• abbreviated protocol
• colorectal neoplasms
• liver
• magnetic resonance imaging
• metastasis

• Deep learning-based reconstruction (DLR)
• Gd-EOB-MRI
• Hepatobiliary phase
• Liver tumor
• Magnetic resonance imaging (MRI)

• Humans
• Gadolinium DTPA
• Liver Neoplasms/diagnostic imaging
• Deep Learning
• Retrospective Studies
• Female
• Male
• Contrast Media
• Magnetic Resonance Imaging/methods
• Middle Aged
• Aged
• Adult
• Image Enhancement/methods
• Image Interpretation, Computer-Assisted/methods
• Aged, 80 and over

• Hemangioma
• gadoxetic acid
• liver
• magnetic resonance imaging
• pseudo-washout sign

• Humans
• Contrast Media
• Retrospective Studies
• Gadolinium DTPA
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/blood supply
• Hemangioma/diagnostic imaging
• Hemangioma/blood supply
• Magnetic Resonance Imaging/methods
• Carcinoma, Hepatocellular
• Sensitivity and Specificity

Although contrast-enhanced magnetic resonance imaging (MRI) using gadoxetic acid has been shown to have higher accuracy, sensitivity, and specificity for the detection and characterization of hepatic metastases compared with other modalities, the long examination time would limit the broad indication. Several abbreviated enhanced MRI (Ab-MRI) protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases. However, an optimal protocol has not been established, and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography (CE-CT), which is the preoperative imaging of colorectal cancer staging in clinical settings, to determine the best therapeutic strategy.

To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.

Study participants comprised 87 patients (51 males, 36 females; mean age, 67.2 ± 10.8 years) who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021. Each exam was independently reviewed by two readers in three reading sessions: (1) Only single-shot fast spin echo (FSE) T2-weighted or fat-suppressed-FSE-T2-weighted, diffusion-weighted, and hepatobiliary-phase images (Ab-MRI protocol 1 or 2); (2) all acquired MRI sequences (standard protocol); and (3) a combination of an Ab-MRI protocol (1 or 2) and CE-CT. Diagnostic performance was then statistically analyzed.

A total of 380 Lesions were analyzed, including 195 metastases (51.4%). Results from the two Ab-MRI protocols were similar. The sensitivity, specificity, and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI (P > 0.05), while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone, although the difference was not significant (P > 0.05), and were quite similar to those from standard MRI (P > 0.05).

The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol. Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.

• Colorectal liver metastases
• Gadoxetic acid
• Magnetic resonance imaging
• Hepatobiliary phase
• Contrast-enhanced computed tomography
• Diagnostic performance

• B-mode
• convolutional neural network
• deep multimodal representation learning
• liver tumor
• machine learning

• contrast agent
• hepatocellular carcinoma
• liver
• magnetic resonance imaging
• metastasis

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA; Gadoxetic acid; Gadoxetate disodium) is a hepatocyte-specific MR contrast agent. It acts as an extracellular contrast agent in the early phase after intravenous injection, and then is taken up by hepatocytes later. Using this contrast agent, we can evaluate the hemodynamics of the liver and liver tumors, and can therefore improve the detection and characterization of hepatocellular carcinoma (HCC). Gd-EOB-DTPA helps in the more accurate detection of hypervascular HCC than by other agents. In addition, Gd-EOB-DTPA can detect hypovascular HCC, which is an early stage of the multi-stage carcinogenesis, with a low signal in the hepatobiliary phase. In addition to tumor detection and characterization, Gd-EOB-DTPA contrast-enhanced MR imaging can be applied for liver function evaluation and prognoses evaluation. Thus, Gd-EOB-DTPA plays an important role in the diagnosis of HCC. However, we have to employ optimal imaging techniques to improve the diagnostic ability. In this review, we aimed to discuss the characteristics of the contrast media, optimal imaging techniques, diagnosis, and applications.

• gadoxetic acid
• hepatocellular carcinoma
• liver
• magnetic resonance
• xetate disodium

• Consensus statement
• Diagnosis
• Hepatocellular carcinoma
• Japan Society of Hepatology
• Pathology
• Treatment

Purpose: To evaluate the utility of T2-enhanced spin-echo imaging using the time-reversed gradient echo sequence (T2FFE imaging) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for differentiating hemangiomas from metastatic tumors.

Methods: A total of 61 patients with 133 liver lesions, including 37 hemangiomas and 96 metastatic tumors, were scanned by Gd-EOB-MRI. Four data sets were independently analyzed by two readers: (1) 3D fat-suppressed T2-weighted imaging (FS-T2WI) alone; (2) the combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI; (3) the combination of 3D FS-T2WI, diffusion-weighted imaging (DWI) with the b-value of 1000 s/mm² and the apparent diffusion coefficient (ADC); and (4) a dynamic study of Gd-EOB-MRI. After classifying the lesion sizes as ≤ 10 mm or > 10 mm, we conducted a receiver-operating characteristic analysis to compare diagnostic accuracies among the four data sets for differentiating hemangiomas from metastatic tumors.

Results: The areas under the curves (AUCs) of the four data sets of two readers were: (1) ≤ 10 mm (0.85 and 0.91) and > 10 mm (0.88 and 0.97), (2) ≤ 10 mm (0.94 and 0.94) and > 10 mm (0.96 and 0.95), (3) ≤ 10 mm (0.90 and 0.87) and > 10 mm (0.89 and 0.95), and (4) ≤ 10 mm (0.62 and 0.67) and > 10 mm (0.76 and 0.71), respectively. Data sets (2) and (3) showed no significant differences in AUCs, but both showed significantly higher AUCs compared to that of (4) regardless of the lesion size (P < 0.05).

Conclusion: The combination of 3D FS-T2WI and T2FFE imaging in the HBP of Gd-EOB-MRI achieved an accuracy equivalent to that of the combination of 3D FS-T2WI, DWI, and ADC and might be helpful in differentiating hemangiomas from metastatic tumors.

• T2-enhanced time-reversed gradient echo sequence
• gadoxetic acid-enhanced magnetic resonance imaging
• liver hemangioma
• metastatic tumor

• AUC, area under the ROC curve
• CT, computed tomography
• Gadoxetic acid-enhanced MRI
• HBP, hepatobiliary phase
• HCC, hepatocellular carcinoma
• Liver
• MRI, magnetic resonance imaging
• Magnetic resonance imaging (MRI)
• PSIR, phase-sensitive inversion recovery
• Phase-sensitive inversion recovery (PSIR)
• ROC, receiver operating characteristic
• ROI, region of interest
• SI, signal intensity
• T1 mapping

• Contrast media
• Gadobenic acid
• Gadolinium ethoxybenzyl DTPA
• Liver diseases
• Magnetic resonance imaging

• Colorectal cancer
• Contrast agent
• Diagnosis
• Gadolinium
• Neoplasm metastases

• Liver
• MRI
• colorectal cancer
• contrast agents
• intravenous
• metastases

The purpose of this study was to investigate whether any texture features show a correlation with intrahepatic tumor growth before the metastasis is visible to the human eye.

Eight male C57BL6 mice (age 8–10 weeks) were injected intraportally with syngeneic MC-38 colon cancer cells and two mice were injected with phosphate-buffered saline (sham controls). Small animal magnetic resonance imaging (MRI) at 4.7 T was performed at baseline and days 4, 8, 12, 16, and 20 after injection applying a T2-weighted spin-echo sequence. Texture analysis was performed on the images yielding 32 texture features derived from histogram, gray-level co-occurrence matrix, gray-level run-length matrix, and gray-level size-zone matrix. The features were examined with a linear regression model/Pearson correlation test and hierarchical cluster analysis. From each cluster, the feature with the lowest variance was selected.

Tumors were visible on MRI after 20 days. Eighteen features from histogram and the gray-level-matrices exhibited statistically significant correlations before day 20 in the experiment group, but not in the control animals. Cluster analysis revealed three distinct clusters of independent features. The features with the lowest variance were Energy, Short Run Emphasis, and Gray Level Non-Uniformity.

Texture features may quantitatively detect liver metastases before they become visually detectable by the radiologist.

• Colorectal neoplasms
• Computer-assisted image processing
• Liver
• Magnetic resonance imaging (MRI)
• Neoplasm micrometastases

• Chemotherapy
• GCT
• Liver metastasis
• Neoplasm
• Nonseminomatous GCT

To retrospectively evaluate the diagnostic performance of free-breathing diffusion-weighted imaging (FB-DWI) with modified imaging parameter settings for detecting hepatocellular carcinomas (HCCs).

Fifty-one patients at risk for HCC were scanned with both FB-DWI and respiratory-triggered DWI with the navigator echo respiratory-triggering technique (RT-DWI). Qualitatively, the sharpness of the liver contour, the image noise and the chemical shift artifacts on each DWI with b-values of 1000 s/mm² were independently evaluated by three radiologists using 4-point scoring. We compared the image quality scores of each observer between the two DWI methods, using the Wilcoxon signed-rank test. Quantitatively, we compared the signal-to-noise ratios (SNRs) of the liver parenchyma and lesion-to-nonlesion contrast-to-noise ratios (CNRs) after measuring the signal intensity on each DWI with a b-factor of 1000 s/mm². The average SNRs and CNRs between the two DWI methods were compared by the paired t-test. The detectability of HCC on each DWI was also analyzed by three radiologists. The detectability provided by the two DWI methods was compared using McNemar’s test.

For all observers, the averaged image quality scores of FB-DWI were: Sharpness of the liver contour [observer (Obs)-1, 3.08 ± 0.81; Obs-2, 2.98 ± 0.73; Obs-3, 3.54 ± 0.75], those of the distortion (Obs-1, 2.94 ± 0.50; Obs-2, 2.71 ± 0.70; Obs-3, 3.27 ± 0.53), and the chemical shift artifacts (Obs-1, 3.38 ± 0.60; Obs-2, 3.15 ± 1.07; Obs-3, 3.21 ± 0.85). The averaged image quality scores of RT-DWI were: Sharpness of the liver contour (Obs-1, 2.33 ± 0.65; Obs-2, 2.37 ± 0.74; Obs-3, 2.75 ± 0.81), distortion (Obs-1, 2.81 ± 0.56; Obs-2, 2.25 ± 0.74; Obs-3, 2.96 ± 0.71), and the chemical shift artifacts (Obs-1, 2.92 ± 0.59; Obs-2, 2.21 ± 0.85; Obs-3, 2.77 ± 1.08). All image quality scores of FB-DWI were significantly higher than those of RT-DWI (P < 0.05). The average SNR of the normal liver parenchyma by FB-DWI (11.0 ± 4.8) was not significantly different from that shown by RT-DWI (11.0 ± 5.0); nor were the lesion-to-nonlesion CNRs significantly different (FB-DWI, 21.4 ± 17.7; RT-DWI, 20.1 ± 15.1). For all three observers, the detectability of FB-DWI (Obs-1, 43.6%; Obs-2, 53.6%; and Obs-3, 45.0%) was significantly higher than that of RT-DWI (Obs-1, 29.1%; Obs-2, 43.6%; and Obs-3, 34.5%) (P < 0.05).

FB-DWI showed better image quality and higher detectability of HCC compared to RT-DWI, without significantly reducing the SNRs of the liver parenchyma and lesion-to-nonlesion CNRs.

• Diffusion weighted-imaging
• Liver
• Magnetic resonance imaging
• Hepatocellular carcinoma
• Free-breathing technique

• Gadofosveset trisodium
• Gadoxetic acid
• Liver
• Magnetic resonance imaging
• Metastases

• Aged
• Bile Duct Neoplasms/diagnosis
• Bile Duct Neoplasms/diagnostic imaging
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/diagnostic imaging
• Cholangiocarcinoma/diagnosis
• Cholangiocarcinoma/diagnostic imaging
• Diagnosis, Differential
• Female
• Gadolinium DTPA/analysis
• Humans
• Image Interpretation, Computer-Assisted/methods
• Liver Neoplasms/diagnosis
• Liver Neoplasms/diagnostic imaging
• Magnetic Resonance Imaging/methods
• Male
• Middle Aged

• MRI
• gadofosveset trisodium
• gadoxetic acid
• hepatobiliary imaging
• liver

• Cholangiocarcinoma
• Elastography
• Focal nodular hyperplasia
• Hemangioma
• Hepatic adenoma
• Hepatocellular carcinoma
• Imaging
• Liver

• Adenoma/diagnosis
• Bile Duct Neoplasms/diagnosis
• Bile Ducts, Intrahepatic
• Carcinoma, Hepatocellular/diagnosis
• Cholangiocarcinoma/diagnosis
• Contrast Media
• Cysts/diagnosis
• Focal Nodular Hyperplasia/diagnosis
• Hemangioma/diagnosis
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/secondary
• Magnetic Resonance Imaging
• Tomography Scanners, X-Ray Computed
• Ultrasonography, Doppler, Color

• Adolescent
• Adult
• Aged
• Female
• Hemangioma/classification
• Hemangioma/diagnostic imaging
• Humans
• Liver Neoplasms/classification
• Liver Neoplasms/diagnostic imaging
• Male
• Middle Aged
• Neoplasms, Multiple Primary/classification
• Neoplasms, Multiple Primary/diagnostic imaging
• Observer Variation
• Reproducibility of Results
• Retrospective Studies
• Sensitivity and Specificity
• Tumor Burden
• Ultrasonography/methods
• Young Adult

• Adolescent
• Child
• Child, Preschool
• Contrast Media
• Diagnosis, Differential
• Female
• Focal Nodular Hyperplasia/pathology
• Humans
• Image Enhancement/methods
• Liver Neoplasms/pathology
• Magnetic Resonance Imaging/methods
• Male
• Meglumine/analogs & derivatives
• Organometallic Compounds
• Reproducibility of Results
• Sensitivity and Specificity

• Guidelines
• Multidisciplinary
• Stomach neoplasms

• Biliary cystadenoma
• Diffusion-weighted imaging
• Focal nodular hyperplasia (FNH)
• Hemangioma
• Hepatic MR imaging
• Hepatic adenoma
• Liver
• Liver abscess

• 3D-T2-weighted imaging
• liver
• low-constant
• magnetic resonance imaging
• tissue-specific
• variable refocusing flip-angle

• Bile Duct Neoplasms/diagnosis
• Bile Ducts, Intrahepatic
• Carcinoma, Hepatocellular/diagnosis
• Cholangiocarcinoma/diagnosis
• Contrast Media
• Focal Nodular Hyperplasia/diagnosis
• Humans
• Liver Neoplasms/diagnosis
• Magnetic Resonance Imaging/methods
• Tomography, X-Ray Computed/methods

AIM: To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT).

METHODS: Twenty-six patients with 61 hepatic hemangiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated. The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon’s signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT.

RESULTS: There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT.

CONCLUSION: Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.

• Liver
• Hemangioma
• Magnetic resonance imaging
• Gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid
• Multidetector-row computed tomography

To determine the accuracy of MR imaging with Gd-EOB-DTPA for the detection of liver metastases.

PUBMED, EMBASE, the Web of Science, and the Cochrane Library were searched for original articles published prior to February 2012. The criteria for the inclusion of articles were as follows: reported in the English language; MR imaging with Gd-EOB-DTPA was performed to detect liver metastases; histopathologic analysis (surgery, biopsy), intraoperative observation (manual palpatation, intraoperative ultrasonography), and/or follow-up US was the reference standard; and data were sufficient for the calculation of true-positive or false-negative values. The methodological quality was assessed by using the quality assessment of diagnostic studies instrument. The data were extracted to calculate sensitivity, specificity, predictive value, diagnostic odds ratio, and areas under hierarchical summary receiver operating characteristic (HSROC) curve to perform heterogeneity test and threshold effect test, as well as publication bias analysis and subgroup analyses.

From 229 citations, 13 were included in the meta-analysis with a total of 1900 lesions. We detected heterogeneity between studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.93 (95% CI: 0.90, 0. 95), the specificity was 0.95 (95% CI: 0.91, 0.97), the positive likelihood ratio was 18.07 (95% CI: 10.52, 31.04), the negative likelihood ratio was 0.07 (95% CI: 0.05, 0.10), and the diagnostic odds ratio was 249.81 (95% CI: 125.12, 498.74). The area under the receiver operator characteristic curve was 0.98 (95% CI: 0.96, 0.99).

MR imaging with Gd-EOB-DTPA is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of liver metastases. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.

• Gadolinium DTPA
• Humans
• Liver/pathology
• Liver Neoplasms/diagnosis
• Liver Neoplasms/pathology
• Liver Neoplasms/secondary
• Magnetic Resonance Imaging/methods
• ROC Curve
• Sensitivity and Specificity