“Speckled Enhancement” on Gd-EOB-DTPA Enhanced MR Imaging of Primary Hepatic Mucosa-associated Lymphoid Tissue Lymphoma

Abstract

Purpose: To elucidate MRI features of primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma, particularly, the “speckled enhancement” on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. Methods: The institutional review board approved this retrospective observational study and waived informed consent. Using our picture archiving and communication systems and electronic medical records, five patients histopathologically diagnosed as hepatic MALT lymphoma and clinically confirmed as primary lesions who had undergone dynamic contrast-enhanced (DCE)-CT and DCE-MRI with Gd-EOB-DTPA were identified from September 2009 to December 2020. Two radiologists assessed their CT and MRI data in consensus with a pathologist’s advice. Results: Overall, five lesions in five patients were included in this study. Precontrast CT showed hypoatte-nuation in all lesions. In the arterial phase of DCE-CT, four lesions (80%) showed hyperattenuation, whereas all lesions showed iso-to hypoattenuation in the delayed phase. A vessel penetration sign was also observed in all lesions. On MRI, all lesions showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and restricted diffusion on diffusion-weighted images. Both DCE-CT and DCE-MRI with Gd-EOB-DTPA showed similar enhancement patterns, except for the hepatocyte phase. Notably, how-ever, four out of five lesions showed characteristic “speckled enhancement” that refers to punctate positive enhancements within the low signal lesions on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI pathologically confirmed to be hepatocyte clusters that remained in the tumor. Conclusion: Primary hepatic MALT lymphomas were characterized by arterial phase enhancement, restricted diffusion, vessel penetration sign, and more specifically “speckled enhancement” in the hepato-biliary phase of DCE-MRI with Gd-EOB-DTPA.