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01.01.2013 | Hepatobiliary-Pancreas

Separation of advanced from mild hepatic fibrosis by quantification of the hepatobiliary uptake of Gd-EOB-DTPA

verfasst von: Bengt Norén, Mikael Fredrik Forsgren, Olof Dahlqvist Leinhard, Nils Dahlström, Johan Kihlberg, Thobias Romu, Stergios Kechagias, Sven Almer, Örjan Smedby, Peter Lundberg

Erschienen in: European Radiology | Ausgabe 1/2013

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Abstract

Objectives

To apply dynamic contrast-enhanced (DCE) MRI on patients presenting with elevated liver enzymes without clinical signs of hepatic decompensation in order to quantitatively compare the hepatocyte-specific uptake of Gd-EOB-DTPA with histopathological fibrosis stage.

Methods

A total of 38 patients were prospectively examined using 1.5-T MRI. Data were acquired from regions of interest in the liver and spleen by using time series of single-breath-hold symmetrically sampled two-point Dixon 3D images (non-enhanced, arterial and venous portal phase; 3, 10, 20 and 30 min) following a bolus injection of Gd-EOB-DTPA (0.025 mmol/kg). The signal intensity (SI) values were reconstructed using a phase-sensitive technique and normalised using multiscale adaptive normalising averaging (MANA). Liver-to-spleen contrast ratios (LSC_N) and the contrast uptake rate (K _Hep) were calculated. Liver biopsy was performed and classified according to the Batts and Ludwig system.

Results

Area under the receiver-operating characteristic curve (AUROC) values of 0.71, 0.80 and 0.78, respectively, were found for K _Hep, LSC_N10 and LSC_N20 with regard to severe versus mild fibrosis. Significant group differences were found for K _Hep (borderline), LSC_N10 and LSC_N20.

Conclusions

Liver fibrosis stage strongly influences the hepatocyte-specific uptake of Gd-EOB-DTPA. Potentially the normalisation technique and K _Hep will reduce patient and system bias, yielding a robust approach to non-invasive liver function determination.

Key Points

• In chronic liver disease, staging of hepatic fibrosis is essential for prognosis.

• The accuracy of liver biopsy for assessing fibrosis has been questioned.

• Liver fibrosis stage strongly influences the hepatocyte-specific uptake of Gd-EOB-DTPA on MRI.

• Normalisation technique and K _Hep are valuable for non-invasive liver function assessment.

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Titel: Separation of advanced from mild hepatic fibrosis by quantification of the hepatobiliary uptake of Gd-EOB-DTPA
verfasst von: Bengt Norén
Mikael Fredrik Forsgren
Olof Dahlqvist Leinhard
Nils Dahlström
Johan Kihlberg
Thobias Romu
Stergios Kechagias
Sven Almer
Örjan Smedby
Peter Lundberg
Publikationsdatum: 01.01.2013
Verlag: Springer-Verlag
Erschienen in: European Radiology / Ausgabe 1/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-012-2583-2

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Separation of advanced from mild hepatic fibrosis by quantification of the hepatobiliary uptake of Gd-EOB-DTPA