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Harper KC, Ronot M, Wells ML, Luna A, Ba-Ssalamah A, Wang J, Welle CL, Silva AC, Fidler J, Venkatesh SK. Hypointense Findings on Hepatobiliary Phase MR Images. Radiographics 2025; 45:e240090. [PMID: 39883575 DOI: 10.1148/rg.240090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2025]
Abstract
Hepatobiliary (HB) contrast agents are increasingly valuable diagnostic tools in MRI, offering a wider range of applications as their clinical use expands. Normal hepatocytes take up HB contrast agents, which are subsequently excreted in bile. This property creates a distinct HB phase providing valuable insights into liver function and biliary anatomy. HB contrast agents can assist in diagnosing a broad spectrum of HB diseases ranging from diffuse liver disease to focal hepatic lesions and can delineate anatomic details of the biliary tree. Understanding the pharmacodynamics of HB contrast agents is paramount to their appropriate clinical application and troubleshooting. HB phase hypointensity can arise from various diffuse and focal abnormalities that may or may not be associated with biliary excretion. Hypointensity during the HB phase can be broadly grouped into diffuse hypointensity, regional hypointensity, and focal lesions for better evaluation of the underlying cause. Abnormalities may arise from hepatic parenchymal, biliary, or vascular causes, or a combination thereof in each of the broad groups. Recognition of a suboptimal hypointense HB phase is important in the evaluation of focal lesions in patients with cirrhosis of the liver and particularly in those with hepatocellular carcinoma. Furthermore, hypointensity can also suggest the aggressiveness of malignancies such as hepatocellular carcinoma or colorectal metastases, which may affect the prognosis. It is essential to consider all imaging findings relative to the clinical context and the complete set of the MRI sequences performed for diagnosis of liver abnormalities. This comprehensive approach minimizes the risk of misinterpretation or pitfalls. The authors aim to equip radiologists with key insights for accurately understanding hypointensity in the HB phase, ultimately leading to more accurate diagnoses. ©RSNA, 2025 Supplemental material is available for this article.
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Affiliation(s)
- Kelly C Harper
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Maxime Ronot
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Michael L Wells
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Antonio Luna
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Ahmed Ba-Ssalamah
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Jin Wang
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Christopher L Welle
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Alvin C Silva
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Jeff Fidler
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (K.C.H., M.L.W., C.L.W., J.F., S.K.V.); Department of Medical Imaging, University of Ottawa, Ottawa, Ontario, Canada (K.C.H.); Department of Medical Imaging, Beaujon University Hospital, Clichy, France (M.R.); HT Medica, Madrid, Spain (A.L.); Department of Radiology, University of Vienna, Vienna, Austria (A.B.S.); Department of Radiology, Sun Yat Sen University, Guangzhou, China (J.W.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic, Scottsdale, Ariz (A.C.S.)
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Wu X, Wang Y, He Y, Yang Y. Development and Validation of a Predictive Model for Liver Failure After Transarterial Chemoembolization Using Gadoxetic Acid-Enhanced MRI and Functional Liver Imaging Score. Acad Radiol 2025:S1076-6332(24)01056-0. [PMID: 39809606 DOI: 10.1016/j.acra.2024.12.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 12/29/2024] [Accepted: 12/29/2024] [Indexed: 01/16/2025]
Abstract
RATIONALE AND OBJECTIVES Post-transarterial chemoembolization liver failure (PTLF) is a potentially fatal complication of transarterial chemoembolization (TACE). Accurate preoperative prediction of PTLF is crucial for improving patient outcomes. This study aimed to develop and validate a prediction model based on the functional liver imaging score (FLIS) to assess the risk of PTLF. MATERIALS AND METHODS A total of 156 patients underwent Gadoxetic acid-enhanced MRI within four weeks before TACE. Two radiologists, unaware of the clinical data, independently assessed FLIS on hepatobiliary phase images to quantitatively assess liver function. Univariate and multivariate logistic regression analyses identified independent predictors of PTLF. A nomogram was developed and subjected to internal validation through bootstrap resampling of 1000 samples. The model's performance was conducted through the area under the curve (AUC), Hosmer-Lemeshow test, calibration curves, and decision curve analysis (DCA). P< 0.05 was considered statistically significant. RESULTS PTLF occurred in 37.2% of patients (58/156). Significant differences were observed in factors such as portal vein thrombosis, albumin, aspartate transaminase, international normalized ratio (INR), model for end-stage liver disease scoring, albumin-bilirubin score, and FLIS. Multivariate analysis showed FLIS, portal vein thrombosis, and INR as independent predictors. The model achieved an AUC of 0.759, with 87.8% specificity and 56.9% sensitivity, and demonstrated good calibration (χ² = 7.101, P=0.526). Calibration curves and DCA confirmed its clinical utility. CONCLUSION This FLIS-based prediction model performs well in predicting PTLF, potentially serving as a practical clinical tool.
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Affiliation(s)
- Xinru Wu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Yihuan Wang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Yiwei He
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Yongbo Yang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China.
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Ageeva SF, Sinitsyn VE, Mershina EA, Rucheva NA, Petrova EI. Liver function assessment based on hepatobiliary contrast agent-enhanced magnetic resonance imaging. DIGITAL DIAGNOSTICS 2024; 5:137-148. [DOI: 10.17816/dd624826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
BACKGROUND: Liver function assessment is very important in clinical practice. The use of magnetic resonance imaging for the anatomical and functional evaluation of the liver is possible in actual clinical practice.
AIM: To examine the possibility of using hepatobiliary contrast-enhanced magnetic resonance imaging for the evaluation of liver function.
MATERIALS AND METHODS: Datasets of patients who underwent gadoxetic acid-enhanced magnetic resonance imaging were retrospectively reviewed. Patients were divided into two groups: group 1 included patients with impaired liver function, and group 2 included those with normal liver function. Based on magnetic resonance imaging in the hepatobiliary phase, the liver parenchyma signal intensity and its ratio to spleen signal intensity and portal vein signal intensity were estimated. Differences among these parameters were compared between groups. The correlation between liver parenchyma signal intensity and laboratory blood tests reflecting liver function (total bilirubin, albumen, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma glutamyl transpeptidase, and prothrombin time) were analyzed.
RESULTS: Datasets of 53 patients (25 men and 28 women, aged 24–84 years) were analyzed. Group 1 included 19 patients, whereas group 2 included 34. The median liver parenchyma signal intensity was 919.05 [669.65; 1258.35] in group 1 and 1525.13 [1460.5; 1631.4] in group 2 (p=0.0000001). The median ratio of liver parenchyma signal intensity to spleen signal intensity was 1.2 [1.04;1.7] in group 1 and 1.7 [1.46; 1.96] in group 2 (p=0.00076). The median ratio of liver parenchyma signal intensity to portal vein signal intensity was 1.44 [1.29; 1.83] in group 1 and 1.6 [1.43; 1.83] in group 2 (p=0.1). The estimated correlation values between liver parenchyma signal intensity and blood tests parameters were as follows: total bilirubin (r=–0.61; p=0.000001), albumen (r=0.13; p=0.61), aspartate aminotransferase (r=–0.57; p=0.000009), alanine aminotransferase (r=–0.44; p=0.001), alkaline phosphatase (r=–0.45; p=0.0007), gamma glutamyl transpeptidase (r=–0.5; p=0.0003), prothrombin time (r=–0.34; p=0.04).
CONCLUSION: The study reflects the ability to assess liver function using indices (liver parenchyma signal intensity and its ratio to spleen signal intensity) derived from gadoxetic acid-enhanced magnetic resonance imaging. However, this study did not confirm the assumed effectiveness of using the liver parenchyma signal intensity to portal vein signal intensity ratio as an index of liver function. A significant inverse correlation was identified between liver parenchyma signal intensity and blood test parameters in reflecting liver function, except for albumin. The results indicate the possibility of using magnetic resonance imaging to assess liver function.
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Affiliation(s)
| | | | | | - Natalia A. Rucheva
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs
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Yoon S, Shim YS, Park SH, Sung J, Nickel MD, Kim YJ, Lee HY, Kim HJ. Hepatobiliary phase imaging in cirrhotic patients using compressed sensing and controlled aliasing in parallel imaging results in higher acceleration. Eur Radiol 2024; 34:2233-2243. [PMID: 37731096 DOI: 10.1007/s00330-023-10226-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE We aimed to compare the image quality and focal lesion detection ability of hepatobiliary phase (HBP) images obtained using compressed sensing (CS) and controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) in patients with liver cirrhosis. MATERIALS AND METHODS We retrospectively included 244 gadoxetic acid-enhanced liver MRI from 244 patients with cirrhosis obtained by two HBP images using CS and CAIPIRINHA from July 2020 to December 2020. The optimized resolution and scan time for CS-HBP and CAIPIRINHA-HBP were 0.9 × 0.9 × 1.5 mm3 and 15 s and 1.3 × 1.3 × 3 mm3 and 16 s, respectively. We compared the image quality between the two sets of images in 244 patients and focal lesion (n = 294) analyses for 112 patients. RESULTS CS-HBP showed comparable overall image quality (3.7 ± 0.9 vs. 3.6 ± 0.8, p = 0.680), superior liver edge sharpness (3.9 ± 0.6 vs. 3.6 ± 0.5, p < 0.001), and fewer respiratory motion artifacts (4.0 ± 0.7 vs. 3.8 ± 0.5, p < 0.001), but higher non-respiratory artifacts (3.4 ± 0.7 vs. 3.6 ± 0.6, p < 0.001) and subjective image noise (3.5 ± 0.8 vs. 3.6 ± 0.7, p = 0.014) than CAIPIRINHA-HBP. CS-HBP showed a higher signal-to-noise ratio in the liver than CAIPIRINHA-HBP (20.9 ± 9.0 vs. 18.9 ± 7.1, p = 0.008). The pooled sensitivity, specificity, and AUC were 90.0%, 77.5%, and 0.84 for CS-HBP and 73.5%, 82.4%, and 0.78 for CAIPIRINHA-HBP, respectively. CONCLUSIONS CS-HBP showed better focal lesion detection ability, comparable overall image quality, and fewer respiratory motion artifacts, but higher non-respiratory artifacts and noise compared to CAIPIRINHA-HBP. Thus, CS-HBP could be recommended for liver MRI in patients with cirrhosis to improve diagnostic performance. CLINICAL RELEVANCE STATEMENT Thin-slice CS-HBP may be useful for detecting sub-centimeter hepatocellular carcinoma in cirrhotic patients with Child-Pugh classification A while maintaining comparable subjective image quality. KEY POINTS • Compared with controlled aliasing in parallel imaging results in higher acceleration, compressed sensing hepatobiliary phase yielded thinner slices and shorter scan time at a higher accelerating factor. • Compressed sensing hepatobiliary phase showed comparable overall image quality, superior liver edge sharpness, and fewer respiratory motion artifacts, but higher non-respiratory artifacts and subjective image noise than controlled aliasing in parallel imaging results in higher acceleration-hepatobiliary phase. • Compressed sensing hepatobiliary phase can detect sub-centimeter hepatocellular carcinoma in cirrhotic patients with Child-Pugh classification A.
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Affiliation(s)
- Sungjin Yoon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Jaekon Sung
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | | | - Ye Jin Kim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Hee Young Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Xu L, Ren Z, Li G, Xu D, Miao J, Ju J, Mo X, Wang X, Deng H, Xu M. Liver-targeting MRI contrast agent based on galactose functionalized o-carboxymethyl chitosan. Front Bioeng Biotechnol 2023; 11:1134665. [PMID: 37284241 PMCID: PMC10239977 DOI: 10.3389/fbioe.2023.1134665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Commercial gadolinium (Gd)-based contrast agents (GBCAs) play important role in clinical diagnostic of hepatocellular carcinoma, but their diagnostic efficacy remained improved. As small molecules, the imaging contrast and window of GBCAs is limited by low liver targeting and retention. Herein, we developed a liver-targeting gadolinium (Ⅲ) chelated macromolecular MRI contrast agent based on galactose functionalized o-carboxymethyl chitosan, namely, CS-Ga-(Gd-DTPA)n, to improve hepatocyte uptake and liver retention. Compared to Gd-DTPA and non-specific macromolecular agent CS-(Gd-DTPA)n, CS-Ga-(Gd-DTPA)n showed higher hepatocyte uptake, excellent cell and blood biocompatibility in vitro. Furthermore, CS-Ga-(Gd-DTPA)n also exhibited higher relaxivity in vitro, prolonged retention and better T1-weighted signal enhancement in liver. At 10 days post-injection of CS-Ga-(Gd-DTPA)n at a dose of 0.03 mM Gd/Kg, Gd had a little accumulation in liver with no liver function damage. The good performance of CS-Ga-(Gd-DTPA)n gives great confidence in developing liver-specifc MRI contrast agents for clinical translation.
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Affiliation(s)
- Li Xu
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhanying Ren
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
- Southern University of Science and Technology, Shenzhen, China
| | - Guolin Li
- Department of Stomatology, Shanghai 8th People’s Hospital, Shanghai, China
| | - Danni Xu
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiaqian Miao
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingxuan Ju
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuan Mo
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xianghui Wang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Hongping Deng
- Shanghai Frontiers Science Center of TCM Chemical Biology, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Xu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
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The value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting decompensation and transplant-free survival in chronic liver disease. Eur Radiol 2023; 33:3425-3434. [PMID: 36897349 DOI: 10.1007/s00330-023-09489-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To investigate the value of contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine for predicting clinical outcomes in patients with chronic liver disease (CLD). METHODS Three hundred and fourteen CLD patients who underwent gadobenate dimeglumine-enhanced hepatic magnetic resonance imaging were stratified into three groups: nonadvanced CLD (n = 116), compensated advanced CLD (n = 120), and decompensated advanced CLD (n = 78) groups. The liver-to-portal vein contrast ratio (LPC) and liver-spleen contrast ratio (LSC) at the hepatobiliary phase were measured. The value of LPC for predicting hepatic decompensation and transplant-free survival was assessed using Cox regression analysis and Kaplan-Meier analysis. RESULTS The diagnostic performance of LPC was significantly better than LSC in evaluating the severity of CLD. During a median follow-up period of 53.0 months, the LPC was a significant predictor for hepatic decompensation (p < 0.001) in patients with compensated advanced CLD. The predictive performance of LPC was higher than that of the model for end-stage liver disease score (p = 0.006). With the optimal cut-off value, patients with LPC ≤ 0.98 had a higher cumulative incidence of hepatic decompensation than patients with LPC > 0.98 (p < 0.001). The LPC was also a significant predictive factor for transplant-free survival in patients with compensated advanced CLD (p = 0.007) and those with decompensated advanced CLD (p = 0.002). CONCLUSIONS Contrast-enhanced portal vein imaging at the hepatobiliary phase obtained with gadobenate dimeglumine is a valuable imaging biomarker for predicting hepatic decompensation and transplant-free survival in CLD patients. KEY POINTS • The liver-to-portal vein contrast ratio (LPC) significantly outperformed liver-spleen contrast ratio in evaluating the severity of chronic liver disease. • The LPC was a significant predictor for hepatic decompensation in patients with compensated advanced chronic liver disease. • The LPC was a significant predictor for transplant-free survival in patients with compensated and those with decompensated advanced chronic liver disease.
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Tang G, Liu J, Liu P, Huang F, Shao X, Chen Y, Xie A. Evaluation of liver function in patients with liver cirrhosis and chronic liver disease using functional liver imaging scores at different acquisition time points. Front Genet 2022; 13:1071025. [PMID: 36561314 PMCID: PMC9765309 DOI: 10.3389/fgene.2022.1071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: This paper aims to explore whether functional liver imaging score (FLIS) based on Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) images at 5, 10, and 15 min can predict liver function in patients with liver cirrhosis or chronic liver disease and its association with indocyanine green 15-min retention rate (ICG-R15), Child-Pugh (CP) score, albumin-bilirubin (ALBI) score, and model for end-stage liver disease (MELD) score. In addition, it also examines the inter- and intra-observer consistency of FLIS and three FLIS parameters at three different time points. Methods: This study included 110 patients with chronic liver disease (CLD) or liver cirrhosis (LC) (93 men, 17 women; mean ± standard deviation = 56.96 ± 10.16) between July 2019 and May 2022. FLIS was assigned in accordance with the sum of the three hepatobiliary phase characteristics, all of which were scored on the 0-2 ordinal scale, including the biliary excretion, hepatic enhancement and portal vein signal intensity. FLIS was calculated independently by two radiologists using transitional and hepatobiliary phase images at 5, 10, and 15 min after enhancement. The relationship between FLIS and three FLIS quality scores and the degree of liver function were evaluated using Spearman's rank correlation coefficient. The ability of FLIS to predict hepatic function was investigated using receiver operating characteristic (ROC) curves. Results: Intra- and inter-observer intraclass correlation coefficients (ICCs) (ICC = 0.937-0.978, 95% CI = 0.909-0.985) for FLIS at each time point indicated excellent agreement. At each time point, FLIS had a moderate negative association with liver function classification (r = [-0.641]-[-0.428], p < 0.001), and weak to moderate correlation with some other clinical parameters except for creatinine (p > 0.05). FLIS showed moderate discriminatory ability between different liver function levels. The area under the ROC curves (AUCs) of FLIS at 5, 10, and 15 min after enhancement to predict ICG-R15 of 10% or less were 0.838, 0.802, and 0.723, respectively; those for predicting ICG-R15 greater than 20% were 0.793, 0.824, and 0.756, respectively; those for predicting ICG-R15 greater than 40% were 0.728, 0.755, and 0.741, respectively; those for predicting ALBI grade 1 were 0.734, 0.761, and 0.691, respectively; those for predicting CP class A cirrhosis were 0.806, 0.821, and 0.829, respectively; those for predicting MELD score of 10 or less were 0.837, 0.877, and 0.837, respectively. No significant difference was found in the AUC of FLIS at 5, 10 and 15 min (p > 0.05). Conclusion: FLIS presented a moderate negative correlation with the classification system of hepatic function at a delay of 5, 10, and 15 min, and patients with LC or CLD were appropriately stratified based on ICG-R15, ALBI grade, MELD score, and CP classification. In addition, the use of FLIS to evaluate liver function can reduce the observation time of the hepatobiliary period.
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Affiliation(s)
- Guixiang Tang
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Jianbin Liu
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Feng Huang
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Xunuo Shao
- School of Mathematics and Statistics, Hunan Normal University, Changsha, China
| | - Yao Chen
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - An Xie
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China,*Correspondence: An Xie,
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Chen YD, Zhang L, Zhou ZP, Lin B, Jiang ZJ, Tang C, Dang YW, Xia YW, Song B, Long LL. Radiomics and nomogram of magnetic resonance imaging for preoperative prediction of microvascular invasion in small hepatocellular carcinoma. World J Gastroenterol 2022; 28:4399-4416. [PMID: 36159011 PMCID: PMC9453772 DOI: 10.3748/wjg.v28.i31.4399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/05/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Microvascular invasion (MVI) of small hepatocellular carcinoma (sHCC) (≤ 3.0 cm) is an independent prognostic factor for poor progression-free and overall survival. Radiomics can help extract imaging information associated with tumor pathophysiology.
AIM To develop and validate radiomics scores and a nomogram of gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for preoperative prediction of MVI in sHCC.
METHODS In total, 415 patients were diagnosed with sHCC by postoperative pathology. A total of 221 patients were retrospectively included from our hospital. In addition, we recruited 94 and 100 participants as independent external validation sets from two other hospitals. Radiomics models of Gd-EOB-DTPA-enhanced MRI and diffusion-weighted imaging (DWI) were constructed and validated using machine learning. As presented in the radiomics nomogram, a prediction model was developed using multivariable logistic regression analysis, which included radiomics scores, radiologic features, and clinical features, such as the alpha-fetoprotein (AFP) level. The calibration, decision-making curve, and clinical usefulness of the radiomics nomogram were analyzed. The radiomic nomogram was validated using independent external cohort data. The areas under the receiver operating curve (AUC) were used to assess the predictive capability.
RESULTS Pathological examination confirmed MVI in 64 (28.9%), 22 (23.4%), and 16 (16.0%) of the 221, 94, and 100 patients, respectively. AFP, tumor size, non-smooth tumor margin, incomplete capsule, and peritumoral hypointensity in hepatobiliary phase (HBP) images had poor diagnostic value for MVI of sHCC. Quantitative radiomic features (1409) of MRI scans) were extracted. The classifier of logistic regression (LR) was the best machine learning method, and the radiomics scores of HBP and DWI had great diagnostic efficiency for the prediction of MVI in both the testing set (hospital A) and validation set (hospital B, C). The AUC of HBP was 0.979, 0.970, and 0.803, respectively, and the AUC of DWI was 0.971, 0.816, and 0.801 (P < 0.05), respectively. Good calibration and discrimination of the radiomics and clinical combined nomogram model were exhibited in the testing and two external validation cohorts (C-index of HBP and DWI were 0.971, 0.912, 0.808, and 0.970, 0.843, 0.869, respectively). The clinical usefulness of the nomogram was further confirmed using decision curve analysis.
CONCLUSION AFP and conventional Gd-EOB-DTPA-enhanced MRI features have poor diagnostic accuracies for MVI in patients with sHCC. Machine learning with an LR classifier yielded the best radiomics score for HBP and DWI. The radiomics nomogram developed as a noninvasive preoperative prediction method showed favorable predictive accuracy for evaluating MVI in sHCC.
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Affiliation(s)
- Yi-Di Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ling Zhang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Peng Zhou
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Zhuang Autonomous Region, China
| | - Bin Lin
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin 541001, Guangxi Zhuang Autonomous Region, China
| | - Zi-Jian Jiang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Cheng Tang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi-Wu Dang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning 5350021, Guangxi Zhuang Autonomous Region, China
| | - Yu-Wei Xia
- Department of Technology, Huiying Medical Technology (Beijing), Beijing 100192, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Ling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Aslan S, Eryuruk U, Tasdemir MN, Cakir IM. Determining the efficacy of functional liver imaging score (FLIS) obtained from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Albumin-Bilirubin (ALBI) grade and FLIS. Abdom Radiol (NY) 2022; 47:2325-2334. [PMID: 35672474 DOI: 10.1007/s00261-022-03557-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE (1) To evaluate the efficacy of functional liver imaging score (FLIS) in predicting liver function on gadoxetic acid-enhanced MRI in patients with chronic liver disease (CLD) or liver cirrhosis (LC) and its relationship with ALBI grade. (2) To assess the intra-reader reliability and interreader agreement of readers with different levels of experience in abdominal imaging of FLIS. METHODS We retrospectively included 131 patients (70 men, 61 women; mean ± SD, 53.7 ± 14.6 years) with CLD and LC who underwent GA-enhanced MRI between November 2019 and March 2022. FLIS was assigned as a result of the sum of three hepatobiliary phase (HBP) images features, each scored 0-2: liver parenchymal enhancement, biliary contrast excretion, and portal vein sign. FLIS was calculated using HPB images independently by three radiologists with different experience. In addition, 50 randomly selected patients were reviewed a second time by a reader to assess intra-reader reliability. Patients were divided into the following three groups according to the albumin-bilirubin (ALBI) grade: ALBI grade 1, 2, and 3. We evaluated the correlation between ALBI grade and both FLIS and its parameters using Spearman's rank correlation for each reader. Receiver operating characteristic (ROC) curve analysis was performed to show the optimal cut-off value of FLIS to distinguish between ALBI grades. Intra-reader reliability and inter-reader agreement were evaluated by intraclass correlation coefficient (ICC). RESULTS FLIS and three FLIS parameters showed very strong correlation with ALBI grade for each readers (r = - 0.843 to 0.976, - 0.831 to 0.962, and - 0.819 to 0.902, respectively). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of ALBI grade 1 for each readers (sensitivity, 83.7% to 95.4%; specificity, 82.6% to 87%; accuracy, 88.6% to 93.6% and area under the curve (AUC), 0.882 to 0.917), and FLIS ≤ 3 was the optimal cutoff for distinguish ALBI grade 3 from other grades for each readers (sensitivity, 100%; specificity, 95.2% to 96%; accuracy, 95.4% to 96.2% and AUC, 0.974 to 0.994). Intra-reader reliability (ICC = 0.95; 95% CI 0.93-0.96) and inter-reader agreement (ICC = 0.85 to 0.90; 95% CI 0.82-0.97) for FLIS were excellent. CONCLUSION FLIS showed a very correlation with hepatic function level and can stratify the ALBI grades. This feature has demonstrated the potential of FLIS to be excellent radiological tools for predicting of liver function of CLD and LC patients in clinical practice. Also, the excellent agreement of FLIS among readers with different levels of experience indicates that it can be used with high accuracy and reproducibility regardless of experience.
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Affiliation(s)
- Serdar Aslan
- Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey.
| | - Uluhan Eryuruk
- Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Merve Nur Tasdemir
- Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ismet Mirac Cakir
- Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey
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Luo N, Huang X, Ji Y, Jin G, Qin Y, Xiang B, Su D, Tang W. A functional liver imaging score for preoperative prediction of liver failure after hepatocellular carcinoma resection. Eur Radiol 2022; 32:5623-5632. [PMID: 35294586 DOI: 10.1007/s00330-022-08656-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/11/2022] [Accepted: 02/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Posthepatectomy liver failure (PHLF) is a challenging complication after resection to treat hepatocellular carcinoma (HCC), and it is associated with high mortality. Preoperative prediction of PHLF may improve patient subsequent and reduce such mortality. This study examined whether a functional liver imaging score (FLIS) based on preoperative gadoxetic acid-enhanced magnetic resonance imaging (MRI) could predict PHLF. MATERIALS AND METHODS The study included 502 patients who underwent preoperative gadoxetic acid-enhanced MRI, followed by HCC resection. Significant preoperative predictors of PHLF were identified using logistic regression analysis. The ability of FLIS to predict PHLF was evaluated using receiver operating characteristic curves, and its predictive power was compared to that of the model for end-stage liver disease (MELD) score, albumin-bilirubin (ALBI) score, and indocyanine green 15-min retention rate (ICG-R15). RESULTS In multivariate analysis, PHLF was independently associated with FLIS (OR 0.452, 95% CI 0.361 to 0.568, p < 0.001) and major resection (OR 1.898, 95% CI 1.057 to 3.408, p = 0.032). FLIS was associated with a higher area under the receiver operating characteristic curve (0.752) than the MELD score (0.557), ALBI score (0.609), or ICG-R15 (0.605) (all p < 0.05). Patients with FLIS ≤ 4 who underwent major resection were at 9.4-fold higher risk of PHLF than patients with lower FLIS who underwent minor resection. CONCLUSION FLIS is an independent predictor of PHLF, and it may perform better than the MELD score, ALBI score, and ICG-R15 clearance. We propose treating elevated FLIS and major resection as risk factors for PHLF. KEY POINTS • A functional liver imaging score can independently predict posthepatectomy liver failure in patients with HCC. • The score may predict such failure better than MELD and ALBI scores and ICG-R15. • Patients with scores ≤ 4 who undergo major hepatic resection may be at nearly tenfold higher risk of posthepatectomy liver failure.
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Affiliation(s)
- Ningbin Luo
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xiangyang Huang
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yinan Ji
- Department of Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Guanqiao Jin
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yunying Qin
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Bangde Xiang
- Department of Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Danke Su
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, China.
| | - Weizhong Tang
- Department of Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
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Hwang JA, Min JH, Kim SH, Choi SY, Lee JE, Moon JY. Total Bilirubin Level as a Predictor of Suboptimal Image Quality of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI in Patients with Extrahepatic Bile Duct Cancer. Korean J Radiol 2022; 23:389-401. [PMID: 35029076 PMCID: PMC8961017 DOI: 10.3348/kjr.2021.0407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/16/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination. Materials and Methods We retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0–2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0–3) or high-FLIS (4–6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed. Results Of the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32–1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9–98.4) and a specificity of 89.0% (95% CI: 80.2–94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6–98.3) and a specificity of 83.8% (95% CI: 68.0–93.8). Conclusion Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Yoon Moon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
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Sabottke CF, Spieler BM, Moawad AW, Elsayes KM. Artificial Intelligence in Imaging of Chronic Liver Diseases: Current Update and Future Perspectives. Magn Reson Imaging Clin N Am 2021; 29:451-463. [PMID: 34243929 DOI: 10.1016/j.mric.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Here we review artificial intelligence (AI) models which aim to assess various aspects of chronic liver disease. Despite the clinical importance of hepatocellular carcinoma in the setting of chronic liver disease, we focus this review on AI models which are not lesion-specific and instead review models developed for liver parenchyma segmentation, evaluation of portal circulation, assessment of hepatic fibrosis, and identification of hepatic steatosis. Optimization of these models offers the opportunity to potentially reduce the need for invasive procedures such as catheterization to measure hepatic venous pressure gradient or biopsy to assess fibrosis and steatosis. We compare the performance of these AI models amongst themselves as well as to radiomics approaches and alternate modality assessments. We conclude that these models show promising performance and merit larger-scale evaluation. We review artificial intelligence models that aim to assess various aspects of chronic liver disease aside from hepatocellular carcinoma. We focus this review on models for liver parenchyma segmentation, evaluation of portal circulation, assessment of hepatic fibrosis, and identification of hepatic steatosis. We conclude that these models show promising performance and merit a larger scale evaluation.
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Affiliation(s)
- Carl F Sabottke
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell, P.O. Box 245067, Tucson, AZ 85724-5067, USA.
| | - Bradley M Spieler
- Department of Radiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Rm 343, New Orleans, LA 70112, USA
| | - Ahmed W Moawad
- Department of Imaging Physics, The University of Texas, MD Anderson Cancer Center, Unit 1472, P.O. Box 301402, Houston, TX 77230-1402, USA
| | - Khaled M Elsayes
- Department of Abdominal Imaging, The University of Texas, MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA
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Lee HJ, Hong SB, Lee NK, Kim S, Seo HI, Kim DU, Han SY, Choo KS. Validation of functional liver imaging scores (FLIS) derived from gadoxetic acid-enhanced MRI in patients with chronic liver disease and liver cirrhosis: the relationship between Child-Pugh score and FLIS. Eur Radiol 2021; 31:8606-8614. [PMID: 33881570 DOI: 10.1007/s00330-021-07955-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To validate the functional liver imaging score (FLIS) for prediction of hepatic function in gadoxetic acid-enhanced MRI. METHODS We retrospectively identified 134 patients (88 men, 46 women; mean age, 58.8 years) between January 2015 and December 2018 with the following inclusion criteria: patients diagnosed with liver cirrhosis or chronic liver disease (CLD) who underwent gadoxetic acid-enhanced MRI. Three parameters on hepatobiliary phase images were evaluated for FLIS: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified as CLD (n = 11), Child-Pugh (CP) class A (n = 87), CP B (n = 22), or CP C (n = 14). We assessed the correlation between CP score and both FLIS and its components using Spearman rank correlation. Receiver operating characteristic (ROC) curve analysis was performed to demonstrate the cutoff value of FLIS for differentiating between CP classes. The associations between patient characteristics, serum markers, FLIS, and hepatic decompensation were evaluated with Cox proportional hazard models. RESULTS FLIS and three FLIS parameters showed strong to very strong correlation with CP score (r = -0.60 to 0.82). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of CP class A or CLD (sensitivity, 83.7%; specificity, 94.4%; area under the curve [AUC], 0.93). FLIS < 5 was independently associated with the development of first hepatic decompensation in patients with CP A (HR, 50.0; 95% confidence interval, 6.2, 400.4). CONCLUSION FLIS showed a strong correlation with hepatic function and can stratify the CP class. In addition, FLIS can help prediction for the development of first decompensation. KEY POINTS • Functional liver imaging scores (FLIS) and its three parameters, derived from hepatobiliary phase image, have strong to very strong correlations with Child-Pugh (CP) scores. • FLIS can stratify patients with chronic liver disease or liver cirrhosis according to CP classification. • Low FLIS is an independent predictor for first hepatic decompensation in patients with CP class A.
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Affiliation(s)
- Ho Jun Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea.
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Hyung Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Ki Suk Choo
- Department of Radiology, Biomedical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
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Comparison of Conventional Gadoxetate Disodium-Enhanced MRI Features and Radiomics Signatures With Machine Learning for Diagnosing Microvascular Invasion. AJR Am J Roentgenol 2021; 216:1510-1520. [PMID: 33826360 DOI: 10.2214/ajr.20.23255] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. This study aimed to determine the best model for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) using conventional gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced MRI features and radiomics signatures with machine learning. MATERIALS AND METHODS. This retrospective study included 269 patients with a postoperative pathologic diagnosis of HCC. Gadoxetate disodium-enhanced MRI features were assessed, including T1 relaxation time, tumor margin, tumor size, peritumoral enhancement, peritumoral hypointensity, and ADC. Radiomics models were constructed and validated by machine learning. The least absolute shrinkage and selection operator (LASSO) was used for feature selection, and radiomics-based LASSO models were constructed with six classifiers. Predictive capability was assessed using the ROC AUC. RESULTS. Histologic examination confirmed MVI in 111 (41.3%) of the 269 patients. ADC value, nonsmooth tumor margin, and 20-minute T1 relaxation time showed diagnostic accuracy with AUC values of 0.850, 0.847, and 0.846, respectively (p < .05 for all). A total of 1395 quantitative imaging features were extracted. In the hepatobiliary phase (HBP) model, the support vector machine (SVM), extreme gradient boosting (XGBoost), and logistic regression (LR) classifiers showed greater diagnostic efficiency for predicting MVI, with AUCs of 0.942, 0.938, and 0.936, respectively (p < .05 for all). CONCLUSION. ADC value, nonsmooth tumor margin, and 20-minute T1 relaxation time show high diagnostic accuracy for predicting MVI. Radiomics signatures with machine learning can further improve the ability to predict MVI and are best modeled during HBP. The SVM, XGBoost, and LR classifiers may serve as potential biomarkers to evaluate MVI.
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Yang M, Zhang Y, Zhao W, Cheng W, Wang H, Guo S. Evaluation of liver function using liver parenchyma, spleen and portal vein signal intensities during the hepatobiliary phase in Gd-EOB-D TPA-enhanced MRI. BMC Med Imaging 2020; 20:119. [PMID: 33081713 PMCID: PMC7576754 DOI: 10.1186/s12880-020-00519-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
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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Affiliation(s)
- Ming Yang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Wenlu Zhao
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Wen Cheng
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Han Wang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China
| | - Shengren Guo
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street No. 1055, Suzhou, 215004, Jiangsu, China.
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Vietti Violi N, Argiriadi P, Rosen A, Cherny M, Weiss A, Hernandez-Meza G, Babb JS, Kihira S, Lewis S, Taouli B. Gadoxetate disodium-enhanced MRI: Assessment of arterial phase artifacts and hepatobiliary uptake in a large series. Eur J Radiol 2020; 132:109313. [PMID: 33053495 DOI: 10.1016/j.ejrad.2020.109313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the quality of gadoxetate disodium MRI in a large series by assessing the prevalence of: 1) arterial phase (AP) artifacts and its predictive factors, 2) decreased hepatic contrast uptake during the hepatobiliary phase (HBP). METHODS This retrospective single center study included 851 patients (M/F:537/314, mean age: 63y) with gadoxetate disodium MRI. The MRI protocol included unenhanced, dual arterial [early and late arterial phases (AP)], portal venous, transitional and hepatobiliary phases. Three radiologists graded dynamic images using a 5-scale score (1: no motion, 5: severe, nondiagnostic) for assessment of transient severe motion (TSM, defined as a score ≥4 during at least one AP with a score ≤3 during other phases). HBP uptake was assessed using a 3-scale score (based on portal vein/hepatic signal). The association between demographic, clinical and acquisition parameters with TSM was tested in uni- and multivariate logistic regression. RESULTS TSM was observed in 103/851 patients (12.1 %): 83 (9.8 %) in one AP and 20 (2.3 %) in both APs. A score of 5 (nondiagnostic) was assigned in 7 patients in one AP (0.8 %) and none in both. Presence of TSM was significantly associated with age (p = 0.002) and liver disease (p = 0.033) in univariate but not in multivariate analysis (p > 0.05). No association was found between acquisition parameters and TSM occurrence. Limited or severely limited HBP contrast uptake was observed in 87 patients (10.2 %), and TSM was never associated with severely limited HBP contrast uptake. CONCLUSION TSM was present in approximately 12 % of gadoxetate disodium MRIs, rarely on both APs (2.3 %), and was poorly predicted. TSM was never associated with severely limited HBP contrast uptake.
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Affiliation(s)
- Naik Vietti Violi
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland.
| | - Pamela Argiriadi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Ally Rosen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Mathew Cherny
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Amanda Weiss
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - James S Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY USA.
| | - Shingo Kihira
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sara Lewis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Abstract
Contrast enhanced MRI of the liver provides valuable information in the evaluation of both chronic liver disease and focal liver lesions. Currently, two classes of MRI contrast agents are available for clinical use, namely the extracellular contrast agent (ECA) and the hepatobiliary agent (HBA). The use of appropriate contrast agents for liver MRI requires knowledge of the clinical situation and question to be answered. ECAs have been used for decades since their introduction into clinical practice and provide excellent dynamic phase information that is useful in characterizing focal liver lesions. In the last decade, HBAs, particularly Gadoxetate, have been found useful for characterizing lesions with functioning hepatocytes and more importantly in evaluating the biliary tree. Gadoxetate, however, provides less satisfactory dynamic phase images compared to ECAs, particularly during the arterial phase. In this perspective article, we will discuss the various intravenous contrast agents used for liver MRI and their ideal utilization.
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Chen Y, Qin X, Long L, Zhang L, Huang Z, Jiang Z, Li C. Diagnostic Value of Gd‐EOB‐DTPA‐Enhanced MRI for the Expression of Ki67 and Microvascular Density in Hepatocellular Carcinoma. J Magn Reson Imaging 2019; 51:1755-1763. [PMID: 31675163 DOI: 10.1002/jmri.26974] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Yidi Chen
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Xiali Qin
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Liling Long
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Ling Zhang
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Zhongkui Huang
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Zijian Jiang
- First Affiliated Hospital of Guangxi Medical University, Radiology Department, Guangxi, China
| | - Chenhui Li
- Siemens Healthineers, Department of MR Application, Guangdong Province, China
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Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers. Abdom Radiol (NY) 2019; 44:2769-2780. [PMID: 31041497 DOI: 10.1007/s00261-019-02041-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)-based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis. MATERIALS AND METHODS This retrospective study included 67 patients (55 male and 12 female; mean age 62.5 years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver-spleen contrast ratio (LSC), liver-portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard. RESULTS The fibrosis stages were F0-F1 (n = 17), F2 (n = 7), F3 (n = 20), and F4 (n = 23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r = -0.786); LSC (r = - 0.718); LPC (r = - 0.448); and SIR (r = - 0.617; all P < 0.001). For diagnosis of either significant liver fibrosis (≥ F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC = 0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC = 0.699 and 0.715; all P < 0.05). The CEI displayed similar diagnostic accuracy for ≥ F2 or F4 when using TE (AUC = 0.866 and 0.884, both P > 0.05) or ElastPQ [AUC = 0.751 (P = 0.021) and AUC = 0.786 (P = 0.234)]. CONCLUSIONS The CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.
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Liver assessment using Gd-EOB-DTPA-enhanced magnetic resonance imaging in primary biliary cholangitis patients. Jpn J Radiol 2019; 37:412-419. [PMID: 30798469 DOI: 10.1007/s11604-019-00822-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/12/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the feasibility of utilizing gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for the assessment of Child-Pugh class and for differentiating between patients with primary biliary cholangitis (PBC) and posthepatitic cirrhosis. MATERIALS AND METHODS 45 PBC patients and 45 posthepatitic cirrhosis patients were enrolled and Gd-EOB-DTPA-enhanced MRI was applied. The average relative signal enhancement (RE) of the liver and average contrast to noise ratio (CNR) of common bile duct at 4, 20, and 50 min between different Child-Pugh classes of PBC patients were compared. The RE and CNR in all timepoints in patients with the same Child-Pugh class were compared between PBC patients and posthepatitic cirrhosis patients. RESULTS The RE of liver and CNR of common bile duct at 4, 20, and 50 min was significantly different between all Child-Pugh classes of PBC patients. There were also no significant differences in the RE of liver and CNR of common bile duct in all timepoints between patients with PBC and posthepatitic cirrhosis in the same Child-Pugh class. CONCLUSION Gd-EOB-DTPA-enhanced MRI is feasible for liver function assessment in PBC patients. However, the ability of this modality in differentiating liver cirrhosis of different etiologies requires further investigation.
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Zhang W, Wang X, Miao Y, Hu C, Zhao W. Liver function correlates with liver-to-portal vein contrast ratio during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MR at 3 Tesla. Abdom Radiol (NY) 2018; 43:2262-2269. [PMID: 29476347 DOI: 10.1007/s00261-018-1462-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSES To determine if liver-to-portal vein contrast ratio (LPC) correlates with liver function in patients with hepatitis B virus (HBV)-related cirrhosis on gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced MR imaging. METHODS A total of 92 patients with normal (n = 20) or HBV-related cirrhotic livers graded by Child-Pugh class A (n = 50), B (n = 17) or C (n = 5) who underwent Gd-EOB-DTPA-enhanced 3Tesla MR imaging were retrospectively reviewed. LPC was defined as the signal intensity ratio of liver parenchyma to portal vein on hepatobiliary phase (HBP) acquired at 20 min, and it was compared between normal and cirrhotic livers. The correlation between LPC and hepatic function parameters at HBP after injection was quantitatively analyzed as well. RESULTS LPC differed between normal and cirrhotic livers significantly (P < 0.001). LPC constantly and significantly decreased from normal to cirrhotic livers with Child-Pugh class C at HBP imaging (P < 0.001). Multiple regression analysis revealed that total bilirubin (P = 0.011), albumin (P < 0.001), and platelet count (P = 0.007) were independent predictors of LPC at HBP imaging. A receiver operating characteristic (ROC) curve analysis revealed that the optimal cutoff value for LPC to distinguish normal group from cirrhotic groups was 2.05 (AUC 0.98) with a sensitivity of 84.1% and a specificity of 100%. CONCLUSION The level of LPC on Gd-EOB-DTPA MR imaging can efficaciously indicate the severity of liver function in patients with HBV-related cirrhosis and was correlated with liver function parameters significantly. It might be used as an alternative imaging biomarker for assessing liver function.
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Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 2018; 43:56-74. [PMID: 28940042 DOI: 10.1007/s00261-017-1325-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate detection and characterization of liver observations to enable HCC diagnosis and staging using LI-RADS requires a technically adequate imaging exam. To help achieve this objective, LI-RADS has proposed technical requirements for CT, MR, and contrast-enhanced ultrasound of liver. This article reviews the technical requirements for liver imaging, including the description of minimum acceptable technical standards, such as the scanner hardware requirements, recommended dynamic imaging phases, and common technical challenges of liver imaging.
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Affiliation(s)
- Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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24
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Peng Z, Li C, Chan T, Cai H, Luo Y, Dong Z, Li ZP, Feng ST. Quantitative evaluation of Gd-EOB-DTPA uptake in focal liver lesions by using T1 mapping: differences between hepatocellular carcinoma, hepatic focal nodular hyperplasia and cavernous hemangioma. Oncotarget 2017; 8:65435-65444. [PMID: 29029443 PMCID: PMC5630343 DOI: 10.18632/oncotarget.18918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/14/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives To investigate the difference of T1 relaxation time on Gd-EOB-DTPA-enhanced MRI in hepatocellular carcinoma (HCC), hepatic focal nodular hyperplasia (FNH) and cavernous hemangioma of liver (CHL), and to quantitatively evaluate the uptake of Gd-EOB-DTPA in these three focal liver lesions (FLLs). Results The T1P of CHL was significantly higher than those of HCC and FNH (P < 0.05). Reduction of T1 relaxation time on hepatobiliary phase could be observed in all three types of lesions. There were significant differences of T1P, T1E, T1D and T1D% between FNH, CHL and HCC (P < 0.001). Spearman correlation analysis revealed that T1D% was the best indicator for diagnostic differentiation, with a correlation coefficient of 0.702. Discriminant analysis using three variables (T1P, T1E, and T1D%) showed that the classification accuracy was 88.2%. Materials and Methods 74 patients diagnosed with focal liver lesions underwent Gd-EOB-DTPA-enhanced MRI including T1 mapping were enrolled, consisting of 51 HCCs, 10 FNHs, and 13 CHLs. T1 relaxation times of these lesions were measured on pre-contrast (T1P) and on hepatobiliary phase images at 20 minute after contrast (T1E). The reduction of T1 relaxation time on hepatobiliary (T1D) and the percentage reduction (T1D%) was calculated. The differences of T1P, T1E, T1D and T1D% in these FLLs were analyzed. The usefulness of these parameters for classification of FLLs was evaluated. Conclusions Uptake of Gd-EOB-DTPA is different between in HCC, FNH and CHL. These three lesions can be distinguished using T1 mapping.
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Affiliation(s)
- Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Chang Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Tao Chan
- Department of Diagnostic Radiology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
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Assessment of Orthotopic Liver Transplant Graft Survival on Gadoxetic Acid–Enhanced Magnetic Resonance Imaging Using Qualitative and Quantitative Parameters. Invest Radiol 2016; 51:728-734. [DOI: 10.1097/rli.0000000000000286] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Rao SX, Zeng MS. Assessment of liver function by Gd-EOB-DTPA enhanced magnetic resonance imaging. Shijie Huaren Xiaohua Zazhi 2016; 24:3940-3945. [DOI: 10.11569/wcjd.v24.i28.3940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), a liver-specific magnetic resonance imaging (MRI) contrast agent, is increasingly used for imaging-based liver function tests. Like indocyanine green and mebrofenin, Gd-EOB-DTPA is taken up by hepatocytes through organic anion-transporting polypeptides 1 (OATP1) B1 and B3 and is then excreted into the bile by multi-drug resistance protein (MRP2). The advantages of Gd-EOB-DTPA-based liver function tests include function measurement integrated in an existing MRI protocol, ability of evaluating segmental liver function, and no ionizing radiation. The approaches based on Gd-EOB-DTPA for function measurement are as follows: measurement of biliary elimination, hepatic parenchymal enhancement, MR relaxometry, and MR perfusion. These approaches have potential value for assessing liver reserve, hepatic fibrosis, non-alcoholic fatty liver disease and so on.
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Agnello F, Dioguardi Burgio M, Picone D, Vernuccio F, Cabibbo G, Giannitrapani L, Taibbi A, Agrusa A, Bartolotta TV, Galia M, Lagalla R, Midiri M, Brancatelli G. Magnetic resonance imaging of the cirrhotic liver in the era of gadoxetic acid. World J Gastroenterol 2016; 22:103-111. [PMID: 26755863 PMCID: PMC4698478 DOI: 10.3748/wjg.v22.i1.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/22/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Gadoxetic acid improves detection and characterization of focal liver lesions in cirrhotic patients and can estimate liver function in patients undergoing liver resection. The purpose of this article is to describe the optimal gadoxetic acid study protocol for the liver, the unique characteristics of gadoxetic acid, the differences between gadoxetic acid and extra-cellular gadolium chelates, and the differences in phases of enhancement between cirrhotic and normal liver using gadoxetic acid. We also discuss how to obtain and recognize an adequate hepatobiliary phase.
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28
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Aguirre-Reyes DF, Sotelo JA, Arab JP, Arrese M, Tejos R, Irarrazaval P, Tejos C, Uribe SA, Andia ME. Intrahepatic portal vein blood volume estimated by non-contrast magnetic resonance imaging for the assessment of portal hypertension. Magn Reson Imaging 2015; 33:970-7. [PMID: 26117696 DOI: 10.1016/j.mri.2015.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/21/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the feasibility of estimating the portal vein blood volume that flows into the intrahepatic volume (IHPVBV) in each cardiac cycle using non-contrast MR venography technique as a surrogate marker of portal hypertension (PH). MATERIALS AND METHODS Ten patients with chronic liver disease and clinical symptoms of PH (40% males, median age: 54.0, range: 44-73 years old) and ten healthy volunteers (80% males, median age: 54.0, range: 44-66 years old) were included in this study. A non-contrast Triple-Inversion-Recovery Arterial-Spin-Labeling (TIR-ASL) technique was used to quantify the IHPVBV in one and two cardiac cycles. Liver (LV) and spleen volumes (SV) were measured by manual segmentation from anatomical MR images as morphological markers of PH. All images were acquired in a 1.5T Philips Achieva MR scanner. RESULTS PH patients had larger SV (P=0.02) and lower liver-to-spleen ratio (P=0.02) compared with healthy volunteers. The median IHPVBV in healthy volunteers was 13.5cm(3) and 26.5cm(3) for one and two cardiac cycles respectively, whereas in PH patients a median volume of 3.1cm(3) and 9.0cm(3) was observed. When correcting by LV, the IHPVBV was significantly higher in healthy volunteers than PH patients for one and two cardiac cycles. The combination of morphological information (liver-to-spleen ratio) and functional information (IHPVBV/LV) can accurately identify the PH patients with a sensitivity of 90% and specificity of 100%. CONCLUSION Results show that the portal vein blood volume that flows into the intrahepatic volume in one and two cardiac cycles is significantly lower in PH patients than in healthy volunteers and can be quantified with non-contrast MRI techniques.
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Affiliation(s)
- Daniel F Aguirre-Reyes
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Electrical Engineering Department, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Computation Sciences and Electronic Department, Universidad Tecnica Particular de Loja, Ecuador, Loja 1101608, Ecuador.
| | - Julio A Sotelo
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Electrical Engineering Department, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile.
| | - Juan P Arab
- Gastroenterology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, 8331150, Chile.
| | - Marco Arrese
- Gastroenterology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, 8331150, Chile.
| | - Rodrigo Tejos
- Gastroenterology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, 8331150, Chile.
| | - Pablo Irarrazaval
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Electrical Engineering Department, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile.
| | - Cristian Tejos
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Electrical Engineering Department, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile.
| | - Sergio A Uribe
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, 8331150, Chile.
| | - Marcelo E Andia
- Biomedical Imaging Center, Pontificia Universidad Catolica de Chile, Santiago, 7820436, Chile; Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, 8331150, Chile.
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Imura S, Shimada M, Utsunomiya T. Recent advances in estimating hepatic functional reserve in patients with chronic liver damage. Hepatol Res 2015; 45:10-9. [PMID: 24606181 DOI: 10.1111/hepr.12325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 02/16/2014] [Accepted: 03/05/2014] [Indexed: 12/17/2022]
Abstract
Preoperative estimation of liver functional reserve is important in liver surgery to prevent postoperative liver failure. Although the hepatic functional reserve of patients with chronic liver disease is generally evaluated by measuring indocyanine green dye retention at 15 min, no standard method of estimating regional liver function has been established to date. Several recently introduced imaging modalities, such as hepatobiliary scintigraphy and magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, may be used to evaluate liver function. Here, we review recent advances in estimating hepatic functional reserve, mainly by radiological modalities, in patients with chronic liver damage.
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Affiliation(s)
- Satoru Imura
- Department of Surgery, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
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Imaging Approach to Hepatocellular Carcinoma, Cholangiocarcinoma, and Metastatic Colorectal Cancer. Surg Oncol Clin N Am 2015; 24:19-40. [DOI: 10.1016/j.soc.2014.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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31
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Hope TA, Fowler KJ, Sirlin CB, Costa EAC, Yee J, Yeh BM, Heiken JP. Hepatobiliary agents and their role in LI-RADS. ACTA ACUST UNITED AC 2014; 40:613-25. [DOI: 10.1007/s00261-014-0227-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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32
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Guglielmo FF, Mitchell DG, Gupta S. Gadolinium contrast agent selection and optimal use for body MR imaging. Radiol Clin North Am 2014; 52:637-56. [PMID: 24889165 DOI: 10.1016/j.rcl.2014.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Proper selection of a gadolinium-based contrast agent (GBCA) for body magnetic resonance imaging (MRI) cases requires understanding the indication for the MRI exam, the key features of the different GBCAs, and the effect that the GBCA has on the selected imaging protocol. The different categories of GBCAs require timing optimization on postcontrast sequences and adjusting imaging parameters to obtain the highest T1 contrast. Gadoxetate disodium has many advantages when evaluating liver lesions, although there are caveats and limitations that need to be understood. Gadobenate dimeglumine, a high-relaxivity GBCA, can be used for indications when stronger T1 relaxivity is needed.
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Affiliation(s)
- Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA.
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA
| | - Shiva Gupta
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1473, FCT15.5013, Houston, TX 77030, USA
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Kagen A, Fowler K, Sirlin CB. Insight into hepatocellular carcinoma biology with gadoxetate disodium-enhanced MRI. Hepat Oncol 2014; 1:95-105. [PMID: 30190944 PMCID: PMC6114011 DOI: 10.2217/hep.13.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The current algorithm for the imaging diagnosis of hepatocellular carcinoma accurately detects large, progressed tumors displaying the classical imaging features of arterial hyperenhancement with 'washout' and/or 'capsule' appearance. Liver MRI with the relatively newer hepatobiliary agent, gadoxetate disodium, provides information on hepatocellular function in addition to vascularity, facilitates detection of small progressed tumors, as well as early/vaguely nodular tumors, and shows promise for characterizing hepatocellular carcinoma biology. Prediction of tumor grade, presence of biliary and stem cell markers, microvascular invasion, future hypervascularization and post-treatment recurrence have all been studied with gadoxetate disodium-enhanced MRI with encouraging results. Incorporation of gadoxetate disodium-enhanced MRI into standard diagnostic and management algorithms will likely unfold in the future.
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Affiliation(s)
- Alexander Kagen
- Beth Israel Medical Center, Department of Radiology, 2nd Floor, First Avenue at 16th Street, New York, NY 11231, USA
| | - Kathryn Fowler
- Washington University School of Medicine, 510 S. Kings Highway Boulevard, St Louis, MO 63110, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, San Diego, CA 92013-8226, USA
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Nakamura Y, Hirokawa Y, Kitamura S, Yamasaki W, Arihiro K, Tatsugami F, Iida M, Kakizawa H, Date S, Awai K. Effect of lapatinib on hepatic parenchymal enhancement on gadoxetate disodium (EOB)-enhanced MRI scans of the rat liver. Jpn J Radiol 2013; 31:386-92. [PMID: 23605127 DOI: 10.1007/s11604-013-0208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/09/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of lapatinib treatment on hepatic parenchymal enhancement on Gd-EOB-MRI scans in rat. MATERIALS AND METHODS Institutional animal review board approval was received prior to the commencement of all studies. Five rats received a single oral dose of 100 mg/kg/day lapatinib for 7 consecutive days. The controls (n = 5) were given 0.5 % (w/v) aqueous hydroxypropyl methyl cellulose containing 0.1 % (v/v) Tween 80 for 7 days. After the acquisition of gadoxetate disodium-enhanced MR images using 0.025 mmol gadolinium/kg, their livers were subjected to pathologic study to determine the expression level of organic anion-transporting polypeptide 1 (oatp1) and multi-drug resistance-associated protein 2 (mrp2). RESULTS Relative enhancement of the liver was similar in both groups. At the hepatobiliary phase, which in rats occurs 3 min after the injection of Gd-EOB, it was 0.90 ± 0.06 in lapatinib-treated rats and 0.84 ± 0.08 in the controls (p = 0.30). There was also no difference in the expression level of oatp1 and mrp2. CONCLUSION In rats, the administration of lapatinib for 7 days had no effect on hepatic parenchymal enhancement on Gd-EOB-MRI scans.
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
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Bae KE, Kim SY, Lee SS, Kim KW, Won HJ, Shin YM, Kim PN, Lee MG. Assessment of hepatic function with Gd-EOB-DTPA-enhanced hepatic MRI. Dig Dis 2012; 30:617-22. [PMID: 23258104 DOI: 10.1159/000343092] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Assessment of hepatic function is essential in determining the prognosis and clinical management of a patient who has chronic liver disease or undergoes liver surgery. For a patient with locally varying hepatic parenchymal abnormalities, a regional assessment of hepatic function mapped onto hepatic anatomy is clinically more meaningful than conventional global metrics of hepatic function. Of late, hepatic magnetic resonance imaging has been increasingly used because of its superb tissue contrast and delineation of hepatic morphology and underlying abnormalities. The introduction of hepatocyte-specific contrast agents such as Gd-EOB-DTPA allows us to view not only the hepatic anatomy but also assess regional hepatic function. In this article, we review and discuss recently published studies that used Gd-EOB-DTPA-enhanced magnetic resonance imaging to evaluate hepatic function.
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Affiliation(s)
- Kyung Eun Bae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
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