Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can be used as an imaging-based liver function test. This study aims to further corroborate its validity.
Purpose
To compare Gd-EOB-DTPA-enhanced MRI as an imaging-based liver function test with the 13C-methacetin breath test.
Material and Methods
Fifty-three patients who underwent Gd-EOB-DTPA-enhanced MRI T1 relaxometry before and 20 min after intravenous Gd-EOB-DTPA administration as well as a 13C-methacetin breath test (LiMAx test) were retrospectively analyzed. T1 relaxation times of liver parenchyma, total liver volume (TLV), and functional liver volume (FLV) were determined. Pearson correlations, multiple linear regression analysis, and receiver operating characteristic curve analysis were performed with indices derived from T1 relaxometry, liver volumetry, and laboratory parameters to identify the best predictor of liver function as determined by the LiMAx test.
Results
T1 reduction rate (T1 RR), T1 RR × TLV, T1 RR × FLV, and T1 relaxation time 20 min after intravenous Gd-EOB administration showed a statistically significant correlation with LiMAx and discriminatory capacity between patients with LiMAx of > and < 315 µg/kg/h. Of the indices investigated, T1 RR showed the best discriminatory capacity and proved to be the only statistically significant parameter in multiple linear regression analysis.
Conclusion
Gd-EOB-DTPA-enhanced MRI as an imaging-based liver function test also correlates with the LiMAx test which in turn reflects cytochrome P450 function. The T1 reduction rate of the liver on Gd-EOB-DTPA-enhanced MRI allows prediction of liver function as determined by the LiMAx test both for 1.5 and 3.0 T.
SeyamaYKokudoN.Assessment of liver function for safe hepatic resection.Hepatol Res2009;
39:107–116.
2.
KatsubeTOkadaMKumanoS, et al.
Estimation of liver function using T2* mapping on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging.Eur J Radiol2012;
81:1460–1464.
3.
TamadaTItoKHigakiA, et al.
Gd-EOB-DTPA-enhanced MR imaging: evaluation of hepatic enhancement effects in normal and cirrhotic livers.Eur J Radiol2011;
80:e311–316.
4.
SaitoKLedsamJSourbronS, et al.
Assessing liver function using dynamic Gd-EOB-DTPA-enhanced MRI with a standard 5-phase imaging protocol.J Magn Reson Imaging2013;
37:1109–1114.
5.
BesaCBaneOJajamovichG, et al.
3D T1 relaxometry pre and post gadoxetic acid injection for the assessment of liver cirrhosis and liver function.Magn Reson Imaging2015;
33:1075–1082.
6.
YoonJHLeeJMPaekM, et al.
Quantitative assessment of hepatic function: modified look-locker inversion recovery (MOLLI) sequence for T1 mapping on Gd-EOB-DTPA-enhanced liver MR imaging.Eur Radiol2016;
26:1775–1782.
7.
YoonJHLeeJMKimE, et al.
Quantitative liver function analysis: volumetric T1 mapping with fast multisection B1 inhomogeneity correction in hepatocyte-specific contrast-enhanced liver MR imaging.Radiology2017;
282:408–417.
8.
VerlohNHaimerlMZemanF, et al.
Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla.Eur Radiol2014;
24:1013–1019.
9.
HaimerlMVerlohNFellnerC, et al.
MRI-based estimation of liver function: Gd-EOB-DTPA-enhanced T1 relaxometry of 3T vs. the MELD score.Sci Rep2014;
4:5621.
10.
HinrichsHHinrichsJBGutberletM, et al.
Functional gadoxetate disodium-enhanced MRI in patients with primary sclerosing cholangitis (PSC).Eur Radiol2016;
26:1116–1124.
11.
UtsunomiyaTShimadaMHanaokaJ, et al.
Possible utility of MRI using Gd-EOB-DTPA for estimating liver functional reserve.J Gastroenterol2012;
47:470–476.
12.
YamadaAHaraTLiF, et al.
Quantitative evaluation of liver function with use of gadoxetate disodium-enhanced MR imaging.Radiology2011;
260:727–733.
13.
YoonJHChoiJIJeongYY, et al.
Pre-treatment estimation of future remnant liver function using gadoxetic acid MRI in patients with HCC.J Hepatol2016;
65:1155–1162.
14.
MotosugiUIchikawaTOguriM, et al.
Staging liver fibrosis by using liver-enhancement ratio of gadoxetic acid-enhanced MR imaging: comparison with aspartate aminotransferase-to-platelet ratio indexMagn Reson Imaging. 2011;
29:1047–1052.
15.
WatanabeHKanematsuMGoshimaS, et al.
Staging hepatic fibrosis: comparison of gadoxetate disodium-enhanced and diffusion-weighted MR imaging–preliminary observations.Radiology2011;
259:142–150.
16.
ChenBBHsuCYYuCW, et al.
Dynamic contrast-enhanced magnetic resonance imaging with Gd-EOB-DTPA for the evaluation of liver fibrosis in chronic hepatitis patients.Eur Radiol2012;
22:171–180.
17.
NishieAUshijimaYTajimaT, et al.
Quantitative analysis of liver function using superparamagnetic iron oxide- and Gd-EOB-DTPA-enhanced MRI: comparison with Technetium-99m galactosyl serum albumin scintigraphy.Eur J Radiol2012;
81:1100–1104.
18.
NakagawaMNamimotoTShimizuK, et al.
Measuring hepatic functional reserve using T1 mapping of Gd-EOB-DTPA enhanced 3T MR imaging: A preliminary study comparing with 99mTc GSA scintigraphy and signal intensity based parameters.Eur J Radiol2017;
92:116–123.
19.
SaitoKLedsamJSourbronS, et al.
Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI: a preliminary study comparing galactosyl human serum albumin scintigraphy with indocyanine green retentionEur Radiol2014;
24:112–119.
20.
UnalEAkataDKarcaaltincabaM.Liver function assessment by magnetic resonance imaging.Semin Ultrasound CT MR2016;
37:549–560.
21.
Geisel D, Ludemann L, Keuchel T, et al. Increase in left liver lobe function after preoperative right portal vein embolisation assessed with gadolinium-EOB-DTPA MRI. Eur Radiol 2013;23:2555–2560.
22.
Geisel D, Ludemann L, Hamm B, et al. Imaging-Based Liver Function Tests--Past, Present and Future. Rofo 2015;187:863–871.
23.
HaimerlMVerlohNZemanF, et al.
Gd-EOB-DTPA-enhanced MRI for evaluation of liver function: Comparison between signal-intensity-based indices and T1 relaxometry.Sci Rep2017;
7:43347.
24.
KatsubeTOkadaMKumanoS, et al.
Estimation of liver function using T1 mapping on Gd-EOB-DTPA-enhanced magnetic resonance imaging.Invest Radiol2011;
46:277–283.
25.
KamimuraKFukukuraYYoneyamaT, et al.
Quantitative evaluation of liver function with T1 relaxation time index on Gd-EOB-DTPA-enhanced MRI: comparison with signal intensity-based indices.J Magn Reson Imaging2014;
40:884–889.
26.
YoneyamaTFukukuraYKamimuraK, et al.
Efficacy of liver parenchymal enhancement and liver volume to standard liver volume ratio on Gd-EOB-DTPA-enhanced MRI for estimation of liver function.Eur Radiol2014;
24:857–865.
27.
HaimerlMSchlabeckMVerlohN, et al.
Volume-assisted estimation of liver function based on Gd-EOB-DTPA-enhanced MR relaxometry.Eur Radiol2016;
26:1125–1133.
28.
Stockmann M, Lock JF, Riecke B, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 2009;250:119–125.
NassifAJiaJKeiserM, et al.
Visualization of hepatic uptake transporter function in healthy subjects by using gadoxetic acid-enhanced MR imaging.Radiology2012;
264:741–750.
31.
JiaJKeiserMNassifA, et al.
A LC-MS/MS method to evaluate the hepatic uptake of the liver-specific magnetic resonance imaging contrast agent gadoxetate (Gd-EOB-DTPA) in vitro and in humans.J Chromatogr B Analyt Technol Biomed Life Sci2012;
891–892:20–26.
32.
JaraMBednarschJValleE, et al.
Reliable assessment of liver function using LiMAx.J Surg Res2015;
193:184–189.
33.
Malinowski M, Jara M, Luttgert K, et al. Enzymatic liver function capacity correlates with disease severity of patients with liver cirrhosis: a study with the LiMAx test. Dig Dis Sci 2014;59:2983–2991.
34.
RubinTMHeyneKLuchterhandA, et al.
Kinetic validation of the LiMAx test during 10 000 intravenous (13)C-methacetin breath tests.J Breath Res2017;
12:016005.
35.
LockJFWestphalTRubinT, et al.
LiMAx test improves diagnosis of chemotherapy-associated liver injury before resection of colorectal liver metastases.Ann Surg Oncol2017;
24:2447–2455.
36.
Jara M, Malinowski M, Luttgert K, et al. Prognostic value of enzymatic liver function for the estimation of short-term survival of liver transplant candidates: a prospective study with the LiMAx test. Transpl Int 2015;28:52–58.
37.
Stockmann M, Lock JF, Malinowski M, et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 2010;12:139–146.
38.
Jara M, Reese T, Malinowski M, et al. Reductions in post-hepatectomy liver failure and related mortality after implementation of the LiMAx algorithm in preoperative work-up: a single-centre analysis of 1170 hepatectomies of one or more segments. HPB (Oxford) 2015;17:651–658.
39.
de BazelaireCMDuhamelGDRofskyNM, et al.
MR imaging relaxation times of abdominal and pelvic tissues measured in vivo at 3.0 T: preliminary results.Radiology2004;
230:652–659.
40.
ShenYGoernerFLSnyderC, et al.
T1 relaxivities of gadolinium-based magnetic resonance contrast agents in human whole blood at 1.5, 3, and 7 T.Invest Radiol2015;
50:330–338.
41.
Hajian-TilakiK.Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation.Caspian J Intern Med2013;
4:627–635.
42.
OkadaMMurakamiTKuwatsuruR, et al.
Biochemical and clinical predictive approach and time point analysis of hepatobiliary phase liver enhancement on Gd-EOB-DTPA-enhanced MR images: a multicenter study.Radiology2016;
281:474–483.
43.
ZhouZPLongLLQiuWJ, et al.
Comparison of 10- and 20-min hepatobiliary phase images on Gd-EOB-DTPA-enhanced MRI T1 mapping for liver function assessment in clinic.Abdom Radiol (NY)2017;
42:2272–2278.
