Inter- and intra-reader agreement for gadoxetic acid–enhanced MRI parameter readings in patients with chronic liver diseases

Abstract

ObjectivesTo examine inter- and intra-observer agreement for four simple hepatobiliary phase (HBP)–based scores on gadoxetic acid (GA)–enhanced MRI and their correlation with liver function in patients with mixed chronic liver disease (CLD).MethodsThis single-center, retrospective study included 287 patients (62% male, 38% female, mean age 53.5 ± 13.7 years) with mixed CLD (20.9% hepatitis C, 19.2% alcoholic liver disease, 8% hepatitis B) who underwent GA-enhanced MRI of the liver for clinical care between 2010 and 2015. Relative liver enhancement (RLE), contrast uptake index (CUI), hepatic uptake index (HUI), and liver-to-spleen contrast index (LSI) were calculated by two radiologists independently using unenhanced and GA-enhanced HPB (obtained 20 min after GA administration) images; 50 patients selected at random were reviewed twice by one reader to assess intra-observer reliability. Agreement was assessed by intraclass correlation coefficient (ICC). The albumin-bilirubin (ALBI) score, the model of end-stage liver disease (MELD), and the Child-Turcotte-Pugh (CTP) score were calculated as standards of reference for hepatic function.ResultsIntra-observer ICCs ranged from 0.814 (0.668–0.896) for CUI to 0.969 (0.945–0.983) for RLE. Inter-observer ICCs ranged from 0.777 (0.605–0.874) for HUI to 0.979 (0.963–0.988) for RLE. All HBP-based scores correlated significantly (all p < 0.001) with the ALBI, MELD, and CTP scores and were able to discriminate patients with a MELD score ≥ 15 versus ≤ 14, with area under the curve values ranging from 0.760 for RLE to 0.782 for HUI.ConclusionGA-enhanced, MRI-derived, HBP-based parameters showed excellent inter- and intra-observer agreement. All HBP-based parameters correlated with clinical and laboratory scores of hepatic dysfunction, with no significant differences between each other.Key Points • Radiological parameters that quantify the hepatic uptake of gadoxetic acid are highly reproducible. • These parameters can be used interchangeably because they correlate with each other and with scores of hepatic dysfunction. • Assessment of these parameters may be helpful in monitoring disease progression. Electronic supplementary materialThe online version of this article (10.1007/s00330-019-06182-z) contains supplementary material, which is available to authorized users.

MRI‐defined sarcopenia predicts mortality in patients with chronic liver disease

“…Note that this same cohort has been used previously 10,11 when we evaluated the prognostic value of the functional liver imaging score (FLIS) evaluated on gadoxetic acid-enhanced MRI. In the present study, we aimed to assess the ability to diagnose sarcopenia on non-contrast-and contrast-enhanced MRI sequences and to evaluate whether sarcopenia is a risk factor for hepatic decompensation and mortality.…”

Quantification of liver function using gadoxetic acid-enhanced MRI

“…2). Most importantly, Beer et al [18] found that all four of these scores showed a strong positive correlation with each other, answering the fierce debate as to which of these methods was superior [18]. Furthermore, our group confirmed that all four MRI-derived HPB scores correlated moderately with liver disease severity, as assessed by the Albumin-Bilirubin (ALBI) score, Model of End-Stage Liver Disease (MELD), and Child-Turcotte-Pugh (CTP) scores.…”

“…Previously described methods with which to assess the hepatobiliary phase uptake include the relative liver enhancement, the hepatic uptake index, the contrast enhancement index, and T1 relaxation values [18,22,24]. These methods all require complex computations and have vendor, field strength, and sequence dependencies that complicate their clinical application.…”

“…Several practical and simple quantitative imaging biomarkers of liver function have been introduced, obviating the need for the complex methods used in the animal models and human trials mentioned above. The relative liver enhancement (RLE), hepatic uptake index (HUI), contrast uptake index (CUI), and liver-to-spleen contrast index (LSI) [ 18 , 29 , 30 ] are such methods, relying on only two sequences: noncontrast, and 20-min HBP, which are both part of the routine MRI liver protocol. A simple equation yields any of these biomarkers, each of which has been shown to correlate with liver function parameters (Fig.…”

“…Organic acid efflux from hepatocytes may also occur through the sinusoidal membrane because of bidirectional transport with OATP1B1/3 and MRP3 [17]. These insights into the cellular mechanism of transportation have led to a better understanding of how this unique contrast agent acts, as well as enabling the correlation of radiologic with histologic features of certain focal liver lesions, and also aiding in the staging of diffuse CLD [16,18]. There are two main factors that determine the cellular uptake and excretion of gadoxetic acid (Fig.…”