Huppertz Alexander, Haraida Sibylle, Kraus Armin, Zech Christoph J, Scheidler Juergen, Breuer Josy, Helmberger Thomas K, Reiser Maximilian F
Department of Clinical Radiology and Institute of Pathology, Ludwig-Maximilians University, Munich, Germany.
Radiology. 2005 Feb;234(2):468-78. doi: 10.1148/radiol.2342040278. Epub 2004 Dec 10.
To detect hepatocyte-selective enhancement of focal lesions with gadoxetic acid at magnetic resonance (MR) imaging and to correlate enhancement in hepatocyte-selective phases with histopathologic findings and in arterial and portal venous phases with biphasic computed tomographic (CT) findings.
Study was supported by local ethics committee; all patients gave written informed consent. In 19 men and 14 women recruited in three clinical studies, histopathologic correlation and CT scans of 41 focal lesions (13 primary malignant lesions, 21 metastases, three adenomas, three cases of focal nodular hyperplasia [FNH], and one cystadenoma) and ultrasonographic confirmation of five cysts were available. MR was performed before and during arterial and portal venous phases and in hepatocyte-selective phases 10 and 20 minutes after injection of gadoxetic acid. Enhancement was evaluated in consensus by two observers. Enhancement pattern and morphologic features during arterial and portal venous phases were correlated between gadoxetic acid-enhanced MR and CT images by means of adjusted chi(2) test.
Hepatocyte-selective uptake was observed 10 and 20 minutes after injection in FNH (three of three), adenoma (two of three), cystadenoma (one of one), and highly differentiated hepatocellular carcinoma (HCC [grade G1], two of four). Uptake was not detected in metastases (21 of 21), cholangiocarcinoma (three of three), combined hepatocellular cholangiocarcinoma (one of one), undifferentiated carcinoma (one of one), moderately or poorly differentiated HCC (grade G2-G3) (four of four), HCC (grade G1, two of four), adenoma with atypia (one of three), or cysts (five of five). During arterial and portal venous phases, there was high overall agreement rate of 0.963 between gadoxetic acid-enhanced MR and CT (simultaneous 95% confidence interval: 0.945, 0.981).
Liver-specific enhancement of focal lesions is hepatocyte selective and correlates with various histopathologic diagnoses regarding presence of certain hepatocytic functions. Arterial and portal venous MR images obtained with gadoxetic acid are comparable to those of CT.
在磁共振（MR）成像中利用钆塞酸检测局灶性病变的肝细胞选择性强化，并将肝细胞选择性期的强化与组织病理学结果相关联，将动脉期和门静脉期的强化与双期计算机断层扫描（CT）结果相关联。
本研究得到当地伦理委员会的支持；所有患者均签署了书面知情同意书。在三项临床研究招募的19名男性和14名女性中，有41个局灶性病变（13个原发性恶性病变、21个转移瘤、3个腺瘤、3例局灶性结节性增生[FNH]和1个囊腺瘤）的组织病理学相关性及CT扫描结果，还有5个囊肿的超声检查确诊结果。在注射钆塞酸之前、动脉期和门静脉期以及注射后10分钟和20分钟的肝细胞选择性期进行MR检查。由两名观察者共同评估强化情况。通过校正卡方检验将钆塞酸增强MR和CT图像在动脉期和门静脉期的强化模式及形态学特征进行相关性分析。
在FNH（3例中的3例）、腺瘤（3例中的2例）、囊腺瘤（1例中的1例）和高分化肝细胞癌（HCC[G1级]，4例中的2例）中，注射后10分钟和20分钟观察到肝细胞选择性摄取。在转移瘤（21例中的21例）、胆管癌（3例中的3例）、肝内胆管癌（1例中的1例）、未分化癌（1例中的1例）、中分化或低分化HCC（G2 - G3级）（4例中的4例）、HCC（G1级，4例中的2例）、非典型腺瘤（3例中的1例）或囊肿（5例中的5例）中未检测到摄取。在动脉期和门静脉期，钆塞酸增强MR与CT之间的总体一致性较高，为0.963（同时95%置信区间：0.945，0.981）。
局灶性病变的肝脏特异性强化具有肝细胞选择性，并且与某些肝细胞功能存在与否的各种组织病理学诊断相关。用钆塞酸获得的动脉期和门静脉期MR图像与CT图像相当。
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