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Gadoxetic acid-enhanced MR imaging for hepatocellular carcinoma: molecular and genetic background

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Abstract

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) plays important roles in diagnosis of hepatic lesions because of its superiority in the detectability of small lesions, its differentiation ability, and its utility for the early diagnosis of hepatocellular carcinoma (HCC). In HCC, expression of organic anion transporting polypeptide (OATP) 1B3 correlates with the enhancement ratio in the hepatobiliary phase. Gadoxetic acid-enhanced MRI, an indirect molecular imaging method, reflects OATP1B3 expression in HCC. OATP1B3 expression gradually decreases from the dysplastic nodule stage to advanced HCC. Decreased expression is a sensitive marker of multistep hepatocarcinogenesis, especially in the early stages. Hypervascular HCCs commonly show hypointensity in the hepatobiliary phase corresponding to a decrease in OATP1B3; however, approximately 10% of HCCs show hyperintensity due to OATP1B3 overexpression. This hyperintense HCC shows less aggressive biological features and has a better prognosis than hypointense HCC. Hyperintense HCC can be classified into a genetic subtype of HCC with a mature hepatocyte-like molecular expression. OATP1B3 expression and the less aggressive nature of hyperintense HCC are regulated by the molecular interaction of β-catenin signaling and hepatocyte nuclear factor 4α, a tumor suppressor factor. Gadoxetic acid-enhanced MR imaging has the potential to be an imaging biomarker for HCC.

Key Points

• The hepatobiliary phase is a sensitive indirect indicator of organic anion transporting polypeptide1B3 (OATP1B3) expression in hepatocellular carcinoma (HCC).

• The OATP1B3 expression, namely, enhancement in the hepatobiliary phase, decreases from the very early stage of hepatocarcinogenesis, contributing to early diagnosis of HCC.

• HCC showing hyperintensity on the hepatobiliary phase is a peculiar genetic subtype of HCC with OATP1B3 overexpression, a less aggressive nature, and mature hepatocyte-like molecular/genetic features.

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Abbreviations

AFP:

Alpha fetoprotein

CT:

Computed tomography

FNH:

Focal nodular hyperplasia

FOXM:

Forkhead box M

HCA:

Hepatocellular adenoma

HCC:

Hepatocellular carcinoma

HNF:

Hepatocyte nuclear factor

MRI:

Magnetic resonance imaging

MRP:

Multidrug-resistance-associated protein

OATP:

Organic anion transporting polypeptide

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  1. Azusa Kitao and Osamu Matsui contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, 920-8641, Japan

    Azusa Kitao, Osamu Matsui, Norihide Yoneda, Kazuto Kozaka, Wataru Koda, Dai Inoue, Takahiro Ogi, Kotaro Yoshida & Toshifumi Gabata

  2. Department of Quantum Medical Technology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan

    Satoshi Kobayashi

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  1. Azusa Kitao
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Correspondence to Azusa Kitao.

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Kitao, A., Matsui, O., Yoneda, N. et al. Gadoxetic acid-enhanced MR imaging for hepatocellular carcinoma: molecular and genetic background. Eur Radiol 30, 3438–3447 (2020). https://doi.org/10.1007/s00330-020-06687-y

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