Rationale and Objectives
To evaluate the ability of segmental linear fitting analysis of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid liver perfusion magnetic resonance imaging (MRI) to assess liver function and liver fibrosis.
Materials and Methods
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid liver perfusion MRI was performed in 41 patients, and perfusion estimates were generated by segmental linear fitting analysis of the time-intensity curves. The relationships of T in , T out , K up , and the ratio between the signal intensities of the peak and the last phase with liver fibrosis stage and laboratory measurements of liver function were evaluated.
Results
Serum prealbumin concentration was significantly positively correlated with K up and the signal intensity ratio and was significantly negatively correlated with T in and T out . T in and T out were significantly higher and K up and the signal intensity ratio were significantly lower in patients with advanced fibrosis than those without. T out was the best predictor of advanced fibrosis, with an area under the receiving operating characteristic curve of 0.843, a sensitivity of 100%, and a specificity of 80%.
Conclusions
A new procedure of quantifying the hepatocyte-specific uptake of a T1-enhancing contrast agent can be used to assess impaired hepatobiliary function. The parameters obtained from perfusion MRI have the potential to predict advanced fibrosis.
Assessment of segmental liver function plays an important role in the preoperative evaluation of liver tumors, as regional differences in hepatocyte function may occur in patients with chronic liver diseases. Quantitatively derived estimates are useful and even necessary for reproducible and robust evaluation of liver function. These estimates can also be used to evaluate liver function preoperatively to plan segmental liver resections and postoperatively to evaluate the effects of treatment. Scintigraphic and single photon emission computed tomography (SPECT) methods are currently the only imaging-based liver function tests in clinical use . These methods, however, are not widely accepted for the preoperative evaluation. Use of a hepatocyte-specific contrast agent, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA, Primovist; Bayer Schering Pharma AG, Berlin), has been shown to improve the detection and characterization of focal liver lesions in T1-weighted magnetic resonance imaging (MRI) . Moreover, Gd-EOB-DTPA has the potential to directly measure liver function . The pharmacokinetic properties of Gd-EOB-DTPA are similar to those of the 99mTc-iminodiacetic acid family, in that hepatocellular uptake occurs through the organic anionic transport system and subsequent biliary excretion by glutathione S-transferase . Pharmacokinetic studies have shown that approximately 50% of the administered dose of Gd-EOB-DTPA is extracted by the liver and secreted through the hepatobiliary system . Thus, hepatic uptake of Gd-EOB-DTPA and subsequent excretion are dependent on the integrity of the hepatocyte mass. The liver showed early enhancement, with a steep increase in signal intensity during the first minute after administration of the contrast agent and a further, although slower, increase for up to about 20 minutes . The degree and time course of signal intensity enhancement may be used to measure liver function. Relative enhancement between plain signal intensity and contrast-enhanced signal intensity was found to differ significantly between patients with normal liver function and patients with impaired liver function .
Some model-free approaches to data analysis have been reported to quantitatively assess hepatic function in patients, correlating with disease severity . Recently proposed model-based approaches have demonstrated simultaneous measurement of liver perfusion and hepatocellular function . Measures of liver function obtained by routine Gd-EOB-DTPA dynamic contrast enhanced (DCE)-MRI with tracer kinetic modeling may provide a suitable method for the evaluation of liver functional reserve . However, model-based approaches require data processing with specific programs and complicated computations. Additionally, although some estimates showed a potential to discriminate between impaired and normal hepatobiliary function, their clinical relevance has not yet been fully determined. This study, which uses a simple method to analyze perfusion data, was performed to determine whether parameters obtained by this method correlate with clinical characteristics.
Materials and methods
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Results
Histologic Findings
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Perfusion MR Imaging Findings
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Table 1
Perfusion Parameters in Patients with S0–2 and S3–4 Liver Fibrosis
Parameters S0–2 ( n = 18) S3–4 ( n = 13)Z Value_P_ Value_T_ in (s) 15.90 ± 6.90 23.46 ± 9.75 −2.07 .038T out (s) 95.05 ± 49.04 165.36 ± 20.58 −3.12 .002K up 0.19 ± 0.16 0.05 ± 0.06 −2.98 .003 Signal intensity ratio 1.03 ± 0.07 0.96 ± 0.06 −2.85 .004
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Discussion
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