Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MRI improves diagnosis and efficacy evaluation of early-stage hepatocellular carcinoma

Objective: To investigate the use of hepatocyte-specific contrast agent Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and efficacy evaluation of patients with early-stage hepatocellular carcinoma.

Methods: A retrospective clinical study was conducted on 157 patients diagnosed with stage Ia-Ib liver cancer. Of these, 100 patients underwent preoperative EOB-MRI, while 57 patients underwent contrast-enhanced computerized tomography (CECT). The study compared the accuracy, sensitivity, and specificity of these two imaging modalities in diagnosing early-stage hepatocellular carcinoma. In the EOB-MRI group, 100 patients underwent radiofrequency ablation or interventional procedures, and imaging data were collected post-scan. The following arterial and hepatobiliary phase enhancement features were analyzed: length-diameter difference (LDD), signal intensity ratio of metastases to liver parenchyma (RatioM/L), relative signal intensity difference (RSID), normalized relative enhancement (NRE), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) values. Based on treatment outcomes, patients were categorized into high and low response rate groups, and the imaging parameters between these two groups were compared. Univariate and multivariate analyses were performed to evaluate the significance of these parameters in predicting patient outcomes.

Results: The accuracy of lesion detection by EOB-MRI was 97.4%, significantly higher than that of CECT (80.0%) (P < 0.05). The area under the curve (AUC) for the EOB-MRI group was 0.923 (95% CI: 0.784-1.000), with a sensitivity of 97.4% and a specificity of 83.3%. In comparison, the AUC for the CECT group was 0.712 (95% CI: 0.582-0.843), with a sensitivity of 77.2% and a specificity of 65.2%. The median response rate of patients with early-stage hepatocellular carcinoma to systemic therapy was 60% (range: 36%-81%). Using 60% as the cut-off value, patients were divided into a high response rate group (n = 53) and a low response rate group (n = 47). Univariate and multivariate logistic regression analyses of the EOB-MRI parameters in both groups identified ADC and NRE as independent predictors for assessing the treatment efficacy of early-stage hepatocellular carcinoma.

Conclusion: EOB-MRI is effective for both the diagnosis and evaluation of treatment efficacy in early-stage hepatocellular carcinoma.