Korean J Radiol.  2011 Aug;12(4):403-415. 10.3348/kjr.2011.12.4.403.

Consensus Report of the 4th International Forum for Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid Magnetic Resonance Imaging

• Lee JM
• Zech CJ
• Bolondi L
• Jonas E
• Kim MJ
• Matsui O
• Merkle EM
• Sakamoto M
• Choi BI

• KMID: 1783206
• DOI: http://doi.org/10.3348/kjr.2011.12.4.403

Abstract

This paper reports on issues relating to the optimal use of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA MR imaging) together with the generation of consensus statements from a working group meeting, which was held in Seoul, Korea (2010). Gd-EOB-DTPA has been shown to improve the detection and characterization of liver lesions, and the information provided by the hepatobiliary phase is proving particularly useful in differential diagnoses and in the characterization of small lesions (around 1-1.5 cm). Discussion also focused on advances in the role of organic anion-transporting polypeptide 8 (OATP8) transporters. Gd-EOB-DTPA is also emerging as a promising tool for functional analysis, enabling the calculation of post-surgical liver function in the remaining segments. Updates to current algorithms were also discussed.

Keyword

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging; Hepatocellular carcinomas; Organic anion-transporting polypeptide 8; Cirrhotic liver; Incidental liver lesions

MeSH Terms

Algorithms
Contrast Media/*diagnostic use/metabolism
Diagnosis, Differential
Gadolinium DTPA/*diagnostic use/metabolism
Humans
Liver Diseases/*diagnosis/metabolism/surgery
Liver Function Tests
*Magnetic Resonance Imaging
Organic Anion Transporters, Sodium-Independent/metabolism
Postoperative Complications/diagnosis
Practice Guidelines as Topic

Figure

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  Fig. 1 Image illustrating appearance of grade I foci in dysplastic nodule (A) and grade II foci in early hepatocellular carcinoma (B).

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  Fig. 2 Distribution of lesion type according to size. Most nodules may be sub-clinical (i.e. ≤ 5 mm) (15). DN = dysplastic nodule, eHCC = early hepatocellular carcinoma, G = grade, HGDN = high-grade dysplastic nodule, LGDN = low-grade dysplastic nodule

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  Fig. 3 Signal intensity on hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging and expression of OATP8 during multi-step hepatocarcinogenesis. eHCC = early hepatocellular carcinoma, HGDN = high-grade dysplastic nodule, LGDN = low-grade dysplastic nodule, OATP8 = organic anion-transporting polypeptide 8, RN = regenerative nodule

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  Fig. 4 Correlation between tumor enhancement ratio on hepatobiliary phase of Gd-EOB-DTPA-enhanced MR imaging and amount of OATP8 expression at polymerase chain reaction. Expression score = (tumor transporter value/tumor b-actin value)/(background transporter value/background b-actin value). Enhancement ratio = (pre-enhancement signal intensity [SI] minus post-enhancement SI)/pre-enhancement SI. Reprinted, with permission, from Kitao et al. Radiology 2010;256(3):817-826. © Radiological Society of North America (7).

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  Fig. 5 Dynamic phase of Gd-EOB-DTPA MR imaging (A) shows clear arterial enhancement and washout of two hepatocellular carcinomas but hepatobiliary phase (B) also shows several subcentimeter hypointense nodules confirmed as well-differentiated, hepatocellular carcinoma.

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  Fig. 6 Proposed algorithm for work-up of incidental lesions using Gd-EOB-DTPA MR imaging in patients without increased risk of HCC. CE-CT = contrast enhanced CT, DWI = diffusion-weighted imaging, FNH = focal nodular hyperplasia, HBP = hepatobiliary phase, HCC = hepatocellular carcinoma, T1W = T1-weighted, T2W = T2-weighted, THID = transient hepatic signal intensity differences, US = ultrasound

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  Fig. 7 Case study of 50-year-old male, post-cholecystectomy, with mild, common bile duct dilation. T2-weighted MR imaging data (A) might suggest stenosis in pre-papillary area, but in corresponding Gd-EOB-DTPA-enhanced T1-weighted MR imaging (B) contrast agent was excreted into duodenum after 15 minutes, ruling out possibility of stenosis.

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