Elsevier

European Journal of Radiology

Volume 85, Issue 11, November 2016, Pages 2001-2007
European Journal of Radiology

Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers

https://doi.org/10.1016/j.ejrad.2016.09.003Get rights and content

Abstract

Purpose

To evaluate the association between gadoxetic-acid-enhanced magnetic resonance (MR) imaging measurements and laboratory and clinical biomarkers of liver function and fibrosis.

Materials and methods

One hundred thirty nine consecutive patients with suspected liver disease or liver tumor underwent gadoxetic-acid-enhanced MR imaging. MR imaging measurements during the hepatobiliary phase included biliary tract structure-to-muscle signal intensity ratio (SIR). These measurements were compared with Child-Pugh classification, end-stage liver disease (MELD) score, and aspartate aminotransferase-to-platelet ratio index (APRI).

Results

The SIRs of cystic duct and common bile duct were significantly correlated with Child-Pugh classification (P = 0.012 for cystic duct and P < 0.0001 for common bile duct), MELD score (P = 0.0016 and P = 0.0033), and APRI (P = 0.0022 and P = 0.0015). The sensitivity, specificity, and area under the receiver-operating-characteristic curve were: (74%, 88%, 0.86) with the SIR of common bile duct for the detection of patients with Child-Pugh class B or C; (100%, 87%, 0.94) with the SIR of cystic duct for MELD score (>10); (65%, 76%, 0.70) with the SIR of common bile duct for APRI (>1.5).

Conclusion

Gadoxetic-acid contrast enhancement of cystic duct and common bile duct could be used as biomarkers to assess liver function.

Introduction

When patients are presented with clinically suspected liver dysfunction, their management requires decisions on liver function tests, follow-up, and treatment. These decisions are based on our understanding of the type of liver dysfunction as well as the outcome of appropriate liver function tests. Liver function is often determined by standard laboratory measurements such as the level of serum bilirubin, albumin, and prothrombin time. In addition, several well-known scoring systems including Child-Pugh classification, indocyanine green (ICG) test, and the model for end-stage liver disease (MELD) score aspartate aminotransferase (AST)-to-platelet ratio index (APRI), are widely used for the evaluation of liver function or fibrosis [1], [2], [3]. In particular, the MELD score has been validated as an accurate predictor of short and median-term survival of patients with liver diseases [4].

Previous studies reported that some liver function indices could be obtained from magnetic resonance (MR) imaging such as a relative contrast medium enhancement of liver and quantitative liver-spleen contrast ratio (Q-LSC) [5], [6]. In particular, compared to other MR contrast agents, gadoxetic acid is known to be liver-specific and has been widely used for the detection and characterization of liver lesions [7], [8], [9]. Gadoxetic acid acting as both extracellular and hepatocyte-specific contrast agent is excreted with approximately 50% of the injected amount through the biliary tract. Consequently, the excretion of gadoxetic acid to the biliary tract is compromised in patients with hepatic dysfunction and presented with reduced biliary tract contrast enhancement during the hepatobiliary phase (HBP) of MR imaging in these patients [10], [11], [12].

We hypothesized that signal intensities of biliary tract structures in gadoxetic acid-enhanced hepatobiliary phase may be associated with a patient’s liver function. Thus, the purpose of this study was to evaluate the association between gadoxetic acid-enhanced MR imaging measurements and other laboratory and clinical biomarkers of liver function and fibrosis.

Section snippets

Patients

This retrospective study was approved by our institutional review board and written informed consent was waived. From January 2013 to December 2013 in our hospital, 367 consecutive patients suspected of having liver disease or liver tumor based on clinical history or previously performed computed tomography (CT) or MR imaging, underwent gadoxetic acid-enhanced MR imaging. Two hundred twenty eight of the 367 patients were excluded because of status post partial hepatectomy (n = 68), inadequate

Patient background factors

Patient characteristics of the two groups in each of the three biomarkers are summarized in Table 1. No significant difference in terms of patient age (P = 0.48–0.85), BMI (P = 0.32–0.61), serum creatinine (P = 0.44–0.87), eGFR (P = 0.75–0.91), or gender (P = 0.070–0.95) was found between the two groups in each of the three biomarkers. Serum albumin (P < 0.0001–0.0005), prothrombin time (%) (P < 0.0001–0.0003), and platelet (P < 0.0001–0.0023) of Child-Pugh class B or C, MELD or APRI group B were significantly

Discussion

Gadoxetic acid is a liver-specific MR contrast agent taken up by hepatocytes through organic anion transporting polypeptides (OATP) [21], [22] and excreted into biliary tract. In patients with hepatic dysfunction, the expression of OATP in the liver cell membrane is reduced, resulting in a decrease in gadoxetic acid uptake and enhancement as well as poor biliary tract visualization [11], [12], [23]. The liver or biliary tract enhancement effects of gadoxetic acid are assumed to be associated

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