Author(s)

Makoto Hasegawa, Miki Sugiyama, Nozomu Murata, Masashi Nagamoto, Tatsuya Gomi

Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan.

Background: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA; gadoxetic acid disodium, Primovist, Bayer Healthcare, Berlin, Germany) is a gadolinium based contrast agent with hepatocyte specific properties. In patients scanned for hepatic metastasis using Gd-EOB-DTPA, it is important to differentiate hepatic metastasis with cysts and hemangiomas, which are the two most common benign lesions seen in the liver. Yet, in some cases it is difficult to differentiate these lesions. Purpose: The purpose of this study was to retrospectively investigate the usefulness of combining Fluid-attenuated inversion recovery (FLAIR) with Gd-EOB-DTPA enhanced MRI. Material and Methods: Gd-EOB-DTPA enhanced MRIs of 47 patients (19 male, 27 female) with a mean age of 68 years (range 32 - 85 years old) with a total of 121 lesions (68 cysts, 37 metastasis, 16 hemangiomas) were included in the study. T1WI, T2WI, heavy T2WI, dynamic contrast enhanced MRI, and FLAIR images of these lesions were evaluated. The patients were randomly divided into two groups (Groups A and B), and two independent radiologists were asked to give a diagnosis for each lesion. The radiologists were allowed to view FLAIR images for only Group B. Diagnostic performance regarding the differentiation of cysts, hemangiomas and metastases was assessed. MRI examinations were scanned using a 1.5 Tesla system (Echlon Vega, Hitachi,) with an 8 channel multiple array coil (RAPID body coil). Results: An statistically significant improvement (p < 0.05) of the specificity for cysts was seen from 71.9% (Group A) to 90.9% (Group B) for Reader 1, and 75.0% (Group A) to 93.3% (Group B) for Reader 2. No statistical differences were seen between the two groups for sensitivity and specificity of hemangiomas. Although no statistical difference was seen between the two groups, an improvement (77.8 in Group A to 97.2 in Group B for Reader 1, and 85.7 in Group A to 100 in Group B for Reader 2) was seen for the sensitivity of metastasis with the addition of FLAIR. Conclusion: An improvement of diagnostic accuracy, especially for cysts, was seen with the addition of FLAIR to Gd-EOB-DTPA enhanced MRI.

MRI, Abdomen, Liver Imaging, EOB, FLAIR, Heavy T2WI, Metastasis, Hemangioma, Cyst

Hasegawa, M. , Sugiyama, M. , Murata, N. , Nagamoto, M. and Gomi, T. (2017) FLAIR in Gd-EOB-DTPA Enhanced MRI: Does It Make a Difference?. Open Journal of Radiology, 7, 130-142. doi: 10.4236/ojrad.2017.72015.