Comparison of Enhancement Patterns of Histologically Confirmed Hepatocellular Carcinoma Between Gadoxetate- and Ferucarbotran-enhanced Magnetic Resonance Imaging

Purpose: To compare enhancenent patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) between gadoxetate- and ferucarbotran-enhanced MRI. Materials and Methods: Patients recruited from ultrasound surveillance for HCC in chronic liver diseases were enrolled in this prospective study approved by institutional review board. Thirty-six patients with 37 histologically proven HCC, including 22 well-differentiated HCCs (wHCC), 15 moderately to poorly differentiated HCCs (mpHCCs), and 4 DNs, underwent gadoxetate-enhanced and ferucarbotran-enhanced MRI. We compared hepatobiliary phase image of gadoxetate-enhanced MRI with ferucarbotran-enhanced MR image regarding signal intensity of HCC and DN relative to surrounding liver parenchyma. We calculated contrast ratios between tumor and liver on pre-enhancement, hepatobiliary phase of gadoxetate-enhanced MRI and ferucarbotran-enhanced MRI. Results: On ferucarbotran-enhanced MRI, all mpHCCs showed hyper-intensity, while 14 wHCCs (14/22; 63%) showed iso-intensity. On hepatobiliary phase of gadoxetate-enhanced MRI, 13 mpHCCs (13/15; 86%) and 20 wHCCs (20/22; 91%) showed hypo-intensity. Two DNs and the other two showed iso- and hypo-intensity, respectively, on gadoxetate-enhanced MRI, whereas all DNs revealed iso-intensity on ferucarbotran-enhanced MRI. Gadoxetate-postcontrast ratio was significantly lower than ferucarbotran-postcontrast ratio in wHCC (P = 0.015). Conclusion: The uptake function of hepatocytes that are targeted by gadoxetate is more sensitive than that of Kupffer cells targeted by ferucarbotran in stepwise hepatocarcinogenesis.