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Value of hepatocellular phase imaging after intravenous gadoxetate disodium for assessing hepatic metastases from gastroenteropancreatic neuroendocrine tumors: comparison with other MRI pulse sequences and with extracellular agent

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Abstract

Objective

To compare hepatocellular phase imaging after intravenous gadoxetate disodium with other MRI pulse sequences and with extracellular agent for assessing hepatic metastases from gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN).

Materials and methods

In this IRB-approved, HIPAA-compliant retrospective study, we included 30 patients (15 women, mean age: 58 years, range 44–77 years) with GEP-NEN metastatic to the liver, who underwent MRI with gadoxetate disodium. Six MRI sequences were reviewed by two radiologists to score tumor–liver interface (TLI) on a 5-point scale, to assess lesion detectability in different liver segments (divided into 3 zones/patient), and to measure lesion size. Contrast-to-noise ratio (CNR) was calculated on each sequence. In 19 patients, lesion size and CNR on dynamic imaging with gadopentetate dimeglumine was compared with hepatocellular phase. Wilcoxon signed-rank test was used to compare TLI scores, lesion size, and median CNR, using Bonferroni correction for multiple testing. Interobserver agreement for TLI was analyzed using Krippendorff's alpha, and for lesion size using concordance correlation coefficient (CCC) and mean relative difference.

Results

Hepatocellular phase had the best TLI (mean TLI for reader 1 = 1.2, reader 2 = 1.3) compared to all other sequences (p < 0.0001) with excellent interobserver agreement (Krippendorff's alpha = 1.0), maximum lesion detectability (61/90 zones), highest interobserver agreement for lesion measurement (CCC 0.9875 and smallest mean relative difference − 1.567%), and highest median CNR (31.2, p < 0.008). Hepatocellular phase also had the highest CNR when compared with gadopentetate imaging.

Conclusion

Hepatocellular phase imaging offers significant advantages for assessment of hepatic metastasis in GEP-NEN, and should be routinely considered for follow-up of these patients.

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Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Sree Harsha Tirumani, Jyothi P. Jagannathan, Marta Braschi-Amirfarzan, Nikhil H. Ramaiya & Atul B. Shinagare

  2. Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, USA

    Jyothi P. Jagannathan, Marta Braschi-Amirfarzan, Lei Qin, Nikhil H. Ramaiya & Atul B. Shinagare

  3. Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Boston, MA, USA

    Patricia Balthazar & Atul B. Shinagare

Authors
  1. Sree Harsha Tirumani
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  2. Jyothi P. Jagannathan
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  4. Lei Qin
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  5. Patricia Balthazar
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  6. Nikhil H. Ramaiya
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  7. Atul B. Shinagare
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Correspondence to Sree Harsha Tirumani.

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Scientific Guarantor: Atul B. Shinagare, MD.

Appendix

Appendix

See Table 9.

Table 9 MR imaging parameters on 1.5 and 3.0 Tesla scanners
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Tirumani, S.H., Jagannathan, J.P., Braschi-Amirfarzan, M. et al. Value of hepatocellular phase imaging after intravenous gadoxetate disodium for assessing hepatic metastases from gastroenteropancreatic neuroendocrine tumors: comparison with other MRI pulse sequences and with extracellular agent. Abdom Radiol 43, 2329–2339 (2018). https://doi.org/10.1007/s00261-018-1496-1

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  • DOI: https://doi.org/10.1007/s00261-018-1496-1

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