Usefulness of Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI for diagnosis of pancreatic head cancer and hepatic metastases
Teikyo University Hospital, Mizonokuchi
Drs. Hiroshi Yamashita and Dr. Takaki Hayashi, Dept. of Radiology
DATE : 2021
Introduction
Patient’s background
Male; 70s; body weight: 50 kg; pancreatic head cancer with hepatic metastasis
Assessment objectives
The patient had been administered medication for diabetes at a different hospital for approximately 2 years. Rapid HbA1c increase was found, and the patient was referred to the authors’ hospital for educational hospitalization. At that time, as the CA19-9 level was elevated, at 129 U/mL, dynamic computed tomography (CT) was performed, and pancreatic head cancer was indicated. Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI was then performed to search for hepatic metastases.
Contrast agent used
Gadoxetate disodium(Gd-EOB-DTPA) injection, 0.1 mL/kg
Case explanation
Although hepatic metastases could not be detected by dynamic CT, a metastasis 7 mm in diameter was found in the right lobe by Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI, and the condition was judged to be at Stage IV. As the patient was at Stage IV, surgery was not performed, but gemcitabine chemotherapy was performed. The tumor gradually increased in size, and nab-paclitaxel was added to the ongoing chemotherapy, but the patient’s general condition gradually deteriorated, and he died approximately 16 months after the diagnosis.
Imaging findings
Irregular dilation of the main pancreatic duct was found, and a mass in the pancreatic head was suspected.
Fig. 1. Dynamic CT early phase
Hepatic metastases could not be found.
Fig. 2. Dynamic CT early phase
Hepatic metastases could not be found.
Fig. 3. Dynamic CT late phase
The hepatic metastasis was unclear.
Fig. 4. Diffusion-weighted image
Decrease in EOB uptake was found in the right lobe of the liver, and hepatic metastasis was suspected.
Fig. 5. Hepatobiliary phase
Photography protocol
| Imaging type | Photography sequence | Photography duration | TE （msec） | TR （msec） | FA （deg） | Flipback (yes/no) | Fat sat (type) | ETL (number) | P-MRI (Reduction Factor) | Holding breath (yes/no) | NEX (calculation number) |
| Dual echo | FSPGR | 15sec | 1.1 2.3 | 5.4 | 12 | ー | ー | ー | Phase1.75 Slice1.0 | Yes | ー |
| Contrast agent administration | |||||||||||
| Dynamic | LAVA-Flex | 12sec | 1.7 | 5.6 | 15 | ー | SPECIAL | ー | Phase2.0 Slice1.5 | Yes | ー |
| DWI | SE/EPI | 4:11 | 68 | 8571 | ー | ー | SPECIAL | ー | Phase2.0 Slice1.0 | No | ー |
| T2WI | FR-PROPELLER | 4:32 | 60 | 6316 | 90 | Yes | CHESS | 20 | Phase2.0 Slice1.0 | No | 24 |
| HBP | LAVA-Flex | 12sec | 1.7 | 5.6 | 15 | ー | SPECIAL | ー | Phase2.0 Slice1.5 | Yes | ー |
| Imaging type | k-space | In-plane resolution (mm) | Slice thickness (mm) | FOV (mm) | Rectangular FOV(%) | Phase direction (step number) | Read direction (matrix number) | Slice Gap (mm) | Slice number | Three-dimensional partition number |
| Dual echo | ー | 1.2×1.8 | 4.4 | 360 | 80 | 292 | 192 | ー | 136 | 1 |
| Contrast agent administration | ||||||||||
| Dynamic | Sequential | 1.1×1.9 | 4.0 | 360 | 80 | 320 | 192 | ー | 100 | 4 |
| DWI | ー | 3.1×3.1 | 5.0 | 400 | 100 | 128 | 128 | 0.5 | 72 | ー |
| T2WI | ー | 0.9×0.9 | 5.0 | 360 | 100 | 384 | 384 | 0.5 | 36 | ー |
| HBP | Sequential | 1.1×1.9 | 4.0 | 360 | 80 | 320 | 192 | ー | 100 | 1 |
Devices used and contrast conditions
| MRI device | DISCOVERY MR750w 3.0T |
| Automatic injection device | Sonic Shot 7 |
| Workstation | AW VolumeShare7 |
| Contrast conditions | Dose (mL) | Administration rate (mL/s) | Photography timing | |||||
| Gadoxetate disodium(Gd-EOB-DTPA) | Simultaneous injection | Contrast agent | 4.97 | Simultaneous injection | Contrast agent | 3.0 | 35sec 70sec 110sec | |
| Physiological saline solution | 2.13 | Physiological saline solution | 1.0 | |||||
| Physiological saline solution for flushing | 37.87 | 2 | ||||||
Usefulness of Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI with this patient
A small hepatic metastasis, difficult to detect by dynamic CT, was detected by Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI, which had a major effect on the decision about the approach to treatment. As the stage was evaluated correctly, at IV, unnecessary surgery and invasive treatment were avoided. Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI was confirmed to show excellent detection capability even for smaller hepatic metastases.
Precautions relating to administration
9. Precautions relating to patients with specific background factors (taken from the Package Insert)
9.8 Elderly patients
Administration must be performed with care, and with sufficient monitoring of the patient’s condition.
Elderly patients generally have depressed physiological function.
- *The case introduced is just one clinical case, so the results are not the same as for all cases.
- *Please refer to the Package Insert for the effects and indications, dosage and administration method, and warnings, contraindications, and other precautions with use.
