Liver parenchymal enhancement of hepatocyte‐phase images in Gd‐EOB‐DTPA‐enhanced MR imaging: Which biological markers of the liver function affect the enhancement?

Abstract

Purpose: To clarify the factors that predict enhancement of the liver parenchyma in hepatocyte-phase of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging. Materials and Methods:Gd-EOB-DTPA-enhanced hepatocyte-phase MR images of 198 patients with chronic liver diseases (Child-Pugh class A in 112 patients, class B in 74 patients, and class C in 12 patients) were retrospectively analyzed. The hepatocyte-phase images were obtained using fat-suppressed T1-weighted gradient-echo images with a 3D acquisition sequence 10 min and 20 min after IV administration of Gd-EOB-DTPA (0.025 mmol/kg body weight). The quantitative liver-spleen contrast ratio (Q-LSC) was calculated using the signal intensities of the liver and spleen. Serum albumin levels, total bilirubin levels, prothrombin activity, and the results of indocyanine green clearance tests (ICGs) were recorded and correlated with the Q-LSC. Logistic regression analysis was performed to analyze which factors predict sufficient liver enhancement using a Q-LSC of 1.5 as a cutoff value.Results: Only ICGs and Child-Pugh classifications showed a statistically significant correlation with the Q-LSC. Logistic regression analysis showed that ICGs were the only factors that accurately predicted liver enhancement on hepatocyte-phase images.Conclusion: ICGs were found to be predictors of sufficient liver enhancement on hepatocyte-phase images.

Outcome of hypovascular hepatic nodules revealing no gadoxetic acid uptake in patients with chronic liver disease

“…the hypercellular area should have less amount of contrast agent in equilibrium-phase, whereas the latter indicates decreased hepatocyte function (11,31,32). In our experience, nodules showing low intensity on hepatocyte-phase gadoxetic acid-enhanced MR images do not always show low density on equilibrium-phase dynamic CT, and vice versa.…”

“…A bolus injection of gadoxetic acid enables the assessment of tumor vascularity on arterial-phase images as well as a functional hepatic (i.e., hepatocyte-phase) images (8,9). The hepatocyte-phase assessments can be performed approximately 20 min after administration of the contrast agent, when approximately 50% of the agent has been taken up by the hepatocytes (10)(11)(12). Studies have shown that the majority of HCCs appear as relatively hypointense lesions on hepatocyte-phase images because of the lack of gadoxetic acid uptake.…”

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

“…2 Very high signal intensity on a T 2 -weighted image might help distinguish between hemangioma and liver malignancies, such as metastasis, 3 but gadoxetic acid should not be used when the purpose of the MR examination is to conˆrm a hemangioma diagnosis rather than detect small focal liver lesions. The second disadvantage of gadoxetic acid is that its uptake is not always su‹cient to provide the contrast necessary to distinguish between liver parenchyma and lesions [4][5][6] (Fig. 1a, b).…”

“…Several clinical parameters, including ChildPugh score, serum bilirubin levels, and indocyanine green test results, are associated with uptake of gadoxetic acid (or signal intensity of the liver on hepatocyte phase images). [4][5][6][7] No known imaging parameter predicts liver enhancement on hepatocyte phase images before gadoxetic acid administration, 7 though liverˆbrosis or stiŠness as measured by MR elastography might indicate insufcient liver enhancement. 8 We suggest using an alternative contrast agent, such as an extracellular GBCA, when previous MR examinations indicate insu‹cient liver enhancement after gadoxetic acid administration.…”

Gd-EOB-DTPA-enhanced MRI for the assessment of liver function and volume in liver cirrhosis

“…In human studies, liver parenchymal enhancement after administration of Gd-EOB-DTPA has been shown to correlate with ICG clearance and with liver cirrhosis as assessed by the CPS [26,27], and subsequent biliary excretion has been shown to be delayed in patients with impaired liver function [28]. In a study of patients with primary biliary cirrhosis, quantitative parameters indicative of liver function derived from DA were shown to correlate with disease severity [29].…”