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Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions

  • Hepatobiliary-Pancreas
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Abstract

A multicenter study has been employed to evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) using the new liver-specific contrast agent gadoxetic acid (Gd-EOB-DTPA, Primovist), as opposed to contrast-enhanced biphasic spiral computed tomography (CT), in the diagnosis of focal liver lesions, compared with a standard of reference (SOR). One hundred and sixty-nine patients with hepatic lesions eligible for surgery underwent Gd-EOB-DTPA-enhanced MRI as well as CT within 6 weeks. Pathologic evaluation of the liver specimen combined with intraoperative ultrasound established the SOR. Data sets were evaluated on-site (14 investigators) and off-site (three independent blinded readers). Gd-EOB-DTPA was well tolerated. Three hundred and two lesions were detected in 131 patients valid for analysis by SOR. The frequency of correctly detected lesions was significantly higher on Gd-EOB-DTPA-enhanced MRI compared with CT in the clinical evaluation [10.44%; 95% confidence interval (CI): 4.88, 16.0]. In the blinded reading there was a trend towards Gd-EOB-DTPA-enhanced MRI, not reaching statistical significance (2.14%; 95% CI: −4.32, 8.6). However, the highest rate of correctly detected lesions with a diameter below 1 cm was achieved by Gd-EOB-DTPA-enhanced MRI. Differential diagnosis was superior for Gd-EOB-DTPA-enhanced MRI (82.1%) versus CT (71.0%). A change in surgical therapy was documented in 19 of 131 patients (14.5%) post Gd-EOB-DTPA-enhanced MRI. Gd-EOB-DTPA-enhanced MRI was superior in the diagnosis and therapeutic management of focal liver lesions compared with CT.

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Acknowledgements

The authors especially want to thank Martina Franz for the supervision of the clinical study conduct.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, ZRAD, Haus 23 C, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany

    Renate Hammerstingl

  2. Imaging Science Institute, Charitè - Siemens, Robert-Koch-Platz 7, 10115, Berlin, Germany

    Alexander Huppertz

  3. Gobal Clinical Development Diagnostics, Bayer Schering Pharma AG, Muellerstr. 178, 13342, Berlin, Germany

    Josy Breuer & Thomas Balzer

  4. Department of Radiology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK

    Anthony Blakeborough

  5. Bayer Health Care Ltd., The Brow, Burgess Hill, West Sussex, RH15 9NE, UK

    Rick Carter

  6. Liver Unit, Department of Internal Medicine, Hospital Vall d`Hebròn, Paseo Vall d` Hebrón, 119-129, 08035, Barcelona, Spain

    Lluis Castells Fusté

  7. Allg. Krankenhaus der Stadt Wien, Universitätsklinik für Radiodiagnostik, Waehringer Guertel 18-20, 1097, Wien, Germany

    Gertraud Heinz-Peer

  8. Department of Magnetic Resonance Imaging and Spectroscopy, University Hospital Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria

    Werner Judmaier

  9. Institute for Diagnostic Radiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Michael Laniado

  10. Department of Radiology, Policlinico, University of Verona, P. le L.A. Scuro 10, 37134, Verona, Italy

    Riccardo M. Manfredi

  11. Centre d’Imagerie, 1 bd de la République, 13100, Aix en Provence, France

    Didier G. Mathieu

  12. Department of Radiology (L1), Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Koenraad Mortelè

  13. Department of Radiology, Georg-August Universität, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Dieter Müller

  14. Department of Radiology, Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Germany

    Peter Reimer

  15. Institute of Clinical Radiology, Ludwig-Maximilians-University Munich - Klinikum Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Maximilian F. Reiser

  16. Department of Clinical Radiology, St James’s University Hospital, Beckett Street, Leeds, LS9 7TF, UK

    Philip J. Robinson

  17. Corporate Clinical Operations, Berlex Laboratories Inc., P.O. Box 1000, 340 Changebridge Road, Montville, NJ, 07045-1000, USA

    Kohkan Shamsi

  18. Department of Diagnostic Radiology, University Hospital, Franz-Josef-Strauss Allee 11, 93042, Regensburg, Germany

    Michael Strotzer

  19. Department of Radiology, Universitätsklinikum Charitè, Med. Fakultät der Humboldt-Universität, Schumannstr. 20-21, 10098, Berlin, Germany

    Matthias Taupitz

  20. Institute of Clinical Radiology, Westfälische Wilhelms Universität Münster, Albert-Schweitzer-Str. 33, 48129, Münster, Germany

    Bernd Tombach

  21. Department of Radiology, University of Ancona, Regional Hospital Torette, Via Conca, Torette, 60020, Ancona, Italy

    Gianluca Valeri

  22. Department of Radiology, Université Catholique de Louvain, St-Luc University Hospital, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Bernhard E. van Beers

  23. Institute of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, ZRAD Haus 23 C, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany

    Thomas J. Vogl

Authors
  1. Renate Hammerstingl
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  2. Alexander Huppertz
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  3. Josy Breuer
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  4. Thomas Balzer
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  5. Anthony Blakeborough
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  13. Dieter Müller
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  14. Koenraad Mortelè
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  15. Peter Reimer
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  16. Maximilian F. Reiser
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  18. Kohkan Shamsi
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  22. Gianluca Valeri
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  23. Bernhard E. van Beers
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  24. Thomas J. Vogl
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For the European EOB-study group

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Correspondence to Renate Hammerstingl.

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Hammerstingl, R., Huppertz, A., Breuer, J. et al. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18, 457–467 (2008). https://doi.org/10.1007/s00330-007-0716-9

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  • DOI: https://doi.org/10.1007/s00330-007-0716-9

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