The combination of hepatobiliary phase with Gd-EOB-DTPA and DWI is highly accurate for the detection and characterization of liver metastases from neuroendocrine tumor

Eur Radiol. 2020 Dec;30(12):6593-6602. doi: 10.1007/s00330-020-06930-6. Epub 2020 Jun 29.


Objectives: To compare the diagnostic accuracy of dynamic contrast-enhanced phases, hepatobiliary phase (HBP), and diffusion-weighted imaging (DWI) for the detection of liver metastases from neuroendocrine tumor (NET).

Methods: Sixty-seven patients with suspected NET liver metastases underwent gadoxetic acid-enhanced MRI. Three radiologists read four imaging sets separately and independently: DWI, T2W+dynamic, T2WI+HBP, and DWI+HBP. Reference standard included all imaging, histological findings, and clinical data. Sensitivity and specificity were calculated and compared for each imaging set. Interreader agreement was evaluated by intraclass correlation coefficient (ICC). Univariate logistic regression was performed to evaluate lesion characteristics (size, ADC, and enhancing pattern) associated to false positive and negative lesions.

Results: Six hundred twenty-five lesions (545 metastases, 80 benign lesions) were identified. Detection rate was significantly higher combining DWI+HBP than the other imaging sets (sensitivity 86% (95% confidence interval (CI) 0.845-0.878), specificity 94% (95% CI 0.901-0.961)). The sensitivity and specificity of the other sets were 82% and 65% for DWI, 88% and 69% for T2WI, and 90% and 82% for HBP+T2WI, respectively. The interreader agreement was statistically higher for both HBP sets (ICC = 0.96 (95% CI 0.94-0.97) for T2WI+HBP and ICC = 0.91 (95% CI 0.87-0.94) for DWI+HBP, respectively) compared with that for DWI (ICC = 0.76 (95% CI 0.66-0.83)) and T2+dynamic (ICC = 0.85 (95% CI 0.79-0.9)). High ADC values, large lesion size, and hypervascular pattern lowered the risk of false negative.

Conclusion: Given the high diagnostic accuracy of combining DWI+HBP, gadoxetic acid-enhanced MRI is to be considered in NET patients with suspected liver metastases. Fast MRI protocol using T2WI, DWI, and HBP is of interest in this population.

Key points: • The combined set of diffusion-weighted (DW) and hepatobiliary phase (HBP) images yields the highest sensitivity and specificity for neuroendocrine liver metastasis (NELM) detection. • Gadoxetic acid should be the contrast agent of choice for liver MRI in NET patients. • The combined set of HBP and DWI sequences could also be used as a tool of abbreviated MRI in follow-up or assessment of treatment such as somatostatin analogs.

Keywords: Gd-EOB-DTPA; Liver; Magnetic resonance imaging; Metastasis; Neuroendocrine tumor.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biometry
  • Contrast Media
  • Diffusion Magnetic Resonance Imaging*
  • False Positive Reactions
  • Female
  • Gadolinium DTPA
  • Gastrointestinal Tract / diagnostic imaging
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Intestinal Neoplasms / diagnostic imaging*
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / secondary
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / diagnostic imaging*
  • Pancreatic Neoplasms / diagnostic imaging*
  • Regression Analysis
  • Sensitivity and Specificity
  • Stomach Neoplasms / diagnostic imaging*
  • Young Adult


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA

Supplementary concepts

  • Gastro-enteropancreatic neuroendocrine tumor