Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings.
OBJECTIVE
To evaluate the safety and efficacy of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging for the detection of focal liver lesions, with results of histopathologic examination and/or intraoperative ultrasonography used as a standard of reference.


METHODS
One hundred sixty-nine patients who were known to have or suspected of having focal liver lesions and were scheduled for liver surgery were included in this study. Results in 131 patients could be included in the efficacy analysis. MR imaging was performed before and immediately and 20 minutes after bolus injection of 0.025 mmol/kg of the liver-specific hepatobiliary contrast agent gadoxetic acid. T1-weighted gradient-echo (with and without fat saturation and including dynamic data sets) and T2-weighted fast spin-echo/turbo spin-echo sequences were performed. All images were evaluated on site and by three independent and blinded off-site reviewers. Lesion matching based on the standard-of-reference results was performed. Differences in lesion detection with precontrast and with postcontrast MR images were assessed with the two-sided Wilcoxon signed rank test.


RESULTS
Gadoxetic acid was well tolerated. In the on-site review, the number of patients in whom all lesions were correctly matched increased from 89 of 129 patients at precontrast MR imaging to 103 of 129 patients at postcontrast MR imaging. In the off-site evaluation, the number of patients in whom all lesions were correctly matched and the corresponding sensitivity values increased from 72 (55.8%), 68 (52.7%), and 66 (51.2%) with the precontrast images to 88 (68.2%), 69 (53.5%), and 76 (58.9%) with the postcontrast images for readers 1, 2, and 3, respectively. Two of the three blinded readers showed a statistically significant difference in lesion detection between precontrast and postcontrast MR imaging (P <.001 and P =.008). A large number of additionally correctly detected and localized lesions were smaller than 1 cm.


CONCLUSIONS
MR imaging with gadoxetic acid is safe and improves lesion detection and localization.
Huppertz
Alexander
A
Institute of Clinical Radiology, Klinikum Grosshadern, University of Munich, Germany. a;exander.huppertz@schering.de
Balzer
Thomas
T
Blakeborough
Anthony
A
Breuer
Josy
J
Giovagnoni
Andrea
A
Heinz-Peer
Gertraud
G
Laniado
Michael
M
Manfredi
Riccardo M
RM
Mathieu
Didier G
DG
Mueller
Dieter
D
Reimer
Peter
P
Robinson
Philip J
PJ
Strotzer
Michael
M
Taupitz
Matthias
M
Vogl
Thomas J
TJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA