Clinical usefulness of the ablative margin assessed by magnetic resonance imaging with Gd-EOB-DTPA for radiofrequency ablation of hepatocellular carcinoma.

Abstract

BACKGROUND & AIMS:

The aim of this study was to investigate the feasibility of ablative margin (AM) grading by magnetic resonance imaging (MRI) with Gd-EOB-DTPA administered prior to radiofrequency ablation (RFA), and to identify factors for achieving a sufficient AM and predictors for local tumor progression.

METHODS:

A total of 124 hepatocellular carcinomas (HCCs) were treated by RFA after Gd-EOB-DTPA administration. MRI and enhanced CT were performed within seven hours and one month after RFA. The AM assessment was categorized using three grades: AM (+), low-intensity area with continuous high-intensity rim; AM zero, low-intensity area with discontinuous high-intensity rim; and AM (-), low-intensity area extends beyond the high-intensity rim. Patients were followed and local tumor progression was observed.

RESULTS:

AM (+), AM zero, AM (-), and indeterminate were found in 34, 33, 26, and 31 nodules, respectively. The overall agreement rate between MRI and enhanced CT for the diagnosis of AM was 56.8%. The κ coefficient was 0.326 (p<0.001), indicating moderate agreement. Multivariate logistic regression analysis showed that a significant factor for the achievement of AM (+) on MRI was no contiguous vessels. The cumulative local tumor progression rates (0% at 1, 2, and 3 years) in 33 AM (+) nodules were significantly lower than those (3.6%, 11.5%, and 18.3% at 1, 2, and 3 years respectively) in 32 AM zero nodules. A multivariate Cox proportional hazards model identified tumor size as an independent predictor for local tumor progression.

CONCLUSION:

Gd-EOB-DTPA-MRI enabled an early assessment of RFA effectiveness in the majority ofHCC nodules. Local tumor progression was not detected in AM (+) nodules during the follow-up.

• Authors: Masahiko Koda, Shiho Tokunaga, Toshiaki Okamoto, Masanori Hodozuka, Kennichi Miyoshi, Manabu Kishina, Yuki Fujise, Jun Kato, Tomomitsu Matono, Takaaki Sugihara, Kenji Oyama, Keiko Hosho, Jun-ichi Okano, Yoshikazu Murawaki, Suguru Kakite, Eijiro Yamashita
• Journal: Journal of hepatology (J Hepatol) Vol. 63 Issue 6 Pg. 1360-7 (Dec 2015) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 26232269 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Contrast Media
• gadolinium ethoxybenzyl DTPA
• Gadolinium DTPA

Topics

• Aged
• Carcinoma, Hepatocellular (pathology, surgery)
• Catheter Ablation
• Contrast Media
• Disease Progression
• Female
• Gadolinium DTPA
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (pathology, surgery)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Tomography, X-Ray Computed