Dynamic gadoxetate‐enhanced MRI for the assessment of total and segmental liver function and volume in primary sclerosing cholangitis

Nilsson, Henrik; Blomqvist, Lennart; Douglas, Lena; Nordell, Anders; Jacobsson, Hans; Hagen, Karin; Bergquist, Annika; Jonas, Eduard

doi:10.1002/jmri.24250

Cited by 36 publications

(37 citation statements)

References 19 publications

(24 reference statements)

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“…29 First, gadoxetate-enhanced MRI can provide information on hepatic function in localized hepatic abnormalities, which is more clinically relevant than a global assessment. 34 ICG clearance is a method for global assessment of liver function. Although the scintigraphic method is used for the evaluation of regional hepatic function, it is limited by poor spatial resolution.…”

Section: Clinical Applications Of Gadoxetate-enhanced Mri Evaluation mentioning

confidence: 99%

Use of gadoxetate disodium for functional MRI based on its unique molecular mechanism

Choi¹,

Huh²,

Woo³

et al. 2016

BJR

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Gadolinium ethoxybenzyl dimeglumine (gadoxetate) is a recently developed hepatocyte-specific MRI contrast medium. Gadoxetate demonstrates unique pharmacokinetic and pharmacodynamic properties, because its uptake in hepatocytes occurs via the organic anion transporting polypeptide (OATP) transporter expressed at the sinusoidal membrane, and its biliary excretion via the multidrug resistance-associated proteins (MRPs) at the canalicular membrane. Based on these characteristics, gadoxetate-enhanced MRI can provide functional information on hepatobiliary diseases, including liver function estimation, biliary drainage evaluation and characterization of hepatocarcinogenesis. In addition, understanding its mode of action can provide an opportunity to use gadoxetate for cellular and molecular imaging. Radiologists and imaging scientists should be familiar with the basic mechanism of gadoxetate and OATP/MRP transporters.

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Section: Clinical Applications Of Gadoxetate-enhanced Mri Evaluation mentioning

confidence: 99%

Use of gadoxetate disodium for functional MRI based on its unique molecular mechanism

Choi¹,

Huh²,

Woo³

et al. 2016

BJR

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“…For instance, hemangiomas and focal nodular hyperplasia do not require any therapeutic intervention, whereas adenomas possess a risk for malignant transformation, and therefore require treatment [112]. Dynamic hepatocyte contrast enhanced MRI is a valuable tool for the assessment of liver volume and liver functional capacity in patients with primary sclerosing cholangitis [113]. Gadoxetate uptake and enhancement in patients with diffuse chronic liver disease is generally lower than in healthy individuals, due to differences in transporter number or activity.…”

Section: Current Clinical Use Of Gadoxetate In Liver Disease Diagnosismentioning

confidence: 99%

Noninvasive Preclinical and Clinical Imaging of Liver Transporter Function Relevant to Drug-Induced Liver Injury

Kenna

Waterton

Baudy

et al. 2018

Methods in Pharmacology and Toxicology

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Imaging technologies can evaluate many different biological processes in vitro (in cell culture models) and in vivo (in animals and humans), and many are used routinely in investigation of human liver diseases. Some of these methods can help understand liver toxicity caused by drugs in vivo in animals, and druginduced liver injury (DILI) which arises in susceptible humans. Imaging could aid assessment of the relevance to humans in vivo of toxicity caused by drugs in animals (animal/human translation), plus toxicities observed using in vitro model systems (in vitro/in vivo translation). Technologies and probe substrates for quantitative evaluation of hepatobiliary transporter activities are of particular importance. This is due to the key role played by sinusoidal transporter mediated hepatic uptake in DILI caused by many drugs, plus the strong evidence that inhibition of the hepatic bile salt export pump (BSEP) can initiate DILI. Imaging methods for investigation of these processes are reviewed in this chapter, together with their scientific rationale, and methods of quantitative data analysis. In addition to providing biomarkers for investigation of DILI, such approaches could aid the evaluation of clinically relevant drug-drug interactions mediated via hepatobiliary transporter perturbation.

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“…The hepatic extraction fraction can then be calculated for every voxel [55 -57]. This method provides excellent correlation with clinical and laboratory parameters [58,59]. For dynamic data acquisition, sufficiently fast and highly resolved T1-weighted MRI sequences are now available, e. g., the CAIPIRINHI-Dixon-TWIST sequence (controlled aliasing in parallel imaging results in higher acceleration (CAIPIRI-NHA) time-resolved angiography with stochastic trajectories (TWIST) based on a 3 D gradient echo sequence [60].…”

Section: Mri As Imaging-based Liver Function Testmentioning

confidence: 99%

“…This method has two disadvantages: only one input function, the arterial (AIF) or the portal venous (PVIF), which differ greatly, can be taken into consideration; singular value decomposition is very susceptible to noise. The validity of this approach in primary biliary cirrhosis, liver cirrhosis, and primary sclerosing cholangitis was able to be shown [58,59,66]. The additional use of the keyhole technique as implemented in the TWIST sequence allows inclusion of the AIF as a result of the higher temporal resolution [65,67].…”

Section: Mri As Imaging-based Liver Function Testmentioning

confidence: 99%

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Imaging-Based Liver Function Tests – Past, Present and Future

Geisel

Lüdemann

Hamm

et al. 2015

Fortschr Röntgenstr

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Preoperative assessment of liver function and?prediction of postoperative functional reserve are important in patients scheduled for liver resection. While determination of absolute liver function currently mostly relies on laboratory tests and clinical scores, postoperative remnant liver function is estimated volumetrically using imaging data obtained with computed tomography (CT) or magnetic resonance imaging (MRI). Accurate estimation of hepatic function is also relevant for intensive care patients, oncologic patients, and patients with diffuse liver disease. The indocyanine green (ICG) test is still the only established test for estimating true global liver function. However, more recent tools such as the LiMAx test also allow global assessment of hepatic function. These tests are limited when liver function is inhomogeneously distributed, which is the case in such conditions as unilateral cholestasis or after portal vein embolization. Imaging-based liver function tests were first developed in nuclear medicine and, compared with laboratory tests, have the advantage of displaying the spatial distribution of liver function. Nuclear medicine scans are obtained using tracers such as?99mTc galactosyl and 99mTc mebrofenin. Liver function is typically assessed using planar scintigraphy. However, three-dimensional volumetry is possible with single-photon emission computed tomography (SPECT-CT). Another technique for image-based liver function estimation is Gd-EOB-enhanced MRI. While metabolization of Gd-EOB in the body is similar to that of ICG and mebrofenin, its distribution in the liver can be displayed by MRI with higher temporal and spatial resolution. Moreover, MRI-based determination of liver function can be integrated into routine preoperative imaging. This makes MRI an ideal candidate for preoperative determination of?liver function, though the best pulse sequence and the parameter to be derived from the image information remain to be identified. Another question to be answered is how the results may be affected by renal function and the presence of hyperbilirubinemia. As more results from clinical evaluation including comparison with postoperative liver function data become available, image-based liver function tests, especially with use of Gd-EOB as the contrast medium, have the potential to add another dimension to preoperative imaging. Key Points: ??Liver function consists of a multitude of subfunctions such as biotransformation, excretion and storage. ??Global liver function tests are score-based tests such as Child-Pugh or MELD as well as the ICG- and LiMAx-test. ??Imaging-based liver function tests add spatial information. Current clinical standard is the 99mTc-Mebrofenin-scintigraphy. ??MRI-based function tests with Gd-EOB-DTPA have the potential to integrate seamlessly into clinical workup, feature a higher temporal and spatial resolution and do not rely on ionizing radiation. Citation Format: ??Geisel D, L?demann L, Hamm B et?al. Imaging-Based Liver Function Tests ? Past, Present and F...

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Dynamic gadoxetate‐enhanced MRI for the assessment of total and segmental liver function and volume in primary sclerosing cholangitis

Abstract: The study demonstrates a new method to quantify total and segmental liver function using DHCE-MRI in patients with PSC.

Cited by 36 publications

References 19 publications

Use of gadoxetate disodium for functional MRI based on its unique molecular mechanism

Use of gadoxetate disodium for functional MRI based on its unique molecular mechanism

Noninvasive Preclinical and Clinical Imaging of Liver Transporter Function Relevant to Drug-Induced Liver Injury

Imaging-Based Liver Function Tests – Past, Present and Future

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