Chen YY, Yang L, Li J, Rao SX, Ding Y, Zeng MS. Gadoxetic acid-enhanced magnetic resonance imaging in the assessment of hepatic sinusoidal obstruction syndrome in a mouse model. World J Hepatol 2024; 16(8): 1167-1176 [DOI: 10.4254/wjh.v16.i8.1167]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yuan-Yuan Chen, Li Yang, Jun Li, Sheng-Xiang Rao, Ying Ding, Meng-Su Zeng, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Chen YY contributed to the conception, design, acquisition, analysis, interpretation of data, wrote the manuscript; Yang L and Li J collected and preprocessed the data; Rao SX provided supervision and methodology; Ding Y revised the manuscript and gave the final approval of the version to be published; Zeng MS was responsible for conceptualization and supervision.
Supported bythe National Science Foundation for Young Scientists of China, No. 81701682.
Institutional animal care and use committee statement: Animal experimental procedures were reviewed and approved by Zhongshan Hospital Institutional Ethics and Animal Care on February 4, 2017.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request at ding.ying@zs-hospital.sh.cn.
ARRIVE guidelines statement: The authors have read the ARRIVE Guidelines, and the manuscript was prepared and revised according to the ARRIVE Guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: May 15, 2024 Revised: July 13, 2024 Accepted: August 2, 2024 Published online: August 27, 2024 Processing time: 97 Days and 23.7 Hours
Abstract
BACKGROUND
Neoadjuvant chemotherapy can cause hepatic sinusoidal obstruction syndrome (SOS) in patients with colorectal cancer liver metastases and increases postoperative morbidity and mortality.
AIM
To evaluate T1 mapping based on gadoxetic acid-enhanced magnetic resonance imaging (MRI) for diagnosis of hepatic SOS induced by monocrotaline.
METHODS
Twenty-four mice were divided into control (n = 10) and experimental (n = 14) groups. The experimental groups were injected with monocrotaline 2 or 6 days before MRI. MRI parameters were: T1 relaxation time before enhancement; T1 relaxation time 20 minutes after enhancement (T1post); a reduction in T1 relaxation time (△T1%); and first enhancement slope percentage of the liver parenchyma (ESP). Albumin and bilirubin score was determined. Histological results served as a reference. Liver parenchyma samples from the control and experimental groups were analyzed by western blotting, and organic anion transporter polypeptide 1 (OATP1) was measured.
RESULTS
T1post, △T1%, and ESP of the liver parenchyma were significantly different between two groups (all P < 0.001) and significantly correlated with the total histological score of hepatic SOS (r = -0.70, 0.68 and 0.79; P < 0.001). △T1% and ESP were positively correlated with OATP1 levels (r = 0.82, 0.85; P < 0.001), whereas T1post had a negative correlation with OATP1 levels (r = -0.83; P < 0.001).
CONCLUSION
T1 mapping based on gadoxetic acid-enhanced MRI may be useful for diagnosis of hepatic SOS, and MRI parameters were associated with OATP1 levels.
Core Tip: Neoadjuvant chemotherapy could cause hepatic sinusoidal obstruction syndrome (SOS) in colorectal liver metastases patients and increases postoperative morbidity and mortality. We used a mouse model of monocrotaline-induced hepatic SOS. We confirmed the relationship between magnetic resonance imaging (MRI) parameters T1 relaxation time 20 minutes after enhancement, a reduction in T1 relaxation time and first enhancement slope percentage of the liver parenchyma and hepatic SOS, suggesting a potential method for the assessment of hepatic SOS. Our results also demonstrated that MRI parameters were correlated with organic anion transporter polypeptide 1 levels.
Citation: Chen YY, Yang L, Li J, Rao SX, Ding Y, Zeng MS. Gadoxetic acid-enhanced magnetic resonance imaging in the assessment of hepatic sinusoidal obstruction syndrome in a mouse model. World J Hepatol 2024; 16(8): 1167-1176
Hepatic sinusoidal obstruction syndrome (SOS) is also known as hepatic veno-occlusive disease of the liver[1]. The main pathological feature of hepatic SOS is damage to liver terminal vessels, and the clinical symptoms of it include ascites and abdominal pain[2]. It was first proposed in 1979 as an early complication of hematopoietic stem cell transplantation[3].The prevalence ranges from 5% to 60%, and hepatic SOS is a potentially severe complication and can even lead to death in severe cases[4]. Recently, systemic neoadjuvant chemotherapy became widely regarded as one of the causes hepatic SOS in the patients with advanced metastatic colorectal cancer[5,6], especially those were treated with oxaliplatin[7,8].
Oxaliplatin-based preoperative chemotherapy is used for patients with colorectal liver metastases as the standard regimen[8,9], because it could improve tumor resection outcome by shrinking the metastatic sites and reducing recurrence rate[10]. Nevertheless, chemotherapy-induced hepatic SOS has been associated with a higher risk of postresection morbidity[11], such as intraoperative bleeding, intraoperative transfusions, and postoperative liver failure[12]. Therefore, it is important to detect and diagnose of hepatic SOS timely. Currently, the gold standard is still based on liver biopsy[13], but it is an invasive procedure and has several limitations and complications, such as hemorrhage[14]. A noninvasive diagnostic modality is needed for the assessment of hepatic SOS.
Some noninvasive tools have been used for diagnosis of hepatic SOS. Researchers have utilized a preoperative platelet count and aspartate aminotransferase to platelet ratio index[15]. In addition, some imaging methods such as shear wave ultrasonography, computed tomography, and gadoxetic acid-enhanced magnetic resonance imaging (MRI) have been promoted as useful methods for evaluation of hepatic SOS[16-18]. Recent studies with monocrotaline (MCT)-treated rats were conducted to investigate diagnosis and prediction of severity of SOS. For example, intravoxel incoherent motion diffusion-weighted imaging, non-Gaussian diffusion models, and T1 rho quantification[19,20]. The MCT-induced hepatic SOS animal model was reproducible, with a detailed pathological scoring criteria[21].
Gadoxetic acid is a hepatocyte-specific contrast substance, which can provide parenchymal contrast in the hepatobiliary phase. It is reported that gadoxetic acid is absorbed into the liver parenchyma via organic anion transporter polypeptide 1 (OATP1) on the hepatocyte membranes[22-24]. Recently, several authors have described the feasibility of gadoxetic acid-enhanced MRI for the diagnosis of oxaliplatin-induced hepatic SOS[25]. They mainly diagnosed hepatic SOS based on the signal intensity of the hepatobiliary specific phase. However, there were several limitations due to the inconsistency between signal intensity of the liver parenchyma and the concentration of contrast agent for evaluation of the degree of hepatic SOS[26]. Therefore, we measured T1 relaxation time on parametric mapping because it is linearly related to the concentration of the contrast agent and is not affected by other factors[27]. Yang et al[28] demonstrated T1mapping on gadoxetic acid-enhanced MRI for the assessment of oxaliplatin-induced liver injury in a C57BL/6 mouse model. However, the main pathological changes in their model were hepatocyte degeneration and fibrosis.
Therefore, we aimed to explore the effectiveness of T1 mapping based on gadoxetic acid-enhanced MRI for the diagnosis of hepatic SOS in a C57BL/6 mouse model, as well as a possible relation between OATP1 Levels and MRI parameters.
MATERIALS AND METHODS
Animal models
Male 6-week-old C57BL/6 mice (17-22 g) were purchased from Shanghai Jiesijie Laboratory Animal Institution (Shanghai, China) and maintained according to the institutional animal care guidelines. Animal experimental procedures were reviewed and approved by our hospital Institutional Ethics and Animal Care. Twenty-four mice were randomly distributed into control (n = 10) and two experimental (n = 7) groups. SOS was induced by MCT as described previously[19]. The experimental mice were injected intraperitoneally (ip) with 360 mg/kg MCT, while control mice were treated with tap water. To assess experimental mice with different severity of hepatic SOS, MRI was randomly performed on 2 and 6 days after administration of MCT.
MRI protocols
All examinations were carried out on a 3.0 T MRI scanner (Verio; Siemens Medical Solutions, Erlangen, Germany). During the examination, each mouse was placed in a prone position with a mouse coil and the abdomen of the mouse was restrained with a belt to minimize the effects of respiratory movement: (1) T1 mapping were obtained before and 20 minutes after the tail vein injection of 0.1 mL/kg gadoxetic acid (Primovist; Bayer Schering Pharma AG, Berlin, Germany), by using a dual flip angle 3D gradient echo sequence with volumetric interpolation breath-holding examination sequence (VIBE): Repetition time (TR), 5.32 millisecond; echo time (TE), 1.73 millisecond; flip angle, 2° and 12°; field of view (FOV), 108 mm; matrix, 160 × 160; slice thickness, 1.5 mm; and R factor, 2; and (2) Dynamic contrast-enhanced (DCE) MRI was performed as the same time as the start of contrast injection, using T1-weighted fast dynamic VIBE: TR, 6.64 millisecond; TE, 1.53 millisecond; flip angle, 9°; FOV, 108 mm; slice thickness, 1.5 mm; R factor, 2; 48 consecutive acquisitions over a period of 6:04 minutes.
Image analysis
All MRI datasets were transmitted to a workstation (Leonardo; Siemens). For T1 mapping, three regions of interest (ROIs) were chosen at the same locations in the liver parenchyma of the pre- and post-T1 maps (Figure 1). Each ROI was excluded blood vessels and the margin of liver, and the mean value was taken as the representative of the T1 relaxation time. All MRIs were measured by a radiologist with 15 years’ abdominal imaging experience, who was double-blind to the animal groups and pathology results. The MRI analyses were as follows: (1) Reduction rate of T1 relaxation time (ΔT1%) was quantified as 100% × (T1pre - T1post)/T1pre, where T1pre and T1post respectively refers T1 relaxation time before and after enhancement; and (2) The first rapid enhancement slope percentage (ESP) in the liver parenchyma was quantified as [(SI1st - SIbase)/SIbase] × △T × 100%; where SIbase referred to the mean signal value obtained in the first two images after a dynamic enhanced scan; SI1st was the maximum value in the liver parenchyma reached in the first perfusion on the time-signal curve; and △T denoted the interval of time from SIbase to SI1st. These data were calculated in custom software on a postprocessing workstation (Mean Curve, Syngo MR B17; Siemens). The same ROIs were selected in the liver parenchyma as those in T1 mapping. The time-signal curve for the liver parenchyma was also constructed using this software (Figure 2).
Figure 1 Regions of interest in the same area in the liver parenchyma before and after enhancement in the same C57BL/6 mouse.
A: Before enhancement in the same C57BL/6 mouse; B: After enhancement in the same C57BL/6 mouse. 1The region of interest in the middle hepatic lobe are delineated to avoid blood vessels within the liver parenchyma; 2The region of interest in the right hepatic lobe are delineated to avoid blood vessels within the liver parenchyma; 3The region of interest in the right hepatic lobe are delineated to avoid blood vessels within the liver parenchyma.
Figure 2 Liver parenchyma time–signal curve: The x axis represents the time axis, and the y axis represents T1 relaxation time, and the slope represents the first rapid enhancement slope percentage.
The three lines represent the values of the three regions of interest (ROIs). We selected the same ROIs in the liver parenchyma for T1 mapping.
Laboratory and histological analysis
After MRI, the mice were anesthetized and humanely killed by cervical dislocation, and blood samples were collected. An upper portion of serum was collected after centrifugation, total bilirubin and albumin levels were determined, and an albumin and bilirubin score (ALBI) was calculated as log10 bilirubin (μmol/L)´ 0.66 + albumin (g/L)´ - 0.085. The liver samples were stained with hematoxylin-eosin (HE) and Masson’s dye to examine pathological changes in hepatic structure and to evaluate hepatic SOS. The hepatic SOS histological scores were assessed by a pathologist blinded to the group assignments and imaging results. Histological features of hepatic SOS included sinusoidal hemorrhage, lobular inflammation, endothelial damage to the central vein, subendothelial hemorrhage in the central vein, centrilobular fibrosis, and coagulation necrosis of hepatocytes. Each feature was rated on a four-point scale via consensus (0 = absent; 1 = mild; 2 = moderate; and 3 = severe). We calculated the final pathology score by summing the individual scores of the six features.
OATP1 detection
Western blotting was performed to quantify OATP levels: (1) Protein extraction: The liver specimen was washed with ice-cold phosphate buffer three times, and an appropriate amount of lysis buffer was supplemented with benzyl sulfonyl fluoride to a final concentration of 1 mmol/L. Lysis buffer (100 μL) was added per 10 mg tissue; the mixture was shaken for 2 minutes in a 4-gauge homogenizer until full disintegration; and the supernatant was collected after 5 minutes of centrifugation at 10000 g; (2) Protein quantification: A human BCA working solution was prepared by mixing reagents A and B of the BCA Protein Quantitative Kit (Beyotime, Shanghai) at a volume ratio of 50:1. An appropriate amount of each liver tissue sample was placed into a 1.5 mL centrifuge tube; isosmotic saline was added to obtain a total volume of 100 μL; and 1 mL human BCA working solution was added. The protein concentration was calculated from the standard curve; (3) PAGE: This assay was carried out on a Bole electrophoresis apparatus (Bio-Rad, Hercules, CA, United States). The protein samples (lysates) were electrophoresed until the dye reached the top of the separation gel at a constant voltage of 120 V, and when bromophenol blue was just out of the loading gel, they were electrophoresed at a constant voltage of 160 V; and (4) Immunoassay: After a fresh sealing solution was prepared, skimmed milk powder was added to Tris-buffered saline supplemented with 0.05% of Tween 20 (TBST) to a final concentration of 0.05 kg/L. A diluted primary antibody was incubated with the samples overnight at 4 °C. The type and concentration of the antibody were as follows: A rabbit anti-mouse OATP1 antibody and the dilution ratio of 1:1000.
Statistical analysis
Descriptive statistics were calculated for MRI parameters, ALBI and OATP1 levels, and were presented as mean ± SD. Statistical significance was performed by using the student’s t test between groups. Spearman’s rank correlation coefficient was calculated to evaluate the correlation between histological scores and individual MRI parameters, ALBI. The correlation between individual MRI parameters, ALBI and OATP1 Levels was assessed using Pearson’s correlation. P < 0.05 was considered statistically significant. All data analyses were performed SPSS 26 (IBM Corp., Armonk, NY, United States).
RESULTS
Animal models
One mouse died during the experiment period; therefore, there were 13 mice in the experimental group. In the HE and Masson staining findings, sinusoidal hemorrhage and endothelial damage to the central vein were noted in each mouse in the experimental group, whereas there was no endothelial damage in the control group. Table 1 summarizes the results of the histopathological examination. Typical samples from the experimental groups are shown in Figure 3. Table 2 presents the correlations between MRI parameters and the total histological scores. T1pre showed no correlation with the total histological score (r = 0.37, P = 0.095), T1post had a negative correlation with the total histological score of hepatic SOS (r = -0.70,P < 0.001), whereas ΔT1% and ESP (r = 0.68, 0.79, P < 0.001) significantly increased with the total histological of hepatic SOS. ALBI was also decreased with the total histological of hepatic SOS (r = -0.76, P < 0.001).
Figure 3 Hematoxylin and eosin staining (400 ×).
Histological findings of monocrotaline mouse models, the liver specimen demonstrates sinusoidal hemorrhage and hepatocytes necrosis, which are characteristic findings of sinusoidal obstruction syndrome. The triangle represents the central vein, the white arrow indicates dilated hepatic sinusoids hemorrhage, and the black arrow indicates hepatocyte necrosis.
Table 1 Histological features in sinusoidal obstruction syndrome.
No.
Central vein endothelial damage
Central vein subendothelial hemorrhage
Sinusoidal hemorrhage
Lobular inflammation
Hepatocyte necrosis
Centrilobular fibrosis
All scores
1
2
1
2
1
0
0
6
2
0
1
1
0
0
0
2
3
1
1
1
1
0
0
4
4
1
1
1
0
0
0
3
5
0
1
1
0
0
2
2
6
1
0
0
1
0
0
2
7
1
0
0
0
0
0
1
8
1
1
0
1
1
1
5
9
1
1
1
1
0
1
5
10
2
2
1
1
1
1
8
11
1
2
1
1
0
1
6
12
1
2
2
1
1
1
8
13
2
3
3
3
0
0
11
Table 2 Correlations between magnetic resonance imaging, albumin bilirubin, and total histological score.
T1pre
T1post
△T1%
ESP
ALBI
r
0.37
-0.70
0.68
0.79
-0.76
P value
0.095
< 0.001
< 0.001
< 0.001
< 0.001
Comparisons of MRI parameters and ALBI between the control and experimental groups
Table 3 and Figure 4 show the comparisons of MRI parameters and ALBI between the control and experimental groups. Among the MRI parameters, T1pre showed no significant difference between the control and experimental groups, whereas T1post, ΔT1%, and ESP did. The SOS-mice had a significantly lower T1post than the normal mice had (P < 0.001), and the difference in mean T1post between the control and experimental groups was 288 milliseconds; ΔT1% and ESP were significantly higher in the SOS than in the control group (P < 0.001, P < 0.001), and the difference between the groups was 46.56% and 15.53%, respectively. ALBI also significantly differed between the control and experimental groups.
Figure 4 Box plots in control and experimental groups.
A: Box plots of T1 relaxation time before enhancement (T1pre); B: T1 relaxation times 20 minutes after enhancement (T1post); C: The reduction of T1 relaxation time (△T1%); D: The first enhancement slope percentage of the liver parenchyma in control and experimental groups. T1pre: T1 relaxation time before enhancement; T1post: T1 relaxation time 20 minutes after enhancement; △T1%: Reduction rate of T1 relaxation time; ESP: The first enhancement slope percentage in liver parenchyma.
Table 3 Magnetic resonance imaging and albumin/bilirubin in control and experimental groups.
Parameters
Control group (n = 10)
Experimental group (n = 13)
P value
T1pre (millisecond)
659.13 ± 24.07
681.57 ± 40.58
0.137
T1post (millisecond)
408.87 ± 27.21
120.48 ± 53.71
< 0.001
△T1%
37.84 ± 5.46
82.40 ± 7.62
< 0.001
ESP
4.14 ± 0.95
19.67 ± 12.12
< 0.001
ALBI
0.95 ± 0.04
0.12 ± 0.89
< 0.001
OATP1 Levels between the control and experimental groups
The levels of OATP1 in the control and experimental groups were 29952 ± 11475 and 422060 ± 178634, which was a significant difference (P < 0.001).
Correlations of MRI parameters, ALBI and OATP1 levels
In Pearson’s correlation analysis, T1pre showed no correlation with OATP1 (r = 0.06, P = 0.457). ΔT1% and ESP were strongly positively correlated with OATP1 levels (r = 0.82, 0.85, respectively; P < 0.001), whereas T1post was negatively correlated with OATP1 levels (r = -0.83; P < 0.001; Table 4). In addition, ALBI exhibited a moderate negative correlation with OATP1 Levels (r = -0.56; P = 0.005).
Table 4 Correlation between magnetic resonance imaging, albumin/bilirubin and organic transporter polypeptide 1.
r
P value
T1pre
-0.06
0.803
T1post
-0.83
< 0.001
△T1%
0.82
< 0.001
ESP
0.85
< 0.001
ALBI
-0.56
0.005
DISCUSSION
In this study, we used a mouse model of MTC-induced hepatic SOS. We confirmed the relationship between MRI parameters T1post, △T1% and ESP and hepatic SOS, suggesting a potential method for the assessment of hepatic SOS. Our results also demonstrated that MRI parameters were correlated with OATP1 levels.
We showed that T1post and △T1% had significant differences between the control and experimental groups and were associated with total histological score. Several previous studies[29,30] have reported that T1 mapping on gadoxetic acid-enhanced MRI could reflect the liver function in rats with hepatic fibrosis and found that T1post and △T1% could be better than apparent diffusion coefficient for assessing the rate of liver necro-inflammatory activity and stage of liver fibrosis. Yang et al[28] showed that T1 relaxation time and △T1% might be a sensitive tool for diagnosis of oxaliplatin-induced liver injury by using gadoxetic acid-enhanced MRI. However, they did not explore the relationship between OATP1 Levels and MRI parameters. After injection, gadoxetic acid is gradually taken into the liver parenchyma through OATP1 on the hepatocyte membranes. Our experimental group also found that T1post and △T1% were correlated with expression of OATP1, which was consistent with the literature. Previous studies[31,32] have confirmed that OATP1a1 measurement had a negative correlation with gadoxetic acid in liver fibrosis rats caused by carbon tetrachloride. A recent case[32] reported a patient with hepatic SOS, indicating that changes in expression of OATP seem to be related to the appearance of a low signal in the hepatobiliary phase. These results indicate that T1post and △T1% are reliable methods for diagnosis of hepatic SOS. Gadoxetic acid-enhanced MRI could be applied clinically to examine hepatic SOS in colorectal cancer patients treated with oxaliplatin prior to liver surgery.
In addition to T1post and △T1%, our findings suggested that ESP was helpful for the evaluation of hepatic SOS. ESP exhibited a significant difference between the experimental and control mice. Both animal and human studies have demonstrated the potential of perfusion parameters acquired from DCE-MRI with gadoxetic acid in the assessment of liver function and fibrosis[33,34]. However, the analysis of hepatic DCE-MRI involves complex mathematical modeling, and no model has been generally accepted at present[35]. We calculated ESP to evaluate hemodynamic changes in the liver, which could be easily adapted to clinical practice. Previous research found that ESP of the liver could assess bile duct ligation caused by cholestatic liver injury and has diagnostic efficacy[36]. Our data showed that the ESP was significantly higher in SOS than in the control liver. These findings were consistent with several previous research[36,37]. Chen et al[37] found that arterial fraction was elevated with the severity of liver fibrosis by using DCE-MRI with gadoxetic acid-enhanced MRI in patients with chronic hepatitis. Wu et al[38] also showed that the fraction of hepatic arterial blood volume increased with severity of nonalcoholic fatty liver disease or in fibrotic liver. Based on the results of our study and previous literature, we hypothesized that hepatic SOS might increase blood flow in the damaged liver. Nevertheless, further studies are required to explain this phenomenon.
ALBI grade is a newly proposed, simple, and significant tool for assessment of liver function[39]. Our data revealed the ALBI scores of SOS were significantly different from the ALBI score of the normal liver. A recent study showed mathematical combinations with ALBI were able to identify chemotherapy-associated liver injury[40], which supports that ALBI might be a noninvasive tool for detecting hepatic SOS. Nevertheless, ALBI reflected the whole-liver function, while gadoxetic acid-enhanced MRI could provide information of regional liver function. Zhou et al[41] indicated that T1mapping based on gadoxetic acid-enhanced MRI could be used to assess the function of hepatic segments. This suggested that gadoxetic acid-enhanced MRI could better reflect liver function than laboratory examination index.
There are other imaging techniques that have been suggested to be helpful for detecting hepatic SOS. For example, Park et al[42] confirmed the potential of acoustic-radiation-pulsed elastography for diagnosis, severity evaluation and follow-up of hepatic SOS in animal models. However, the application of ultrasound elastography has limitations and the results rely more on the subjective judgment of the examiners. Hong et al[19] and Lyu et al[20] respectively demonstrated the traditional double-exponential Gaussian model and non-Gaussian model to diagnose the severity of hepatic SOS. Compared with other tools, gadoxetic acid-enhanced MRI also can detect chemotherapy-related focal nodular hyperplasia-like lesions and accurately identify liver metastases, and it can allow “one-stop shopping” in one examination.
There were some limitations to our research. First, our study involved MCT-induced SOS, which was considered as a reproducible animal model, rather than clinical oxaliplatin-induced SOS. Second, the sample size was small; however, T1post and △T1% were significantly associated with the severity of hepatic SOS. A large sample size study on humans should be researched to confirm these results.
CONCLUSION
In conclusion, our findings suggest that T1 mapping on gadoxetic acid-enhanced MRI was suitable for detecting hepatic SOS. In addition, we conclude that T1 relaxation time correlated with OATP1.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade B
Creativity or Innovation: Grade B
Scientific Significance: Grade A
P-Reviewer: Sijens PE S-Editor: Li L L-Editor: A P-Editor: Zhang L
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