly US-detected nodule between 1-2 cm (study group). Twenty healthy subjects were used as control group. Qualitative and quantitative analysis of the liver contrast uptake in the HBP assessed by Relative Liver-Enhancement (RLE), Liver-Spleen (LSCR), Liver-Muscle (LMCR), and Liver-Kidney Contrast-Ratio (LKCR), Contrast Enhancement Index (CEI), and Hepatic Uptake (HUI), and biliary excretion, were registered. CSPH was confirmed invasively (HVPG > 10 mmHg) or by indirect parameters. The appearance of HCC at the HBP was analyzed. Nineteen patients (30.6%) did not have CSPH. In 41 patients (66.1%) the final diagnosis was HCC. All indices were significantly higher in the control group, indicating a more intense HBP liver signal intensity compared to patients with cirrhosis, even if the comparison was restricted to patients with no CSPH. CSPH was associated to a lower rate of HCC hypointensity in the HBP (51.9% Liver uptake of Gd-EOB-DTPA at the HBP is decreased in cirrhosis even if the liver function is minimally impaired and it falls down significantly in patients with CSPH compromising the recognition of hypointense lesions. This fact may represent a limitation for the detection of small HCC in patients with cirrhosis and CSPH.
Sections du résumé
BACKGROUND
The aim of the study was to analyze the association between the liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the hepatobiliary phase (HBP) in cirrhotic patients and the presence of clinically significant portal hypertension (CSPH), and how these features impact on hepatocellular carcinoma (HCC) detection in the HBP.
PATIENTS AND METHODS
Post-hoc analysis of a prospective cohort of 62 cirrhotic patients with newly US-detected nodule between 1-2 cm (study group). Twenty healthy subjects were used as control group. Qualitative and quantitative analysis of the liver contrast uptake in the HBP assessed by Relative Liver-Enhancement (RLE), Liver-Spleen (LSCR), Liver-Muscle (LMCR), and Liver-Kidney Contrast-Ratio (LKCR), Contrast Enhancement Index (CEI), and Hepatic Uptake (HUI), and biliary excretion, were registered. CSPH was confirmed invasively (HVPG > 10 mmHg) or by indirect parameters. The appearance of HCC at the HBP was analyzed.
RESULTS
Nineteen patients (30.6%) did not have CSPH. In 41 patients (66.1%) the final diagnosis was HCC. All indices were significantly higher in the control group, indicating a more intense HBP liver signal intensity compared to patients with cirrhosis, even if the comparison was restricted to patients with no CSPH. CSPH was associated to a lower rate of HCC hypointensity in the HBP (51.9%
CONCLUSIONS
Liver uptake of Gd-EOB-DTPA at the HBP is decreased in cirrhosis even if the liver function is minimally impaired and it falls down significantly in patients with CSPH compromising the recognition of hypointense lesions. This fact may represent a limitation for the detection of small HCC in patients with cirrhosis and CSPH.
Identifiants
pubmed: 35776837
pii: raon-2022-0024
doi: 10.2478/raon-2022-0024
pmc: PMC9400438
doi:
Substances chimiques
Contrast Media
0
gadolinium ethoxybenzyl DTPA
0
Gadolinium DTPA
K2I13DR72L
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
292-302Informations de copyright
© 2022 Carla Caparroz, Alejandro Forner, Jordi Rimola, Anna Darnell, Ángeles García-Criado, Juan Ramón Ayuso, María Reig, Jordi Bruix, Carmen Ayuso, published by Sciendo.
Références
Bosch J, Groszmann RJ, Shah VH. Evolution in the understanding of the pathophysiological basis of portal hypertension: how changes in paradigm are leading to successful new treatments. J Hepatol 2015; 62: S121-30. doi: 10.1016/j.jhep.2015.01.003
doi: 10.1016/j.jhep.2015.01.003
de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension. J Hepatol 2015; 63: 743-52. doi: 10.1016/j.jhep.2015.05.022
doi: 10.1016/j.jhep.2015.05.022
Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, et al. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50: 923-8. doi: 10.1016/j.jhep.2009.01.014
doi: 10.1016/j.jhep.2009.01.014
Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, García-Criado A, et al. BCLC strategy for prognosis prediction and treatment recommendation Barcelona Clinic Liver Cancer (BCLC) staging system. The 2022 update. J Hepatol 2022; 76: 681-93. doi: 10.1016/J.JHEP.2021.11.018
doi: 10.1016/J.JHEP.2021.11.018
Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, et al. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 2018; 69: 182-236. doi: 10.1016/j.jhep.2018.03.019
doi: 10.1016/j.jhep.2018.03.019
Van Beers BE, Pastor CM, Hussain HK. Primovist, Eovist: what to expect? J Hepatol 2012; 57: 421-9. doi: 10.1016/j.jhep.2012.01.031
doi: 10.1016/j.jhep.2012.01.031
Kitao A, Zen Y, Matsui O, Gabata T, Kobayashi S, Koda W, et al. Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR Imaging – correlation with molecular transporters and histopathologic features. Radiology 2010; 256: 817-26. doi: 10.1148/radiol.10092214
doi: 10.1148/radiol.10092214
Choi JW, Lee JM, Kim SJ, Yoon JH, Baek JH, Han JK, et al. Hepatocellular carcinoma: imaging patterns on gadoxetic acid-enhanced MR Images and their value as an imaging biomarker. Radiology 2013; 267: 776-86. doi: 10.1148/radiol.13120775
doi: 10.1148/radiol.13120775
Ricke J, Seidensticker M. Molecular imaging and liver function assessment by hepatobiliary MRI. J Hepatol 2016; 65: 1081-2. doi: 10.1016/j. jhep.2016.10.004
doi: 10.1016/j.jhep.2016.10.004
Kukuk GM, Schaefer SG, Fimmers R, Hadizadeh DR, Ezziddin S, Spengler U, et al. Hepatobiliary magnetic resonance imaging in patients with liver disease: correlation of liver enhancement with biochemical liver function tests. Eur Radiol 2014; 24: 2482-90. doi: 10.1007/s00330-014-3291-x
doi: 10.1007/s00330-014-3291-x
Kobi M, Paroder V, Flusberg M, Rozenblit AMM, Chernyak V. Limitations of GD-EOB-DTPA-enhanced MRI: can clinical parameters predict suboptimal hepatobiliary phase? Clin Radiol 2017; 72: 55-62. doi: 10.1016/j. crad.2016.10.004
doi: 10.1016/j.crad.2016.10.004
Okada M, Murakami T, Kuwatsuru R, Nakamura Y, Isoda H, Goshima S, et al. Biochemical and clinical predictive approach and time point analysis of hepatobiliary phase liver enhancement on Gd-EOB-DTPA-enhanced MR images: a multicenter study. Radiology 2016; 281: 474-83. doi: 10.1148/ radiol.2016151061
doi: 10.1148/radiol.2016151061
Zhang W, Wang X, Miao Y, Hu C, Zhao W. Liver function correlates with liver-to-portal vein contrast ratio during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MR at 3 Tesla. Abdom Radiol 2018; 43: 2262-9. doi: 10.1007/s00261-018-1462-y
doi: 10.1007/s00261-018-1462-y
Öcal O, Peynircioglu B, Loewe C, van Delden O, Vandecaveye V, Gebauer B, et al. Correlation of liver enhancement in gadoxetic acid-enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial. Eur Radiol 2021; 32: 1320-9. doi: 10.1007/s00330-021-08218-9
doi: 10.1007/s00330-021-08218-9
Liang M, Zhao J, Xie B, Li C, Yin X, Cheng L, et al. MR liver imaging with Gd-EOB-DTPA: The need for different delay times of the hepatobiliary phase in patients with different liver function. Eur J Radiol 2016; 85: 546-52. doi: 10.1016/j.ejrad.2015.12.015
doi: 10.1016/j.ejrad.2015.12.015
Ippolito D, Famularo S, Giani A, Orsini EB, Pecorelli A, Pinotti E, et al. Estimating liver function in a large cirrhotic cohort: Signal intensity of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI. Dig Liver Dis 2019; 51: 1438-45. doi: 10.1016/J.DLD.2019.04.009
doi: 10.1016/J.DLD.2019.04.009
Yoon JH, Choi JI, Jeong YY, Schenk A, Chen L, Laue H, et al. Pre-treatment estimation of future remnant liver function using gadoxetic acid MRI in patients with HCC. J Hepatol 2016; 65: 1155-62. doi: 10.1016/j.jhep.2016.07.024
doi: 10.1016/j.jhep.2016.07.024
Yoon JH, Lee JM, Kang H, Ahn SJ, Yang H, Kim E, et al. Quantitative assessment of liver function by using Gadoxetic Acid-enhanced MRI: hepatocyte uptake ratio. Radiology 2019; 290: 125-33. doi: 10.1148/radiol.2018180753
doi: 10.1148/radiol.2018180753
Yamada S, Shimada M, Morine Y, Imura S, Ikemoto T, Saito Y, et al. A new formula to calculate the resection limit in hepatectomy based on Gd-EOB-DTPA-enhanced magnetic resonance imaging. PLoS One 2019; 14: e0210579. doi: 10.1371/journal.pone.0210579
doi: 10.1371/journal.pone.0210579
Notake T, Shimizu A, Kubota K, Ikehara T, Hayashi H, Yasukawa K, et al. Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy. BJS Open 2021; 55(4): zraa048. doi: 10.1093/BJSOPEN/ZRAA048
doi: 10.1093/BJSOPEN/ZRAA048
Daire JL, Leporq B, Vilgrain V, Van Beers BE, Schmidt S, Pastor CM. Liver perfusion modifies Gd-DTPA and Gd-BOPTA hepatocyte concentrations through transfer clearances across sinusoidal membranes. Eur J Drug Metab Pharmacokinet 2017; 42: 657-67. doi: 10.1007/s13318-016-0382-x
doi: 10.1007/s13318-016-0382-x
Ayuso C, Forner A, Darnell A, Rimola J, García-Criado Á, Bianchi L, et al. Prospective evaluation of gadoxetic-acid MR for the diagnosis of HCC in newly detected nodules ≤ 2 cm in cirrhosis. Liver Int 2019; 39: 1281-91. doi: 10.1111/liv.14133
doi: 10.1111/liv.14133
Llop E, Berzigotti A, Reig M, Erice E, Reverter E, Seijo S, et al. Assessment of portal hypertension by transient elastography in patients with compensated cirrhosis and potentially resectable liver tumors. J Hepatol 2012; 56: 103-8. doi: S0168-8278(11)00606-4 [pii] 10.1016/j.jhep.2011.06.027
doi: S0168-8278(11)00606-4[pii]10.1016/j.jhep.2011.06.027
Neri E, Bali MA, Ba-Ssalamah A, Boraschi P, Brancatelli G, Alves FC, et al. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 2016; 26: 921-31. doi: 10.1007/ s00330-015-3900-3
doi: 10.1007/s00330-015-3900-3
Ba-Ssalamah A, Bastati N, Wibmer A, Fragner R, Hodge JC, Trauner M, et al. Hepatic gadoxetic acid uptake as a measure of diffuse liver disease: where are we? J Magn Reson Imaging 2017; 45: 646-59. doi: 10.1002/jmri.25518
doi: 10.1002/jmri.25518
Motosugi U, Ichikawa T, Oguri M, Sano K, Sou H, Muhi A, et al. Staging liver fibrosis by using liver-enhancement ratio of gadoxetic acid-enhanced MR imaging: comparison with aspartate aminotransferase-to-platelet ratio index. Magn Reson Imaging 2011; 29: 1047-52. doi: 10.1016/j.mri.2011.05.007
doi: 10.1016/j.mri.2011.05.007
Watanabe H, Kanematsu M, Goshima S, Kondo H, Onozuka M, Moriyama N, et al. Staging hepatic fibrosis: comparison of Gadoxetate Disodium-enhanced and diffusion-weighted MR imaging – preliminary observations. Radiology 2011; 259: 142-50. doi: 10.1148/radiol.10100621
doi: 10.1148/radiol.10100621
Besa C, Lewis S, Pandharipande PV, Chhatwal J, Kamath A, Cooper N, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol 2017; 42: 179-90. doi: 10.1007/s00261-016-0841-5
doi: 10.1007/s00261-016-0841-5
Vietti Violi N, Taouli B. Abbreviated MRI for HCC surveillance: is it ready for clinical use? Eur Radiol 2020; 30: 4147-9. doi: 10.1007/s00330-020-06904-8
doi: 10.1007/s00330-020-06904-8
Canellas R, Rosenkrantz AB, Taouli B, Sala E, Saini S, Pedrosa I, et al. Abbreviated MRI protocols for the abdomen. Radiographics 2019; 39: 744-58. doi: 10.1148/rg.2019180123
doi: 10.1148/rg.2019180123
Koh DM, Ba-Ssalamah A, Brancatelli G, Fananapazir G, Fiel MI, Goshima S, et al. Consensus report from the 9th International Forum for Liver Magnetic Resonance Imaging: applications of gadoxetic acid-enhanced imaging. Eur Radiol 2021; 31: 5615-28. doi: 10.1007/S00330-020-07637-4
doi: 10.1007/S00330-020-07637-4
Hanada K, Nakai K, Tanaka H, Suzuki F, Kumada H, Ohno Y, et al. Effect of nuclear receptor downregulation on hepatic expression of cytochrome P450 and transporters in chronic hepatitis C in association with fibrosis development. Drug Metab Pharmacokinet 2012; 27: 301-6. doi: 10.2133/ dmpk.dmpk-11-rg-077
doi: 10.2133/dmpk.dmpk-11-rg-077
Thakkar N, Slizgi JR, Brouwer KLR. Effect of liver disease on hepatic transporter expression and function. J Pharm Sci 2017; 106: 2282-94. doi: 10.1016/j.xphs.2017.04.053
doi: 10.1016/j.xphs.2017.04.053
Shin NY, Kim MJ, Lim JS, Park MS, Chung YE, Choi JY, et al. Accuracy of gadoxetic acid-enhanced magnetic resonance imaging for the diagnosis of sinusoidal obstruction syndrome in patients with chemotherapy-treated colorectal liver metastases. Eur Radiol 2012; 22: 864-71. doi: 10.1007/ s00330-011-2333-x
doi: 10.1007/s00330-011-2333-x
Yoneda N, Matsui O, Ikeno H, Inoue D, Yoshida K, Kitao A, et al. Correlation between Gd-EOB-DTPA-enhanced MR imaging findings and OATP1B3 expression in chemotherapy-associated sinusoidal obstruction syndrome. Abdom Imaging 2015; 40: 3099-103. doi: 10.1007/s00261-015-0503-z
doi: 10.1007/s00261-015-0503-z
Asenbaum U, Ba-Ssalamah A, Mandorfer M, Nolz R, Furtner J, Reiberger T, et al. Effects of portal hypertension on Gadoxetic Acid-Enhanced liver magnetic resonance: diagnostic and prognostic implications. Invest Radiol 2017; 52: 462-9. doi: 10.1097/RLI.0000000000000366
doi: 10.1097/RLI.0000000000000366
Hectors SJ, Bane O, Kennedy P, Cuevas J, Thung S, Fischman A, et al. Noninvasive diagnosis of portal hypertension using gadoxetate DCE-MRI of the liver and spleen. Eur Radiol 2021; 31: 4804-12. doi: 10.1007/s00330-020-07495-0
doi: 10.1007/s00330-020-07495-0
Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma. Part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2014; 273: 30-50. doi: 1148/ radiol.14132362
doi: 1148/radiol.14132362
Renzulli M, Golfieri R, Bologna Liver Oncology Group (BLOG). Proposal of a new diagnostic algorithm for hepatocellular carcinoma based on the Japanese guidelines but adapted to the Western world for patients under surveillance for chronic liver disease. J Gastroenterol Hepatol 2016; 31: 69-80. doi: 10.1111/jgh.13150
doi: 10.1111/jgh.13150
Renzulli M, Biselli M, Brocchi S, Granito A, Vasuri F, Tovoli F, et al. New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm. Gut 2018; 67: 1674-82. doi: 10.1136/ gutjnl-2017-315384
doi: 10.1136/gutjnl-2017-315384
Ding Y, Rao SX, Chen C, Li R, Zeng MS. Assessing liver function in patients with HBV-related HCC: a comparison of T1 mapping on Gd-EOB-DTPA-enhanced MR imaging with DWI. Eur Radiol 2015; 25: 1392-8. doi: 10.1007/ s00330-014-3542-x
doi: 10.1007/s00330-014-3542-x
Haimerl M, Verloh N, Zeman F, Fellner C, Müller-Wille R, Schreyer AG, et al. Assessment of clinical signs of liver cirrhosis using T1 mapping on Gd-EOB-DTPA-enhanced 3T MRI. PLoS One 2013; 8: e85658 doi: 10.1371/JOURNAL.PONE.0085658
doi: 10.1371/JOURNAL.PONE.0085658