Assessing the Malignancy of Hepataocellular Carcinoma in Cirrhosis Using the Hepatocellular Contrast Agent Gd-EOB-DTPA and Correlation with the Cytometric DNA Index
Aim: Investigation whether the
signal intensity of hepatocellular carcinoma (HCC) on dynamic magnetic
resonance imaging (MRI) with hepatocellular contrast medium (CM) correlates with
the histologic malignancy grade and cytometric DNA index.Material and Methods: MRI at 1.5 T with hepatocellular CM
Gd-DTPA-EOB of 63 patients (52 men, 11 women; 64.0 ± 8.5 years) with HCC in
cirrhosis. SI of the tumor and liver tissue in sequences (T1, T1fs, T2fs, T1fs
+ CM (arterial, venous, late venous phase) were correlated like the asymmetry
coefficient of the SI in the arterial and venous phases respective the native
and late venous phases of the tumor with the histologic malignancy grade and DNA
index indicating the grade of abnormal DNA steam line respective aneuploid DNA.Results: SI did not significantly
correlate with the histologic malignancy grade or DNA index for precontrast or
postcontrast images. There is
a significant correlation for the asymmetry coefficient of the SI in the
arterial and venous phases with the DNA-index (p values of 0.00089 (Pearson)
and 0.0082 (Spearman). Conclusion: A
highly arterialized hepatocellular carcinoma with rapid washout in the venous
phase corresponds to a higher malignant potential. These
findings suggest that the MR parameters investigated here may predict the
malignant potential and prognosis of HCC before surgery.
References
[1]
M. Scharitzer, “Characterization of Hepatocellular Tumors: Value of Mangafodipir-Enhanced Magnetic Resonance Imaging,” Journal of Computer Assisted Tomography, Vol. 29, No. 2, 2005, pp. 181-190.
doi:10.1097/01.rct.0000156397.51640.a1
[2]
T. J. Vogl, K. Eichler, S. Zangos, M. Mack and R. Hammerstingl, “Das Hepatozellul?re Karzinom: Rolle der Bildgebung zur Detektion, Therapieplanung und Therapiekontrolle,” Fortschr R?ntgenstr, Vol. 174, No. 11, 2002, pp. 1358-1368.
doi:10.1055/s-2002-35349
[3]
Y. Tang and Y. Yamashita, “Detection of Hepatocellular Carcinoma Arising in Cirrhotic Livers: Comparison of Gadolinium- and Fermoxides-Enhanced MR Imaging,” American Journal of Roentgenology, Vol. 172, No. 6, 1999, pp. 1547-54
[4]
F. W. Kolkmann, “Die Bedeutung der Statischen DNA-Zytometrie in Diagnostik und Therapie: 21. Interdisziplin?res Forum der Bundes?rztekammer, Fortschritt und Fortbildung in der Medizin,” Deutsches ?rzteblatt, Vol. 94, No. 14, 1997, p. 924.
[5]
H. Abou-Rebyeh, V. Borgmann, R. Nagel and H. Al-Abadi, “DNA Ploidy Is a Valuable Predictor for Prognosis of Patients with Resected Renal Cell Carcinoma,” Cancer, Vol. 92, No. 9, 2001, pp. 2280-2285.
doi:10.1002/1097-0142(20011101)92:9<2280::AID-CNCR1574>3.0.CO;2-2
[6]
H. Abou-Rebyeh, H. Al-Abadi, S. Jonas, I. Rotter, W. O. Bechstein and P. Neuhaus, “DNA Analysis of Cholangiocarcinoma Cells: Prognostic and Clinical Importance,” Cancer Detection and Prevention, Vol. 26, No. 4, 2002, pp. 313-319. doi:10.1016/S0361-090X(02)00057-0
[7]
H. Al-Abadi, S. Jonas and P. Neuhaus, “DNA-Content and Survival Rate of Patients with Hepatocellular Carcinoma,” Cancer Detection and Prevention, Vol. 22, No. 1, 1998, p. 180
[8]
H. Al-Abadi and R. Nagel, “Zellkern-DNA-Analyse bei Nierenzellkarzinomen unter Berücksichtigung des Morphologischen Malignit?tsgrade,” Aktuel Urol, Vol. 18, No. 3, 1987, pp. 137-141. doi:10.1055/s-2008-1061435
[9]
T. Bl?ndal and J. Ponten, “DNA Ploidy in Small Cell Carcinoma of the Lung,” Anticancer Research, Vol. 3, No. 1, 1983, pp. 47-52
[10]
S. Jonas, H. Al-Abadi, Ch. Benckert, A. Thelen, M. Hippler-Benscheid, K. Saribeyoglu, B. Radtke, J. Pratschke and P. Neuhaus, “Prognostic Significance of the DNA-Index in Liver Transplantation for Hepatocellular Carcinoma in Cirrhosis,” Annals of Surgery, Vol. 250, No. 6, 2009, pp. 1008-1013.
doi:10.1097/SLA.0b013e3181b2b195
[11]
S. Jonas, W. O. Bechstein, T. Steinmüller, R. Herrmann, C. Radke, T. Berg, U. Settmacher and P. Neuhaus, “Vascular Invasion and Histopathologic Grading Determine Outcome after Liver Transplantation for Hepatocellular Carcinoma in Cirrhosis,” Hepatology, Vol. 33, No. 5, 2001, pp. 1080-1086. doi:10.1053/jhep.2001.23561
[12]
H. Gustafson, B. Tribukait and P. L. Eposti, “DNA Profile and Progression in Patient with Superficial Bladder Tumors,” Urological Research, Vol. 10, No. 1, 1982, pp. 13-18. doi:10.1007/BF00256518
[13]
B. Ljundberg, G. Cewrien, R. Stenling and A. Zetterberg, “The Prognostic Significance of Nuclear DNA Content in Renal Cell Carcinoma,” Journal of Urology, Vol. 135, No. 2, 1986, pp. 422-426
[14]
S. K. Kim, H. K. Lim and W. J. Lee, “Detection of Hepatocellular Carcinoma: Comparison of Dynamic Three-Phase Computed Tomography Images and Four-Phase Computed Tomography Images Using Multidetector Row Helical Computed Tomography,” Journal of Computer Assisted Tomography, Vol. 26, No. 5, 2002, pp. 691-698.
doi:10.1097/00004728-200209000-00005
[15]
C. R. Habermann, F. Weiss, M. Hillner, C. Staedler, V. Schoder, J. Welger, E. Bücheler and G. Adam, “Stellenwert der Dreiphasischen Spiral-CT in der Detektion des Hepatozellul?ren Karzinoms bei Leberzirrhose,” R?fo, Vol. 174, No. 1, 2002, pp. 96-100.
[16]
T. Denecke, C. Grieser, V. Fr?ling, I. G. Steffen, B. Rudolph, L. Stelter, L. Lehmkuhl, F. Streitparth, J. Langrehr, P. Neuhaus and H. E. Lopez, “Multislice Computed Tomography Using a Triple-Phase Contrast Protocol for Preoperative Assessment of Hepatic Tumor Load in Patients with Hepatocellular Carcinoma before Liver Transplantation,” Transplant International, Vol. 22, No. 4, 2009, pp. 395-402. doi:10.1111/j.1432-2277.2008.00793.x
[17]
M. Kanematsu, H. Hoshi, T. Yamada, T. Murakami, T. Kim, M. Kato, R. Yokoyama and H. Nakamura, “Small Hepatic Nodules in Cirrhosis: Ultrasonic, CT, and MR Imaging Findings,” Abdominal Imaging, Vol. 24, No. 1, 1999, pp. 47-55. doi:10.1007/s002619900439
[18]
C. Bartolozzi, R. Lencioni, D. Caramella, A. Palla, A. M. Bassi and G. Di Candio, “Small Hepatocellular Carcinoma: Detection with US, CT, MR Imaging, DSA and Lipiodol-CT,” Acta Radiologica, Vol. 37, No. 1, 1996, pp. 69-74. doi:10.1080/02841859609174362
[19]
T. Murakami, T. Kim and M. Takamura, “Hypervascular Hepatocellular Carcinoma: Detection with Double Arterial Phase Multi-Detector Row Helial CT,” Radiology, Vol. 218, No. 3, 2001, pp. 763-767.
[20]
H. Oi, T. Murakami, T. Kim, M. Matsushita, H. Kishimoto and H. Nakamura, “Dynamic MR Imaging and Early-Phase Heliacal CT for Detection Small Intrahepatic Metastases of Hepatocellular Carcinoma,” American Journal of Roentgenology, Vol. 166, No. 2, 1996, pp. 369-374.
[21]
H. R. Hentrich, L. Marti-Bonmati, A. Vanzulli, M. A. Kirchin, G. Piorovano, A. Spinazzi and K. P. Lodemann, “Charakterisierung Fokaler Leberl?sionen: Wertigkeit von Multi-Hance (Gd-BOPTA) in der Kontrastverst?rkten MR-Bildgebung,” Vortrag auf dem Deutschen R?ntgenkongress, Wiesbaden, 2000.
[22]
H. Horigome, T. Nomura, K. Saso, M. Itoh, T. Joh and H. Ohara, “Limitation of Imaging Diagnosis for Small Hepatocellular Carcinoma: Comparison with Histological Findings,” Journal of Gastroenterology and Hepatology, Vol. 14, No. 6, 1999, pp. 559-565.
doi:10.1046/j.1440-1746.1999.01915.x
[23]
S. Jonas, T. Steinmüller, U. Settmacher, J. Langrehr, A. Müller and P. Neuhaus, “Liver Transplantation for Recurrent Hepatocellular Carcinoma in Europe,” Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 8, No. 5, 2001, pp. 422-426. doi:10.1007/s005340100004
[24]
V. Mazzaferro, E. Regalia and R. Doci, “Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis,” The New England Journal of Medicine, Vol. 334, No. 11, 1996, pp. 693-699.
doi:10.1056/NEJM199603143341104
[25]
C. Benckert, S. Jonas, A. Thelen, A. Spinelli, G. Schumacher, M. Heise, J. Langrehr and P. Neuhaus, “Liver Transplantation for Hepatocellular Carcinoma in Cirrhosis: Prognostic Parameters,” Transplantation Proceedings, Vol. 37, No. 4, 2005, pp. 1693-1694.
doi:10.1016/j.transproceed.2005.03.143.
