title: The value of paradoxical uptake of hepatocellular carcinoma on the hepatobiliary phase of gadoxetic acid-enhanced liver magnetic resonance imaging for the prediction of lipiodol uptake after transcatheter arterial chemoembolization.
abstract: OBJECTIVE
  To compare the response to transcatheter arterial chemoembolization (TACE) between hepatocellular carcinoma (HCC) with paradoxical uptake on the hepatobiliary phase (HBP) (HCCpara) and HCC with defect on the HBP (HCCdef), and to identify some imaging features that can differentiate between two groups.
  
  
  METHODS
  Ninety-three HCCs from 54 patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) prior to TACE were included. HCCs were classified into two groups according to the signal intensity (SI) on the HBP: HCCparaand HCCdef. Using post-TACE computed tomography (CT) as a reference standard, initial compact lipiodol uptake was assessed and compared between groups. The arterial enhancement ratio (AER), SI ratios of the arterial phase and HBP, and presence of the capsule appearance were compared between groups. After initial response, local tumor recurrence within 6 and 18 months was evaluated based on follow-up CT or MRI.
  
  
  RESULTS
  Fifteen HCCparaand 78 HCCdefwere included. Compared to HCCdef, HCCparashowed more frequent initial compact lipiodol uptake (p=0.009), larger mean size (p=0.019), lower AER (p=0.005), higher SI ratio of the HBP (p<0.0001), and more frequent capsule appearance (p<0.0001). Local tumor recurrence rate within 6 months was also significantly lower in HCCparathan in HCCdef(p=0.008).
  
  
  CONCLUSIONS
  Despite larger size and lower AER, HCCparashowed more frequent initial compact lipiodol uptake and lower early local recurrence rate after TACE than did HCCdef.
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: pridebio@naver.com.
authors.forename: Jeong Woo
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: chlee86@korea.ac.kr.
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: pys797979@naver.com.
authors.forename: Yang Shin
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: g1q1papa@korea.ac.kr.
authors.forename: Tae Seok
authors.initials: TS
authors.lastname: Seo
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: acube808@naver.com.
authors.forename: Myung Gyu
authors.initials: MG
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: kjhhepar@naver.com.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: kahkim@korea.ac.kr.
authors.forename: Kyeong Ah
authors.initials: KA
authors.lastname: Kim
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address: radpic@hanmail.net.
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media / Q000493:pharmacokinetics; D004998:Ethiodized Oil / Q000493:pharmacokinetics; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D004998:Ethiodized Oil; D019786:Gadolinium DTPA
keywords: Gadoxetic acid; Hepatocellular carcinoma; Lipiodol uptake; Magnetic resonance imaging; Transcatheter arterial chemoembolization