E Reizine1, M Ronot2,3,4, M Ghosn5, J Calderaro6,7,8, N Frulio9, P Bioulac-Sage10,11, H Trillaud12, V Vilgrain2,3,4, V Paradis4,12, A Luciani5,7,8. 1. Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France. ereizine@gmail.com. 2. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. 3. University Paris Diderot, Sorbonne Paris Cité, Paris, France. 4. INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. 5. Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France. 6. Department of Pathology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France. 7. Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France. 8. INSERM Unit U 955, Equipe 18, 94010, Créteil, France. 9. CHU Bordeaux Department of Diagnostic and Interventional Radiology, Université de Bordeaux, 33000, Bordeaux, France. 10. Inserm, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, Université de Bordeaux, 33076, Bordeaux, France. 11. Department of Pathology, Pellegrin Hospital, CHU de Bordeaux, 33076, Bordeaux, France. 12. Department of Pathology, Beaujon Hospital, APHP, Clichy, France.
Abstract
OBJECTIVES: To assess the value of hepatospecific MR contrast agent uptake on hepatobiliary phase (HBP) images to detect marked activation of the β-catenin pathway in hepatocellular adenomas (HCAs). METHODS: This multicentric retrospective IRB-approved study included all patients with a pathologically proven HCA who underwent gadobenate dimeglumine-enhanced liver MRI with HBP. Tumor signal intensity on HBP was first assessed visually, and lesions were classified into three distinct groups-hypointense, isointense, or hyperintense-according to the relative signal intensity to liver. Uptake was then quantified using the lesion-to-liver contrast enhancement ratio (LLCER). Finally, the accuracy of HBP analysis in depicting marked β-catenin activation in HCA was evaluated. RESULTS: A total of 124 HCAs were analyzed including 12 with marked β-catenin activation (HCA B+). Visual analysis classified 94/124 (76%), 12/124 (10%), and 18/124 (14%) HCAs as being hypointense, isointense, and hyperintense on HBP, respectively. Of these, 1/94 (1%), 3/12 (25%), and 8/18 (44%) were HCA B+, respectively (p < 0.001). The LLCER of HCA B+ was higher than that of HCA without marked β-catenin activation in the entire cohort (means 4.9 ± 11.8% vs. - 19.8 ± 11.4%, respectively, p < 0.001). A positive LLCER, i.e., LLCER ≥ 0%, had 75% (95% CI 43-95%) sensitivity and 97% (95% CI 92-99%) specificity, with a LR+ of 28 (95% CI 8.8-89.6) for the diagnosis of HCA B+. CONCLUSIONS: Hepatospecific contrast uptake on hepatobiliary phase is strongly associated with marked activation of the β-catenin pathway in hepatocellular adenoma, and its use might improve hepatocellular adenoma subtyping on MRI. KEY POINTS: • Tumor uptake on hepatobiliary phase in both the visual and quantitative analyses had a specificity higher than 90% for the detection of marked β-catenin activation in hepatocellular adenoma. • However, the sensitivity of visual analysis alone is inferior to that of LLCER quantification on HBP due to the high number of HCAs with signal hyperintensity on HBP, especially those developed on underlying liver steatosis.
OBJECTIVES: To assess the value of hepatospecific MR contrast agent uptake on hepatobiliary phase (HBP) images to detect marked activation of the β-catenin pathway in hepatocellular adenomas (HCAs). METHODS: This multicentric retrospective IRB-approved study included all patients with a pathologically proven HCA who underwent gadobenate dimeglumine-enhanced liver MRI with HBP. Tumor signal intensity on HBP was first assessed visually, and lesions were classified into three distinct groups-hypointense, isointense, or hyperintense-according to the relative signal intensity to liver. Uptake was then quantified using the lesion-to-liver contrast enhancement ratio (LLCER). Finally, the accuracy of HBP analysis in depicting marked β-catenin activation in HCA was evaluated. RESULTS: A total of 124 HCAs were analyzed including 12 with marked β-catenin activation (HCA B+). Visual analysis classified 94/124 (76%), 12/124 (10%), and 18/124 (14%) HCAs as being hypointense, isointense, and hyperintense on HBP, respectively. Of these, 1/94 (1%), 3/12 (25%), and 8/18 (44%) were HCA B+, respectively (p < 0.001). The LLCER of HCA B+ was higher than that of HCA without marked β-catenin activation in the entire cohort (means 4.9 ± 11.8% vs. - 19.8 ± 11.4%, respectively, p < 0.001). A positive LLCER, i.e., LLCER ≥ 0%, had 75% (95% CI 43-95%) sensitivity and 97% (95% CI 92-99%) specificity, with a LR+ of 28 (95% CI 8.8-89.6) for the diagnosis of HCA B+. CONCLUSIONS: Hepatospecific contrast uptake on hepatobiliary phase is strongly associated with marked activation of the β-catenin pathway in hepatocellular adenoma, and its use might improve hepatocellular adenoma subtyping on MRI. KEY POINTS: • Tumor uptake on hepatobiliary phase in both the visual and quantitative analyses had a specificity higher than 90% for the detection of marked β-catenin activation in hepatocellular adenoma. • However, the sensitivity of visual analysis alone is inferior to that of LLCER quantification on HBP due to the high number of HCAs with signal hyperintensity on HBP, especially those developed on underlying liver steatosis.
Entities:
Keywords:
Contrast media; Hepatocellular adenoma; Magnetic resonance imaging
Authors: Ahmed Ba-Ssalamah; Célia Antunes; Diana Feier; Nina Bastati; Jacqueline C Hodge; Judith Stift; Maria A Cipriano; Friedrich Wrba; Michael Trauner; Christian J Herold; Filipe Caseiro-Alves Journal: Radiology Date: 2015-05-18 Impact factor: 11.105