Prediction of Sufficient Liver Enhancement on the Gadoxetate Disodium-enhanced Hepatobiliary Phase Imaging Using Transitional Phase Images and Albumin–bilirubin Grade

Abstract

To investigate whether the contrast enhancement effect in hepatobiliary phase (HBP) images can be predicted using transitional phase (3-min delay) images on liver magnetic resonance imaging (MRI) based on the quantitative liver-spleen contrast ratio (Q-LSC) and albumin-bilirubin (ALBI) grade. Methods: Overall, 212 patients (124 men and 88 women; mean age 66.7 ± 11.1 years) who underwent blood tests (assessed within 1 month of performing MRI) were included; patients with diffuse tumor, hepatectomy, splenectomy, Gamna-Gandy bodies in the spleen, and movement artifacts were excluded. Q-LSC was calculated using the signal intensity of the liver divided that of the spleen. Q-LSC > 1.5 (cut-off value) indicates a relatively higher sensitivity for detecting of hepatic lesions. To predict the contrast enhancement effect in HBP using Q-LSC of 3-min delay images, Q-LSC of 10-and 15-min delay images were compared for each ALBI grade based on Q-LSC of 3-min delay images. Furthermore, to verify the accuracy of this prediction, the proportion of cases with Q-LSC > 1.5 in 10-and 15 min delay images was calculated based on Q-LSC on 3-min delay images. Results: The higher the Q-LSC on the 3-min delay image, the higher was the Q-LSC on its 10-and 15-min delay images. The proportion of cases with Q-LSC > 1.5 in 10-and 15-min delay images was higher for ALBI grade 1 than for ALBI grades 2 and 3 even in the same Q-LSC on 3-min delay images. Q-LSC was <1 in a 3-min delay image and <1.5 in a 15-min delay image in 62.2% of patients with ALBI grade 1 and 82.1% of patients with ALBI grades 2 and 3. Conclusion: The liver contrast enhancement effect in HBP images could be predicted using a 3-min delay image based on Q-LSC and ALBI grade.

Evaluation of liver function in patients with liver cirrhosis and chronic liver disease using functional liver imaging scores at different acquisition time points

“…Previous studies have shown that a delay of 10 min is sufficient for diagnosis in patients without a history of CLD; for patients with mild liver dysfunction, a 15-min delay is enough to diagnose; and for patients with moderate or severe liver dysfunction, > 5 min delay is not effective ( Motosugi et al, 2009b ; van Kessel et al, 2012 ; Esterson et al, 2015 ; Liang et al, 2016 ). Takatsu et al (2021) reported that the higher the quantitative liver-spleen contrast ratio (Q-LSC) of delay images at 3 min, the higher the Q-LSC of delay images at 10 and 15 min. Based on the Q-LSC, transitional phase delay images at 3 min on liver MRI can be used to predict the contrast enhancement effect of HBP images.…”

Optimization of hepatobiliary phase imaging in gadoxetic acid-enhanced magnetic resonance imaging: a narrative review

“…In order to avoid giving more expensive drugs to patients who cannot benefit from HBP, Kobi et al (37) showed that a model for end-stage liver disease score, direct bilirubin, and total bilirubin could accurately predict suboptimal HBP to optimize HBP acquisition. Another report showed that suboptimal HBP could be predicted by combining the albumin-bilirubin grading with the liver-to-spleen ratio (LSR) during the 3-minute transition phase (38). The combination of MR elastography and serological examination of liver function using the Bayesian method can also predict applicable HBP to help radiologists and MRI technicians assess the benefits of GD-EOB-DTPA and prevent diagnostic pitfalls (39).…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“…uptake of contrast materials by the liver) on contrast-enhanced CT or MRI, are reportedly influenced by liver function as measured by ALBI. [94] , [95] , [96] Other studies have reported the effect of liver function, as assessed by ALBI, on serum levels of tumour markers, such as CA-125, 97 and the frequency of muscle cramps in patients with cirrhosis. 98 Several pharmacokinetic studies have assessed the role of liver dysfunction in relation to drug-induced adverse events.…”

“… Takatsu et al. 96 Retrospective 212 Hepatobiliary phase enhancement by EOB-MRI Quantitative liver-spleen contrast ratio and ALBI grade could predict the liver contrast enhancement effect in hepatobiliary phase images of EOB-MRI. Edula et al.…”

“…In the area of radiology, the enhancement effects of liver images (i.e. uptake of contrast materials by the liver) on contrast-enhanced CT or MRI, are reportedly J o u r n a l P r e -p r o o f influenced by liver function as measured by ALBI [94][95][96]. Other studies have reported the effect of liver function, as assessed by ALBI, on serum levels of tumor markers such as, CA-125 [97] and the frequency of muscle cramps in cirrhotic patients [98].…”