Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2018; 24(3): 415-423
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.415
Optimization of hepatobiliary phase delay time of Gd-EOB-DTPA-enhanced magnetic resonance imaging for identification of hepatocellular carcinoma in patients with cirrhosis of different degrees of severity
Jian-Wei Wu, Yue-Cheng Yu, Xian-Li Qu, Yan Zhang, Hong Gao
Jian-Wei Wu, Xian-Li Qu, Yan Zhang, Hong Gao, Department of Radiology, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing 210002, Jiangsu Province, China
Yue-Cheng Yu, Liver Disease Center, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing 210002, Jiangsu Province, China
Author contributions: Wu JW and Yu YC conceived and wrote the manuscript; Wu JW, Yu YC, Qu XL, Zhang Y and Gao H participated in designing the research, collecting and analyzing the data, and approving the final version.
Institutional review board statement: The study was reviewed and approved by the Academic Committee of Bayi Hospital, Nanjing University of Chinese Medicine.
Informed consent statement: Written informed consent for the GED-MRI scanning was obtained from all the enrolled patients and controls.
Conflict-of-interest statement: All the authors listed above have no potential conflicts of interest relevant to this article to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yue-Cheng Yu, MD, PhD, Chief Doctor, Professor, Liver Disease Center, Bayi Hospital, Nanjing University of Chinese Medicine, No. 34, Section 34, Yanggongjing, Qinhuai District, Nanjing 210002, Jiangsu Province, China. gslsycy@163.com
Telephone: +86-25-80864059 Fax: +86-25-84586476
Received: October 24, 2017
Peer-review started: October 25, 2017
First decision: November 21, 2017
Revised: December 18, 2017
Accepted: December 26, 2017
Article in press: December 26, 2017
Published online: January 21, 2018
Abstract
AIM

To optimize the hepatobiliary phase delay time (HBP-DT) of Gd-EOB-DTPA-enhanced magnetic resonance imaging (GED-MRI) for more efficient identification of hepatocellular carcinoma (HCC) occurring in different degrees of cirrhosis assessed by Child-Pugh (CP) score.

METHODS

The liver parenchyma signal intensity (LPSI), the liver parenchyma (LP)/HCC signal ratios, and the visibility of HCC at HBP-DT of 5, 10, 15, 20, and 25 min (i.e., DT-5, DT-10, DT-15, DT-20, and DT-25 ) after injection of Gd-EOB-DTPA were collected and analyzed in 73 patients with cirrhosis of different degrees of severity (including 42 patients suffering from HCC) and 18 healthy adult controls.

RESULTS

The LPSI increased with HBP-DT more significantly in the healthy group than in the cirrhosis group (F = 17.361, P < 0.001). The LP/HCC signal ratios had a significant difference (F = 12.453, P < 0.001) among various HBP-DT points, as well as between CP-A and CP-B/C subgroups (F = 9.761, P < 0.001). The constituent ratios of HCC foci identified as obvious hypointensity (+++), moderate hypointensity (++), and mild hypointensity or isointensity (+/-) kept stable from DT-10 to DT-25: 90.6%, 9.4%, and 0.0% in the CP-A subgroup; 50.0%, 50.0%, and 0.0% in the CP-B subgroup; and 0.0%, 0.0%, and 100.0% in the CP-C subgroup, respectively.

CONCLUSION

The severity of liver cirrhosis has significant negative influence on the HCC visualization by GED-MRI. DT-10 is more efficient and practical than other HBP-DT points to identify most of HCC foci emerging in CP-A cirrhosis, as well as in CP-B cirrhosis; but an HBP-DT of 15 min or longer seems more appropriate than DT-10 for visualization of HCC in patients with CP-C cirrhosis.

Keywords: Magnetic resonance imaging, Gd-EOB-DTPA, Hepatobiliary phase, Delay time, Hepatocellular carcinoma, Cirrhosis, Optimization

Core tip: In order to optimize the hepatobiliary phase delay time (HBP-DT) of Gd-EOB-DTPA-enhanced magnetic resonance imaging for more efficient identification of hepatocellular carcinoma (HCC) in cirrhosis of different degrees of severity, we analyzed the signal intensity and ratios between liver parenchyma and HCC, and the percentages of HCC visibility at a series of HBP-DT points in those patients. The severity of cirrhosis was shown to negatively influence HCC visibility, but DT-10 is already enough and more efficient than longer DT to identify HCC in Child-Pugh (CP)-A and CP-B cirrhosis. DT-15 or longer DT seems more appropriate for HCC visibility in patients with CP-C cirrhosis.