title: Is there an added value of a hepatobiliary phase with gadoxetate disodium following conventional MRI with an extracellular gadolinium agent in a single imaging session for detection of primary hepatic malignancies?
abstract: To determine added value of hepatobiliary phase (HBP) using gadoxetate disodium compared to MRI with extracellular gadolinium-based contrast agent (GBCA) for detection of primary hepatic malignancies in a single imaging session.
  
  
  
  IRB approved this HIPAA compliant retrospective study. Within 90 days of resection or liver transplant, thirty patients underwent MRI with extracellular GBCA followed by separate injection of gadoxetate for HBP. Two sets of images were reviewed: Set #1-unenhanced and enhanced images with an extracellular GBCA and set #2-with addition of HBP. Data were analyzed in two groups, cases with hepatocellular carcinoma (HCC) only and cases with either HCC and/or cholangiocarcinoma. Observer diagnostic accuracy (Az), sensitivity, and specificity were calculated.
  
  
  
  14/30 subjects had HCC (46%, CI 28-66%), 2/30 (2%, CI 1-22%) cholangiocarcinoma, and 14/30 (46%, CI 28-66%) no malignancy. There was no significant change in A z value with addition of gadoxetate in the detection of HCC (range 0.84-0.97 set #1 and 0.85-0.97 set #2, p > 0.05). Sensitivity and specificity showed no significant differences (p > 0.05) between the image sets for all readers. When stratified by lesion size, there was no significant difference in accuracy, sensitivity, or specificity for any reader (p > 0.05).
  
  
  
  When compared to extracellular GBCA, gadoxetate HBP imaging does not result in a significant difference in accuracy or sensitivity in diagnosis of HCC or cholangiocarcinoma and may result in a decrease in specificity.
authors.affiliation: Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. jay.pahade@yale.edu.
authors.forename: Jay K
authors.identifier: 0000-0002-4399-1938
authors.initials: JK
authors.lastname: Pahade
authors.affiliation: Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.|Department of Radiology, UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
authors.forename: David
authors.initials: D
authors.lastname: Juice
authors.affiliation: Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Staib
authors.affiliation: Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Israel
authors.affiliation: Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. dcornfel@gmail.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Cornfeld
authors.affiliation: Department of Pathology, Yale School of Medicine, 310 Cedar Street, PO Box 208023, New Haven, CT, 06520-8023, USA.
authors.forename: Kisha
authors.initials: K
authors.lastname: Mitchell
authors.affiliation: Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weinreb
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Eovist; Gadoxetate; Gadoxetic acid; Hepatobiliary phase; Hepatocellular carcinoma