The Clinical Application Study Of Hepatobiliary Specific Contrast Agent Gd-EOB-DTPA

Part I The Clinical application study Gd-EOB-DTPA Enhanced Magnetic Resonance Imaging in Dectecting for Focal Hepatic LesionsObjective: To evaluate the detection efficacy of Gd-EOB-DTPA enhanced MRI in detecting focal liver lesons(FLLs)compared with non-enhanced MRI ? dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),and to study the features of Gd-EOB-DTPA enhanced MRI in FLLs,trying to increase the accuracy of detection and diagnosis in focal hepatic lesions.Materials and methods: 72 patients with FLLs in our hospital underwent pre-contrast(T1WI sequences with fat suppression,T2 WI sequence with fat suppression),Gd-EOBDTPA DCE-MRI and delayed hepatobiliary phase after 20 minutes were retrospectively analyzed.Dynamic enhancement MRI included arterial phase,portal phase and equilibrium phase.The number of lesions detected,and absolute value of lesion-liver contrast to noise ratios(CNR)were calculated and quantitative analyzed.Results: A total of 119 focal hepatic lesions(? 2cm)were identified.The absolute value of lesion-liver CNR was remarkably increased in all phases after Gd-EOB-DTPA enhancent(P<0.001).There were 116 lesions on Gd-EOB-DTPA enhancement sequences(dynamic enhancement and hepatobiliary phase),there were significant differences between Gd-EOB-DTPA enhancement sequenced and precontrast sequences(P<0.001).In 20 min hepatocyte-phase,3 cases of focal nodular hyperplasia(FNH)showed hyper-intensity,and 2 cases of FNH showed iso-intensity;1 hepatocellular adenoma(HCA)showed hyper-intensity,2 cases of HCA showed hypo-intensity;relative iso-intensity in 3 cases of regenerative nodules(RN),and 1 case of RN showed hypo-intensity;3 cases of hepatocellular carcinomas(HCC)showed iso-intensity,29 cases of HCC showed hypo-intensity.Relative hypo-intensity was showed in all of the rest of the lesions including hemangiomas,dysplastic nodule,cholangiocarcinoma,hepatic metastases.Conclusion: Gd-EOB-DTPA DCE-MRI.has the ability that could increase the detection rate of FLLs.Gd-EOB-DTPA DCE-MRI combined with hepatocyte-phase was able to provide more diagnosis information and to improve the confidence in diagnosis.Part II Different Imaging patterns of Hepatocellular Carcinoma on Gd-EOB-DTPA MRI and the correlation with the Histological GradePurpose: To purpose of this study the patterns of hepatobiliary phase on Gd-EOB-DTPA enhanced magnetic resonance(MR)imaging of hepatocellular carcinoma(HCC)and try to find wherther it has the correlation with the histological grade.Materials and methods: 92 patients underwent Gd-EOB-DTPA with 102 pathologicallyconfirmed HCCs were retrospectively analyzed.Typical enhancement of HCC during dynamic phases was defined as hyperintensity on arterial phase(AP)and hypointensity on portal venous phase(PVP),as defined in AASLD.If a HCC didn't meet the AASLD criteria,it was regarded as atypical enhancement.In addition,according to the signal on hepatobiliary phase(HBP)images,HCCs were classified as hypointensity,heterogeneous intensity,iso-to hyperintensity.As a consequence,9 imaging patterns of HCC on Gd-EOB-DTPA MRI were defined.The absolute value of contrast to noise ratios(CNR)of liver to lesion on HBP was calculated.Among the different histological grades,the signal of HCCs on HBP were compared using c2 test,and the absolute lesion to liver contrast to noise ratios(CNR)of HCCs on HBP were compared using and Kruskal-Wallis test.Results: All the 102 HCCs were defined into 5 imaging patterns,as follows: 89.3 %(91/102)of HCCs with type I,II,and 10.7%(11/102)with type IV,VII and IX.Type I,II,and III had typic enhancement and HBP hypointensity,heterogeneous intensity,retrospectively.Type IV and VII had atypical enhancement and HBP hypointensity,hypointensity,iso-intensity,retrospectively.Most(92/102)of HCCs appear hypointense in the HBP.The signal of HCCs on HBP were not correlated with histological grades(P=0.371),the absolute value of CNR of liver to lesion of HCCs' on HBP were correlated with histologic grades(P<0.001).Conclusion: The combination of DCE-MRI and HBP imaging is useful for the diagnosis of HCCs.In most of the cases,the HCC enhancement mode was typical,and a small number of HCC was not typical.The signal of HCCs in the HBP of Gd-EOB-DTPA enhanced MR imaging negatively correlated with histologic grades.But the absolute value of CNR of liver to lesion on HCCs' HBP were correlated with histological grades(P<0.001).Part III Effect of Different liver function on Contrast-enhanced MR cholangiography with Gd-EOB-DTPAPurpose: To assess the effect of liver function on biliary tract visualization using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography(CE-MRC)in patients with different liver function.Materials and methods: A total of 90 patients with and without liver cirrhosis disease(normal liver group,n=30;chronic liver disease group,n=60)were included in our study.All patients were prospectively enrolled for evaluation of known or suspected focal liver lesions.The 90 patients were divided into four groups according to their Child-Pugh classification: normal liver function(NLF)group(n=30);liver cirrhosis with Child-Pugh A(LCA)group(n=30);liver cirrhosis with Child-Pugh B(LCB)group(n=19)and liver cirrhosis with Child-Pugh C(LCC)group(n=11).Relative signal intensity(RSI)of common bile duct(CBD)(RSI=SICBD/mean SI erect spinae muscle),and the RSI of liver parenchyma was measured and calculated in the same way.RSI of CBD and RSI of liver parenchyma was entered into regression analysis.Results: The mean RSI of liver parenchyma of NLF and LCA to LCC groups were 0.62 ±0.06,0.56 ± 0.02,0.40 ± 0.05,and 0.29 ± 0.02,respectively.The average RSI of CBD for the four groups of patients 20 min was 18.04 ±0.29,17.12 ± 0.41,3.95 ± 0.63,and 3.33 ± 0.30,respectively.CE-MRC images of NLF and LCA were significantly better than those of LCB and LCC in terms of both visualization ratings and RSI of CBD.Conclusion: The results of our study demonstrate that Gd-EOB-DTPA enhanced MRI can accurately evaluated liver function quantitatively,and different liver function according to Child-Pugh classification significantly affects biliary system visualization in Gd-EOB-DTPA enhanced CE-MRC.