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

Abstract

The aim of this exploratory study was to evaluate the influence of hepatic steatosis on the detection rate of metastases in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). A total of 50 patients who underwent gadoxetic acid-enhanced MRI (unenhanced T1w in- and opposed-phase, T2w fat sat, unenhanced 3D-T1w fat sat and 3-phase dynamic contrast-enhanced (uDP), 3D-T1w fat sat hepatobiliary phase (HP)) were retrospectively included. Two blinded observers (O1/O2) independently assessed the images to determine the detection rate in uDP and HP. The hepatic signal fat fraction (HSFF) was determined as the relative signal intensity reduction in liver parenchyma from in- to opposed-phase images. A total of 451 liver metastases were detected (O1/O2, n = 447/411). O1/O2 detected 10.9%/9.3% of lesions exclusively in uDP and 20.2%/15.5% exclusively in HP. Lesions detected exclusively in uDP were significantly associated with a larger HSFF (area under curve (AUC) of receiver operating characteristic (ROC) analysis, 0.93; p < 0.001; cutoff, 41.5%). The exclusively HP-positive lesions were significantly associated with a smaller diameter (ROC-AUC, 0.82; p < 0.001; cutoff, 5 mm) and a smaller HSFF (ROC-AUC, 0.61; p < 0.001; cutoff, 13.3%). Gadoxetic acid imaging has the advantage of detecting small occult metastatic liver lesions in the HP. However, using non-optimized standard fat-saturated 3D-T1w protocols, severe steatosis (HSFF > 30%) is a potential pitfall for the detection of metastases in HP.

Effect of body mass index (BMI) on image contrast in the hepatobiliary phase of Gd-EOB-DTPA-enhanced-MRI and the feasibility of the application of half-dose Gd-EOB-DTPA to hepatobiliary phase imaging in patients with a BMI less than 24: a comparative study

“…For the portal vein signal, since the main component of the portal vein was flowing blood and was not affected by BMI, which was manifested by the portal vein signal remaining relatively stable on the lava sequence. However, for the hepatic parenchymal signal, group A with a lower BMI had lower liver fat content than the group B with a higher BMI, which was manifested by less hepatic parenchymal signal loss on the lava sequence in group A compared to group B ( 35 ). As a result, their ratio was significantly different between the two groups, and group A was higher than group B.…”

Ability of dynamic gadoxetic acid–enhanced magnetic resonance imaging combined with water-specific T1 mapping to reflect inflammation in a rat model of early-stage nonalcoholic steatohepatitis

“…The possible interference in T1 mapping caused by the presence of fat was not fully considered in previous studies ( 25 , 28 ). Recent research has shown that intracellular hepatocyte lipid is a strong confounder for T1 quantification in patients with NAFLD ( 19 , 29 ), and it has even been demonstrated that severe liver steatosis (>30%) may confound detection performed according to distribution of Gd-EOB-DTPA ( 30 ). However, the wT1 mapping technique used in our previous phantom study showed good accuracy and independence from the fat fraction ( 20 ).…”