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Combined gadoxetic acid and gadofosveset enhanced liver MRI for detection and characterization of liver metastases

  • Hepatobiliary-Pancreas
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Abstract

Purpose

To compare gadoxetic acid alone and combined gadoxetic acid/gadofosveset trisodium-enhanced liver MRI for detection of metastases and differentiation of metastases from haemangiomas.

Methods

Ninety-one patients underwent gadoxetic acid-enhanced liver MRI before and after additional injection of gadofosveset. First, two readers retrospectively identified metastases on gadoxetic acid alone enhanced delayed hepatobiliary phase T1-weighted images together with all other MR images (dynamic images, T2-weighted images, diffusion-weighted images). Second, readers assessed additional T1-weighted images obtained after administration of gadofosveset trisodium. For both interpretations, readers rated lesion conspicuity and confidence in differentiating metastases from haemangiomas. Results were compared using alternative free-response receiver-operating characteristic (AFROC) and conventional ROC methods. Histology and follow-up served as reference standard.

Results

There were 145 metastases and 16 haemangiomas. Both readers detected more metastases using combined gadoxetic acid/gadofosveset (reader 1 = 130; reader 2 = 124) compared to gadoxetic acid alone (reader 1 = 104; reader 2 = 103). Sensitivity of combined gadoxetic acid/gadofosveset (reader 1 = 90 %; reader 2 = 86 %) was higher than that of gadoxetic acid alone (reader 1 = 72 %; reader 2 = 71 %, both P < 0.01). AFROC-AUC was higher for the combined technique (0.92 vs. 0.86, P < 0.001). Sensitivity for correct differentiation of metastases from haemangiomas was higher for the combined technique (reader 1 = 98 %; reader 2 = 99 % vs. reader 1 = 86 %; reader 2 = 91 %, both P < 0.01). ROC-AUC was significantly higher for the combined technique (reader 1 = 1.00; reader 2 = 1.00 vs. reader 1 = 0.87; reader 2 = 0.92, both P < 0.01).

Conclusion

Combined gadoxetic acid/gadofosveset-enhanced MRI improves detection and characterization of liver metastases compared to gadoxetic acid alone.

Key Points

• Combined gadoxetic acid and gadofosveset-enhanced liver MRI significantly improves detection of metastases.

• The combined enhancement technique improves the accuracy to differentiate metastases from haemangiomas.

• Prospective studies need to determine the clinical impact of the combined technique

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Acknowledgments

The scientific guarantor of this publication is Scott B. Reeder. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Alejandro Munoz del Rio, PhD kindly provided statistical advice for this manuscript. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Study subjects or cohorts have not been previously reported. Methodology: retrospective, cross-sectional study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA

    Peter Bannas, Candice A. Bookwalter, Tim Ziemlewicz, Utaroh Motosugi, Alejandro Munoz del Rio, Theodora A. Potretzke, Scott K. Nagle & Scott B. Reeder

  2. Department of Radiology, University Hospital, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Peter Bannas

  3. Department of Radiology, University of Yamanashi, Yamanashi, Japan

    Utaroh Motosugi

  4. Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA

    Scott K. Nagle & Scott B. Reeder

  5. Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA

    Scott K. Nagle

  6. Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

  7. Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

  8. Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA

    Scott B. Reeder

Authors
  1. Peter Bannas
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  2. Candice A. Bookwalter
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  5. Alejandro Munoz del Rio
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  6. Theodora A. Potretzke
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  7. Scott K. Nagle
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Corresponding author

Correspondence to Peter Bannas.

Electronic supplementary material

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Supplementary Movie 1

Scrolling through images with gadoxetic acid alone and combined gadoxetic acid/gadofosveset-enhanced liver MRI images provides a much greater appreciation for the look and feel of the improvement in visualization of the combined contrast protocol. Note the improved conspicuity of the small perivascular metastasis in liver segment 4a/b in this 53-year-old woman with oesophageal cancer (same as in Fig. 3b). This histologically confirmed metastases was missed by both readers on gadoxetic alone-enhanced images but detected on combined gadoxetic acid/gadofosveset-enhanced images. (MOV 26107 kb)

Supplementary Movie 2

(MOV 30668 kb)

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Bannas, P., Bookwalter, C.A., Ziemlewicz, T. et al. Combined gadoxetic acid and gadofosveset enhanced liver MRI for detection and characterization of liver metastases. Eur Radiol 27, 32–40 (2017). https://doi.org/10.1007/s00330-016-4375-6

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  • DOI: https://doi.org/10.1007/s00330-016-4375-6

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