Evaluation of combined Gd-EOB-DTPA and gadobutrol magnetic resonance imaging for the prediction of hepatocellular carcinoma grading

Background Tumor biopsy is not essential for the diagnosis of hepatocellular carcinoma (HCC); however, grading remains important for the prognosis. Purpose To investigate whether combined Gd-EOB-DTPA and gadobutrol liver magnetic resonance imaging (MRI) can predict HCC grading. Material and Methods Thirty patients (66.67.3 years) with histologically confirmed HCC (grade 1, n=5; grade 1-2, n=6; grade 2, n=13; grade 2-3, n=2; grade 3, n=4) underwent two liver MRIs, one with gadobutrol and one with Gd-EOB-DTPA, on consecutive days. Blinded to grading, two radiologists reviewed the gadobutrol and Gd-EOB-DTPA images in consensus with respect to: (i) HCC hyper-/iso-/hypointensity in the arterial, portal-venous/delayed, and Gd-EOB-DTPA hepatocellular phase; and (ii) morphologic tumor features (encapsulated growth, vessel invasion, heterogeneity, liver capsule infiltration, satellite metastases). Results A significant correlation with grading was not found for either the combined dynamic information of all gadobutrol phases (r=-0.187, P=0.331) or all the Gd-EOB-DTPA phases (r=0.052, P=0.802). No correlation with grading was found for a combination of arterial and hepatocellular phase in Gd-EOB-DTPA MRI (r=0.209, P=0.305), a combination of both arterial phases (gadobutrol and Gd-EOB-DTPA) with the Gd-EOB-DTPA hepatocellular phase (r=0.240, P=0.248), or a combination of all available gadobutrol and Gd-EOB-DTPA phases (r=0.086, P=0.691). For all gadobutrol information (dynamic phases and morphology; r=0.049, P=0.801) and for all Gd-EOB-DTPA information (r=0.040, P=0.845), no correlation with grading was found. Hepatocellular Gd-EOB-DTPA phase iso-/hyperintensity never occurred in grade 3 HCCs. Conclusion Histological HCC grading cannot be predicted by combined Gd-EOB-DTPA/gadobutrol MRI. However, Gd-EOB-DTPA hepatocellular phase iso-/hyperintensity was never detected in grade 3 HCCs.