So Yeon Kim MD, Presenter: Nothing to Disclose

Benjamin M. Yeh MD, Abstract Co-Author: Research Grant, General Electric Company Consultant, General Electric Company

En-Haw Wu MD, Abstract Co-Author: Nothing to Disclose

Zhen Jane Wang MD, Abstract Co-Author: Nothing to Disclose

Thomas A. Hope MD, Abstract Co-Author: Speaker, Guerbet SA Research Grant, General Electric Company

Judy Yee MD, Abstract Co-Author: Research Grant, EchoPixel, Inc

Liqin Zhao MD, Abstract Co-Author: Nothing to Disclose

Wei-Chou Chang MD, Abstract Co-Author: Nothing to Disclose

To compare the conspicuity of hepatocellular carcinoma (HCC) on the delayed phase images of extracellular contrast (gadodiamide) versus hepatobiliary contrast (gadoxetate disodium)-enhanced MR relative to liver function.

We retrospectively identified 86 patients with newly diagnosed HCC on liver MR between 2010 and 2013 and recorded the severity of liver disease by Child-Pugh class (CPC). 38 patients had MR enhanced with gadodiamide and 48 with gadoxetate disodium on a 1.5T scanner. The conspicuity of 86 HCCs (mean size, 2.7cm; range, 1-9.1 cm) was visually graded on a 3-point scale (1=invisible, 2=fair, 3=clear cut) on the delayed phase images (5-minute delay for gadodiamide and 20-minute delay hepatobiliary phase for gadoxetate). Conspicuity was quantitatified by tumor-to-liver contrast ratios (TLC). The relative liver parenchymal enhancement (RPE) was measured on the delayed enhanced versus unenhanced images. For different CPCs, we compared the visual and quantitative conspicuity of and RPE between gadodiamide and gadoxetate.

For the 65 patients with mild liver disease (CPC A), the visual and quantitative conspicuity of the 27 HCCs imaged with gadodiamide was significantly worse than of the 38 HCCs with gadoxetate (P=.01, <.01, respectively). RPE was also worse in gadodiamide scans than gadoxetate scans (P=.01). However, in the 21 HCCs in patients with moderate to severe liver disease (CPC B and C), HCC appeared more frequently as clear-cut hypointensity when imaged with gadodiamide (72.7%, 8 of 11 HCCs) than gadoxetate (20%, 2 of 10 HCCs, P=.03). TLC was significantly higher in the gadodiamide scans than in the gadoxetate scans (median, 17.7 vs. 5.1, P=.04). RPE tended to be higher in gadodiamide scans than gadoxetate scans (median, 83.1 vs. 44.0, P=.06).

In patients with moderate to severe liver disease, hypointensity of HCC is more conspicuous on the delayed phase with gadodiamide than with gadoxetate. This may reflect the high extracellular uptake of gadodiamide and poor hepatocyte uptake of gadoxetate in patients with compromised liver function.

Liver function is critical to consider when selecting between an extracellular versus hepatobiliary contrast agent for optimal visualization of HCC at MR imaging.

Kim, S, Yeh, B, Wu, E, Wang, Z, Hope, T, Yee, J, Zhao, L, Chang, W, Comparison of HCC Conspicuity on Delayed MR Images with Extracellular versus Hepatobiliary Contrast Agent for Patients with Compromised Liver Function.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006820.html