Optimizing predictions: improved performance of preoperative gadobenate-enhanced MRI hepatobiliary phase features in predicting vessels encapsulating tumor clusters in hepatocellular carcinoma-a multicenter study.

BACKGROUND: Vessels Encapsulating Tumor Clusters (VETC) are now recognized as independent indicators of recurrence and overall survival in hepatocellular carcinoma (HCC) patients. However, there has been limited investigation into predicting the VETC pattern using hepatobiliary phase (HBP) features from preoperative gadobenate-enhanced MRI. METHODS: This study involved 252 HCC patients with confirmed VETC status from three different hospitals (Hospital 1: training set with 142 patients; Hospital 2: test set with 64 patients; Hospital 3: validation set with 46 patients). Independent predictive factors for VETC status were determined through univariate and multivariate logistic analyses. Subsequently, these factors were used to construct two distinct VETC prediction models. Model 1 included all independent predictive factors, while Model 2 excluded HBP features. The performance of both models was assessed using the Area Under the Curve (AUC), Decision Curve Analysis, and Calibration Curve. Prediction accuracy between the two models was compared using Net Reclassification Improvement (NRI) and Integrated Discriminant Improvement (IDI). RESULTS: CA199, IBIL, shape, peritumoral hyperintensity on HBP, and arterial peritumoral enhancement were independent predictors of VETC. Model 1 showed robust predictive performance, with AUCs of 0.836 (training), 0.811 (test), and 0.802 (validation). Model 2 exhibited moderate performance, with AUCs of 0.813, 0.773, and 0.783 in the respective sets. Calibration and decision curves for both models indicated consistent predictions between predicted and actual VETC, benefiting HCC patients. NRI showed Model 1 increased by 0.326, 0.389, and 0.478 in the training, test, and validation sets compared to Model 2. IDI indicated Model 1 increased by 0.036, 0.028, and 0.025 in the training, test, and validation sets compared to Model 2. CONCLUSION: HBP features from preoperative gadobenate-enhanced MRI can enhance the predictive performance of VETC in HCC.

Gadolinium-based contrast agents aggravate mechanical and thermal hyperalgesia in a nitroglycerine-induced migraine model in male mice.

In the diagnosis of migraine, which is a neurovascular disease, gadolinium-based contrast agents (GBCAs) are used to rule out more serious conditions. On the other hand, it remains unclear as a scientific gap whether GBCAs may trigger migraine-related pain. The aim of this study was to investigate the effect of GBCAs on mechanical and thermal pain behaviour in a nitroglycerin (NTG)-induced migraine model in mice. NTG (10 mg/kg) was administered intraperitoneally to adult (6-8weeks old) BALB/c mice 2 h before behavioral tests 5 times every other day on days 1st, 3rd, 5th and 9th to induce migraine model (N = 50). As GBCAs, gadobenate dimeglumine (linear-ionic), Gadodiamide (linear-nonionic), and gadobutrol (macrocyclic-nonionic) were delivered intravenously through the tail vein of mice for 5 days on test days. Mechanical pain threshold (plantar and facial withdrawal threshold) was evaluated by plantar von Frey and periorbital von Frey tests on days 1st, 5th, and 9th, and thermal pain threshold (latency) was evaluated by hot plate and cold plate tests on days 3rd and 7th. There was a statistically significant increase in mechanical and thermal hyperalgesia in NTG administered groups compared to the control group. Gadodiamide, gadobutrol and gadobenate dimeglumine administration significantly decreased latency, paw and facial withdrawal threshold (0.18 ± 0.05, 0.17 ± 0.07, 0.16 ± 0.09; 9th day values respectively) compared to NTG group (0.27 ± 0.05). The results of this in vivo study show that GBCAs produce effects that may trigger migraine attacks in migraine. It is recommended that these effects be further investigated and supported by further clinical studies.

Beta-Catenin-Mutated Hepatocellular Adenomas at Hepatobiliary Phase MRI: A Systematic Review and Meta-Analysis.

BACKGROUND: Beta-catenin-mutated hepatocellular adenomas (ß-HCAs) can appear iso- to hyperintense at the hepatobiliary phase (HBP) at magnetic resonance imaging (MRI). Given the relatively lower prevalence of ß-HCAs, prior studies had limited power to show statistically significant differences in the HBP signal intensity between different subtypes. PURPOSE: To assess the diagnostic performance of HBP MRI to discriminate ß-HCA from other subtypes. STUDY TYPE: Systemic review and meta-analysis. POPULATION: Ten original studies were included, yielding 266 patients with 397 HCAs (9%, 36/397 ß-HCAs and 91%, 361/397 non-ß-HCAs). FIELD STRENGTH/SEQUENCE: 1.5 T and 3.0 T, HBP. ASSESSMENT: PubMed, Web of Science, and Embase databases were searched from January 1, 2000, to August 31, 2023, for all articles reporting HBP signal intensity in patients with histopathologically proven HCA subtypes. QUADAS-2 was used to assess risk of bias and concerns regarding applicability. STATISTICAL TESTS: Univariate random-effects model was used to calculate pooled estimates. Heterogeneity estimates were assessed with I2 heterogeneity index. Meta-regression (mixed-effect model) was used to test for differences in the prevalence of HBP signal between HCA groups. The threshold for statistical significance was set at P < 0.05. RESULTS: HBP iso- to hyperintensity was associated with ß-HCAs (pooled prevalence was 72.3% in ß-HCAs and 6.3% in non-ß-HCAs). Pooled sensitivity and specificity were 72.3% (95% confidence interval 54.1-85.3) and 93.7% (93.8-97.7), respectively. Specificity had substantial heterogeneity with I2 of 83% due to one study, but not for sensitivity (I2 = 0). After excluding this study, pooled sensitivity and specificity were 77.4% (59.6-88.8) and 94.1% (88.9-96.9), with no substantial heterogeneity. One study had high risk of bias for patient selection and two studies were rated unclear for two domains. DATA CONCLUSION: Iso- to hyperintensity at HBP MRI may help to distinguish ß-HCA subtype from other HCAs with high specificity. However, there was heterogeneity in the pooled estimates. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

The value of periportal hyperintensity sign from gadobenate dimeglumine-enhanced hepatobiliary phase MRI for predicting clinical outcomes in patients with decompensated cirrhosis.

OBJECTIVES: To determine the value of periportal hyperintensity sign from gadobenate dimeglumine (Gd-BOPTA)-enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI) for predicting clinical outcomes in patients with decompensated cirrhosis. METHODS: A total of 199 cirrhotic patients who underwent Gd-BOPTA-enhanced MRI were divided into control group (n = 56) and decompensated cirrhosis group (n = 143). The presence of periportal hyperintensity sign on HBP MRI was recorded. The Cox regression model was used to investigate the association between periportal hyperintensity sign and clinical outcomes. RESULTS: There was a significant difference in the frequency of periportal hyperintensity sign on HBP between compensated and decompensated cirrhotic patients (p < 0.05). After a median follow-up of 29.0 months (range, 1.0-90.0 months), nine out of 143 patients (6.2%) with decompensated cirrhosis died. Periportal hyperintensity sign on HBP MRI was a significant risk factor for death (hazard ratio (HR) = 23.677; 95% confidence interval (CI) = 4.759-117.788; p = 0.0001), with an area under the curve (AUC) of 0.844 (95% CI = 0.774-0.899). Thirty patients (20.9%) developed further decompensation. Periportal hyperintensity sign on HBP MRI was also a significant risk factor for further decompensation (HR = 2.594; 95% CI = 1.140-5.903; p = 0.023). CONCLUSIONS: Periportal hyperintensity sign from Gd-BOPTA-enhanced HBP MRI is valuable for predicting clinical outcomes in patients with decompensated cirrhosis. CRITICAL RELEVANCE STATEMENT: Periportal hyperintensity sign from gadobenate dimeglumine-enhanced hepatobiliary phase magnetic resonance imaging is a new noninvasive method to predict clinical outcomes in patients with decompensated cirrhosis. KEY POINTS: • There was a significant difference in the frequency of periportal hyperintensity sign on HBP between compensated and decompensated cirrhotic patients. • Periportal hyperintensity sign on the hepatobiliary phase was a significant risk factor for death in patients with decompensated cirrhosis. • Periportal hyperintensity sign on the hepatobiliary phase was a significant risk factor for further decompensation in patients with decompensated cirrhosis.

Clinical-Radiologic Morphology-Radiomics Model on Gadobenate Dimeglumine-Enhanced MRI for Identification of Highly Aggressive Hepatocellular Carcinoma: Temporal Validation and Multiscanner Validation.

BACKGROUND: Highly aggressive hepatocellular carcinoma (HCC) is characterized by high tumor recurrence and poor outcomes, but its definition and imaging characteristics have not been clearly described. PURPOSE: To develop and validate a fusion model on gadobenate dimeglumine-enhanced MRI for identifying highly aggressive HCC. STUDY TYPE: Retrospective. POPULATION: 341 patients (M/F = 294/47) with surgically resected HCC, divided into a training cohort (n = 177), temporal validation cohort (n = 77), and multiscanner validation cohort (n = 87). FIELD STRENGTH/SEQUENCE: 3T, dynamic contrast-enhanced MRI with T1-weighted volumetric interpolated breath-hold examination gradient-echo sequences, especially arterial phase (AP) and hepatobiliary phase (HBP, 80-100 min). ASSESSMENT: Clinical factors and diagnosis assessment based on radiologic morphology characteristics associated with highly aggressive HCCs were evaluated. The radiomics signatures were extracted from AP and HBP. Multivariable logistic regression was performed to construct clinical-radiologic morphology (CR) model and clinical-radiologic morphology-radiomics (CRR) model. A nomogram based on the optimal model was established. Early recurrence-free survival (RFS) was evaluated in actual groups and risk groups calculated by the nomogram. STATISTICAL TESTS: The performance was evaluated by receiver operating characteristic curve (ROC) analysis, calibration curves analysis, and decision curves. Early RFS was evaluated by using Kaplan-Meier analysis. A P value <0.05 was considered statistically significant. RESULTS: The CRR model incorporating corona enhancement, cloud-like hyperintensity on HBP, and radiomics signatures showed the highest diagnostic performance. The area under the curves (AUCs) of CRR were significantly higher than those of the CR model (AUC = 0.883 vs. 0.815, respectively, for the training cohort), 0.874 vs. 0.769 for temporal validation, and 0.892 vs. 0.792 for multiscanner validation. In both actual and risk groups, highly and low aggressive HCCs showed statistically significant differences in early recurrence. DATA CONCLUSION: The clinical-radiologic morphology-radiomics model on gadobenate dimeglumine-enhanced MRI has potential to identify highly aggressive HCCs and non-invasively obtain prognostic information. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

The value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting decompensation and transplant-free survival in chronic liver disease.

OBJECTIVES: To investigate the value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting clinical outcomes in patients with chronic liver disease (CLD). METHODS: Three hundred and fourteen CLD patients who underwent gadobenate dimeglumine-enhanced hepatic magnetic resonance imaging were stratified into three groups: nonadvanced CLD (n = 116), compensated advanced CLD (n = 120), and decompensated advanced CLD (n = 78) groups. The liver-to-portal vein contrast ratio (LPC) and liver-spleen contrast ratio (LSC) at the hepatobiliary phase were measured. The value of LPC for predicting hepatic decompensation and transplant-free survival was assessed using Cox regression analysis and Kaplan-Meier analysis. RESULTS: The diagnostic performance of LPC was significantly better than LSC in evaluating the severity of CLD. During a median follow-up period of 53.0 months, the LPC was a significant predictor for hepatic decompensation (p < 0.001) in patients with compensated advanced CLD. The predictive performance of LPC was higher than that of the model for end-stage liver disease score (p = 0.006). With the optimal cut-off value, patients with LPC ≤ 0.98 had a higher cumulative incidence of hepatic decompensation than patients with LPC > 0.98 (p < 0.001). The LPC was also a significant predictive factor for transplant-free survival in patients with compensated advanced CLD (p = 0.007) and those with decompensated advanced CLD (p = 0.002). CONCLUSIONS: Contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine is a valuable imaging biomarker for predicting hepatic decompensation and transplant-free survival in CLD patients. KEY POINTS: • The liver-to-portal vein contrast ratio (LPC) significantly outperformed liver-spleen contrast ratio in evaluating the severity of chronic liver disease. • The LPC was a significant predictor for hepatic decompensation in patients with compensated advanced chronic liver disease. • The LPC was a significant predictor for transplant-free survival in patients with compensated and those with decompensated advanced chronic liver disease.

A preoperative model based on gadobenate-enhanced MRI for predicting microvascular invasion in hepatocellular carcinomas (≤ 5 cm).

Purpose: The present study aimed to develop and validate a preoperative model based on gadobenate-enhanced magnetic resonance imaging (MRI) for predicting microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) size of ≤5 cm. In order to provide preoperative guidance for clinicians to optimize treatment options. Methods: 164 patients with pathologically confirmed HCC and preoperative gadobenate-enhanced MRI from July 2016 to December 2020 were retrospectively included. Univariate and multivariate logistic regression (forward LR) analyses were used to determine the predictors of MVI and the model was established. Four-fold cross validation was used to verify the model, which was visualized by nomograms. The predictive performance of the model was evaluated based on discrimination, calibration, and clinical utility. Results: Elevated alpha-fetoprotein (HR 1.849, 95% CI: 1.193, 2.867, P=0.006), atypical enhancement pattern (HR 3.441, 95% CI: 1.523, 7.772, P=0.003), peritumoral hypointensity on HBP (HR 7.822, 95% CI: 3.317, 18.445, P<0.001), and HBP hypointensity (HR 3.258, 95% CI: 1.381, 7.687, P=0.007) were independent risk factors to MVI and constituted the HBP model. The mean area under the curve (AUC), sensitivity, specificity, and accuracy values for the HBP model were as follows: 0.830 (95% CI: 0.784, 0.876), 0.71, 0.78, 0.81 in training set; 0.826 (95% CI:0.765, 0.887), 0.8, 0.7, 0.79 in test set. The decision curve analysis (DCA) curve showed that the HBP model achieved great clinical benefits. Conclusion: In conclusion, the HBP imaging features of Gd-BOPTA-enhanced MRI play an important role in predicting MVI for HCC. A preoperative model, mainly based on HBP imaging features of gadobenate-enhanced MRI, was able to excellently predict the MVI for HCC size of ≤5cm. The model may help clinicians preoperatively assess the risk of MVI in HCC patients so as to guide clinicians to optimize treatment options.

Hepatobiliary Phase Features of Preoperative Gadobenate-Enhanced MR can Predict Early Recurrence of Hepatocellular Carcinoma in Patients Who Underwent Anatomical Hepatectomy.

Purpose: The purpose of this study was to establish a model for predicting early recurrence (≤2 years) of hepatocellular carcinoma (HCC) after anatomical hepatectomy based on the hepatobiliary phase (HBP) imaging characteristics of gadobenate-enhanced MRI. Methods: A total of 155 patients who underwent anatomical hepatectomy HCC therapy and gadobenate-enhanced MRI were included retrospectively. The patients were divided into the early recurrence-free group (n = 103) and the early recurrence group (n = 52). Univariate and multivariate Cox regression analysis was used to determine the independent risk factors related to early recurrence, and four models were established. The preoperative model with/without HBP imaging features (HBP-pre/No HBP-pre model) and the postoperative model with/without HBP imaging features (HBP-post/No HBP-post model). Bootstrap resampling 1,000 times was used to verify the model and displayed by nomograms. The performance of nomograms was evaluated by discrimination, calibration, and clinical utility. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate the differences between models and to select the optimal model. Results: Shape, arterial peritumoral enhancement, AFP-L3, and peritumoral hypointensity on HBP were identified as independent risk factors. Prothrombin time (PT) and r-glutamyltransferase (GGT) were selected by multivariate Cox regression. These six factors construct the HBP-pre model. Removing peritumoral hypointensity on HBP was the No HBP-pre model. Adding microvascular invasion (MVI) and microscopic capsule factors were the HBP-post and No HBP-post model. The C-index was 0.766, 0.738, 0.770, and 0.742, respectively. The NRI and IDI of the HBP-pre vs. the No HBP-pre model and the HBP-post vs. the No HBP-post model significantly increased 0.258, 0.092, 0.280, and 0.086, respectively. The calibration curve and decision curve analysis (DCA) had good consistency and clinical utility. However, the NRI and IDI of the No HBP-post vs. the No HBP-pre model and the HBP-post vs. the HBP-pre model did not increase significantly. Conclusions: Preoperative gadobenate-enhanced MR HBP imaging features significantly improve the model performance while the postoperative pathological factors do not. Therefore, the HBP-pre model is selected as the optimal model. The strong performance of this model may help hepatologists to assess the risk of recurrence in order to guide the selection of treatment options.

Comparison of Gadobenate-Enhanced MRI and Gadoxetate-Enhanced MRI for Hepatocellular Carcinoma Detection Using LI-RADS Version 2018: A Prospective Intraindividual Randomized Study.

BACKGROUND. Gadobenate and gadoxetate show different degrees of intracellular accumulation within hepatocytes, potentially impacting these agents' relative performance for hepatocellular carcinoma (HCC) diagnosis. OBJECTIVE. The purpose of this article was to perform an intraindividual comparison of gadobenate-enhanced MRI and gadoxetate-enhanced MRI for detection of HCC and to assess the impact of inclusion of hepatobiliary phase images on HCC detection for both agents. METHODS. This prospective study enrolled 126 patients (112 men, 14 women; mean age, 52.3 years) at high risk for HCC who consented to undergo two 3-T liver MRI examinations (one using gadobenate [0.05 mmol/kg], one using gadoxetate [0.025 mmol/kg]) separated by 7-14 days. The order of the two contrast agents was randomized. All examinations included postcontrast dynamic and hepatobiliary phase images (120 minutes for gadobenate, 20 minutes for gadoxetate). Three radiologists independently reviewed the gadobenate and gadoxetate examinations in separate sessions and recorded the location of detected observations. Observations were classified using LI-RADS version 2018 and using a LI-RADS modification whereby hepatobiliary phase hypointensity may upgrade observations from category LR-4 to LR-5. Observations classified as LR-5 were considered positive interpretations for HCC. Diagnostic performance for histologically confirmed HCC (n = 96) was assessed. RESULTS. Across readers, sensitivity for HCC for gadobenate versus gadoxetate was 74.0-80.2% versus 54.2-67.7% using dynamic images alone and 82.1-87.4% versus 66.3-81.1% using dynamic and hepatobiliary phase images. For HCCs measuring 1.0-2.0 cm, sensitivity for gadobenate versus gadoxetate was 61.9% (all readers) versus 38.1-57.1% using dynamic images alone and 76.2-85.7% versus 52.4-61.9% using dynamic and hepatobiliary phase images. PPV for HCC ranged from 88.6% to 97.4% across readers, agents, and image sets. CONCLUSION. Sensitivity for HCC was higher for gadobenate than for gadoxetate, whether using dynamic images alone or dynamic and hepatobiliary phase images; the improved sensitivity using gadobenate was more pronounced for small HCCs. Whereas hepatobiliary phase images improved sensitivity for both agents, sensitivity of gadobenate using dynamic images alone compared favorably with that of gadoxetate using dynamic and hepatobiliary phase images. CLINICAL IMPACT. The findings support gadobenate as a preferred agent over gadoxetate when performing liver MRI in patients at high risk for HCC.

A case of gadobenate dimeglumine-induced anaphylactic shock: a case report.

A 70-year-old man was admitted to our hospital due to "liver cirrhosis; grade 3 hypertension; pulmonary infection". On May 27, 2019, during upper abdomen plain and enhanced magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP), the patient experienced anaphylactic shock, manifested as sudden unconsciousness and lack of response, after intravenous administration of gadobenate dimeglumine (Multihance®). Gadobenate dimeglumine is a paramagnetic contrast used during diagnostic MRI. It has hepatobiliary specificity with very good imaging performance. A small amount is absorbed by normal liver cells after intravenous injection and excreted via the bile ducts while maintaining the chemical structure of gadobenate dimeglumine. It allows the visualization of local angiogenesis and perfusion, which reflect the hepatic blood supply and recent liver function, thereby providing a reference for clinical diagnosis. Gadobenate dimeglumine intravenous injection may cause adverse reactions such as nausea, dizziness, and anaphylactic shock. Anaphylactic shock is a known serious adverse reaction of gadobenate dimeglumine injection. In this paper, we report a case of gadobenate dimeglumine-induced anaphylactic shock based on the temporal relationship between the onset of symptoms and the injection. The patient received chest compressions and balloon-assisted ventilation in addition to rehydration and volume expansion and vasoactive drugs to maintain blood pressure, etc. The patient died despite treatments. In the clinical, physicians, nurses, and clinical pharmacists should closely monitor patients and promptly discontinue drug administration and provide symptomatic care in case of adverse reactions.

Dynamic contrast-enhanced MRI perfusion quantification in hepatocellular carcinoma: comparison of gadoxetate disodium and gadobenate dimeglumine.

OBJECTIVES: (1) To assess the quality of the arterial input function (AIF) during dynamic contrast-enhanced (DCE) MRI of the liver and (2) to quantify perfusion parameters of hepatocellular carcinoma (HCC) and liver parenchyma during the first 3 min post-contrast injection with DCE-MRI using gadoxetate disodium compared to gadobenate dimeglumine (Gd-BOPTA) in different patient populations. METHODS: In this prospective study, we evaluated 66 patients with 83 HCCs who underwent DCE-MRI, using gadoxetate disodium (group 1, n = 28) or Gd-BOPTA (group 2, n = 38). AIF qualitative and quantitative features were assessed. Perfusion parameters (based on the initial 3 min post-contrast) were extracted in tumours and liver parenchyma, including model-free parameters (time-to-peak enhancement (TTP), time-to-washout) and modelled parameters (arterial flow (Fa), portal venous flow (Fp), total flow (Ft), arterial fraction, mean transit time (MTT), distribution volume (DV)). In addition, lesion-to-liver contrast ratios (LLCRs) were measured. Fisher's exact tests and Mann-Whitney U tests were used to compare the two groups. RESULTS: AIF quality, modelled and model-free perfusion parameters in HCC were similar between the 2 groups (p = 0.054-0.932). Liver parenchymal flow was lower and liver enhancement occurred later in group 1 vs group 2 (Fp, p = 0.002; Ft, p = 0.001; TTP, MTT, all p < 0.001), while there were no significant differences in tumour LLCR (max. positive LLCR, p = 0.230; max. negative LLCR, p = 0.317). CONCLUSION: Gadoxetate disodium provides comparable AIF quality and HCC perfusion parameters compared to Gd-BOPTA during dynamic phases. Despite delayed and decreased liver enhancement with gadoxetate disodium, LLCRs were equivalent between contrast agents, indicating similar tumour conspicuity. KEY POINTS: • Arterial input function quality, modelled, and model-free dynamic parameters measured in hepatocellular carcinoma are similar in patients receiving gadoxetate disodium or gadobenate dimeglumine during the first 3 min post injection. • Gadoxetate disodium and gadobenate dimeglumine show similar lesion-to-liver contrast ratios during dynamic phases in patients with HCC. • There is lower portal and lower total hepatic flow and longer hepatic mean transit time and time-to-peak with gadoxetate disodium compared to gadobenate dimeglumine.

Dose-Lowering in Contrast-Enhanced MRI of the Central Nervous System: A Retrospective, Parallel-Group Comparison Using Gadobenate Dimeglumine.

BACKGROUND: Concerns over gadolinium (Gd) retention encourage the use of lower Gd doses. However, lower Gd doses may compromise imaging performance. Higher relaxivity gadobenate may be suited to reduced dose protocols. PURPOSE: To compare 0.05 mmol/kg and 0.1 mmol/kg gadobenate in patients undergoing enhanced MRI of the central nervous system (CNS). STUDY TYPE: Retrospective, multicenter. POPULATION: Three hundred and fifty-two patients receiving 0.05 (n = 181) or 0.1 (n = 171) mmol/kg gadobenate. FIELD STRENGTH/SEQUENCES: 1.5 T and 3.0 T/precontrast and postcontrast T1-weighted spin echo/fast spin echo (SE/FSE) and/or gradient echo/fast field echo (GRE/FFE); precontrast T2-weighted FSE and T2-FLAIR. ASSESSMENT: Images of patients with extra-axial lesions at 1.5 T or any CNS lesion at 3.0 T were reviewed by three blinded, independent neuroradiologists for qualitative (lesion border delineation, internal morphology visualization, contrast enhancement; scores from 1 = poor to 4 = excellent) and quantitative (lesion-to-brain ratio [LBR], contrast-to-noise ratio [CNR]; SI measurements at regions-of-interest on lesion and normal parenchyma) enhancement measures. Noninferiority of 0.05 mmol/kg gadobenate was determined for each qualitative endpoint if the lower limit of the 95% confidence interval (CI) for the difference in precontrast + postcontrast means was above a noninferiority margin of -0.4. STATISTICAL TESTS: Student's t-test for comparison of mean qualitative endpoint scores, Wilcoxon signed rank test for comparison of LBR and CNR values; Wilcoxon rank sum test for comparison of SI changes. Tests were significant for P < 0.05. RESULTS: The mean change from precontrast to precontrast + postcontrast was significant for all endpoints. Readers 1, 2, and 3 evaluated 304, 225, and 249 lesions for 0.05 mmol/kg gadobenate, and 382, 309, and 298 lesions for 0.1 mmol/kg gadobenate. The lower limit of the 95% CI was above -0.4 for all comparisons. Significantly, higher LBR and CNR was observed with the higher dose. DATA CONCLUSION: 0.05 mmol/kg gadobenate was noninferior to 0.1 mmol/kg gadobenate for lesion visualization. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.

Hepatobiliary phase hypointensity on gadobenate dimeglumine-enhanced magnetic resonance imaging may improve the diagnosis of hepatocellular carcinoma.

BACKGROUND: To determine the clinical value of hepatobiliary phase (HBP) hypointensity for noninvasive diagnosis of hepatocellular carcinoma (HCC). METHODS: A total of 246 high-risk patients with 263 selected nodules (126 HCCs, 137 non-HCCs) undergoing gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) were included in the study. Imaging-based diagnoses of small (≤3 cm) and large (>3 cm) HCCs were made using the following 4 criteria: (I) non-rim arterial phase hyper-enhancement (APHE) plus hypointensity on the portal venous phase (PVP); (II) non-rim APHE plus hypointensity on the PVP and/or transitional phase (TP); (III) non-rim APHE plus hypointensity on the PVP and/or TP and/or HBP; (IV) criterion 3 plus non-LR-1/2/M. Based on typical imaging features, LR-1, LR-2, or LR-M (if definitely benign, probably benign, malignant but not HCC specific, respectively) were defined according to the Liver Imaging Reporting and Data System (LI-RADS). Sensitivities and specificities of imaging criteria were calculated and compared using McNemar's test. RESULTS: Among the diagnostic criteria for small HCCs, criterion 3 and 4, which included HBP hypointensity, showed significantly higher sensitivities (96.4% and 94.6%, respectively) than criterion 1 (58.9%, P<0.001 for both). Moreover, criterion 4, which included HBP hypointensity and ancillary features, showed significantly higher specificity (94.7%) than criterion 3 (66.7%, P<0.001) and comparable specificity to criterion 1 (97.4%, P=0.375), achieving the highest accuracies (94.7%). The diagnostic performance of criterion 4 for large HCCs was similar to that for small HCCs. CONCLUSIONS: HBP hypointensity acquired from Gd-BOPTA-MRI can improve sensitivity and maintain high specificity in the diagnosis of both small and large HCCs after excluding benignities or non-HCC malignancies according to characteristic imaging features.

A radiomics nomogram based on contrast-enhanced MRI for preoperative prediction of macrotrabecular-massive hepatocellular carcinoma.

BACKGROUND: Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) represents an aggressive form of hepatocellular carcinoma and is associated with poor survival outcomes. AIMS: This study aimed to develop a radiomics nomogram based on contrast-enhanced MRI for preoperative prediction of MTM-HCC. METHODS: This study enrolled 88 patients with histologically confirmed HCC, including 32 MTM-HCCs and 56 Non-MTM-HCCs. The clinical and gadobenate dimeglumine (Gd)-enhanced MRI features were retrospectively reviewed by two abdominal radiologists. The regions of interest (ROIs) on the largest cross-sectional image and two adjacent images of the tumor, from which radiomics features were extracted via MaZda software and a radiomics score (Rad-score) was calculated via Python software. Combined with the Rad-score and independent imaging factors, a radiomics nomogram was constructed using R software. Nomogram performance was estimated with calibration curve. RESULTS: A total of eleven top weighted radiomics features were selected among five sequences of MR images. There was a significant difference in Rad-score between MTM-HCC and non-MTM-HCC patients (P < 0.001), where patients with MTM-HCC generally had higher Rad-scores (absolute value). After multivariate analysis, radiomics score (OR = 7.794, P < 0.001) and intratumor fat (OR = 9.963, P = 0.014) were determined as independent predictors associated with MTM-HCC. The area under the receiver operating characteristic (ROC) curve of the selected model was 0.813 (95% CI 0.714-0.912) and the optimal cutoff value was 0.60. The nomogram showed overall satisfactory prediction performance (AUC = 0.785 [95% CI 0.684-0.886]). CONCLUSIONS: A contrast-enhanced MRI-based radiomics nomogram may be useful for preoperative prediction of MTM-HCC in primary HCC patients, allowing opportunity to improve the treatment course and patient outcomes.

Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting.

Hepatobiliary MRI contrast agents are increasingly being used for liver imaging. In clinical practice, most focal liver lesions do not uptake hepatobiliary contrast agents. Less commonly, hepatic lesions may show variable signal characteristics on hepatobiliary phase. This pictorial essay reviews a broad spectrum of benign and malignant focal hepatic observations that may show hyperintensity on hepatobiliary phase in various clinical settings. In non-cirrhotic patients, focal hepatic observations that show hyperintensity in the hepatobiliary phase are usually benign and typically include focal nodular hyperplasia. In patients with primary or secondary vascular disorders, focal nodular hyperplasia-like lesions arise as a local hyperplastic response to vascular alterations and tend to be iso- or hyperintense in the hepatobiliary phase. In oncologic patients, metastases and cholangiocarcinoma are hypointense lesions in the hepatobiliary phase; however, occasionally they may show a diffuse, central and inhomogeneous hepatobiliary paradoxical uptake with peripheral rim hypointensity. Post-chemotherapy focal nodular hyperplasia-like lesions may be tricky, and their typical hyperintense rim in the hepatobiliary phase is very helpful for the differential diagnosis with metastases. In cirrhotic patients, hepatocellular carcinoma may occasionally appear hyperintense on hepatobiliary phase.

Biliary excretion of gadobenate dimeglumine causing degradation of magnetic resonance cholangiopancreatography (MRCP).

PURPOSE: To assess the effect of gadobenate dimeglumine on magnetic resonance cholangiopancreatography (MRCP) and determine an appropriate time frame for performing MRCP sequences. MATERIALS AND METHODS: 2D MRCP sequences obtained after intravenous administration of gadobenate dimeglumine or gadobutrol over 14 months were reviewed retrospectively in randomized order by five abdominal radiologists, using a 3-point scale to rate biliary and pancreatic duct clarity (1 = no-, 2 = limited-, 3 = good visualization). Intraclass correlation coefficients were computed and mean scores were compared for both agents. For gadobenate dimeglumine exams, time delays between arterial phase and MRCP acquisition times were analyzed concerning duct clarity. For gadobutrol, only exams with delays ≥ 15 min were included. RESULTS: 134 exams (107 gadobenate dimeglumine, 27 gadobutrol) were included. Moderate reliability for pancreatic duct visualization and excellent reliability for visualization of intrahepatic bile ducts and upper and lower extrahepatic bile ducts were noted. No difference in mean scores was noted for pancreatic duct visualization (p = 0.66). Bile duct segment scores were lower with gadobenate dimeglumine (mean: 2.1-2.6) compared with gadobutrol (mean: 2.8-2.9) (p ≤ 0.006). For gadobenate dimeglumine, visualization scores varied depending on the delay between the arterial phase and MRCP acquisition (p ≤ 0.047). Good visualization for all bile duct segments was noted with delays of 7.2-9.4 min (95% confidence interval; mean 8.3 min). CONCLUSION: Bile duct clarity degraded on MRCP images with an increasing delay following gadobenate dimeglumine injection. 2D MRCP, thus, should be performed within 7.2 min after obtaining the arterial phase sequence to ensure good visualization of the entire biliary system.

Motion-corrected free-breathing late gadolinium enhancement combined with a gadolinium contrast agent with a high relaxation rate: an optimized cardiovascular magnetic resonance examination protocol.

OBJECTIVE: This prospective study investigated the feasibility of an optimized cardiovascular magnetic resonance (CMR) examination protocol using the motion-corrected (MOCO), balanced steady-state free precession (bSSFP), phase-sensitive inversion recovery (PSIR) sequence combined with a gadolinium contrast agent with a high relaxation rate in patients who cannot hold their breath. METHODS: Fifty-one patients with heart disease underwent CMR examinations twice and these were performed with different late gadolinium enhancement (LGE) imaging sequences (fast low-angle shot [FLASH] sequence vs. MOCO sequence) and different gadolinium contrast agents (gadopentetate dimeglumine vs. gadobenate dimeglumine) with a 48-hour interval. LGE image quality, total time spent in the whole study, and time taken to perform LGE imaging were compared for the two CMR examinations. RESULTS: LGE images with the MOCO bSSFP PSIR sequence showed significantly higher image quality compared with those with the segmented FLASH PSIR sequence. There was a significant difference between the total scan time for the two examinations and different LGE sequences. CONCLUSIONS: The MOCO bSSFP PSIR sequence effectively improves the quality of LGE images. Changing the CMR scanning protocol by combining the MOCO bSSFP PSIR sequence with a gadolinium contrast agent with a high relaxation rate effectively shortens the scan time.Clinical trial registration number: ChiCTR-ROC-17013978.

Hepatic enhancement in cirrhosis in the portal venous phase: what are the differences between gadoxetate disodium and gadobenate dimeglumine?

PURPOSE: To compare the level of parenchymal and portal venous enhancement in the portal venous phase (PVP) in cirrhotic patients undergoing gadoxetate disodium- and gadobenate dimeglumine-enhanced MRI. METHODS: In this retrospective study, 84 cirrhotic patients (mean age ± SD: 66 ± 13 years) who underwent contrast-enhanced MRI with both gadoxetate disodium and gadobenate dimeglumine between 2012 and 2018 were included. Two readers measured signal intensities of hepatic parenchyma, portal vein and psoas muscle on precontrast and PVP. Relative enhancement (RE), image contrast, and portal vein-to-liver contrast difference were calculated. Intraindividual differences were compared with the Wilcoxon signed rank-sum test and inter-reader differences with the intraclass correlation coefficient (ICC). RESULTS: In PVP, gadoxetate disodium provided lower RE than gadobenate dimeglumine (Reader 1: 42.4 ± 44.6 vs. 56.1 ± 58.8, p = 0.044; Reader 2: 42.4 ± 42.9 vs. 57.7 ± 60.5, p = 0.027;), lower image contrast (Reader 1: 0.27 ± 0.11 vs. 0.35 ± 0.11, respectively; p < 0.001; Reader 2: 0.29 ± 0.10 vs. 0.37 ± 0.07, respectively; p < 0.001), and lower portal vein-to-liver contrast difference (Reader 1: 0.89 ± 0.39 vs. 1.42 ± 0.90, p < 0.001; Reader 2: 0.95 ± 0.40 vs. 1.28 ± 0.37, p < 0.001). ICC was 0.94, 0.79, and 0.69 for RE, image contrast, and portal vein-to-liver contrast difference, respectively. CONCLUSION: In cirrhotic patients, gadoxetate disodium yielded lower enhancement of the hepatic parenchyma and lower contrast of the portal vein than gadobenate dimeglumine in PVP.

Gadobenate dimeglumine-enhanced magnetic resonance imaging can accurately predict the severity of esophageal varices and portal vein pressure in patients with hepatitis B cirrhosis.

OBJECTIVE: To explore the effectiveness of gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) in predicting portal hypertension and high-risk esophageal varices (EV) in patients with hepatitis B cirrhosis. METHODS: In total, 71 and 30 patients comprising the training and validation groups, respectively, were enrolled in the study. Univariate and multivariate analyses were performed to detect their risk of developing high-risk EV to generate a formula for scoring EV. The relationships between the relative enhancement ratio (RE) of Gd-BOPTA-enhanced MRI and portal vein pressure were explored. RESULTS: Platelet count, portal vein width and RE were identified as independent predictors of high-risk EV. Based on these parameters, the EV score model were calculated as: -6.483 + 15.612 × portal vein width + 2.251 × RE - 0.176 × platelet count. The area under the receiver operating characteristic curve was 0.903. At a cut-off value of ≤ -2.74, the negative predictive value was 94.00%, while the positive predictive value was as high as 93.80% when the cut-off was set at > 4.00. Gd-BOPTA-enhanced MRI was effective in predicting portal pressure. Its accuracy was confirmed with the validation set. CONCLUSIONS: Gd-BOPTA-enhanced MRI was successfully applied to evaluate high-risk EV and portal hypertension. These results represent an accurate, non-invasive model for detecting high-risk EV, based on which we propose a cost-effective algorithm for EV management, eliminating the need to perform an endoscopy in all patients with cirrhosis.