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European Radiology
Published in: European Radiology 10/2017

01-10-2017 | Hepatobiliary-Pancreas

The value of gadoxetic acid-enhanced MRI for differentiation between hepatic microabscesses and metastases in patients with periampullary cancer

Authors: Seo-Youn Choi, Young Kon Kim, Ji Hye Min, Dong Ik Cha, Woo Kyoung Jeong, Won Jae Lee

Published in: European Radiology | Issue 10/2017

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Abstract

Objectives

We aimed to identify features that differentiate hepatic microabscess from hepatic metastasis on gadoxetic acid-enhanced MRI in patients with periampullary cancer.

Methods

We included 72 patients (31 patients with 83 hepatic microabscesses and 41 patients with 71 hepatic metastases) who had a history of periampullary cancer and underwent gadoxetic acid-enhanced MRI. Image analysis was performed for margin, signal intensity, rim enhancement, perilesional hyperaemia, pattern on DWI and dynamic phases, and size discrepancy between sequences by consensus of two observers.

Results

Multivariate analysis revealed that the following significant parameters favour microabscess: a history of bile duct cancer, perilesional hyperaemia, persistent arterial rim enhancement through the transitional phase (TP), and size discrepancy between T1WI and T2WI and between T1WI and hepatobiliary phase image (HBPI). The diagnostic accuracy for microabscess was highest (90.9%) when showing a size discrepancy ≥30% between T1WI and HBPI or persistent arterial rim enhancement through the TP. When the lesion was positive for both these variables, specificity reached 100%.

Conclusion

The combination of a size discrepancy between T1WI and HBPI and persistent arterial rim enhancement through the TP represents a reliable MRI feature for distinguishing between hepatic microabscess and metastasis in patients with periampullary cancer.

Key points

• Gadoxetic acid-enhanced MRI is useful for distinguishing hepatic microabscess from metastasis.
• Hepatic microabscess showed significant size discrepancy ≥30% between T1WI and HBPI.
• Arterial rim enhancement persistent through the TP indicates hepatic microabscess.
Appendix
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Literature
1.
Jeffrey RB Jr, Tolentino CS, Chang FC, Federle MP (1988) CT of small pyogenic hepatic abscesses: The cluster sign. AJR Am J Roentgenol 151:487–489CrossRefPubMed
2.
Mathieu D, Vasile N, Fagniez PL, Segui S, Grably D, Larde D (1985) Dynamic CT features of hepatic abscesses. Radiology 154:749–752CrossRefPubMed
3.
Balci NC, Semelka RC, Noone TC et al (1999) Pyogenic hepatic abscesses: MRI findings on T1- and T2-weighted and serial gadolinium-enhanced gradient-echo images. J Magn Reson Imaging 9:285–290CrossRefPubMed
4.
Garcia-Eulate R, Hussain N, Heller T et al (2006) CT and MRI of hepatic abscess in patients with chronic granulomatous disease. AJR Am J Roentgenol 187:482–490CrossRefPubMed
5.
Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aube C, Chatellier G (2016) A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol 26:4595–4615CrossRefPubMed
6.
Park HJ, Kim SH, Jang KM, Lee SJ, Park MJ, Choi D (2013) Differentiating hepatic abscess from malignant mimickers: Value of diffusion-weighted imaging with an emphasis on the periphery of the lesion. J Magn Reson Imaging 38:1333–1341CrossRefPubMed
7.
Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007) MR imaging in patients with suspected liver metastases: Value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6:43–52CrossRefPubMed
8.
Danet IM, Semelka RC, Leonardou P et al (2003) Spectrum of MRI appearances of untreated metastases of the liver. AJR Am J Roentgenol 181:809–817CrossRefPubMed
9.
Lee KH, Lee JM, Park JH et al (2013) MR imaging in patients with suspected liver metastases: Value of liver-specific contrast agent gadoxetic acid. Korean J Radiol 14:894–904CrossRefPubMedPubMedCentral
10.
Choi SH, Lee CH, Kim BH et al (2013) "Nondefect" of arterial enhancing rim on hepatobiliary phase in 3.0-T gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced liver magnetic resonance imaging: Distinguishing hepatic abscess from metastasis. J Comput Assist Tomogr 37:849–855CrossRefPubMed
11.
Demir OI, Obuz F, Sagol O, Dicle O (2007) Contribution of diffusion-weighted MRI to the differential diagnosis of hepatic masses. Diagn Interv Radiol 13:81–86PubMed
12.
Eun HW, Kim JH, Hong SS, Kim YJ (2012) Malignant versus benign hepatic masses in patients with recurrent pyogenic cholangitis: MR differential diagnosis. Abdom Imaging 37:767–774CrossRefPubMed
13.
Muhi A, Ichikawa T, Motosugi U et al (2011) Diagnosis of colorectal hepatic metastases: Comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. J Magn Reson Imaging 34:326–335CrossRefPubMed
14.
Hamm B, Staks T, Muhler A et al (1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: Safety, pharmacokinetics, and MR imaging. Radiology 195:785–792CrossRefPubMed
15.
Bartolozzi C, Crocetti L, Lencioni R, Cioni D, Della Pina C, Campani D (2007) Biliary and reticuloendothelial impairment in hepatocarcinogenesis: The diagnostic role of tissue-specific MR contrast media. Eur Radiol 17:2519–2530CrossRefPubMed
16.
Neri E, Bali MA, Ba-Ssalamah A et al (2016) ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 26:921–931CrossRefPubMed
17.
Merkle EM, Zech CJ, Bartolozzi C et al (2016) Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 26:674–682CrossRefPubMed
18.
Tateyama A, Fukukura Y, Takumi K et al (2012) Gd-EOB-DTPA-enhanced magnetic resonance imaging features of hepatic hemangioma compared with enhanced computed tomography. World J Gastroenterol 18:6269–6276CrossRefPubMedPubMedCentral
19.
Doo KW, Lee CH, Choi JW, Lee J, Kim KA, Park CM (2009) "Pseudo washout" sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR Am J Roentgenol 193:W490–W496CrossRefPubMed
20.
Granata V, Catalano O, Fusco R et al (2015) The target sign in colorectal liver metastases: An atypical Gd-EOB-DTPA "uptake" on the hepatobiliary phase of MR imaging. Abdom Imaging 40:2364–2371CrossRefPubMed
21.
Lee MH, Kim SH, Kim H, Lee MW, Lee WJ (2011) Differentiating focal eosinophilic infiltration from metastasis in the liver with gadoxetic acid-enhanced magnetic resonance imaging. Korean J Radiol 12:439–449CrossRefPubMedPubMedCentral
22.
Park MS, Kim MJ, Lim JS et al (2009) Metastasis versus focal eosinophilic infiltration of the liver in patients with extrahepatic abdominal cancer: An evaluation with gadobenate dimeglumine-enhanced magnetic resonance imaging. J Comput Assist Tomogr 33:119–124CrossRefPubMed
23.
Chan JH, Tsui EY, Luk SH et al (2001) Diffusion-weighted MR imaging of the liver: Distinguishing hepatic abscess from cystic or necrotic tumor. Abdom Imaging 26:161–165CrossRefPubMed
Metadata
Title
The value of gadoxetic acid-enhanced MRI for differentiation between hepatic microabscesses and metastases in patients with periampullary cancer
Authors
Seo-Youn Choi
Young Kon Kim
Ji Hye Min
Dong Ik Cha
Woo Kyoung Jeong
Won Jae Lee
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-4782-3

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