University of Tokyo Hospital
Institute of Medical Science Hospital, University of Tokyo
Dept. of Radiology:
Drs. Shigeru Kiryu (current position: Dean of Radiology, School of Medicine, International University of Health and Welfare), Yusuke Inoue (current affiliation: Dept. of Diagnostic Radiology, Kitasato University School of Medicine)
University of Tokyo Hospital:
Dept. of Radiology: Dr. Kuni Otomo (current position: President, International University of Health and Welfare)
Hepatobiliary and Pancreatic Surgery Division: Dr. Hiroshi Imamura (current affiliation: Dept. of Hepatobiliary Pancreatic Surgery, Juntendo University Hospital)
DATE : 2021
During monitoring of progression of chronic hepatitis C, ultrasonography showed a hepatic mass, so the patient was admitted to hospital for thorough examination and treatment. Computed tomography (CT) was performed, and 1 week later MRI using Gadoxetate disodium(Gd-EOB-DTPA) was performed with the aim of qualitative diagnosis of the hepatic mass-type lesion.
a) Arterial phase
b) Portal phase
c) T2-weighted image
d) Pre-contrast, T1-weighted image
e) Arterial phase (20 s after administration)
f) 60 s after administration
g) 5 min after administration
h) Hepatobiliary phase
Blood flow inside the mass was found to increase in the arterial phase, no uptake of Gadoxetate disodium(Gd-EOB-DTPA) by the mass was found in the hepatobiliary phase, and a definitive diagnosis of HCC was made on the basis of these findings. In addition, information about other segments was obtained.
Due to the low dose of the contrast agent, it is difficult to obtain appropriate images during the arterial phase. However, if flushing, an automatic injection device, etc., are used in the administration method, it is possible to achieve a favorable arterial phase. During the hepatobiliary phase, lesions can be investigated in detail using thin slices and a 3D gradient technique, and this technique is an improvement over MRI using superparamagnetic iron oxide contrast agents, in which the imaging is primarily 2D. The prolonged duration of the investigation can be problematic for studies using this contrast agent. However, if a dynamic study, such as post-contrast T2-weighted imaging and search for hepatic metastases, is omitted, one operational approach is to reduce the duration by administering the contrast agent before admitting the patient to the imaging theater .