Therapy response assessment after radioembolization of patients with hepatocellular carcinoma--comparison of MR imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid and gadobutrol.

Abstract

PURPOSE:

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.

MATERIALS AND 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.

• Authors: Juliane Schelhorn, Jan Best, Marcus P Reinboldt, Guido Gerken, Marcus Ruhlmann, Thomas C Lauenstein, Gerald Antoch, Sonja Kinner
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 26 Issue 7 Pg. 972-9 (Jul 2015) ISSN: 1535-7732 [Electronic] United States
• PMID: 25937296 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• AFP protein, human
• Contrast Media
• Organometallic Compounds
• Radiopharmaceuticals
• alpha-Fetoproteins
• gadolinium ethoxybenzyl DTPA
• gadobutrol
• gamma-Glutamyltransferase
• gamma-glutamyltransferase, human
• Gadolinium DTPA

Topics

• Aged
• Aged, 80 and over
• Area Under Curve
• Carcinoma, Hepatocellular (blood, pathology, radiotherapy)
• Contrast Media
• Embolization, Therapeutic (methods)
• Female
• Gadolinium DTPA
• Germany
• Humans
• Liver Neoplasms (blood, pathology, radiotherapy)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Observer Variation
• Organometallic Compounds
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Radiopharmaceuticals (administration & dosage)
• Reproducibility of Results
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• alpha-Fetoproteins (metabolism)
• gamma-Glutamyltransferase (blood)