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07.09.2023 | Gastrointestinal

Comparison between CT volumetry, technetium^99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients

verfasst von: Yujiro Nakazawa, Masahiro Okada, Tomoko Hyodo, Kenichiro Tago, Kazu Shibutani, Mariko Mizuno, Hiroki Yoshikawa, Hayato Abe, Tokio Higaki, Yukiyasu Okamura, Tadatoshi Takayama

Erschienen in: European Radiology | Ausgabe 4/2024

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Abstract

Objectives

To compare the efficacy of computed tomography volumetry (CTV), technetium^99m galactosyl-serum-albumin (^99mTc-GSA) scintigraphy, and gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI) in estimating the liver fibrosis (LF) stage in patients undergoing liver resection.

Methods

This retrospective study included 91 consecutive patients who had undergone preoperative dynamic CT and ^99mTc-GSA scintigraphy. EOB-MRI was performed in 76 patients. CTV was used to measure the total liver volume (TLV), spleen volume (SV), normalised to the body surface area (BSA), and liver-to-spleen volume ratio (TLV/SV). ^99mTc-GSA scintigraphy provided LHL15, HH15, and GSA indices. The liver-to-spleen ratio (LSR) was calculated in the hepatobiliary phase of EOB-MRI. Hyaluronic acid and type 4 collagen levels were measured in 65 patients. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify useful parameters for estimating the LF stage and laboratory data.

Results

According to the multivariable logistic regression analysis, SV/BSA (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.003–1.02; p = 0.011), LSR (OR, 0.06; 95%CI, 0.004–0.70; p = 0.026), and hyaluronic acid (OR, 1.01; 95%CI, 1.001–1.02; p = 0.024) were independent variables for severe LF (F3–4). Combined SV/BSA, LSR, and hyaluronic acid correctly estimated severe LF, with an AUC of 0.91, which was significantly larger than the AUCs of the GSA index (AUC = 0.84), SV/BSA (AUC = 0.83), or LSR (AUC = 0.75) alone.

Conclusions

Combined CTV, EOB-MRI, and hyaluronic acid analyses improved the estimation accuracy of severe LF compared to CTV, EOB-MRI, or ^99mTc-GSA scintigraphy individually.

Clinical relevance statement

The combined analysis of spleen volume on CT volumetry, liver-to-spleen ratio on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI, and hyaluronic acid can identify severe liver fibrosis associated with a high risk of liver failure after hepatectomy and recurrence in patients with hepatocellular carcinoma.

Key Points

• Spleen volume of CT volumetry normalised to the body surface area, liver-to-spleen ratio of EOB-MRI, and hyaluronic acid were independent variables for liver fibrosis.

• CT volumetry and EOB-MRI enable the detection of severe liver fibrosis, which may correlate with post-hepatectomy liver failure and complications.

• Combined CT volumetry, gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI), and hyaluronic acid analyses improved the estimation of severe liver fibrosis compared to technetium^99m galactosyl-serum-albumin scintigraphy.

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Titel: Comparison between CT volumetry, technetium99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients
verfasst von: Yujiro Nakazawa
Masahiro Okada
Tomoko Hyodo
Kenichiro Tago
Kazu Shibutani
Mariko Mizuno
Hiroki Yoshikawa
Hayato Abe
Tokio Higaki
Yukiyasu Okamura
Tadatoshi Takayama
Publikationsdatum: 07.09.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 4/2024
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10219-9

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Comparison between CT volumetry, technetium^99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients