Therapy response assessment after radioembolization of patients with hepatocellular carcinoma--comparison of MR imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid and gadobutrol.
OBJECTIVE
To compare the utility of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA), a liver-specific magnetic resonance (MR) imaging contrast agent, versus gadobutrol for treatment response evaluation of hepatocellular carcinoma (HCC) after radioembolization.


METHODS
This prospective study included 50 patients with HCC undergoing radioembolization. All patients underwent contrast-enhanced computed tomography (CT) and MR imaging with gadobutrol and Gd-EOB-DTPA on 2 consecutive days before radioembolization and 30 days, 90 days, 180 days, and 270 days after radioembolization. The standard of reference indicating tumor progression was CT combined with either α-fetoprotein or γ-glutamyltransferase. Gadobutrol-enhanced MR imaging, Gd-EOB-DTPA-enhanced MR imaging without late phase imaging (Gd-EOB-DTPA-), and Gd-EOB-DTPA-enhanced MR imaging with late phase imaging (Gd-EOB-DTPA+) were evaluated by 2 radiologists in consensus using a 4-point scale: 1 = definitely no tumor progression; 2 = probably no tumor progression; 3 = probably tumor progression; 4 = definitely tumor progression. Diagnostic accuracy was assessed with receiver operating characteristic analysis.


RESULTS
Tumor progression was detected in 14 of 82 study visits according to the reference standard. Pairwise comparison of the area under the curve showed a tendency toward a larger area under the curve for Gd-EOB-DTPA+ compared with gadobutrol (P = .056). Sensitivity and specificity were higher in Gd-EOB-DTPA+ (0.929 and 0.971) than in Gd-EOB-DTPA- (0.786 and 0.941) or gadobutrol (0.643 and 0.956). In 2 cases, tumor progression was detected by Gd-EOB-DTPA+ and by an increase in α-fetoprotein, but not by CT, gadobutrol, or Gd-EOB-DTPA-.


CONCLUSIONS
Gd-EOB-DTPA+ MR imaging was not inferior to gadobutrol-enhanced MR imaging in therapy response evaluation after radioembolization and may allow a more accurate detection of early HCC recurrence in single cases.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany. Electronic address: Juliane.Schelhorn@uk-essen.de.
Juliane
J
Schelhorn
Department of Gastroenterology and Hepatology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany.
Jan
J
Best
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany.
Marcus P
MP
Reinboldt
Department of Gastroenterology and Hepatology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany.
Guido
G
Gerken
Department of Clinic of Nuclear Medicine, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany.
Marcus
M
Ruhlmann
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany.
Thomas C
TC
Lauenstein
Department of Diagnostic and Interventional Radiology (G.A.), Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
Gerald
G
Antoch
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen 45147, Germany.
Sonja
S
Kinner
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000532:radiotherapy*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D005858:Germany; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology* / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D015203:Reproducibility of Results; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000097:blood
C097353:AFP protein, human; D003287:Contrast Media; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D000509:alpha-Fetoproteins; C073590:gadolinium ethoxybenzyl DTPA; C090600:gadobutrol; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human; D019786:Gadolinium DTPA