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The target sign in colorectal liver metastases: an atypical Gd-EOB-DTPA “uptake” on the hepatobiliary phase of MR imaging

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Abstract

Purpose

To describe the MRI findings in colorectal cancer liver metastases using gadoxetic acid (Gd-EOB-DTPA), with special emphasis on the target feature seen on the hepatobiliary phase.

Material and methods

The medical records of 45 colorectal cancer patients with an overall number of 150 liver metastases were reviewed. All patients underwent Gd-EOB-DTPA-enhanced MRI before any kind of treatment. We retrospectively evaluated, for each lesion, the signal intensity on the T1-weighted, T2-weighted, and diffusion-weighted images. Additionally, the enhancement pattern during the arterial-, portal-, equilibrium-, and hepatobiliary-phase was assessed. Fourteen lesions had a pathological correlation.

Results

Lesions size was 5–40 mm (mean 15 mm). All metastases were hypointense on T1-w imaging. Ninety-nine lesions (66%) had a central area of very high signal intensity on T2-w imaging. Fifty-one metastases (34%) were hyperintense on the T2-w images. In DWI, all lesions had a restricted diffusion. The mean ADC value was 1.31 × 10−3 mm2/s (range 1.10–1.45 × 10−3 mm2/s). During the arterial-phase imaging, 61 lesions (41%) showed a rim enhancement, while 89 lesions (59%) appeared as hypointense. All lesions had low signal intensity in the portal and equilibrium phase. Thirty-nine percent of the lesions also showed an enhancing rim on the portal-phase images. During the hepatobiliary phase, 80 lesions (53.3%) were hypointense, while 70 lesions (46.7%) had a target appearance.

Conclusion

A number of metastases show an atypical contrast medium uptake during the hepatobiliary phase of gadoxetic acid-enhanced MRI, consisting in a target appearance.

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Acknowledgements

The authors are grateful to Alessandra Trocino, librarian at the National Cancer Institute of Naples, Italy.

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Authors and Affiliations

  1. First Department of Radiology, Istituto Nazionale Tumori Fondazione G.Pascale, via Mariano Semmola, 80131, Naples, Italy

    Vincenza Granata, Orlando Catalano, Roberta Fusco & Antonella Petrillo

  2. Department of Pathology, Istituto Nazionale Tumori Fondazione G.Pascale, via Mariano Semmola, 80131, Naples, Italy

    Fabiana Tatangelo

  3. Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori Fondazione G.Pascale, via Mariano Semmola, 80131, Naples, Italy

    Daniela Rega

  4. Department of Colorectal Medical Oncology, Istituto Nazionale Tumori Fondazione G.Pascale, via Mariano Semmola, 80131, Naples, Italy

    Guglielmo Nasti

  5. Department of Abdominal Medical Oncology, Istituto Nazionale Tumori Fondazione G.Pascale, via Mariano Semmola, 80131, Naples, Italy

    Antonio Avallone

  6. Department of Hepatobiliary Surgery, Istituto Nazionale Tumori Fondazione G.Pascale, via Mariano Semmola, 80131, Naples, Italy

    Mauro Piccirillo & Francesco Izzo

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  1. Vincenza Granata
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  2. Orlando Catalano
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  8. Mauro Piccirillo
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  9. Francesco Izzo
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  10. Antonella Petrillo
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Corresponding author

Correspondence to Orlando Catalano.

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The authors have no conflict of interest to be disclosed.

Human and animal rights and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Granata, V., Catalano, O., Fusco, R. et al. The target sign in colorectal liver metastases: an atypical Gd-EOB-DTPA “uptake” on the hepatobiliary phase of MR imaging. Abdom Imaging 40, 2364–2371 (2015). https://doi.org/10.1007/s00261-015-0488-7

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  • DOI: https://doi.org/10.1007/s00261-015-0488-7

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