Análise das Indicações para uso do contraste paramagnético hepatoespecífico (Gd-EOD-DTPA)

Abstract

The usual imaging diagnostic methods for the evaluation of liver difuse and focal lesions are ultrasonography (USG), computed tomography (CT) and nuclear magnetic resonance (MR). MR using gadoxic acid contrast (Gd-EOB-DTPA) is indicated for the detection and morphological characterization of hepatic lesions and may also be useful for assessing the biliary tree as well as liver function. Therefore, it can be very useful in guiding medical decisions, both surgical and clinical. Gd-EOB-DTPA is the hepatospecific contrast recently released for clinical use in Brazil. It is a contrast medium introduced mainly in specialized centers in 2013 as in the AC Camargo Cancer Center and so far, there are very few studies in our environment, but It has been used in other countries, like Japan, USA and countries of the European Union. The differential of this contrast lies in its excretion mechanism. Approximately 50% of it is made for bile ducts and hepatic sinusoids, and the remainder through the kidneys. When used in MR studies it is performed in arterial, portal, late phases and a hepatospecific phase twenty minutes after intravenous administration. This study aimed to evaluate the extent of utilization of Gd-EOB-DTPA in the clinical practice in a Brazilian cancer center. This is a retrospective study, approved by the institution's Ethics and Research Committee, conducted through the review of medical records and reports. All MR scans utilizing hepatospecific contrast from November 2013 to July 2015 (n = 131) were analyzed. The mean age of the patients was 41.5 years, ranging from 13 to 90 years. Most studies 98 (74.8%) were performed in female patients. Family history of cancer was present in 29 (22.1%) patients, a history of neoplasia was present in 45 (34.3%) patients and 21 (16.0%) patients presented with chronic liver disease. In 127 (96.9%) patients. The most common indications for the use of Gd-EOD-DTPA contrast were undetermined nodules 56 (42.7%), adenoma versus FNH 43 (32.8%), detection of hepatic metastasis foci 13 (9.9%), Staging of CHC 10 (7.6%), bile duct 01 (0.8%) and other indications 08 (6.1%). The behavior of the lesion was evaluated after administration of hepatospecific intravenous contrast. We observed in this study a high number of exams indicated for the evaluation of focal liver lesions without the clear definition of the diagnostic suspicion 56 (42.7%). Regarding focal lesion vascularity most lesions 43 (79.7%) were hypervascular, and the examination contributed for clinical management in most of them 25 (58.1%). In the hypovascular nodules, the contribution rate was lower 03 (27.2%).

For all the classic indications we identified a high rate of exams that contributed to clinical decision making 41 (63.1%). Patients with an indication for the examination are mostly young adult women, who do not have chronic liver disease and do not have an oncologic history. The impact of the examination on clinical decision-making was greater when the indication was considered classical or for hypervascular focal liver lesions.