Correlation of liver enhancement in gadoxetic acid–enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial

Abstract

Objectives To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study. Methods A total of 359 patients who underwent gadoxetic acid–enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses. Results There was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = −0.215; p < 0.001) and AST (rho = −0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = −0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001). Conclusions The liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands. Key Points • The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI and liver function is consistent in a multicenter-multivendor cohort. • Signal intensity–based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function. • However, absolute values might change between vendors.

Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect

“…Different diagnostic tools may be employed, alone or in association [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Computed tomography (CT) and magnetic resonance imaging (MRI) represent the traditional imaging tools employed during the pre-treatment phase in order to identify and assess the target area [ 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], and in surveillance of the patient to evaluate treatment efficacy and post-procedural complications [ 87 , 88 , 89 , 90 , 91 , 92 , 93 ]. Ultrasound examination (US), without or with contrast medium (CEUS), is an innovative tool, utilized for problem solving during pre- and post-treatment phases [ 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 ], although the main use of interest is the possibility of assessing immediate effects during the procedure [ 60 , 61 ].…”

SIRT in 2025

“…Previous TACE was associated with better survival in the Sorafenib arm [ 47 , 48 ]. The SORAMIC trial also evaluated the alteration of liver enhancement after gadoxetic acid administration during hepatobiliary phase of magnetic resonance imaging (MRI) compared to the spleen enhancement; the Liver-to-Spleen ratio (LSR) directly correlates with reduced liver function: a low LSR was described in the presence of higher levels of AST, bilirubin, ascites and varices [ 49 ]. Extrahepatic disease spread did not significantly impact on survival between the two groups ( p = 0.6483), nor the progression during the study (19% of cases); conversely, lung metastases reduced patients’ survival in both groups ( p = 0.0060).…”

Portal hypertension may influence the registration of hypointensity of small hepatocellular carcinoma in the hepatobiliary phase in gadoxetic acid MR

“…[6][7][8] The uptake of Gd-EOB-DTPA by the hepatocytes during this delayed phase is impaired in chronic liver diseases and in recent years, there have been several attempts to evaluate the potential of magnetic resonance (MR) with Gd-EOB-DTPA as a reliable tool for liver dysfunction assessment. 9 Increased model for end-stage liver disease (MELD), bilirubin and indocyanine green clearance ratio at 15 minutes, and decreased cholesterol have been associated with suboptimal HBP [10][11][12][13][14] , and the parenchymal enhancement among different HBP phases (at 5, 10, 15 and 20 minutes) is lower in Child-Pugh (CP) B and C compared to CP-A patients. 15,16 Also, MR with Gd-EOB-DTPA has been tested for preoperative identification of those patients with major contraindications for hepatectomy.…”