Clinical factors predictive of insufficient liver enhancement on the hepatocyte-phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging in patients with liver cirrhosis

Kim, Hee Yeon; Choi, Jong Young; Park, Chung-Hwa; Song, Myeong Jun; Song, Do Seon; Kim, Chang Wook; Bae, Si Hyun; Yoon, Seung Kew; Lee, Young Joon; Rha, Sung Eun

doi:10.1007/s00535-012-0740-7

Cited by 48 publications

(43 citation statements)

References 28 publications

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“…Results of prior studies have also shown that the liver enhancement level with Gd-EOB-DTPA is correlated with liver function level, such as AST, total bilirubin level, albumin level, ICG-R15, PT activity, and platelet count (9)(10)(11).…”

Section: Discussionmentioning

confidence: 91%

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

Okada¹,

Murakami²,

Kuwatsuru³

et al. 2016

Radiology

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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

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Section: Discussionmentioning

confidence: 91%

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

Okada¹,

Murakami²,

Kuwatsuru³

et al. 2016

Radiology

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“…Among various parameters, the indocyanine green retention rate, AST, platelet count, prothrombin activity, total bilirubin, albumin, sodium, MELD score, MELD-Na score, Child-Pugh score, and the presence of ascites are important factors correlated with liver enhancement (22)(23)(24)(25)(26). We expected that these parameters may be correlated with the change in the calculated FF.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the clinical or histologic factors that cause decreased hepatic enhancement on gadoxetic acid-enhanced MR imaging (22)(23)(24)(25)(26). Among various parameters, the indocyanine green retention rate, AST, platelet count, prothrombin activity, total bilirubin, albumin, sodium, MELD score, MELD-Na score, Child-Pugh score, and the presence of ascites are important factors correlated with liver enhancement (22)(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Effect of Gadoxetic Acid on Quantification of Hepatic Steatosis Using Magnetic Resonance Spectroscopy: A Prospective Study

Kim

Heo

et al. 2017

J Korean Soc Radiol

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Purpose:We prospectively evaluated whether gadoxetic acid (Gd-EOB-DTPA) administration for liver magnetic resonance (MR) imaging affects the quantification of hepatic steatosis using MR spectroscopy (MRS). Materials and Methods: A total of 155 patients were included, who underwent gadoxetic acid-enhanced liver MR imaging and MRS during a 5-month period. Fast breath-hold high-speed T2-corrected multi-echo MRS was used before, and 20 min after, gadoxetic acid injection. The same location was maintained in the pre-contrast and post-contrast MRS. Changes in the fat fraction (FF) were compared between the pre-and post-contrast MRS using a paired t-test. The change in FF between cirrhotic and non-cirrhotic patients was compared using an independent t-test. In cirrhotic patients, the correlation between FF change and biochemical marker using Pearson's correlation test, was evaluated. Results: The mean FF in the post-contrast MRS (5.05 ± 5.26%) was significantly higher than in the pre-contrast MRS (4.77 ± 0.57%) (p < 0.000). The FF change between pre-contrast and post-contrast MRS was significantly higher in non-cirrhotic patients (0.41 ± 0.77%) than in cirrhotic patients (0.14 ± 0.59) (p = 0.010). Albumin and alkaline phosphatase shows weak correlation with FF change (both p < 0.02). Conclusion: Gadoxetic acid affects the quantification of hepatic steatosis by MRS. Hence, MRS should be performed before gadoxetic acid injection, particularly in noncirrhotic patients. Index terms Magnetic Resonance Spectroscopy Fatty Liver Gadoxetic Acid Liver CirrhosisReceived May 5, 2016 Revised July 12, 2016 Accepted July 30, 2016 *Corresponding author: Yong Yeon Jeong, MD Department of Radiology, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun 58128, This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Gadoxetic acid (Gd-EOB-DTPA), which offers an innovative option for imaging the liver, is used for improved medical diagnosis with MR imaging. Gadoxetic acid is believed to be actively taken up in hepatocytes by a canalicular multispecific organic anion transporter 8 (15). Approximately 50% of the injected dose of gadoxetic acid is taken up by hepatocytes and subsequently excreted into the biliary canaliculi (16). Peak enhancement of gadoxetic acid is obtained 20 minutes after injection (17), and hepatobiliary phase imaging is performed at this time (15).A previous study reported that gadoxetic acid does not show a significant effect on measuring fat fractions (FF) between precontrast MRS and post-contrast MRS (18). The study had a relatively small sample size and was limited by the retrospective design. Since gadoxetic acid does not affect proton MRS, it could be performed during the interval of the dynamic phase to save time.Therefore, the purpose of thi...

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“…Particularly, Feier et al [81] found that relative enhancement values correlated strongly with fibrosis stage, with an AUC of 0.83 for > F4; Norén et al [82] found that liver-to-spleen contrast ratios at 10 and at 20 min and contrast uptake rate had AUROCs values of respectively 0.80, 0.78, and 0.71 with regard to severe vs mild fibrosis; Verloh et al [83] found that the mean relative enhancement in patients with Child-Pugh Score A cirrhosis had significant increase between arterial, late arterial, portal and hepato-biliary phases, while for Child-Pugh B+C cirrhosis, relative enhancement increased until portal phase and was significantly reduced in C cirrhosis during hepatobiliary phase; Nojiri et al [84] found that SI at 25 min could discriminate F = 0-3 vs F = 4, with AU-ROC of 0.87; Goshima et al [85] reported that sensitivity, specificity, and AUROC demonstrated by linear regression formula generated by volumetric ratio and contrast enhancement index in predicting fibrous scores were 91%, 100% and 97% for F4. Kim et al [86] reported that the relative enhancement [(hepatocyte phase SI -precontrast SI)/pre-contrast SI] of patients with Child-Pugh cirrhosis was significantly higher than that of patients with Child-Pugh B or C cirrhosis. Few studies have been performed on perfusion MRI.…”

Section: Mrmentioning

confidence: 97%

Noninvasive diagnosis of cirrhosis: A review of different imaging modalities

Robertis

D’Onofrio

Demozzi

et al. 2014

WJG

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Progressive hepatic fibrosis can lead to cirrhosis, so its early detection is fundamental. Staging fibrosis is also critical for prognosis and management. The gold standard for these aims is liver biopsy, but it has several drawbacks, as it is invasive, expensive, has poor acceptance, is prone to inter observer variability and sampling errors, has poor repeatability, and has a risk of complications and mortality. Therefore, non-invasive imaging tests have been developed. This review mainly focuses on the role of transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.

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Clinical factors predictive of insufficient liver enhancement on the hepatocyte-phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging in patients with liver cirrhosis

Cited by 48 publications

References 28 publications

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

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

Effect of Gadoxetic Acid on Quantification of Hepatic Steatosis Using Magnetic Resonance Spectroscopy: A Prospective Study

Noninvasive diagnosis of cirrhosis: A review of different imaging modalities

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