Magnetic resonance imaging (MRI) and 1H magnetic resonance spectroscopy (1H-MRS) have been used in clinics for diagnosis of chronic liver diseases. This study was designed to investigate the relationship between MRI/MRS outcomes and the severity of liver damage. Of 50 patients examined, the MRI signal intensity in the globus pallidus as determined by pallidus index (PI) increased as the disease severity (scored by Child Pugh ranking) worsened (r = 0.353, P < 0.05). The changes in PI values were also linearly associated with Mn concentrations in whole blood (MnB) (r = 0.814, P < 0.01). MRS analysis of four major brain metabolites (i.e., Cho, mI, Glx, and NAA) revealed that the ratios of Cho/Cr and mI/Cr in cirrhosis and CHE patients were significantly decreased in comparison to controls (P < 0.05), whereas the ratio of Glx/Cr was significantly increased (P < 0.05). The Child Pugh scores significantly correlated with mI/ Cr (−0.484, P < 0.01) and Glx (0.369, P < 0.05), as well as MnB (0.368, P < 0.05), but not with other brain metabolites. Three patients who received a liver transplant experienced normalization of brain metabolites within 3 months of post-transplantation; the MR imaging of Mn in the globus pallidus completely disappeared 5 months after the surgery. Taken together, this clinical study, which combined MRI/MRS analysis, autopsy exam and liver transplant, clearly demonstrates that liver injury-induced brain Mn accumulation can reversibly alter the homeostasis of brain metabolites Cho, mI and Glx. Our data further suggest that liver transplantation can restore normal brain Mn levels.
Contract grant sponsorNational Natural Science Foundation of China; Contract grant number: 81260214.BackgroundRecent studies have highlighted the diagnostic value of Gadolinium‐ethoxybenzyl‐diethylenetriamine pentaacetic acid (Gd‐EOB‐DTPA)‐enhanced MRI in small hepatocellular carcinoma (HCC). Ki67 and CD34 are histologic markers that reflect the proliferation of tumor cells and the microvascular density (MVD).PurposeTo explore the diagnostic value of Gd‐EOB‐DTPA‐enhanced MRI for Ki67 expression and MVD in HCC.Study TypeRetrospective.SubjectsIn all, 180 patients with HCC.Field Strength/Sequence3.0T, Gd‐EOB‐DTPA‐enhanced T1WI volumetric interpolated breath‐hold examination (VIBE) axial fat suppression plain, and enhanced scanning.AssessmentThe T1 relaxation time (T1rt) and signal intensity (SI) of the lesion were measured. The Ki67 expressions and MVD were evaluated by immunohistochemistry.Statistical TestReceiver operating characteristic (ROC) curves were used to analyze the diagnostic efficacy of T1rt for high Ki67 expression (≥50%) and high MVD (≥100).ResultsThe T1rt‐20min, rrT1rt‐20min, and SI‐hepatobiliary phase (SI‐HBP) were strongly correlated with Ki67, the r values were 0.846, –0.765, and –0.760 (P < 0.05), respectively. There were moderate correlations with CD34, with r values –0.444, 0.336, and –0.463 (P < 0.05), respectively. The T1rt‐Pre, T1rt‐20min, SI‐Pre, and SI‐HBP were significantly different both between the high and low ki67 expression groups (P < 0.05) and between the high MVD and low MVD groups (P < 0.05). In the two groups the T1rt‐20min and SI‐HBP was 800.06 ± 128.91 vs. 530.06 ± 139.29 (P < 0.05) and 122.29 ± 39.39 vs. 173.49 ± 46.15 (P < 0.05); T1rt‐20min was found to have high diagnostic efficiency for high ki67 expression (area under the curve [AUC], 0.937; P < 0.05) T1rt‐20min had moderate diagnostic value for high MVD (AUC, 0.716; P < 0.05).Data ConclusionThe T1rt and SI of Gd‐EOB‐DTPA‐enhanced MRI were correlated with Ki67 expression and MVD. T1rt‐20min has a high diagnostic value for high ki67 expression and high MVD in HCC tissues.Level of Evidence: 3Technical Efficacy Stage: 2J. Magn. Reson. Imaging 2020;51:1755–1763.
The aim of the present study was to explore the value of T
1
mapping on gadolinium-ethoxybenzyl diethylenetriamine pentaacetic (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for grading hepatocellular carcinoma (HCC) and predicting its recurrence rate. A retrospective study was performed that included 75 patients (66 men and 9 women; mean age, 52.89 years; age range, 23–79 years) with HCC who had undergone Gd-EOB-DTPA-enhanced MRI with T
1
mapping before surgery. The T
1
relaxation time of the 81 lesions and non-tumorous liver parenchyma in 75 patients with HCC were measured before Gd-EOB-DTPA was injected and then at 5, 10 and 20 min after administration, respectively. T
1[lesion (L)-hepatic parenchyma (H)]/H
(%) was calculated as the increment rate of the T
1
value in the lesions relative to the non-tumorous liver parenchyma. One-way analysis of variance and Spearman's correlation analysis was used to compare the differences and relationship of T
1
mapping values among the three grades of HCC. A total of 81 lesions were divided into well-differentiated HCC (grades I; n=21), moderately differentiated HCC (grades II; n=40) and poorly differentiated HCC (grades III; n=20) according to the histopathology. The T
1(L-H)/H
(%) value among grades I, II and III HCC on pre-contrast results and on post-contrast results at the 5-, 10- and 20-min hepatobiliary phase (HBP) were significantly different (P<0.05), and T
1(L-H)/H
(%) was correlated with the histological grade of HCC at each time point (r=0.637, r=0.554, r=0.499 and r=0.560, respectively, P<0.001). A total of 41 recurrence cases [grade I (n=5), grade II (n=23) and grade III (n=13)] were verified by imaging (CT, MRI or ultrasound) or reoperation. Patients with grade III and grade II HCC had higher recurrence rates compared with that in patients with grade I HCC (P<0.05; median recurrence times were 258 days, 605 days and undefined, respectively). According to the optimal cut-off point for the T
1(L-H)/H
(%) of the three grades of HCC, patients with HCC in the low T
1(L-H)/H
(%) value group (≤155.15%) had lower cumulative recurrence rates compared with that in the medium (T
1(L-H)/H
(%) >155.15% and T1
(L-H)/H
(%) ≤241.20%) and high (T
1(L-H)/H
(%) >241.20%) value groups at the 20-min HBP (P<0.05; median recurrence times were undefined, 530 days and 447 days, respectively). These results indicate that the parameters of T
1
mapping would be beneficial for predicting the grading and recurrence of HCC.
BackgroundAssessing the liver function provides valuable information to evaluate surgical risk and plan accordingly. Current studies focus on whole liver function evaluation. However, assessment of segmental liver function is equally important in the clinical practice. The purpose of this study was to investigate whether Gd-EOB-DTPA-enhanced MRI can evaluate the liver function of each segment by using T1 mapping at 3 Tesla MRI.MethodsOne hundred three patients were classified into one of 4 groups: a normal liver function (NLF) group (n = 38), a liver cirrhosis with Child-Pugh A (LCA) group (n = 33), a liver cirrhosis with Child-Pugh B (LCB) group (n = 21), and a liver cirrhosis with Child-Pugh C (LCC) group (n = 11). All patients underwent Gd-EOB-DTPA-enhanced MRI scans. T1 relaxation times were measured on the liver superimposing T1 mapping images. Reduction rate (△%) of T1 relaxation time of the liver parenchyma were calculated.ResultsAfter 20 min of Gd-EOB-DTPA enhancement, the T1 relaxation time of all liver segments in the LCC group were different from those in all the other groups, and more liver segments from the LCB and LCA groups different from the NLF group (p < 0.05). For the LCB group, the areas under the receiver operating characteristic curves (AUCs) of different liver segments for hepatobiliary phase (HBP) were 0.654-0.904 on T1 relaxation time, and 0.709-0.905 on △%. For the LCC group, the AUCs of different liver segments for HBP were 0.842–0.997 on T1 relaxation time, and 0.887–0.990 on △%.ConclusionsFor LCB patients, segmental liver function evaluation is possible using Gd-EOB-DTPA-enhanced MRI T1 mapping. For LCC patients, all liver segments can be used to evaluate liver function and both T1 relaxation time and the △% of T1 relaxation time have good diagnostic performance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-017-0192-x) contains supplementary material, which is available to authorized users.
In comparing 10-min HBP and 20-min HBP T1 mapping after Gd-EOB-DTPA enhancement, our results suggest that 10-min HBP T1 mapping is a feasible option for quantitatively assessing liver function.
Comparing 10 min HBP and 20 min HBP T1 mapping after Gd-EOB-DTPA enhancement, our results suggest that 10 min HBP T1 mapping is feasible for quantitatively assessing liver function.
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