Hepatobiliary phase images using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI as an imaging surrogate for the albumin-bilirubin grading system

Characterization of the evaluation method for hepatobiliary phase image by liver magnetic resonance imaging using Gd-EOB-DTPA

PURPOSE

This study aimed to characterize quantitative liver-spleen contrast (Q-LSC) and hepatocellular uptake index (HUI) for evaluating hepatobiliary phase (HBP) images using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) in liver magnetic resonance imaging and to identify differences in the results obtain from these two measurement methods.

METHODS

Twenty-nine consecutive randomly selected patients were assessed using the 3.0 T MR system. Three regions of interest (ROI) were set for the liver parenchyma and spleen, and signal intensity (SI) was averaged. Q-LSC (SI of the liver divided by the SI of the spleen) and HUI [(Q-LSC-1) × liver volume] were calculated. Moreover, the volume and mean SI of the whole liver and spleen, left lateral segment (LLS), and the other segments were calculated. Subsequently, ROI-based and volume-based values for Q-LSC (R-LSC and V-LSC) and HUI (R-HUI and V-HUI), and the whole and each segment were compared.

RESULTS

R-LSC and V-LSC for the whole and each segment were not significantly different. Conversely, all combinations of HUI, except between R-HUI and V-HUI were significantly different (P < 0.01), for the whole liver. Correlations between R-LSC, R-HUI, and volume-based LLS were lower than the others.

CONCLUSION

Q-LSC and HUI were characterized through an imaging evaluation of HBP with Gd-EOB-DTPA. R-LSC and R-HUI, or V-HUI, of the whole liver were strongly correlated, but the LLS affected the data, and HUI depends on liver volume. R-LSC is simple and easy to use for HBP evaluation.

Predicting post-hepatectomy liver failure with T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI: comparison with the indocyanine green clearance test and albumin-bilirubin scoring system

OBJECTIVES

To explore the value of T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI for predicting post-hepatectomy liver failure (PHLF).

METHODS

Consecutive patients from March 2016 to March 2018 who underwent gadoxetic acid-enhanced MRI in our hospital were retrospectively analyzed, and 37 patients were enrolled. Whole-liver T1 mapping-based histogram analysis was performed. The indocyanine green (ICG) clearance tests were performed, and albumin-bilirubin (ALBI) scores were calculated. Univariate and multivariate binary logistic analyses were performed to identify independent predictors for PHLF. Diagnostic performance was evaluated with ROC analysis. Histogram-extracted parameters were also associated with the ICG test and ALBI scoring system.

RESULTS

In enrolled 37 patients (age 57.19 ± 12.28 years), 28 were male. 35.1% (13/37) of patients developed PHLF. For univariate analysis, pre-contrast T1 relaxation time (T1pre) mean, T1pre 95th percentile, the standard deviation (SD) of T1 relaxation time in hepatobiliary phase (T1HBP SD), T1HBP 95th percentile, T1HBP kurtosis, and ICG percentage retained at 15 min (ICG-R15) showed significant differences between the PHLF and non-PHLF groups (all p < 0.05), whereas the ALBI scores showed no significant differences between the two groups (p = 0.937). Multivariate analysis showed that a higher T1HBP 95th percentile was the independent predictor for PHLF (p < 0.05; odds ratio (OR) = 1.014). In addition, most of the histogram-extracted parameters showed significant correlations to the ICG test.

CONCLUSIONS

T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI is valuable for PHLF prediction and risk stratification, which outperformed the ICG clearance test and ALBI scoring system.

KEY POINTS

Question What is the value of T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI for PHLF? Findings The histogram parameters extracted from gadoxetic acid-enhanced T1 mapping manifested potential for grading liver function preoperatively. Clinical relevance T1 mapping-based whole-liver histogram analysis on gadoxetic acid-enhanced MRI can serve as a convenient one-station radiological tool to help identify potential PHLF risks within the preoperative clinical decision-making framework.

Radiomic analysis using T1 mapping in gadoxetic acid disodium-enhanced MRI for liver function assessment

OBJECTIVES

To explore the value of a T1 mapping-based radiomic model for evaluating liver function.

METHODS

From September 2020 to October 2022, 163 patients were retrospectively recruited and categorized into normal liver function group, chronic liver disease group without cirrhosis, Child‒Pugh class A group, and Child‒Pugh class B and C group. Patients were randomly split into training and testing sets. Radiomic features were extracted from T1 mapping images taken both pre- and post-contrast injection, as well as during the hepatobiliary phase (HBP). Radiomic models were constructed to stratify chronic liver disease, cirrhosis and decompensated cirrhosis. Model performance was assessed with receiver operating characteristic curve analysis, and decision curve analysis.

RESULTS

The K-Nearest Neighbors model demonstrated the best generalization across native T1 map, HBP T1 maps and HBP images. In the training set, based on native T1 maps, it achieved accuracies of 0.83, 0.86, and 0.86 in distinguishing chronic liver disease, cirrhosis, and decompensated cirrhosis, with corresponding AUCs of 0.92, 0.92, and 0.95. In the testing set, the accuracies were 0.75, 0.89, and 0.71, with AUCs of 0.79, 0.92, and 0.83, respectively. When using HBP images with T1 maps, the accuracies were 0.72, 0.90, and 0.72 in the testing set in identifying chronic liver disease, cirrhosis, and decompensated cirrhosis with AUCs of 0.82, 0.93, and 0.79, respectively.

CONCLUSION

Radiomic analysis based on native T1 map, and HBP with or without T1 map images shows promising potential for liver function assessment, particularly in distinguishing cirrhosis.

Can bile excretion on Gd-EOB-MRI be used as a visual criterion for the hepatobiliary phase?

To determine whether visually observed biliary excretion of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) can be used to assess contrast adequacy of hepatobiliary phase (HBP) images. Images of 121 patients undergoing Gd-EOB-DTPA-enhanced magnetic resonance imaging were used. Adequate HBP images were defined as a quantitative liver-spleen contrast ratio (Q-LSC) ≥ 1.5. Visual evaluation was performed to determine if an adequate HBP image could be obtained based on the presence or absence of bile excretion. Common bile duct-paravertebral contrast (CPC) was used to assess the degree of bile excretion, the albumin-bilirubin (ALBI) grade was used to assess liver reserve, and the Q-LSC was used to assess HBP image contrast. The results were used to quantitatively evaluate the relationships of the degree of bile excretion with HBP image contrast and liver reserve. The cases correctly determined by visual evaluation via bile excretion were 80 (66.1%) at HBP 10 min after injection and 89 (73.6%) at HBP 20 min after injection. Among cases with Q-LSC ≥ 1.5 indicating bile excretion, there were 33 cases at HBP 10 min after injection and 86 cases at HBP 20 min after injection. Furthermore, among cases with Q-LSC < 1.5, indicating no bile excretion, there were 47 cases at HBP 10 min after injection and 3 cases at HBP 20 min after injection. Visually observed biliary excretion of Gd-EOB-DTPA is not a criterion for adequate HBP image contrast.

Quantitative and qualitative evaluation of high-quality hepatobiliary phase imaging with shortened timing and utility in patients with compromised liver function

PURPOSE

To compare high flip angle (FA) hepatobiliary-phase (hHBP) imaging with variable time intervals to conventional HBP (cHBP) to assess the impact of increased FA on image quality in shortened HBP imaging.

METHODS

Data from 218 patients, divided into normal liver group (n = 184) and decompensated liver group (n = 34), who underwent liver magnetic resonance imaging (MRI) including 10-min, 15-min, 20-min hHBP, and cHBP were analyzed. Signal-to-noise ratio (SNR), contrast-ratio (CR), contrast-to-noise ratio (CNR), signal intensity ratios (SIRs), and relative enhancement (RE) of the liver were calculated for quantitative analysis. Sharpness, noise, and artifacts of the image, contrast media visibility, overall image quality, and lesion conspicuity were evaluated by two abdominal radiologists.

RESULTS

Quantitative analysis showed that SNR, RE, SIR for liver/muscle, liver/spleen, and CR of all hHBP images demonstrated a significantly higher value compared to cHBP images in the normal liver group (p < 0.001). These values were also superior in the normal liver group compared to the decompensated liver group (p < 0.01). In qualitative analysis, both normal and decompensated liver groups exhibited significantly superior image sharpness in all hHBP images compared to cHBP images and the overall image quality of the 15-min and 20-min hHBP did not show significant difference compared to cHBP. All values tended to be better in the normal liver group than the decompensated liver group with statistical significance except for lesion conspicuity (p < 0.01).

CONCLUSION

High-FA HBP has proven to be a valuable image acquisition method, potentially shortening liver MR imaging time while maintaining acceptable image quality.

Comparison of the efficacy of the gadoxetic acid MRI-derived relative enhancement index (REI) and functional liver imaging score (FLIS) in predicting liver function: validation with Albumin-Bilirubin (ALBI) grade

PURPOSE

This study compared the predictive performance of the relative enhancement index (REI) derived from gadoxetic acid (GA)-enhanced MRI with that of the functional liver imaging score (FLIS) in estimating liver function among patients with chronic liver disease (CLD) or liver cirrhosis (LC) by validating them with the albumin-bilirubin (ALBI) grade.

MATERIALS AND METHODS

We retrospectively examined 166 patients (79 women, 87 men; 57.4 years) who were diagnosed with LC or CLD and underwent GA-enhanced MRI between August 2020 and September 2023. The enhancement ratio (ER) is calculated using the formula: ER = [hepatobiliary phase liver signal (SI HBP20)-precontrast liver signal (SI pre)]/SI pre. The REI is calculated using the formula: REI = Liver Volume (LV) × ER. FLIS was assigned from the sum of three HBP image features, each scored between 0 and 2: liver parenchymal enhancement, biliary contrast excretion, and portal vein sign. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff values of ER, REI, and FLIS in differentiating between ALBI grades. The area under the curve (AUC), accuracy, sensitivity, and specificity were calculated for REI and FLIS to distinguish the ALBI grades. Spearman's rank correlation was used to evaluate the ER, REI, and FLIS correlations between the ALBI grades. To evaluate inter-reader reliability for LV, ER, REI, and FLIS, intraclass correlation coefficient (ICC) was used.

RESULTS

ROC curve analysis showed that the optimal cutoff value of REI for predicting ALBI Grade 1 was 899-905 for readers 1 and 2 and 461-477 for ALBI Grade 3, respectively. REI performed best in predicting ALBI Grade 1, achieving an accuracy range of 94%-92.2%, sensitivity of 94.9%-94.1%, and specificity of 91.7%-87.5% for readers 1 and 2, respectively. All parameters showed high accuracy in distinguishing ALBI Grade 3 from other grades. However, REI outperformed the others, showing an accuracy range of 98.8%-97.6%, sensitivity of 94.4%-94.4%, and specificity of 99.3%-98% for readers 1 and 2, respectively. REI showed the best and very strong correlation with ALBI for both readers.

CONCLUSION

REI showed a very strong correlation with the ALBI grades for assessing liver function. It outperformed FLIS in predicting the ALBI grades, indicating its potential as a radiologic tool comparable to or better than FLIS in predicting liver function, especially given its dependence on liver volume.

Using AI and Gd-EOB-DTPA-enhanced MR imaging to assess liver function, comparing the MELIF score with the ALBI score

Monitoring disease progression is particularly important for determining the optimal treatment strategy in patients with liver disease. Especially for patients with diseases that have a reversible course, there is a lack of suitable tools for monitoring liver function. The development and establishment of such tools is very important, especially in view of the expected increase in such diseases in the future. Image-based liver function parameters, such as the T1 relaxometry-based MELIF score, are ideally suited for this purpose. The determination of this new liver function score is fully automated by software developed with AI technology. In this study, the MELIF score is compared with the widely used ALBI score. The ALBI score was used as a benchmark, as it has been shown to better capture the progression of less severe liver disease than the MELD and Child‒Pugh scores. In this study, we retrospectively determined the ALBI and MELIF scores for 150 patients, compared these scores with the corresponding MELD and Child‒Pugh scores (Pearson correlation), and examined the ability of these scores to discriminate between good and impaired liver function (AUC: MELIF 0.8; ALBI 0.77) and to distinguish between patients with and without cirrhosis (AUC: MELIF 0.83, ALBI 0.79). The MELIF score performed more favourably than the ALBI score and may also be suitable for monitoring mild disease progression. Thus, the MELIF score is promising for closing the gap in the available early-stage liver disease monitoring tools (i.e., identification of liver disease at a potentially reversible stage before chronic liver disease develops).

The ALBI score: From liver function in patients with HCC to a general measure of liver function

The (albumin-bilirubin) ‘ALBI’ score is an index of ‘liver function’ that was recently developed to assess prognosis in patients with hepatocellular carcinoma, irrespective of the degree of underlying liver fibrosis. Other measures of liver function, such as model for end-stage liver disease (MELD) and Child-Pugh score, which were introduced for specific clinical scenarios, have seen their use extended to other areas of hepatology. In the case of ALBI, its application has been increasingly extended to chronic liver disease in general and in some instances to non-liver diseases where it has proven remarkably accurate in terms of prognosis. With respect to chronic liver disease, numerous publications have shown that ALBI is highly prognostic in patients with all types and stages of chronic liver disease. Outside of liver disease, ALBI has been reported as being of prognostic value in conditions ranging from chronic heart failure to brain tumours. Whilst in several of these reports, explanations for the relationship of liver function to a clinical condition have been proposed, it has to be acknowledged that the specificity of ALBI for liver function has not been clearly demonstrated. Nonetheless, and similar to the MELD and Child-Pugh scores, the lack of any mechanistic basis for ALBI’s clinical utility does not preclude it from being clinically useful in certain situations. Why albumin and bilirubin levels, or a combination thereof, are prognostic in so many different diseases should be studied in the future.

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

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.

Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma

Aims

To investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC).

Design

Patients with advanced HCC from the SORAMIC trial were evaluated in this post hoc analysis. Several radiological imaging features were collected from baseline computed tomography (CT) and magnetic resonance imaging (MRI) imaging, besides clinical values. The prognostic value of these features for OS and LD (grade 2 bilirubin increase) was quantified with univariate Cox proportional hazard models and multivariate Least Absolute Shrinkage and Selection Operator (LASSO) regression.

Results

Three hundred and seventy-six patients were included in this study. The treatment arm was not correlated with OS. LASSO showed satellite lesions, atypical HCC, peritumoral arterial enhancement, larger tumour size, higher albumin–bilirubin (ALBI) score, liver–spleen ratio <1.5, ascites, pleural effusion and higher bilirubin values were predictors of worse OS, and higher relative liver enhancement, smooth margin and capsule were associated with better OS. LASSO analysis for LD showed satellite lesions, peritumoral hypointensity in hepatobiliary phase, high ALBI score, higher bilirubin values and ascites were predictors of LD, while randomisation to sorafenib arm was associated with lower LD.

Conclusions

Imaging features showing aggressive tumour biology and poor liver function, in addition to clinical parameters, can serve as imaging biomarkers for OS and LD in patients receiving sorafenib and selective internal radiation therapy for HCC.

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

OBJECTIVES

To evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study.

METHODS

A total of 359 patients who underwent gadoxetic acid-enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses.

RESULTS

There was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = -0.215; p < 0.001) and AST (rho = -0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = -0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001).

CONCLUSIONS

The liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands.

KEY POINTS

• The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid-enhanced MRI and liver function is consistent in a multicenter-multivendor cohort. • Signal intensity-based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function. • However, absolute values might change between vendors.

Assessment of the cut-off value of quantitative liver-portal vein contrast ratio in the hepatobiliary phase of liver MRI

AIM

To calculate the quantitative liver-portal vein contrast ratio (Q-LPC) cut-off value based on tumour detectability by using receiver operating characteristic (ROC) curves.

MATERIALS AND METHODS

Seventy-four patients with tumours (46 men and 28 women; age, 71 ± 8.1 years), who underwent liver magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) were enrolled. Some patients were found to have multiple tumours. In total, 102 tumour images were evaluated for quantitative liver-spleen contrast ratio (Q-LSC) and Q-LPC 10 minutes after the administration of Gd-EOB-DTPA. Q-LPC and Q-LSC were compared to assess the cut-off values and usefulness. The ROC curve was evaluated using the method for continuously distributed test results, with a free scale of 50 mm. A score of ≥30 out of 50 points was considered good. Cut-off values of Q-LPC and Q-LSC were then calculated. The areas under the ROC curve (AUCs) were also examined and compared.

RESULTS

The AUC-ROC for Q-LPC was 0.858 (95% confidence interval [CI], 0.783-0.933). The cut-off value was determined to be at 1.462. Sensitivity was 0.747, and specificity was 0.852 at the cut-off value. The AUC-ROC for Q-LSC was 0.710 (95% CI, 0.597-0.822). The cut-off value was at 1.543, the sensitivity was 0.560, and the specificity was 0.778 at the cut-off value. A significant difference was noted between the AUCs (p=0.0016).

CONCLUSION

Q-LPC can be used for hepatobiliary phase MRI evaluation.

Prediction of Sufficient Liver Enhancement on the Gadoxetate Disodium-enhanced Hepatobiliary Phase Imaging Using Transitional Phase Images and Albumin-bilirubin Grade

Purpose:

To investigate whether the contrast enhancement effect in hepatobiliary phase (HBP) images can be predicted using transitional phase (3-min delay) images on liver magnetic resonance imaging (MRI) based on the quantitative liver–spleen contrast ratio (Q-LSC) and albumin–bilirubin (ALBI) grade.

Methods:

Overall, 212 patients (124 men and 88 women; mean age 66.7 ± 11.1 years) who underwent blood tests (assessed within 1 month of performing MRI) were included; patients with diffuse tumor, hepatectomy, splenectomy, Gamna–Gandy bodies in the spleen, and movement artifacts were excluded. Q-LSC was calculated using the signal intensity of the liver divided that of the spleen. Q-LSC > 1.5 (cut-off value) indicates a relatively higher sensitivity for detecting of hepatic lesions. To predict the contrast enhancement effect in HBP using Q-LSC of 3-min delay images, Q-LSC of 10- and 15-min delay images were compared for each ALBI grade based on Q-LSC of 3-min delay images. Furthermore, to verify the accuracy of this prediction, the proportion of cases with Q-LSC > 1.5 in 10- and 15 min delay images was calculated based on Q-LSC on 3-min delay images.

Results:

The higher the Q-LSC on the 3-min delay image, the higher was the Q-LSC on its 10- and 15-min delay images. The proportion of cases with Q-LSC > 1.5 in 10- and 15-min delay images was higher for ALBI grade 1 than for ALBI grades 2 and 3 even in the same Q-LSC on 3-min delay images. Q-LSC was <1 in a 3-min delay image and <1.5 in a 15-min delay image in 62.2% of patients with ALBI grade 1 and 82.1% of patients with ALBI grades 2 and 3.

Conclusion:

The liver contrast enhancement effect in HBP images could be predicted using a 3-min delay image based on Q-LSC and ALBI grade.

Inter- and intra-reader agreement for gadoxetic acid-enhanced MRI parameter readings in patients with chronic liver diseases

OBJECTIVES

To examine inter- and intra-observer agreement for four simple hepatobiliary phase (HBP)-based scores on gadoxetic acid (GA)-enhanced MRI and their correlation with liver function in patients with mixed chronic liver disease (CLD).

METHODS

This single-center, retrospective study included 287 patients (62% male, 38% female, mean age 53.5 ± 13.7 years) with mixed CLD (20.9% hepatitis C, 19.2% alcoholic liver disease, 8% hepatitis B) who underwent GA-enhanced MRI of the liver for clinical care between 2010 and 2015. Relative liver enhancement (RLE), contrast uptake index (CUI), hepatic uptake index (HUI), and liver-to-spleen contrast index (LSI) were calculated by two radiologists independently using unenhanced and GA-enhanced HPB (obtained 20 min after GA administration) images; 50 patients selected at random were reviewed twice by one reader to assess intra-observer reliability. Agreement was assessed by intraclass correlation coefficient (ICC). The albumin-bilirubin (ALBI) score, the model of end-stage liver disease (MELD), and the Child-Turcotte-Pugh (CTP) score were calculated as standards of reference for hepatic function.

RESULTS

Intra-observer ICCs ranged from 0.814 (0.668-0.896) for CUI to 0.969 (0.945-0.983) for RLE. Inter-observer ICCs ranged from 0.777 (0.605-0.874) for HUI to 0.979 (0.963-0.988) for RLE. All HBP-based scores correlated significantly (all p < 0.001) with the ALBI, MELD, and CTP scores and were able to discriminate patients with a MELD score ≥ 15 versus ≤ 14, with area under the curve values ranging from 0.760 for RLE to 0.782 for HUI.

CONCLUSION

GA-enhanced, MRI-derived, HBP-based parameters showed excellent inter- and intra-observer agreement. All HBP-based parameters correlated with clinical and laboratory scores of hepatic dysfunction, with no significant differences between each other.

KEY POINTS

• Radiological parameters that quantify the hepatic uptake of gadoxetic acid are highly reproducible. • These parameters can be used interchangeably because they correlate with each other and with scores of hepatic dysfunction. • Assessment of these parameters may be helpful in monitoring disease progression.

Estimating liver function in a large cirrhotic cohort: Signal intensity of gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI

BACKGROUND

To assess whether gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI study is useful to estimate liver function in comparison to the presence or absence of cirrhosis, Child Pugh (CP), Model for End-stage Liver Disease (MELD), ALBI scores and biochemical test.

METHODS

We retrospectively reviewed all consecutive Gd-EOB-DTPA-enhanced-MRI studies performed between 2010 and 2016 in patients with focal liver lesions undergoing clinical evaluation. Patients were divided in study and control group according to the presence of cirrhosis, and then classified by CP, MELD and ALBI. Signal intensity was calculated through the liver-to-muscle ratio in portal- (SI-POR) and hepatobiliary-phase(SI-HEP).

RESULTS

Three-hundred-three Gd-EOB-DTPA liver-enhanced-MRI studies were included. One-hundred-ninety-one patients (63%) were cirrhotic. SI-HEP was significantly lower in cirrhotic group (0.55 ± 0.29 vs 0.66 ± 0.40, p = 0.004).The SI-HEP progressively decreased from CP-A to CP-C (0.59 ± 0.28 to 0.25 ± 0.19, p < 0.0001) and a significant difference was found between MELD ≤ 9 and MELD > 9 groups (0.61 ± 0.31 vs 0.49 ± 0.28, p = 0.007). No differences between ALBI grades were evident. Among biochemical parameters a moderate correlation was found among SI-HEP and total bilirubin, AST and albumin.

CONCLUSION

SI-HEP after Gd-EOB-DTPA-enhanced-MRI effectively stratified patients with different Child Pugh grades and MELD scores. This technique could hence be useful as a novel radiological marker to estimate the underlying liver function.