Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

作     者：Daniel Alvarenga Fernandes Eduardo Andreazza Dal Lago Felipe Aguera Oliver Bruna Melo Coelho Loureiro Daniel Lahan Martins Thiago José Penachim Ricardo Hoelz de Oliveira Barros José de ArimatéiaBatista Araújo Filho Larissa Bastos Eloy da Costa Áurea Maria Oliveira da Silva Elaine Cristina de Ataíde Ilka de Fátima Santana Ferreira Boin Nelson Marcio Gomes Caserta 

作者机构：Department of RadiologySchool of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazi Department of RadiologyMedical SchoolSão Paulo State University-UNESPBotucatu 18618-970São PauloBrazil Instituto de RadiologiaHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo-InRad/HC-FMUSPSão Paulo 05403-010SPBrazil Department of RadiologySírio-Libanês HospitalSão Paulo 05652-900SPBrazil Department of PathologySchool of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil Liver Transplant UnitDepartment of SurgerySchool of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2022年第14卷第7期

页      面：1459-1469页

学科分类：0831[工学-生物医学工程（可授工学、理学、医学学位）] 1002[医学-临床医学] 08[工学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Liver Liver neoplasms Liver transplantation Medical oncology Diagnostic imaging Magnetic resonance imaging 

摘      要：BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse outcomes.One of the main innovative trends currently is the use of molecular and functional methods to diagnosis.Numerous liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical practice.METHODS Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL.Two radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage 2.RESULTS The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant FLL.The diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage 2.Addition of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage 4.CONCLUSION The hepatobiliary sequences improve diagnostic accuracy.With growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.