Biochemical and Clinical Predictive Approach and Time Point Analysis of Hepatobiliary Phase Liver Enhancement on Gd-EOB-DTPA–enhanced MR Images: A Multicenter Study

Abstract

Supported by Bayer Yakuhin, Osaka, Japan.q RSNA, 2016 Purpose:To identify biochemical factors associated with liver enhancement over time on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) images and predict the optimal time point of the hepatobiliary phase in various clinical settings. Materials and Methods:This study was approved by the institutional review boards, and written informed consent was obtained from the 1903 patients enrolled. Simple and multiple logistic regression analyses were performed to investigate the biochemical factors associated with liver-to-spleen contrast (LSC) of at least 1.5 in the hepatobiliary phase. Changes in LSC and lesion-to-liver contrast (LLC) of lesions over time (at 5, 10, 15, and 20 minutes) were investigated with a linear mixedeffects model in patients and lesions. For LSC, the optimal cutoff value was determined with receiver operating characteristic analysis of the most significant variable. Differences in LSC and LLC were analyzed in various clinical settings. Results:Ultimately, 1870 patients were evaluated, as 33 were excluded according to study criteria. Prothrombin (PT) activity, total bilirubin level (P = .020), and total cholesterol level (P = .005) were significantly associated with LSC of at least 1.5 at 20 minutes, and PT activity was identified as the most significant factor (odds ratio, 1.271; 95% confidence interval: 1.109, 1.455; P = .001). LSC of at least 1.5 at 20 minutes with PT activity of at least 86.9% and less than 86.9% occurred in 555 of 626 patients (88.6%) and 388 of 575 patients (67.5%), respectively. Satisfactory liver enhancement at 20 minutes was significantly more likely to be achieved by patients with hepatitis B virus than by those with hepatitis C virus (P , .001) and by patients with metastasis than by those with hepatocellular carcinoma (P , .001). No significant difference in LLC was observed in patients examined at 1.5 and 3.0 T (P = .133). Conclusion:Hepatic enhancement is significantly associated with PT activity, total bilirubin level, and total cholesterol level. PT activity of at least 86.9% could be used to shorten examination times at Gd-EOB-DTPA-enhanced MR imaging.q RSNA, 2016

Evaluation of liver function using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging based on a three-dimensional volumetric analysis system

“…These results suggest that EOB-MRI would be applied for evaluating liver function in the clinical situation. Furthermore, the MRI protocol in the previous studies that evaluated liver function using EOB-MRI did not differ widely from that in our study: the slice thickness was 5.0 mm in the study by Okada et al [ 8 ], 4.0 mm by Nishie et al [ 7 ], and 3.8 mm by Matsushima et al [ 4 ]. Second, in the 3D volumetric analysis, extrahepatic-parenchymal tissues such as portal vein or hepatic vein were included in the whole liver signal intensity calculation: the LSR was the metric primarily used.…”

“…However, the difference is not assumed to be significant, as the MRI protocols were similar between the two different machines and all images were taken by T-1 weighted technique. In a previous multicenter study, Okada et al reported no significant differences in signal intensity of the liver on EOB-MRI between different MRI scanners [ 8 ]. Fourth, there were a large number of patients excluded for having prior history of portal vein embolization.…”

“…Gd-EOB-DTPA has a well-known metabolic pathway, and several studies have suggested that EOB-MRI is useful to evaluate liver function [ 3 , 4 ]. The liver-to-spleen signal intensity ratio (LSR) on EOB-MRI has been used as a parameter to assess liver function [ 5 – 8 ], but the conventional method to measure the LSR using two-dimensional (2D) regions of interest might be affected by sampling errors or inter-evaluator variability [ 9 ].…”

Does Hepatic Steatosis Influence the Detection Rate of Metastases in the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI?

“…The additional HP of the gadoxetic acid MRI protocol enables imaging of the liver during a long plateau phase with sufficient hepatocellular uptake for optimal contrast between surrounding parenchyma and malignant lesions. Sufficient uptake is reached as early as 10-20 min after contrast agent injection [20]. Even with standard MRI devices, regardless of the manufacturer, it is possible to achieve good image quality with the very robust 3D T1w fat-saturated breath-hold sequence with a small slice thickness and short breath-hold intervals (approximately 20 s).…”

Child-Pugh Classification using Magnetic Resonance Imaging using Gadoxetic Acid-based Contrast Agent Compared with Indocyanine Green and ^99mTc-galactosyl-human Serum Albumin Liver Scintigraphy

“…15 Furthermore, whether 20 min after Gd-EOB-DTPA administration is the optimal delay to assess liver function remains unclear. Therefore, studies on EOB-MRI have been conducted [16][17][18][19][20][21][22][23][24] using various parameters and indices related to liver enhancement. In this study, liver parenchymal enhancement ratio (LER) is used.…”