Portal hypertension may influence the reg-istration of hypointensity of small hepato-cellular carcinoma in the hepatobiliary phase in gadoxetic acid MR

Authors

  • Carla Caparroz Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. University of Barcelona, Spain.
  • Alejandro Forner BCLC group. Liver Unit. Hospital Clinic Barcelona. IDIBAPS. CIBERehd. University of Barcelona
  • Jordi Rimola Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. University of Barcelona, Spain.
  • Anna Darnell Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. University of Barcelona, Spain.
  • Ángeles García-Criado Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. University of Barcelona, Spain.
  • Juan Ramon Ayuso Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. University of Barcelona, Spain.
  • María Reig Liver Unit. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Spain
  • Jordi Bruix Liver Unit. Barcelona Clinic Liver Cancer (BCLC) group. Hospital Clinic Barcelona. IDIBAPS. CIBERehd. University of Barcelona, Spain
  • Carmen Ayuso Radiology Department. Barcelona Clinic Liver Cancer (BCLC) group. IDIBAPS. CIBERehd. Hospital Clinic Barcelona. University of Barcelona, Spain

Abstract

Background. To analyze the association between the liver uptake of gadoxetic acid (Gd-EOB-DTPA) in the hepatobiliary phase (HBP) in cirrhotic patients and the presence of clinically significant portal hypertension (CSPH), and how these features impact on HCC detection in the HBP.

Patients and methods. Post-hoc analysis of a prospective cohort of 62 cirrhotic patients with newly US-detected nodule between 1-2 cm (study group). Twenty healthy subjects were used as control group. Qualitative and quantitative analysis of the liver contrast uptake in the HBP assessed by Relative Liver-Enhancement (RLE), Liver-Spleen (LSCR), Liver-Muscle (LMCR), and Liver-Kidney Contrast-Ratio (LKCR), Contrast Enhancement Index (CEI), and Hepatic Uptake (HUI), and biliary excretion, were registered. CSPH was confirmed invasively (HVPG >10 mmHg) or by indirect parameters. The appearance of HCC at the HBP was analyzed.

Results. Nineteen patients (30.6%) did not have CSPH. In 41 patients (66.1%) the final diagnosis was HCC. All indices were significantly higher in the control group, indicating a more intense HBP liver signal intensity compared to patients with cirrhosis, even if the comparison was restricted to patients with no CSPH. CSPH was associated to a lower rate of HCC hypointensity in the HBP (51.9% vs 85.7% without CSPH, p=0.004).

Conclusions. Liver uptake of Gd-EOB-DTPA at the HBP is decreased in cirrhosis even if the liver function is minimally impaired and it falls down significantly in patients with CSPH compromising the recognition of hypointense lesions. This fact may represent a limitation for the detection of small HCC in patients with cirrhosis and CSPH.

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Published

2022-09-08

How to Cite

Caparroz, C., Forner, A., Rimola, J., Darnell, A., García-Criado, Ángeles, Ayuso, J. R., Reig, M., Bruix, J., & Ayuso, C. (2022). Portal hypertension may influence the reg-istration of hypointensity of small hepato-cellular carcinoma in the hepatobiliary phase in gadoxetic acid MR. Radiology and Oncology, 56(3), 292–302. Retrieved from https://radioloncol.com/index.php/ro/article/view/3843

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Section

Radiology