Paradoxical high signal intensity of hepatocellular carcinoma in the hepatobiliary phase of Gd-EOB-DTPA enhanced MRI: initial experience

Abstract Purpose To describe the paradoxical high signal intensity of hepatocellular carcinoma (HCC) in the hepatobiliary phase on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). Materials and Methods A database search was performe...

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Bibliographic Details
Published in:Magnetic resonance imaging 2011, Vol.29 (1), p.83-90
Main Authors: Lee, Seun Ah, Lee, Chang Hee, Jung, Woon Yong, Lee, Jongmee, Choi, Jae Woong, Kim, Kyeong Ah, Park, Cheol Min
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Carcinoma, Hepatocellular - pathology
Contrast Media
Female
Gadolinium DTPA
Gadoxetic acid
Gd-EOB-DTPA
Green hepatoma
Hepatocellular carcinoma
Humans
Liver
Liver Neoplasms - pathology
Magnetic Resonance Imaging - methods
Male
Middle Aged
MRI
Radiology
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Summary:Abstract Purpose To describe the paradoxical high signal intensity of hepatocellular carcinoma (HCC) in the hepatobiliary phase on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). Materials and Methods A database search was performed to identify cases of HCC that showed unusual prolonged enhancement in the hepatobiliary phase of Gd-EOB-DTPA MRI. All patients received 3.0-T liver MRI including precontrast T1-weighted images, T2-weighted images and a post Gd-EOB-DTPA-enhanced dynamic study. The signal intensity of HCC was measured at pre-enhanced, arterial, portal, delayed and hepatobiliary phase using regions of interest. Radiologic and pathologic correlation was performed for the paradoxically prolonged enhancing portion of HCC in the hepatobiliary phase. Results Four patients (all male, age range 44–70; mean 57.5 years) were included in this study. All patients showed HCC lesions that were low signal intensity (SI) on T1-WI, high SI on T2-WI, enhanced in arterial phase, and washed-out in delayed phase. All cases showed paradoxically high SI in hepatobiliary phase, which was unusual for HCC. Pathologically, they were all diagnosed as well-differentiated HCC with prominent cytoplasm and a bile secreting appearance. Conclusion HCC may demonstrate the prolonged high signal intensity at the hepatobiliary phase on Gd-EOB-DTPA enhanced MRI. These HCCs tended to be highly differentiated and to have prominent bile secretion.
ISSN:0730-725X
1873-5894
DOI:10.1016/j.mri.2010.07.019