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

Abstract

This study evaluated liver function using gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) to improve assessment of patients with liver tumors compared to Child-Pugh classification (CPC). Materials and methods: The liver function of 59 patients was assessed to determine the indication for heavy ion therapy. Clinical and laboratory assessments, including 99m Tc-GSA liver scintigraphy and indocyanine green retention index (ICGR15), were performed for liver function assessment. EOB-MRI was performed on T1W1 images both before and after Gd-EOB-DTPA administration and hepatobiliary phase images were acquired 20-min post-injection. Liver parenchymal enhancement ratio (LER) was measured based on liver-to-spleen (L╱Sp) ratios calculating the average liver intensity divided by spleen intensity. Results: The mean LER values on MRI were 138.2 ± 12.8 (133.9 ─ 142.5), 115.7 ± 11.6 (110.0 ─ 121.5), and 93.2 ± 15.8 (73.6 ─ 112.9) in CPC-A,-B and-C, respectively. From the correlation between the LER on MRI and ICGR15 and parameters of 99m Tc-GSA liver scintigraphy, LER on MRI was highly significantly correlated with ICGR15 (r＝-0.67; p＜0.0001). Discussion: This study demonstrated that LER values on EOB-MRI could classify liver function and had high correlation with CPC and ICGR15.