Hepatobiliary phases in magnetic resonance imaging using liver-specific contrast for focal lesions in clinical practice

• Published in: World journal of hepatology Vol. 14; no. 7; pp. 1459 - 1469
• Main Authors: Fernandes, Daniel Alvarenga, Dal Lago, Eduardo Andreazza, Oliver, Felipe Aguera, Loureiro, Bruna Melo Coelho, Martins, Daniel Lahan, Penachim, Thiago José, Barros, Ricardo Hoelz de Oliveira, Araújo Filho, José de Arimatéia Batista, Eloy da Costa, Larissa Bastos, da Silva, Áurea Maria Oliveira, de Ataíde, Elaine Cristina, Boin, Ilka de Fátima Santana Ferreira, Caserta, Nelson Marcio Gomes
• Format: Journal Article
• Language: English
• Published: Baishideng Publishing Group Inc 27-07-2022
• Subjects: Observational Study
• ISSN: 1948-5182; 1948-5182
• DOI: 10.4254/wjh.v14.i7.1459

BACKGROUNDChallenging 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 have been 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). AIMTo demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions (FLL) in clinical practice. METHODSOverall, 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. RESULTSThe 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. CONCLUSIONThe 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.