Liver disease and hepatocellular carcinoma (HCC) have become a global health burden. For this reason, the determination of liver function plays a central role in the monitoring of patients with chronic liver disease or HCC. Furthermore, assessment of liver function is important, e.g., before surgery to prevent liver failure after hepatectomy or to monitor the course of treatment. Liver function and disease severity are usually assessed clinically based on clinical symptoms, biopsy, and blood parameters. These are rather static tests that reflect the current state of the liver without considering changes in liver function. With the development of liver-specific contrast agents for MRI, noninvasive dynamic determination of liver function based on signal intensity or using T1 relaxometry has become possible. The advantage of this imaging modality is that it provides additional information about the vascular structure, anatomy, and heterogeneous distribution of liver function. In this review, we summarized and discussed the results published in recent years on this technique. Indeed, recent data show that the T1 reduction rate seems to be the most appropriate value for determining liver function by MRI. Furthermore, attention has been paid to the development of automated tools for image analysis in order to uncover the steps necessary to obtain a complete process flow from image segmentation to image registration to image analysis. In conclusion, the published data show that liver function values obtained from contrast-enhanced MRI images correlate significantly with the global liver function parameters, making it possible to obtain both functional and anatomic information with a single modality.

BACKGROUND: Liver function is one of the most important parameters for the outcome of transarterial chemoembolization (TACE). The Liver Maximum Capacity (LiMAx) -Test is a bedside test that provides a real-time option for liver function testing. The objective of this pilot study is to investigate the suitability of the LiMAX test for estimating the TACE outcome. OBJECTIVE AND METHODS: 20 patients with intermediate-stage hepatocellular carcinoma (HCC) received a LiMAx test 24 h pre and post TACE. In addition, laboratory values were collected to determine liver function and model for endstage liver disease (MELD) scores. The success of TACE was assessed 6 weeks post intervention by morphological imaging tests using modified response evaluation criteria in solid tumors (mRECIST). RESULTS: Patients with an objective response (OR = CR + PR) according to mRECIST post TACE have significantly higher values in the pre-interventional LiMAx test than patients with a non-OR (PD or SD) post TACE (rb(14) = 0.62, p = 0.01). Higher pre-interventional LiMAx values therefore indicate OR. Patients with a disease control (DC = CR + PR + SD) according to mRECIST post TACE have significantly higher values in the pre-interventional LiMAx test than patients with a non-DC (PD) post TACE (rb(14) = 0.65, p = 0.01). Higher pre-interventional LiMAx values therefore indicate DC. The bi-serial correlations of LiMAx values pre and post TACE with the outcome OR or DC are descriptively stronger than those of MELD with OR or DC. This suggests that the LiMAx test correlates better with the treatment response than the MELD score. CONCLUSIONS: For the first time, we were able to show in our study that patients who are scheduled for TACE could benefit from a LiMAx test to be able to estimate the benefit of TACE. The higher the pre-interventional LiMAx values, the higher the benefit of TACE. On the other hand, laboratory parameters summarized in the form of the MELD score, had significantly less descriptive correlation with the TACE outcome.

In the management of patients with chronic liver disease, the assessment of liver function is essential for treatment planning. Gd-EOB-DTPA-enhanced MRI allows for both the acquisition of anatomical information and regional liver function quantification. The objective of this study was to demonstrate and evaluate the diagnostic performance of two fully automatically generated imaging-based liver function scores that take the whole liver into account. T1 images from the native and hepatobiliary phases and the corresponding T1 maps from 195 patients were analyzed. A novel artificial-intelligence-based software prototype performed image segmentation and registration, calculated the reduction rate of the T1 relaxation time for the whole liver (rrT1liver) and used it to calculate a personalized liver function score, then generated a unified score—the MELIF score—by combining the liver function score with a patient-specific factor that included weight, height and liver volume. Both scores correlated strongly with the MELD score, which is used as a reference for global liver function. However, MELIF showed a stronger correlation than the rrT1liver score. This study demonstrated that the fully automated determination of total liver function, regionally resolved, using MR liver imaging is feasible, providing the opportunity to use the MELIF score as a diagnostic marker in future prospective studies.

ZusammenfassungDie MRT wird routinemäßig bei Patienten mit einer Erkrankung der Leber zum Ausschluss oder zur Verlaufskontrolle einer strukturellen Parenchymveränderung eingesetzt. Durch spezielle MRT-Sequenzen und -Techniken lassen sich Eigenschaften der Leber bezüglich Funktion, Fibrosestadium, Fett- und Eisengehalt quantifizieren. Die MRT hilft sowohl bei der ersten Diagnostik eines Krankheitsbildes als auch bei der Überprüfung des Therapieansprechens.

Die MRT wird routinemäßig bei Patienten mit einer Erkrankung der Leber zum Ausschluss oder zur Verlaufskontrolle einer strukturellen Parenchymveränderung eingesetzt. Durch spezielle MRT-Sequenzen und -Techniken lassen sich Eigenschaften der Leber bezüglich Funktion, Fibrosestadium, Fett- und Eisengehalt quantifizieren. Die MRT hilft sowohl bei der ersten Diagnostik eines Krankheitsbildes als auch bei der überprüfung des Therapieansprechens.