Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers
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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Estimating liver function in a large cirrhotic cohort: Signal intensity of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI
2019, Digestive and Liver DiseaseCitation Excerpt :Although portal enhancement was also reduced from an healthy to a cirrhotic liver, no association was found. Different strategies to estimate the hepatobiliary phase intensity has been described: some authors proposed to evaluate the enhancement of the biliary tract [13,14]; another study employed the quantitative liver-to-spleen ratio [15]; while others suggested to analyze the T1-relaxation time on 3T MRI [16–18]. In this study we experimented the liver-to-muscle ratio, based on the assumption that paravertebral muscles are generally considered the reference standard for the signal intensity in MRI.
Evaluation of liver function using Gd-EOB-DTPA-enhanced MRI with T1 mapping
2023, BMC Medical Imaging