Determination of hepatic extraction fraction with gadoxetate low‐temporal resolution DCE‐MRI‐based deconvolution analysis: validation with ALBI score and Child‐Pugh class

Abstract

Introduction In this study, we aimed to investigate the feasibility of gadoxetate low‐temporal resolution (LTR) DCE‐MRI for voxel‐based hepatic extraction fraction (HEF) quantification for liver sparing radiotherapy using a deconvolution analysis (DA) method. Methods The accuracy and consistency of the deconvolution implementation in estimating liver function was first assessed using simulation data. Then, the method was applied to DCE‐MRI data collected retrospectively from 64 patients (25 normal liver function and 39 cirrhotic patients) to generate HEF maps. The normal liver function patient data were used to measure the variability of liver function quantification. Next, a correlation between HEF and ALBI score (a new model for assessing the severity of liver dysfunction) was assessed using Pearson's correlation. Differences in HEF between Child‐Pugh score classifications were assessed for significance using the Kruskal–Wallis test for all patient groups and Mann–Whitney U ‐test for inter‐groups. A statistical significance was considered at a P ‐value <0.05 in all tests. Results The results showed that the implemented method accurately reproduced simulated liver function; root‐mean‐square error between estimated and simulated liver response functions was 0.003, and the coefficient‐of‐variance of HEF was <20%. HEF correlation with ALBI score was r = −0.517, P < 0.0001, and HEF was significantly decreased in the cirrhotic patients compared to normal patients ( P < 0.0001). Also, HEF in Child‐Pugh B/C was significantly lower than in Child‐Pugh A ( P = 0.024). Conclusion The study demonstrated the feasibility of gadoxetate LTR‐DCE MRI for voxel‐based liver function quantification using DA. HEF could distinguish between different grades of liver function impairment and could potentially be used for functional guidance in radiotherapy.

Non‐contrast based approach for liver function quantification using Bayesian‐based intravoxel incoherent motion diffusion weighted imaging: A pilot study

“…This was followed by LTR‐DCE MRI image data, acquired during multiple breath‐holds using an axial 3D SPGR T1‐weighted Dixon pulse sequence. The LTR‐DCE MRI method was described in our previous study 10 …”

“…In addition, hepatic extraction fraction (HEF) maps were generated from the LTR‐DCE MRI image data using the voxelwise truncated singular value decomposition‐deconvolution analysis (TSVD‐DA) method similar to that described by Nilsson et al 8 . and implemented in a previous study by the authors 10 …”

“…The LTR-DCE MRI method was described in our previous study. 10 Finally, post-Gadoxetate administration DFA T1 mapping and hepatobiliary phase images were obtained at 900 s and 1200 s after injection, respectively. We acknowledge the consensus clinical protocol for gadoxetate DCE-MRI in hepatocellular carcinomas, which recommends scanning the hepatobiliary phase (HBP) at 20 min after injection.…”

“…Gadoxetate dynamic contrast‐enhanced (DCE) MRI and T1 mapping have both been investigated to determine relative hepatocyte function globally and spatially with promising results 7–9 . Our previous study reported the feasibility of low temporal resolution Gadoxetate DCE‐MRI (LTR‐DCE MRI) in derivation of the hepatic extraction fraction (HEF) function map in assessing spatial liver function 10 . In addition to Gadoxetate‐based liver function, intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI) may facilitate quantification of both liver tissue diffusion and liver tissue perfusion without the requirement for contrast injection and the associated small risk of patient complications.…”

Role of Functional MRI in Liver SBRT: Current Use and Future Directions

“…When using hepatobiliary contrast agents, another functional parameter that is often used is the hepatic extraction fraction (HEF), which describes the extraction of the contrast agent from plasma by the hepatocytes [ 52 , 55 , 56 ]. While the HEF is indicative of hepatocyte function and is correlated with CP scores [ 57 ], it cannot differentiate between plasma flow and hepatocyte uptake.…”