Benefits of MRI with Primovist® in Cirrhotic Livers

MRI during hepatobiliary phase with hepatocyte-specific contrast allows recognizing HCC with typical and atypical appearance. Thus, it improves HCC detection.

 

 

025_44_image-highlight1_report23_20190228_F2R_PAR0124GiuseppeBrancatelli(1)

Introduction

Cirrhosis of the liver goes along with scars and regeneration, resulting in regenerative nodules.

Dysplastic nodules (DN) are focal nodular regions that can transform to hepatocellular carcinoma (HCC). The process of changing from low grade to high grade DN and later to HCC occur on a cellular level.

 

The more a DN transforms to HCC, the more neoangiogenesis can be observed. At the same time, there is an increasing loss of portal-venous supply. The loss of portal-venous supply leads to wash-out in the portal-venous phase.

Multiphase Imaging

Multiphase imaging is possible with both MRI and CT. Multiphase imaging acquires data during different phases:

  • Before contrast administration
  • During hepato-arterial phase
  • During portal-venous phase
  • During the hepatobiliary phase

Detecting HCC with Primovist®-enhanced MRI

Giuseppe Brancatelli explained that the liver-specific contrast agent Primovist® 0.25 mmol/ml is injected intravenously at a slow injection rate of 1 mL/sec in order to stretch the bolus.

70% of HCC with Typical Appearance

About 70 percent of HCC show the typical pattern of Primovist®-enhanced MRI:

Enhancement in the arterial phase + Washout in the portal-venous phase

 

The most recent guidelines of EASL (European Association for the Study of the Liver) state that based on these criteria, the diagnosis of HCC can be established non-invasively.

30% of HCC with Atypical Appearance

About 30 percent of HCC appear atypically, meaning:

  • either with arterial enhancement + with no portal-venous washout
  • or with no arterial enhancement + with portal-venous washout

025_45_image-highlight2_report23_20190228_F2R_PAR0165GiuseppeBrancatelli(1)

Hepatobiliary Phase + Take-Home Messages

To characterize these lesions, additional informational gained during the hepatobiliary phase can be used: 90% of HCC are hypointense in the HBP because they lose their ability to take up Primovist®.

 

Example: A lesion with arterial enhancement + with no portal-venous washout. No capsule nor threshold growth. This lesion would be graded LR3 according to LIRADS (Liver Imaging Reporting and Data System). If this lesion appears hypointense in HBP, this favors the diagnosis of HCC and the lesion can be upgraded to LR4.

 

Brancatelli’s take-home message #1:

Primovist® increases the sensitivity for HCC diagnosis.

 

Example: A lesion with arterial enhancement + with no washout: In the HBP the lesion appears isointense. This finding indicates high chance that the lesion is no HCC. The lesion will be downgraded from LR3 to LR2.

 

Take-home message #2:

Primovist® increases the specificity for HCC diagnosis.

 

Take-home message #3:

Primovist® improves the detection of minimally hypervascular HCC.

 

Example: A lesion with no enhancement + with no washout: Hypovascular hypointense nodules detected in the HBP carry a significant potential of transforming into hypervascular HCCs (Suh CH et al. AJR 2017).

 

Take-home message #4:

Primovist® improves the early detection of HCC.