Usefulness of EOB-MRI for diagnosis of sigmoid colon cancer and metachronous hepatic metastases
Teikyo University Hospital, Mizonokuchi
Tomohiko Higashida, Dept. of Radiology
DATE : 2021
Introduction
Patient’s background
Male; 70s; body weight: 70 kg; diagnosis of sigmoid colon cancer and metachronous hepatic metastases
Assessment objectives
The patient visited the author’s hospital with bloody stools as the primary complaint. A diagnosis of sigmoid colon cancer was made by computed tomography (CT) and endoscopy, and resection was performed. TS-1 administration was initiated as postoperative chemotherapy, but it was discontinued after a single cycle because of diarrhea. The patient was then monitored by CT. No clear recurrence was found, but PET-CT 1 year after surgery showed scattered loci with mild accumulation in the liver, so EOB-MRI was performed.
Contrast agent used
Gadoxetate disodium(Gd-EOB-DTPA) injection, 0.1 mL/kg
Case explanation
A left-lobe hepatic metastasis was diagnosed, and two cycles of FOLFOX2 chemotherapy were administered. FOLFOX + Bmab chemotherapy was then initiated. After completion of nine cycles, no expansion of the hepatic metastasis was found, but the patient was admitted to the hospital because of fever and SpO2 decrease. A diagnosis of drug-induced interstitial pneumonia was then made,and Solu-Medrol pulse therapy was administered for 3 days, followed by prednine tapering, and discharge from hospital. The patient was subsequently monitored without chemotherapy, but no marked change in hepatic metastasis size was found.
Imaging findings
T2-weighted imaging showed a nodule 8 mm in diameter with a slightly high signal, in S2 of the liver.
A small hemangioma in the right lobe of the liver was suspected.
Fig. 1. Simple, fat-suppressed, T2-weighted imaging
Diffusion-weighted imaging showed a markedly high-signal region in a nodule in S2 of the liver.
Fig. 2. Diffusion-weighted imaging
Little contrast enhancement was found in the nodule in S2 of the liver from early phase to late phase.
Fig. 3. Contrast T1-weighted imaging late phase
A clear decrease in EOB uptake by the nodule in S2 of the liver was found.
Fig. 4. Contrast T1-weighted imaging hepatobiliary phase
Photography protocol
| Imaging type | Photography sequence | Photography duration (min:s) | 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 | 16sec | 1.1 2.3 | 5.3 | 12 | ー | ー | ー | Phase 1.75 Slice 1.0 | Yes | ー |
| Contrast agent administration | |||||||||||
| Dynamic | LAVA-Flex | 14sec | 1.7 | 5.6 | 15 | ー | SPECIAL | ー | Phase 2.0 Slice 1.5 | Yes | ー |
| DWI | SE/EPI | 3:54 | 68 | 8000 | ー | ー | SPECIAL | ー | Phase 2.0 Slice 1.0 | No | ー |
| T2WI | FR-PROPELLER | 3:20 | 57,4 | 8000 | 90 | Yes | CHESS | 20 | Phase 2.0 Slice 1.0 | No | 24 |
| HBP | LAVA-Flex | 12sec | 1.7 | 5.6 | 15 | ー | SPECIAL | ー | Phase 2.0 Slice 1.5 | Yes | ー |
| Imaging type | k-space | In-plane resolution (mm) | Slice thickness (mm) | FOV (mm) | Rectangu-lar 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 | 5.0 | 360 | 80 | 292 | 200 | ー | 76*2 | 1 |
| Contrast agent administration | ||||||||||
| Dynamic | Sequential | 1.1*1.9 | 4.0 | 360 | 80 | 320 | 192 | ー | 104 | 4 |
| DWI | ー | 3.1*3.1 | 5.0 | 420 | 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 | 104 | 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) | Imaging timing after contrast agent injection (s) | |
| Gadoxetate disodium(Gd-EOB-DTPA) | 7 | 3.0 | 35 70 110 | |
| Physiological saline solution for flushing | 40 | 2 |
Usefulness of Gadoxetate disodium(Gd-EOB-DTPA) contrast MRI with this patient
With a hepatic metastasis that could not be readily found with CT, and with which PET-CT showed only slight accumulation, EOB-MRI showed decreased diffusion, and in the hepatobiliary phase clear decrease in EOB uptake was found, so chemotherapy was reinitiated. EOB-MRI was capable of sensitive detection of a hepatic metastasis, despite the lesion being difficult to assess with PET-CT due to physiological accumulation in the liver, and EOB-MRI is therefore considered to be useful for definite diagnosis of 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.
