Hepatobiliary-phase (HBP) gadolinium ethoxybenzyl-diethyl
enetriaminepentaacetic acid MRI (Gd-EOB-DTPA) for pretreatment prediction of efficacy-to-standard-therapies based on Barcelona Clinic Liver Cancer algorithm: an up-todate review

The HBP in EOB-MRI reflecting molecular and pathological factors, may predict hepatocellular carcinoma (HCC) treatment efficacy and guide treatment choices.

This review paper1 featured the potential of the HBP in predicting the outcomes of treatment options for HCC. This paper explained that Gd-EOB-DTPA reflects the expression of organic anion transporting polypeptide (OATP) transporters which could guide treatment selection for HCC. Wnt/β-catenin activation associated with OATP expression is involved in the tumor immune microenvironment and chemo-responsiveness. Microscopic portal vein invasion by a tumor might result in decreased uptake of Gd-EOB-DTPA. This could correlate with the effectiveness of cancer therapies utilizing OATPmediated drug uptake, thus predicting prognosis and treatment outcomes. Hyperintense HBP signals suggest favorable outcomes following transarterial chemoembolization (TACE) and hepatic arterial infusion, while peritumoral hypointensity may indicate poorer outcomes following radiofrequency ablation, liver resection, and liver transplant. Table 1 presents the treatment options for HCC, their corresponding pretreatment findings in the HBP phase, and prognosis.

Table 1. Pretreatment efficacy prediction of treatment options for HCC

Treatment optionPretreatment imaging findings of HCC in the HBP phasePrognosis
AblationPeritumoral hypointensityPoorer RFS
Non-hypervascular hypointense nodulesPoorer RFS and OS
ResectionPeritumoral hypointensityPoorer RFS
Heterogeneous intensity (visual assessment) 
Non-hypervascular hypointense nodulesPoorer RFS and OS
TransplantPeritumoral hypointensityPoorer RFS
TACEHigh signal intensity (relative enhancement ratio ≥ 1)Better RFS
Heterogeneous intensity (visual assessment)Poorer CR
Systemic therapy
High signal intensity (relative enhancement ratio ≥ 0.9)Poorer PFS
Heterogeneous intensity (visual assessment) 
Hepatic arterial infusionHigh signal intensity (signal intensity ratio > 0.39)Better PFS

CR, complete response; HBP, hepatobiliary phase; HCC, hepatocellular carcinoma; OS, overall survival; PFS, progression-free survival; RFS, recurrencefree survival; TACE, transarterial chemoembolization


  1. Minamiguchi, Kiyoyuki, et al. Hepatobiliary-phase gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid MRI for pretreatment prediction of efficacy-to-standard-therapies based on Barcelona Clinic Liver Cancer algorithm: an up-to-date review. European Radiology (2023): 1-12.