Histogram analysis of noncancerous liver parenchyma on gadoxetic acid-enhanced MRI: predictive value for liver function and pathology

Abstract Objectives Effective and non-invasive biomarkers to predict and avoid posthepatectomy liver failure (PHLF) are urgently needed. This systematic review aims to evaluate the efficacy of gadoxetic acid–enhanced MRI-derived parameters as an imaging biomarker in preoperative prediction of PHLF. Methods A systematic literature search was performed in the databases of PubMed/Medline, Web of Science, Embase, and Cochrane Library up to 11 December 2020. Studies evaluating the incidence of PHLF on patients who underwent hepatectomy with preoperative liver function assessment using gadoxetic acid–enhanced MRI were included. Data was extracted using pre-designed tables. The Quality In Prognostic Studies (QUIPS) tool was adopted to evaluate the risk of bias. Results A total of 15 studies were identified for qualitative synthesis and most studies were marked as low to moderate risk of bias in each domain of QUIPS. The most commonly used parameter was relative liver enhancement or its related parameters. The reported incidence of PHLF ranged from 3.9 to 40%. The predictive sensitivity and specificity of gadoxetic acid–enhanced MRI parameters varied from 75 to 100% and from 54 to 93% in ten reported studies. A majority of the studies revealed that the gadoxetic acid–enhanced MRI parameter was a predictor for PHLF. Conclusions Gadoxetic acid–enhanced MRI showed a high predictive capacity for PHLF and represents a promising imaging biomarker in prediction of PHLF. Multicenter, prospective trials with large sample size and reliable, unified liver function parameters are required to validate the efficacy of individual liver function parameters. Key Points • There is an obvious heterogeneity of the published studies, not only in variance of MRI liver function parameters but also in indication and extent of the liver resection. • Signal intensity (SI)–based parameters derived from gadoxetic acid–enhanced MRI are the commonly used method for PHLF prediction. • Gadoxetic acid–enhanced MRI-derived parameters showed high predictive efficacy for PHLF and can potentially serve as a predictor for the incidence of PHLF.

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Quantification of liver function using gadoxetic acid-enhanced MRI

Abdominal Radiology ◽

10.1007/s00261-020-02779-x ◽

2020 ◽

Vol 45 (11) ◽

pp. 3532-3544

Author(s):

Sarah Poetter-Lang ◽

Nina Bastati ◽

Alina Messner ◽

Antonia Kristic ◽

Alexander Herold ◽

...

Keyword(s):

Liver Function ◽

Liver Diseases ◽

Organic Anion ◽

Liver Perfusion ◽

Dynamic Imaging ◽

Gadoxetic Acid ◽

Functional Evaluation ◽

Nonalcoholic Fatty Liver ◽

Enhanced Mri

Abstract The introduction of hepatobiliary contrast agents, most notably gadoxetic acid (GA), has expanded the role of MRI, allowing not only a morphologic but also a functional evaluation of the hepatobiliary system. The mechanism of uptake and excretion of gadoxetic acid via transporters, such as organic anion transporting polypeptides (OATP1,3), multidrug resistance-associated protein 2 (MRP2) and MRP3, has been elucidated in the literature. Furthermore, GA uptake can be estimated on either static images or on dynamic imaging, for example, the hepatic extraction fraction (HEF) and liver perfusion. GA-enhanced MRI has achieved an important role in evaluating morphology and function in chronic liver diseases (CLD), allowing to distinguish between the two subgroups of nonalcoholic fatty liver diseases (NAFLD), simple steatosis and nonalcoholic steatohepatitis (NASH), and help to stage fibrosis and cirrhosis, predict liver transplant graft survival, and preoperatively evaluate the risk of liver failure if major resection is planned. Finally, because of its noninvasive nature, GA-enhanced MRI can be used for long-term follow-up and post-treatment monitoring. This review article aims to describe the current role of GA-enhanced MRI in quantifying liver function in a variety of hepatobiliary disorders.

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Patterns of enhancement in the hepatobiliary phase of gadoxetic acid-enhanced MRI

British Journal of Radiology ◽

10.1259/bjr.20190989 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20190989

Author(s):

Cathryn L Hui ◽

Marcela Mautone

Keyword(s):

Liver Parenchyma ◽

Gadoxetic Acid ◽

Hepatobiliary Phase ◽

Liver Lesions ◽

Enhanced Mri

A variety of patterns of enhancement of liver lesions and liver parenchyma is observed in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI. It is becoming increasingly apparent that many lesions may exhibit HBP enhancement. Much of the literature regarding the role of gadoxetic acid-enhanced MRI in characterising liver lesions is dichotomous, focusing on whether lesions are enhancing or non-enhancing in the HBP, rather than examining the patterns of enhancement. We provide a pattern-based description of HBP enhancement of liver parenchyma and of liver lesions. The role of OATP1B3 transporters, hepatocyte function and lesion composition in influencing patterns of HBP hyperintensity are discussed.

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Evaluation of liver function using liver parenchyma, spleen and portal vein signal intensities during the hepatobiliary phase in Gd-EOB-DTPA-enhanced MRI

10.21203/rs.3.rs-17044/v3 ◽

2020 ◽

Author(s):

Ming Yang ◽

Yue Zhang ◽

Wenlu Zhao ◽

Wen Cheng ◽

Han Wang ◽

...

Keyword(s):

Liver Function ◽

Portal Vein ◽

Contrast Ratio ◽

Liver Parenchyma ◽

International Normalized Ratio ◽

Imaging Biomarkers ◽

Hepatobiliary Phase ◽

Enhanced Mri ◽

Pugh Class ◽

Class C

Abstract Background: Previous studies have used signal intensity (SI) to reflect liver function. However, few studies have evaluated liver function via the portal vein. Regarding the SI of the liver, spleen, and portal vein, no study has indicated which can best reflect liver function. Therefore, the aim of this study is to investigate whether these parameters can evaluate liver function in patients with cirrhosis and determine which is the best parameter.Methods: 120 patients with normal livers (n = 41) or Child–Pugh class A (n = 50), B (n = 21) or C (n = 8) disease who had undergone Gd-EOB-DTPA-enhanced MRI were retrospectively reviewed. Comparisons of the MRI data (liver parenchyma SI, portal vein SI, and spleen SI and liver-to-portal vein contrast ratio (LPC), liver-to-spleen contrast ratio (LSC), and portal vein-to-spleen contrast ratio (PSC)) in the 15-min hepatobiliary phase images were performed among the groups, and the correlations among the liver function parameters (total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, platelet count, prothrombin time and international normalized ratio), liver function scores and MRI data were also quantitatively analysed.Results: Significant differences were observed in the liver parenchyma SI, LPC and LSC among the groups. These values all decreased gradually from normal livers to Child–Pugh class C cirrhotic livers (P < 0.001). The portal vein SI constantly and slightly increased from normal livers to Child–Pugh class C cirrhotic livers, but no differences were found among the groups in the portal vein SI and PSC (P > 0.05). LPC showed a stronger correlation with the Child–Pugh score and MELD score than LSC and the liver parenchyma SI. The order of the AUCs of these parameters, from largest to smallest, was as follows: LPC, LSC, and liver parenchyma SI (P > 0.05).Conclusion: The liver parenchyma SI, LSC and LPC may be used as alternative imaging biomarkers to assess liver function, while the portal vein SI and PSC do not reflect liver function. Furthermore, LPC values can more effectively distinguish severity among patients with cirrhosis than the liver parenchyma SI and LSC.

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Evaluation of the liver function by the liver parenchyma, spleen and portal vein signal intensity during the hepatobiliary phase in Gd-EOB-DTPA-enhanced MRI

10.21203/rs.3.rs-17044/v2 ◽

2020 ◽

Author(s):

Ming Yang ◽

Yue Zhang ◽

Wenlu Zhao ◽

Wen Cheng ◽

Han Wang ◽

...

Keyword(s):

Liver Function ◽

Portal Vein ◽

Signal Intensity ◽

Liver Parenchyma ◽

International Normalized Ratio ◽

Imaging Biomarkers ◽

Hepatobiliary Phase ◽

Enhanced Mri ◽

Pugh Class ◽

Class C

Abstract Background: Previous studies used the signal intensity (SI) to reflect liver function. However, there are still few studies on the assessment of liver function via the portal vein, and no study has pointed out that in terms of SI (liver, spleen, portal vein), which one can better reflect liver function. Therefore, the aim of this study is to investigate whether these parameters can be used to evaluate liver function in patients with cirrhosis and determine which parameter is best.Methods: A total of 120 patients with normal livers (n = 41) or Child–Pugh class A (n = 50), B (n = 21) or C (n = 8) disease who underwent Gd-EOB-DTPA-enhanced MRI were retrospectively reviewed. Comparisons of the SI of the liver parenchyma, portal vein, and spleen and liver-to-portal vein (LPC), liver-to-spleen (LSC), and portal vein-to-spleen (PSC) contrast ratios on the 15-min hepatobiliary phase images were performed among groups, and the correlations among liver function parameters (total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, platelet count, prothrombin time and international normalized ratio), liver function scores and MRI date were also quantitatively analyzed.Results: Significant differences were observed in the SI of the liver parenchyma, LPC and LSC among groups. These values all decreased gradually from normal livers to Child–Pugh class C cirrhotic livers (P < 0.001). The SI of the portal vein constantly and slightly increased from normal livers to Child–Pugh class C cirrhotic livers, but there were no differences among groups in portal vein signal and PSC (P > 0.05). LPC had a stronger correlation with Child-Pugh score and MELD score than LSC and liver parenchyma SI. The order of the AUCs of these parameters, from largest to smallest, was as follows: LPC, LSC, and liver parenchyma SI (P > 0.05).Conclusion: Liver parenchyma SI, LSC and LPC may be used as alternative imaging biomarkers for assessing liver function, while the portal vein signal and PSC could not reflect liver function. Furthermore, LPC values can more effectively distinguish severity among patients with cirrhosis than liver parenchyma SI and LSC.

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Gadoxetic acid enhanced MRI distinguishes advanced chronic liver disease patients with improving liver function after sustained virologic response and patients with persistent liver damage

10.1055/s-0038-1654647 ◽

2018 ◽

Author(s):

M Mandorfer ◽

L Haider ◽

Z Güngören ◽

T Reiberger ◽

N Bastati ◽

...

Keyword(s):

Liver Disease ◽

Liver Function ◽

Chronic Liver Disease ◽

Liver Damage ◽

Sustained Virologic Response ◽

Virologic Response ◽

Chronic Liver ◽

Gadoxetic Acid ◽

Enhanced Mri

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Histogram Analysis of Gadoxetic Acid-Enhanced MRI for Quantitative Hepatic Fibrosis Measurement

PLoS ONE ◽

10.1371/journal.pone.0114224 ◽

2014 ◽

Vol 9 (12) ◽

pp. e114224 ◽

Cited By ~ 20

Author(s):

Honsoul Kim ◽

Seong Ho Park ◽

Eun Kyung Kim ◽

Myeong-Jin Kim ◽

Young Nyun Park ◽

...

Keyword(s):

Hepatic Fibrosis ◽

Gadoxetic Acid ◽

Histogram Analysis ◽

Enhanced Mri

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Correlation of liver enhancement in gadoxetic acid–enhanced MRI with liver functions: a multicenter-multivendor analysis of hepatocellular carcinoma patients from SORAMIC trial

European Radiology ◽

10.1007/s00330-021-08218-9 ◽

2021 ◽

Author(s):

Osman Öcal ◽

Bora Peynircioglu ◽

Christian Loewe ◽

Otto van Delden ◽

Vincent Vandecaveye ◽

...

Keyword(s):

Liver Function ◽

Total Bilirubin ◽

Clinical Findings ◽

Gadoxetic Acid ◽

Imaging Biomarker ◽

Hepatobiliary Phase ◽

Platelet Counts ◽

Enhanced Mri ◽

Grading Systems ◽

Liver Functions

Abstract Objectives To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study. Methods A total of 359 patients who underwent gadoxetic acid–enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses. Results There was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = −0.215; p < 0.001) and AST (rho = −0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = −0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001). Conclusions The liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands. Key Points • The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI and liver function is consistent in a multicenter-multivendor cohort. • Signal intensity–based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function. • However, absolute values might change between vendors.

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