title: MRI for characterization of primary tumors in the non-cirrhotic liver: added value of Gd-EOB-DTPA enhanced hepatospecific phase.
abstract: OBJECTIVE
  To evaluate the added value of hepatospecific phase in Gd-EOB-DTPA enhanced magnetic resonance imaging (MRI) in patients with primary tumors in non-cirrhotic liver.
  
  
  METHODS
  Twenty-nine patients (median, 39 years; range, 18-81 years; 11 male) underwent preoperative Gd-EOB-DTPA enhanced MRI including hepatospecific phase after 10 and 20 min of contrast injection at four institutions in Europe, North America and New Zealand. Images were evaluated by three different readers (R1-R3) who characterized liver tumors with and without consultation of the hepatospecific phase images. Confidence in diagnosis was scored on a visual analog scale from 1 to 10. Histopathology (adenoma, n=5; focal nodular hyperplasia, n=11 and hepatocellular carcinoma, n=13) in all patients served as the standard of reference. Differences were evaluated using the McNemar and Wilcoxon signed rank test.
  
  
  RESULTS
  Without hepatospecific phase images available, 22 (76%), 19 (66%) and 19 (66%) of 29 tumors were characterized correctly by the three readers respectively. Mean confidence in diagnosis was 6.1, 5.7 and 5.8. With the hepatospecific phase included, characterization of liver tumors did not change significantly with 21 (72%), 23 (79%) and 19 (66%) of 29 tumors diagnosed correctly (p>0.05). According confidence ratings increased to 6.3, 6.5 and 7.7, respectively. Increase in diagnostic confidence was significant for R2 and R3 (p<0.05) and independent of reader's experience.
  
  
  CONCLUSIONS
  The additional hepatospecific phase in Gd-EOB-DTPA enhanced MRI did not significantly increase diagnostic accuracy in characterization of primary tumors in the non-cirrhotic liver. However, 2/3 readers showed a significant increase in diagnostic confidence after consultation of the hepatospecific phase.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Olivio F
authors.initials: OF
authors.lastname: Donati
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Hunziker
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Dimitri A
authors.initials: DA
authors.lastname: Raptis
authors.affiliation: Department of Visceral and Transplant Surgery, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Breitenstein
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland; Clinic Hirslanden, Hirslanden Hospital Group, Zurich, Switzerland. Electronic address: Michael.Patak@hirslanden.ch.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Patak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005060:Europe; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D009656:North America; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Contrast media; Gd-EOB-DTPA; Hepatospecific; Liver tumor; Magnetic resonance imaging