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01-01-2015 | Gastrointestinal

Hepatocellular carcinoma: clinical significance of signal heterogeneity in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging

Authors: Nobuhiro Fujita, Akihiro Nishie, Yuichiro Kubo, Yoshiki Asayama, Yasuhiro Ushijima, Yukihisa Takayama, Koichiro Moirta, Ken Shirabe, Shinichi Aishima, Hiroshi Honda

Published in: European Radiology | Issue 1/2015

Abstract

Objectives

To clarify the relationship between the biological behaviour of hepatocellular carcinomas (HCCs) and their signal intensity in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging with a special focus on the signal heterogeneity.

Methods

A total of 68 patients with 70 pathologically proven HCCs were enrolled. On the basis of the signal intensity in the hepatobiliary phase, the lesions were classified into three groups: group 1, homogeneous hypointensity (n = 44); group 2, heterogeneous hyperintensity (n = 20); and group 3, homogeneous hyperintensity (n = 6). The clinicopathological findings were compared among the three groups.

Results

The tumour size and the serum level of protein induced by vitamin K absence or antagonist-II (PIVKA-II) were significantly higher in group 2 compared to group 1 (p = 0.0155, p = 0.0215, respectively) and compared to group 3 (p = 0.0330, p = 0.0220, respectively). The organic anion transporting polypeptide 8 (OATP8) expression in group 2 and group 3 was significantly higher than in group 1 (p < 0.0001, p < 0.0001, respectively). Group 2 showed a significantly lower disease-free survival rate compared to group 1 (p = 0.0125), and group 2 was an independent prognostic factor for disease-free survival (p = 0.0308).

Conclusions

HCCs in the hepatobiliary phase that are heterogeneously hyperintense on gadoxetic acid-enhanced MR imaging have more malignant potential than other types of HCCs.

Key Points

• Heterogeneous uptake of gadoxetic acid suggests more malignant potential in HCC

• Uptake of gadoxetic acid does not suggest less malignancy in HCC

• Evaluation of signal heterogeneity on gadoxetic acid-enhanced MR imaging is useful

Okuda K (1997) Hepatocellular carcinoma: clinicopathological aspects. J Gastroenterol Hepatol 12:314–318CrossRef

Bosch FX, Ribes J, Díaz M, Cléries R (2004) Primary liver cancer: worldwide incidence and trends. Gastroenterology 127:5–16CrossRef

Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917PubMedCrossRef

Vogl TJ, Kümmel S, Hammerstingl R et al (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67PubMedCrossRef

Huppertz A, Balzer T, Blakeborough A, European EOB Study Group et al (2004) Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 230:266–275PubMedCrossRef

Ahn SS, Kim MJ, Lim JS, Hong HS, Chung YE, Choi JY (2010) Added value of gadoxetic acid-enhanced hepatobiliary phase MR imaging in the diagnosis of hepatocellular carcinoma. Radiology 255:459–466PubMedCrossRef

Ichikawa T, Saito K, Yoshioka N et al (2010) Detection and characterization of focal liver lesions: a Japanese phase III, multicenter comparison between gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. Invest Radiol 45:133–141PubMedCrossRef

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 21:1233–1242PubMedCrossRef

Asayama Y, Tajima T, Nishie A et al (2011) Uptake of Gd-EOB-DTPA by hepatocellular carcinoma: radiologic-pathologic correlation with special reference to bile production. Eur J Radiol 80:e243–e248PubMedCrossRef

10.

Kitao A, Zen Y, Matsui O et al (2010) Hepatocellular carcinoma: signal intensity at gadoxetic acid-enhanced MR imaging–correlation with molecular transporters and histopathologic features. Radiology 256:817–826PubMedCrossRef

11.

Narita M, Hatano E, Arizono S et al (2009) Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol 44:793–798PubMedCrossRef

12.

Kitao A, Matsui O, Yoneda N et al (2012) Hypervascular hepatocellular carcinoma: correlation between biologic features and signal intensity on gadoxetic acid-enhanced MR images. Radiology 265:780–789PubMedCrossRef

13.

Choi JW, Lee JM, Kim SJ et al (2013) Hepatocellular carcinoma: imaging patterns on gadoxetic acid-enhanced MR images and their value as an imaging biomarker. Radiology 267:776–786PubMedCrossRef

14.

Choi JY, Kim MJ, Park YN et al (2011) Gadoxetate disodium-enhanced hepatobiliary phase MRI of hepatocellular carcinoma: correlation with histological characteristics. AJR Am J Roentgenol 197:399–405PubMedCrossRef

15.

Kim JY, Kim MJ, Kim KA, Jeong HT, Park YN (2012) Hyperintense HCC on hepatobiliary phase images of gadoxetic acid-enhanced MRI: correlation with clinical and pathological features. Eur J Radiol 81:3877–3882PubMedCrossRef

16.

Kitao A, Matsui O, Yoneda N et al (2011) The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid enhanced MR imaging. Eur Radiol 21:2056–2066PubMedCrossRef

17.

Nishie A, Asayama Y, Ishigami K et al (2014) Clinicopathological significance of the peritumoral decreased uptake area of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid in hepatocellular carcinoma. J Gastroenterol Hepatol 29:561–567PubMedCrossRef

18.

Takayama Y, Nishie A, Nakayama T et al (2012) Hypovascular hepatic nodule showing hypointensity in the hepatobiliary phase of gadoxetic acid-enhanced MRI in patients with chronic liver disease: prediction of malignant transformation. Eur J Radiol 81:3072–3078PubMedCrossRef

19.

Shinozaki K, Yoshimitsu K, Irie H et al (2004) Comparison of test-injection method and fixed-time method for depiction of hepatocellular carcinoma using dynamic steady-state free precession magnetic resonance imaging. J Comput Assist Tomogr 28:628–634PubMedCrossRef

20.

Theise ND, Ishak KG, Kojiro M et al (2010) Hepatocelluilar carinoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds) World Health Organization classification of the digestive system. IARC, Lyon, pp 205–216

21.

International Consensus Group for Hepatocellular Neoplasia (2009) Pathologic diagnosis of early hepatocellular carcinoma: a report of the International Consensus Group for Hepatocellular Neoplasia. Hepatology 49:658–664CrossRef

22.

Miyaaki H, Nakashima O, Kurogi M, Eguchi K, Kojiro M (2007) Lens culinaris agglutinin-reactive alpha-fetoprotein and protein induced by vitamin K absence II are potential indicators of a poor prognosis: a histopathological study of surgically resected hepatocellular carcinoma. J Gastroenterol 42:962–968PubMedCrossRef

23.

Nanashima A, Abo T, Tobinaga S et al (2010) Relationship between period of survival and clinicopathological characteristics in patients with hepatocellular carcinoma who underwent hepatectomy. Hepatogastroenterology 57:540–546PubMed

24.

Jung D, Kullak-Ublick GA (2003) Hepatocyte nuclear factor 1 alpha: a key mediator of the effect of bile acids on gene expression. Hepatology 37:622–631PubMedCrossRef

25.

Vavricka SR, Jung D, Fried M, Grützner U, Meier PJ, Kullak-Ublick GA (2004) The human organic anion transporting polypeptide 8 (SLCO1B3) gene is transcriptionally repressed by hepatocyte nuclear factor 3beta in hepatocellular carcinoma. J Hepatol 40:212–218PubMedCrossRef

26.

Jung D, Podvinec M, Meyer UA et al (2002) Human organic anion transporting polypeptide 8 promoter is transactivated by the farnesoid X receptor/bile acid receptor. Gastroenterology 122:1954–1966PubMedCrossRef

27.

Verloh N, Haimerl M, Zeman F et al (2014) Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla. Eur Radiol 24:1013–1019PubMedCrossRef

28.

Yoneyama T, Fukukura Y, Kamimura K et al (2014) Efficacy of liver parenchymal enhancement and liver volume to standard liver volume ratio on Gd-EOB-DTPA-enhanced MRI for estimation of liver function. Eur Radiol 24:857–865PubMedCrossRef

29.

Nishie A, Ushijima Y, Tajima T et al (2012) Quantitative analysis of liver function using superparamagnetic iron oxide- and Gd-EOB-DTPA-enhanced MRI: comparison with technetium-99m galactosyl serum albumin scintigraphy. Eur J Radiol 81:1100–1104PubMedCrossRef

30.

Verloh N, Haimerl M, Rennert J et al (2013) Impact of liver cirrhosis on liver enhancement at Gd-EOB-DTPA enhanced MRI at 3 Tesla. Eur J Radiol 82:1710–1715PubMedCrossRef

31.

Nishie A, Asayama Y, Ishigami K et al (2012) MR prediction of liver fibrosis using a liver-specific contrast agent: superparamagnetic iron oxide versus Gd-EOB-DTPA. J Magn Reson Imaging 36:664–671PubMedCrossRef

Title: Hepatocellular carcinoma: clinical significance of signal heterogeneity in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging
Authors: Nobuhiro Fujita
Akihiro Nishie
Yuichiro Kubo
Yoshiki Asayama
Yasuhiro Ushijima
Yukihisa Takayama
Koichiro Moirta
Ken Shirabe
Shinichi Aishima
Hiroshi Honda
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3349-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hepatocellular carcinoma: clinical significance of signal heterogeneity in the hepatobiliary phase of gadoxetic acid-enhanced MR imaging

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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