Digestive Diseases and Sciences

, Volume 61, Issue 4, pp 1197–1205 | Cite as

Clinical Impact of Gadoxetic Acid-Enhanced Magnetic Resonance Imaging on Hepatoma Management: A Prospective Study

  • Jing-Houng Wang
  • Tai-Yi Chen
  • Hsin-You Ou
  • Chih-Chi Wang
  • Yueh-Wei Liu
  • Chao-Hung Hung
  • Chien-Hung Chen
  • Chung-Huang Kuo
  • Tsung-Hui Hu
  • Yu-Fan Cheng
  • Sheng-Nan Lu
Original Article



For patients with hepatocellular carcinoma (HCC), gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) improved the diagnosis, migrated Barcelona Clinic Liver Cancer (BCLC) stage, and changed therapeutic decision in retrospective analysis.


This prospective study was to evaluate the clinical impact of EOB-MRI on HCC management.


From September 2012 to February 2014, consecutive patients with suspicion of HCC in BCLC early stage by multidetector computed tomography or dynamic MRI with non-specific gadolinium, well liver function reserve, and admitted for resection evaluation were enrolled prospectively. Additional EOB-MRI was performed. The HCC diagnosis, BCLC staging, and treatment decision were obtained in a liver cancer conference. EOB-MRI impact on HCC management was analyzed.


One hundred and three patients including 68 with typical and 35 with atypical HCC nodules in dynamic imaging studies were enrolled. EOB-MRI characterized 3 (4.4 %) benign and 33 (94.3 %) HCC for patients with typical and atypical HCC nodules, respectively. For 90 HCC patients, additional EOB-MRI changed BCLC stage in 25 (27.8 %) and treatment decision in 17 (18.9 %) patients. There were 66 patients with 78 resected nodules including 65 HCCs, 4 intrahepatic cholangiocarcinomas, and 9 benign nodules. Dynamic study and EOB-MRI detected and characterized 69 and 77 nodules, respectively. The sensitivity and accuracy in HCC diagnosis were 98.5 and 85.7 % for EOB-MRI, which were better than those of dynamic study (p < 0.001).


Additional EOB-MRI improved HCC diagnosis in sensitivity, accuracy but not specificity. It changed BCLC staging and treatment decision in 27.8 and 18.9 % of early-stage HCC patients.


Hepatocellular carcinoma (HCC) Gadoxetic acid (Gd-EOB-DTPA) Magnetic resonance imaging (MRI) Barcelona Clinic Liver Cancer (BCLC) staging Treatment decision 



The study was supported by Grants (CMRPG891531-2 and CMRPG8B0462-3) from Chang Gung Memorial Hospital to Jing-Houng Wang and Tai-Yi Chen.

Compliance with ethical standards

Conflict of interest



  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–2917.CrossRefPubMedGoogle Scholar
  2. 2.
    Santi V, Trevisani F, Gramenzi A, et al. Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival. J Hepatol. 2010;53:291–297.CrossRefPubMedGoogle Scholar
  3. 3.
    Wang JH, Chang KC, Kee KM, et al. Hepatocellular carcinoma surveillance at 4- vs. 12-month intervals for patients with chronic viral hepatitis: a randomized study in community. Am J Gastroenterol. 2013;108:416–424.CrossRefPubMedGoogle Scholar
  4. 4.
    Kuo YH, Lu SN, Chen CL, et al. Hepatocellular carcinoma surveillance and appropriate treatment options improve survival for patients with liver cirrhosis. Eur J Cancer. 2010;46:744–751.CrossRefPubMedGoogle Scholar
  5. 5.
    Tseng PL, Wang JH, Tung HD, et al. Optimal treatment increased survival of hepatocellular carcinoma patients detected with community-based screening. J Gastroenterol Hepatol. 2010;25:1426–1434.CrossRefPubMedGoogle Scholar
  6. 6.
    Bruix J, Sherman M. Management of hepatocellular carcinoma-an update. Hepatology. 2011;53:1020–1022.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    European association for the study of the liver. European organisation for research and treatment of cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–943.CrossRefGoogle Scholar
  8. 8.
    Kudo M. Multistep human hepatocarcinogenesis: correlation of imaging with pathology. J Gastroenterol. 2009;44:112–118.CrossRefPubMedGoogle Scholar
  9. 9.
    Leoni S, Piscaglia F, Golfieri R, et al. The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria. Am J Gastroenterol. 2010;105:599–609.CrossRefPubMedGoogle Scholar
  10. 10.
    Van Beers BE, Pastor CM, Hussain HK. Primovist, Eovist: what to expect? J Hepatol. 2012;57:421–429.CrossRefPubMedGoogle Scholar
  11. 11.
    Wu LM, Xu JR, Gu HY, et al. Is liver-specific gadoxetic acid-enhanced magnetic resonance imaging a reliable tool for detection of hepatocellular carcinoma in patients with chronic liver disease? Dig Dis Sci. 2013;58:3313–3325.CrossRefPubMedGoogle Scholar
  12. 12.
    Liu X, Zou L, Liu F, Zhou Y, Song B. Gadoxetic acid disodium-enhanced magnetic resonance imaging for the detection of hepatocellular carcinoma: a meta-analysis. PLoS One. 2013;8:e70896.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hammerstingl R, Huppertz A, Breuer J, et al. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol. 2008;18:457–467.CrossRefPubMedGoogle Scholar
  14. 14.
    Jin YJ, Nah SY, Lee JW, et al. Utility of adding Primovist magnetic resonance imaging to analysis of hepatocellular carcinoma by liver dynamic computed tomography. Clin Gastroenterol Hepatol. 2013;11:187–192.CrossRefPubMedGoogle Scholar
  15. 15.
    Yoo SH, Choi JY, Jang JW, et al. Gd-EOB-DTPA-enhanced MRI is better than MDCT in decision making of curative treatment for hepatocellular carcinoma. Ann Surg Oncol. 2013;20:2893–2900.CrossRefPubMedGoogle Scholar
  16. 16.
    Rhee H, Kim MJ, Park MS, Kim KA. Differentiation of early hepatocellular carcinoma from benign hepatocellular nodules on gadoxetic acid-enhanced MRI. Br J Radiol. 2012;85:e837–e844.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Omata M, Lesmana LA, Tateishi R, et al. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int. 2010;4:439–474.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Seyama Y, Kokudo N. Assessment of liver function for safe hepatic resection. Hepatol Res. 2009;39:107–116.CrossRefPubMedGoogle Scholar
  19. 19.
    Forner A, Vilana R, Ayuso C, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology. 2008;47:97–104.CrossRefPubMedGoogle Scholar
  20. 20.
    Sangiovanni A, Manini MA, Iavarone M, et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut. 2010;59:638–644.CrossRefPubMedGoogle Scholar
  21. 21.
    Bashir MR, Gupta RT, Davenport MS, et al. Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis? J Magn Reson Imaging. 2013;37:398–406.CrossRefPubMedGoogle Scholar
  22. 22.
    Granito A, Galassi M, Piscaglia F, et al. Impact of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance on the non-invasive diagnosis of small hepatocellular carcinoma: a prospective study. Aliment Pharmacol Ther. 2013;37:355–363.CrossRefPubMedGoogle Scholar
  23. 23.
    Chung YE, Kim MJ, Kim YE, Park MS, Choi JY, Kim KW. Characterization of incidental liver lesions: comparison of multidetector CT versus Gd-EOB-DTPA-enhanced MR imaging. PLoS One. 2013;8:e66141.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Donati OF, Hunziker R, Fischer MA, Raptis DA, Breitenstein S, Patak MA. MRI for characterization of primary tumors in the non-cirrhotic liver: added value of Gd-EOB-DTPA enhanced hepatospecific phase. Eur J Radiol. 2014;83:1074–1079.CrossRefPubMedGoogle Scholar
  25. 25.
    Fowler KJ, Sheybani A, Parker RA III, et al. Combined hepatocellular and cholangiocarcinoma (biphenotypic) tumors: imaging features and diagnostic accuracy of contrast-enhanced CT and MRI. Am J Roentgenol. 2013;201:332–339.CrossRefGoogle Scholar
  26. 26.
    Hwang J, Kim YK, Park MJ, et al. Differentiating combined hepatocellular and cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma using gadoxetic acid-enhanced MRI. J Magn Reson Imaging. 2012;36:881–889.CrossRefPubMedGoogle Scholar
  27. 27.
    Nakamura Y, Tashiro H, Nambu J, et al. Detectability of hepatocellular carcinoma by gadoxetate disodium-enhanced hepatic MRI: tumor-by-tumor analysis in explant livers. J Magn Reson Imaging. 2013;37:684–691.CrossRefPubMedGoogle Scholar
  28. 28.
    Jha RC, Mitchell DG, Weinreb JC, et al. LI-RADS categorization of benign and likely benign findings in patients at risk of hepatocellular carcinoma: a pictorial atlas. Am J Roentgenol. 2014;203:W48–W69.CrossRefGoogle Scholar
  29. 29.
    Kim SH, Lee CH, Kim BH, et al. Typical and atypical imaging findings of intrahepatic cholangiocarcinoma using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging. J Comput Assist Tomogr. 2012;36:704–709.CrossRefPubMedGoogle Scholar
  30. 30.
    Jeong HT, Kim MJ, Chung YE, Choi JY, Park YN, Kim KW. Gadoxetate disodium-enhanced MRI of mass-forming intrahepatic cholangiocarcinomas: imaging-histologic correlation. Am J Roentgenol. 2013;201:W603–W611.CrossRefGoogle Scholar
  31. 31.
    Gupta RT, Marin D, Boll DT, et al. Hepatic hemangiomas: difference in enhancement pattern on 3T MR imaging with gadobenate dimeglumine versus gadoxetate disodium. Eur J Radiol. 2012;81:2457–2462.CrossRefPubMedGoogle Scholar
  32. 32.
    International Consensus Group for Hepatocellular Neoplasia. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology. 2009;49:658–664.CrossRefGoogle Scholar
  33. 33.
    Kogita S, Imai Y, Okada M, et al. Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol. 2010;201:2405–2413.CrossRefGoogle Scholar
  34. 34.
    Shim JH, Han S, Shin YM, et al. Prognostic performance of preoperative gadoxetic acid-enhanced MRI in resectable hepatocellular carcinoma. J Magn Reson Imaging. 2015;41:1115–1123.CrossRefPubMedGoogle Scholar
  35. 35.
    Kim HD, Lim YS, Han S, et al. Evaluation of early-stage hepatocellular carcinoma by magnetic resonance imaging with gadoxetic acid detects additional lesions and increases overall survival. Gastroenterology. 2015;148:1371–1382.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jing-Houng Wang
    • 1
  • Tai-Yi Chen
    • 2
  • Hsin-You Ou
    • 2
  • Chih-Chi Wang
    • 3
  • Yueh-Wei Liu
    • 3
  • Chao-Hung Hung
    • 1
  • Chien-Hung Chen
    • 1
  • Chung-Huang Kuo
    • 1
  • Tsung-Hui Hu
    • 1
  • Yu-Fan Cheng
    • 2
  • Sheng-Nan Lu
    • 1
  1. 1.Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan, ROC
  2. 2.Department of Radiology, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan, ROC
  3. 3.Department of Surgery, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan, ROC

Personalised recommendations