Biologic factors affecting HCC conspicuity in hepatobiliary phase imaging with liver-specific contrast agents

The purpose of this study was to evaluate factors influencing hepatic enhancement and the conspicuity of hepatocellular carcinoma (HCC) on gadobenate dimeglu-mine- and gadoxetate disodium-enhanced hepatobiliary phase MR images.

Patients with chronic liver disease who underwent liver MRI with gadobenate dimeglumine (n = 93) or gadoxetate disodium (n = 92) were included in this study. The degree of hepatic enhancement on 1-hour and 3-hour delayed phase gadobenate dimeglumine-enhanced and 20-minute delayed phase gadoxetate disodium-enhanced hepatobiliary phase images were evaluated with quantitative and visual indexes. The conspicuity of 40 HCCs in the gadobenate dimeglumine group and 38 HCCs in the gadoxetate disodium group were graded on a 5-point scale. Correlation between hepatic enhancement indexes and clinical factors (age, body weight, serum bilirubin concentration, model for end-stage liver disease score, Child-Pugh class, and renal function stage) and association between the conspicuity of HCCs and clinical factors, lesion diameter, and hepatic enhancement indexes were evaluated.

In the gadobenate dimeglumine group, the visual index of hepatic enhancement independently correlated with Child-Pugh class on both 1- and 3-hour delayed images (p < 0.001) and with renal function stage only on 3-hour delayed images (p ≤ 0.031). In the gadoxetate disodium group, both quantitative and visual indexes of hepatic enhancement independently correlated with Child-Pugh class (p ≤ 0.019). The conspicuity of HCCs independently correlated with Child-Pugh class and lesion diameter on 3-hour delayed gadobenate dimeglumine-enhanced images (p ≤ 0.031) and on gadoxetate disodium-enhanced images (p = 0.033) and significantly correlated with the visual index of hepatic enhancement on both gadobenate dimeglumine- and gadoxetate disodium-enhanced images (p ≤ 0.001).

Liver enhancement and conspicuity of HCC are significantly affected by Child-Pugh class on both gadobenate dimeglumine- and gadoxetate disodium-enhanced hepatobiliary phase MR images.