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Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid-Enhanced Magnetic Resonance Imaging Findings of Borderline Lesions at High Risk for Progression to Hypervascular Classic Hepatocellular Carcinoma

Kobayashi, Satoshi MD; Matsui, Osamu MD; Gabata, Toshifumi MD; Koda, Wataru MD; Minami, Tetsuya MD; Ryu, Yasuji MD; Kawai, Keiichi MD; Kozaka, Kazuto MD

Journal of Computer Assisted Tomography: March-April 2011 - Volume 35 - Issue 2 - p 181-186
doi: 10.1097/RCT.0b013e3182026f3b
Abdominal Imaging

Objectives: The objectives of the study were to assess the imaging features of hypovascular borderline lesions containing hypervascular foci on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and to evaluate the ability of Gd-EOB-DTPA-enhanced MRI to diagnose high-risk borderline lesions possibly consistent with early hepatocellular carcinoma (HCC).

Methods: Institutional review board approval was obtained for this retrospective analysis of imaging findings, and informed consent was obtained from 217 consecutive patients undergoing Gd-EOB-DTPA-enhanced MRI and angiography-assisted computed tomography (CT) for examination of hepatocellular nodular lesions in cirrhotic livers. There were 73 nodules showing hypervascular foci in borderline lesions identified by angiography-assisted CT. Signal intensity patterns of the nodules were evaluated on hepatobiliary-phase Gd-EOB-DTPA-enhanced T1-weighted MRI obtained 20 minutes after intravenous injection of contrast media.

Results: Among 73 high-risk borderline lesions, 59 were hypointense (81%), and 14 were isointense (19%), compared with background liver parenchyma. There were 27 untreated lesions followed by CT and/or MRI. Almost half of these nodules transformed into hypervascular HCC, regardless of signal intensities seen on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI.

Conclusions: Although many high-risk borderline HCC lesions are hypointense on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI, some high-risk borderline lesions are isointense and transform at the same rate into hypervascular HCC.

From the Department of Radiology, Kanazawa University School of Medicine, Kanazawa, Japan.

Received for publication August 12, 2010; accepted October 19, 2010.

Reprints: Satoshi Kobayashi, MD, Department of Radiology, Kanazawa University School of Medicine, 13-1, Takara-machi, Kanazawa 920-8641, Japan (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.