Ces radiol. 2011, 65(4):256-265

Detection and characterization of hepatocellular liver lesions by using MRI with hepatospecific contrast agent Gd-EOB-DTPAOriginal article

Milan Mrklovský¹, Ľudovít Klzo², Jan Žižka²

¹ Radiologické centrum Multiscan, Pardubice

² Radiologická klinika LF UK a FN, Hradec Králové

Aim: To prospectively evaluate the possibilities of detection and characterization of hepatocellular liver lesions by means of MRI using hepatospecific contrast agent Gd-EOB-DTPA.

Method: A total of 78 subjects (67 females, 11 males) with known arterial hypervascularized liver lesion (other than haemangioma) were examined on MRI with administration of liver specific contrast agent Primovist (Gd-EOB-DTPA, Bayer Schering Pharma, Berlin, Germany). All studies were performed on General Electric Signa 1.5T system before and after Primovist contrast agent injection in arterial, portal venous, equilibrium phases, and at twenty minutes past injection. Size, signal, enhacement pattern, homogeneity, and presence of central scar were evaluated. Lesions with contrast agent accumulation in liver specific phase were considered to be of hepatocellular origin. Iso-/hyperintense lesion in liver specific phase was in non-cirrhotic liver considered to be focal nodular hyperplasia provided the features on precontrast and dynamic contrast studies were in keeping with this diagnosis. Lesion showing signal increase in liver specific phase, however to a lesser degree than normal non-cirrhotic liver parenchyma was considered to be adenoma. Lesion showing no enhacement in liver specific phase was diagnosed as metastasis.

Results: 101 focal nodular hyperplasias (in 67 subjects) were diagnosed. 14 adenomas (in 4 subjects with 1, 1, 4, and 8 lesions, respectively) were found; three subjects were available to MRI follow-up without progression (after 24, 42, and 17 months, respectively). A single lesion in non-cirrhotic liver was thought to be a hepatoma, less likely an adenoma (adenoma confirmed on biopsy). A single patient presented with tens of lesions due to liver adenomatosis (histologically verified). Two lesions in two patients with liver cirrhosis were diagnosed as hepatomas. Three oncological patients were diagnosed with liver metastases.

Conclusion: Administration of liver specific contrast agent Primovist (Gd-EOB-DTPA) improves specification of hepatocellular liver lesions, particularly in cases of focal nodular hyperplasia where non-invasive diagnosis can be made with high accuracy. Also, differentiation between hypervascularized metastases and lesions of hepatocellular origin is very beneficial.

Keywords: hepatocellular liver lesion, liver specific contrast agent Gd-EOB-DTPA, magnetic resonance imaging

Accepted: July 15, 2011; Published: December 1, 2011  Show citation