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Sakai N, Hayano K, Mishima T, Furukawa K, Takayashiki T, Kuboki S, Takano S, Kawasaki Y, Matsubara H, Ohtsuka M. Fat signal fraction assessed with MRI predicts hepatic recurrence following hepatic resection for colorectal liver metastases. Langenbecks Arch Surg 2022; 407:1981-1989. [PMID: 35362752 DOI: 10.1007/s00423-022-02482-z] [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: 10/04/2021] [Accepted: 02/20/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The effect of hepatic steatosis on the development of colorectal liver metastases (CRLM) remains unknown. This study evaluated the usefulness of fat signal fraction assessed with magnetic resonance imaging (MRI) and the effect of hepatic steatosis on hepatic recurrences following initial hepatectomy for CRLM. METHODS Between January 2013 and December 2019, 64 patients underwent initial hepatectomy for CRLM. The medical records of these patients were reviewed to evaluate the recurrence and survival outcomes. RESULTS The fat signal fraction was positively correlated with the nonalcoholic fatty liver disease activity score and liver-spleen ratio. Recurrence following the initial hepatectomy was observed in 48/64 patients, and hepatic recurrence was observed in 30/64 patients. The fat signal fraction was significantly higher in patients with hepatic recurrence after initial hepatectomy. The hepatic recurrence rate was 69.2% in patients with fat signal fraction ≥ 0.0258, which was significantly higher than that in patients with fat signal fraction < 0.0258. Hepatic recurrence-free survival rate was significantly higher in patients with fat signal fraction < 0.0258 than in those with fat signal fraction ≥ 0.0258. Multivariate analyses revealed that fat signal fraction ≥ 0.0258 was an independent risk factor for hepatic recurrence. CONCLUSION The fat signal fraction assessed with MRI was significantly associated with hepatic recurrence following initial hepatectomy for CRLM.
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Affiliation(s)
- Nozomu Sakai
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Mishima
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Katsunori Furukawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tsukasa Takayashiki
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Satoshi Kuboki
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigetsugu Takano
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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Does Hepatic Steatosis Influence the Detection Rate of Metastases in the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI? J Clin Med 2020; 10:jcm10010098. [PMID: 33396634 PMCID: PMC7796028 DOI: 10.3390/jcm10010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this exploratory study was to evaluate the influence of hepatic steatosis on the detection rate of metastases in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). A total of 50 patients who underwent gadoxetic acid-enhanced MRI (unenhanced T1w in- and opposed-phase, T2w fat sat, unenhanced 3D-T1w fat sat and 3-phase dynamic contrast-enhanced (uDP), 3D-T1w fat sat hepatobiliary phase (HP)) were retrospectively included. Two blinded observers (O1/O2) independently assessed the images to determine the detection rate in uDP and HP. The hepatic signal fat fraction (HSFF) was determined as the relative signal intensity reduction in liver parenchyma from in- to opposed-phase images. A total of 451 liver metastases were detected (O1/O2, n = 447/411). O1/O2 detected 10.9%/9.3% of lesions exclusively in uDP and 20.2%/15.5% exclusively in HP. Lesions detected exclusively in uDP were significantly associated with a larger HSFF (area under curve (AUC) of receiver operating characteristic (ROC) analysis, 0.93; p < 0.001; cutoff, 41.5%). The exclusively HP-positive lesions were significantly associated with a smaller diameter (ROC-AUC, 0.82; p < 0.001; cutoff, 5 mm) and a smaller HSFF (ROC-AUC, 0.61; p < 0.001; cutoff, 13.3%). Gadoxetic acid imaging has the advantage of detecting small occult metastatic liver lesions in the HP. However, using non-optimized standard fat-saturated 3D-T1w protocols, severe steatosis (HSFF > 30%) is a potential pitfall for the detection of metastases in HP.
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Gadoxetic Acid-Enhanced Hepatobiliary-Phase Magnetic Resonance Imaging for Delineation of Focal Nodular Hyperplasia: Superiority of High-Flip-Angle Imaging. J Comput Assist Tomogr 2018; 42:667-674. [PMID: 30119067 DOI: 10.1097/rct.0000000000000777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether hepatobiliary-phase (HBP) flip-angle (FA) increase to 25° improves conspicuity of focal nodular hyperplasia (FNH) and enables HBP delay reduction. METHODS This was a retrospective study of 23 patients with 46 FNHs. In each patient, HBP was performed with reduced-delay high FA (early/high), standard-delay high FA (late/high), and standard-delay standard FA (standard). Relative enhancement of liver and FNH periphery, FNH periphery-to-liver contrast ratio, and FNH periphery-to-central scar contrast ratio were compared between each HBP. RESULTS Early/high, late/high, and standard HBPs were performed after 13.00 ± 2.12, 19.12 ± 3.10, and 19.68 ± 3.22 minutes, respectively. Liver and FNH periphery relative enhancement, FNH periphery-to-liver contrast ratio, and FNH periphery-to-central scar contrast ratio were higher for early/high and late/high than for standard HBP (P < 0.001 to P = 0.0048). CONCLUSIONS Increasing FA to 25° improves delineation of FNHs in HBP. Combining FA increase with delay reduction is superior to standard HBP and is sufficient for FNH characterization.
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Usman S, Smith L, Brown N, Major V. Diagnostic accuracy of Magnetic Resonance Imaging using liver tissue specific contrast agents and contrast enhanced Multi Detector Computed Tomography: A systematic review of diagnostic test in Hepatocellular Carcinoma (HCC). Radiography (Lond) 2018; 24:e109-e114. [PMID: 30292515 DOI: 10.1016/j.radi.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The aim of this systematic review is to investigate diagnostic accuracy of Magnetic Resonance Imaging (MRI) scans using liver specific tissue contrast media over contrast enhanced Multi Detector CT (MDCT) in diagnoses of Hepatocellular Carcinoma (HCC) in patients with chronic liver disease. KEY FINDINGS A total of 8 diagnostic studies were identified and generally considered of high quality. The studies reported sufficient evidence on sensitivity and specificity, which was synthesised and summarised providing an overview of the evidence. Findings indicate that MRI scans using liver specific tissue contrast have a better diagnostic performance compared to contrast enhanced MDCT in diagnostic work-up of HCC in patients with chronic liver disease. CONCLUSION The current review identified sufficient high quality studies reporting statistical difference (P < 0.05), to establish the superiority of gadoxetetic acid enhanced MRI for sensitivity and specificity in comparison to MDCT in the diagnosis of HCC in chronic liver disease.
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Affiliation(s)
- S Usman
- London Northwest NHS Trust, Flat 80 Grand Union Heights, Northwick Road, Wembley, HA0 1LF, United Kingdom.
| | - L Smith
- Medical Imaging and Radiation Sciences, Allied Health Professions and Midwifery, School of Health and Social Work University of Hertfordshire, College Lane, Hatfield, AL10 9AB, United Kingdom.
| | - N Brown
- Department of Allied Health and Midwifery School of Health & Social Work University of Hertfordshire, College Lane, Hatfield, Herts, AL10 9AB, United Kingdom.
| | - V Major
- School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, Herts, AL10 9AB, United Kingdom.
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Qiu T, Ling W, Li J, Lu Q, Lu C, Li X, Zhu C, Luo Y. Can ultrasound elastography identify mass-like focal fatty change (FFC) from liver mass? Medicine (Baltimore) 2017; 96:e8088. [PMID: 28953628 PMCID: PMC5626271 DOI: 10.1097/md.0000000000008088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Focal fatty change (FFC) may mimic liver mass on conventional B-mode ultrasound. Clinical differentiation of mass-like FFC and liver mass is important due to different clinical interventions. Contrast-enhanced imaging (CEI) or biopsy is reliable for this differentiation, but is expensive and invasive. This study aimed to explore utilities of ultrasound elastography for this differentiation.This study enrolled 79 patients with focal liver lesions (FLLs), of which 26 were mass-like FFC confirmed by at least 2 CEI modalities. The other 53 were liver masses, confirmed by pathology (n = 28) or at least 2 CEI modalities (n = 25). Lesion stiffness value (SV), absolute stiffness difference (ASD), and stiffness ratio (SR) of lesion to background were obtained using point shear-wave elastography (pSWE) and compared between FFC group and liver mass group. The performance of SV, ASD, and SR for identifying FFC from liver mass was evaluated.SV was 5.6 ± 2.4 versus 16 ± 12 kPa, ASD was 2.0 ± 1.9 versus 11 ± 12 kPa, and SR was 1.4 ± 0.6 versus 3.0 ± 1.9 for FFC and liver mass group, respectively (P < .0001). The area under the receiver operating characteristic curve of SV, ASD, and SR for discriminating mass-like FFC and liver mass was 0.840, 0.842, and 0.791, respectively (P < .05). Particularly, with cut-off ASD < 1.0 kPa, positive predictive value was 100%, specificity was 100%, and accuracy was 82% for diagnosing FFC.pSWE may be a potential useful modality for identifying mass-like FFC from liver mass, which might help reduce the necessity for further CEI or biopsy for diagnosing mass-like FFC.
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Affiliation(s)
| | | | | | | | - Changli Lu
- Department of Pathology, West China Hospital Sichuan University
| | - Xiaomin Li
- Department of Pathology, West China Hospital Sichuan University
| | - Cairong Zhu
- School of Public Health, Sichuan University, Chengdu, China
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Venkatesh SK, Hennedige T, Johnson GB, Hough DM, Fletcher JG. Imaging patterns and focal lesions in fatty liver: a pictorial review. Abdom Radiol (NY) 2017; 42:1374-1392. [PMID: 27999887 DOI: 10.1007/s00261-016-1002-6] [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: 01/19/2023]
Abstract
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease and affects nearly one-third of US population. With the increasing trend of obesity in the population, associated fatty change in the liver will be a common feature observed in imaging studies. Fatty liver causes changes in liver parenchyma appearance on imaging modalities including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) and may affect the imaging characteristics of focal liver lesions (FLLs). The imaging characteristics of FLLs were classically described in a non-fatty liver. In addition, focal fatty change and focal fat sparing may also simulate FLLs. Knowledge of characteristic patterns of fatty change in the liver (diffuse, geographical, focal, subcapsular, and perivascular) and their impact on the detection and characterization of FLL is therefore important. In general, fatty change may improve detection of FLLs on MRI using fat suppression sequences, but may reduce sensitivity on a single-phase (portal venous) CT and conventional ultrasound. In patients with fatty liver, MRI is generally superior to ultrasound and CT for detection and characterization of FLL. In this pictorial essay, we describe the imaging patterns of fatty change in the liver and its effect on detection and characterization of FLLs on ultrasound, CT, MRI, and PET.
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Pirasteh A, Clark HR, Sorra EA, Pedrosa I, Yokoo T. Effect of steatosis on liver signal and enhancement on multiphasic contrast-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2016; 41:1744-50. [PMID: 27108126 DOI: 10.1007/s00261-016-0736-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the effect of steatosis on liver signal and enhancement in multiphasic contrast-enhanced (MCE) MRI. MATERIALS AND METHODS In this IRB-approved, HIPAA-compliant, retrospective, observational study, 1217 MCE abdominal MRIs performed during 2014 at a single institution were reviewed. Of these, 1085 were excluded, due to potential factors other than steatosis that may affect liver signal intensity and/or enhancement. In the remaining 132, liver fat fraction (FF) was calculated from the in- and opposed-phase 2D T1-weighted images. Liver signal intensity, absolute enhancement, and relative enhancement on fat-suppressed (Dixon method) 3D T1-weighted images before and after injection of gadobutrol (arterial, portal venous, and equilibrium phases) were plotted against co-localized FF values and the linear trend was evaluated by Pearson correlation coefficient (r). P values <0.05 were considered statistically significant. RESULTS Liver signal intensity negatively correlated with FF for all phases (r = -0.388 to -0.544, p < 0.001). Absolute enhancement negatively correlated with FF for the portal venous and equilibrium phases (r = -0.286 and -0.289, respectively, p < 0.001), but not for the arterial phase (r = -0.042, p = 0.632). Relative enhancement did not significantly correlate with FF for any phase (p ≥ 0.125). CONCLUSION Steatosis reduces liver signal intensity in MCE MRI. This effect of steatosis was reduced in calculated absolute enhancement and eliminated in calculated relative enhancement.
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Affiliation(s)
- Ali Pirasteh
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Haley R Clark
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Endel A Sorra
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 2201 Inwood Road, NE2.210B, Dallas, TX, 75390-9085, USA.
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Non-focal liver signal abnormalities on hepatobiliary phase of gadoxetate disodium-enhanced MR imaging: a review and differential diagnosis. Abdom Radiol (NY) 2016; 41:1399-410. [PMID: 26907715 DOI: 10.1007/s00261-016-0685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gadoxetate disodium (Gd-EOB-DTPA) is a linear, non-ionic paramagnetic MR contrast agent with combined extracellular and hepatobiliary properties commonly used for several liver indications. Although gadoxetate disodium is commonly used for detection and characterization of focal lesions, a spectrum of diffuse disease processes can affect the hepatobiliary phase of imaging (i.e., when contrast accumulates within the hepatocytes). Non-focal signal abnormalities during the hepatobiliary phase can be seen with multiple disease processes such as deposition disorders, infiltrating tumors, vascular diseases, and post-treatment changes. The purpose of this paper is to review the different processes which result in non-focal signal alteration during the hepatobiliary phase and to describe imaging patterns that may order a differential diagnosis and facilitate patient management.
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Ohno T, Isoda H, Furuta A, Arizono S, Yamashita R, Ono A, Togashi K. Usefulness of breath-hold inversion recovery-prepared T1-weighted two-dimensional gradient echo sequence for detection of hepatocellular carcinoma in Gd-EOB-DTPA-enhanced MR imaging. Clin Imaging 2016; 40:997-1003. [PMID: 27295329 DOI: 10.1016/j.clinimag.2016.05.002] [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: 11/30/2015] [Revised: 04/11/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
The aim is to evaluate the diagnostic performance and the added value of breath-hold inversion recovery-prepared T1-weighted two-dimensional gradient echo (IR-2D-GRE) sequence for detection of hepatocellular carcinoma (HCC) in patients with insufficient liver parenchymal enhancement during the hepatobiliary phase (HBP) of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Seventeen patients with a quantitative liver-to-spleen contrast ratio of ≤1.5 on HBP images and 36 HCCs were included. Liver-to-lesion contrast ratios on HBP images obtained with IR-2D-GRE sequence were significantly higher than those with three-dimensional gradient echo sequence. The addition of IR-2D-GRE sequence during HBP of Gd-EOB-DTPA-enhanced MRI yielded higher diagnostic accuracy and improved sensitivity.
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Affiliation(s)
- Tsuyoshi Ohno
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shigeki Arizono
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Rikiya Yamashita
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ayako Ono
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Hata H, Inoue Y, Nakajima A, Komi S, Miyatake H. Influence of the Magnetic Field Strength on Image Contrast in Gd-EOB-DTPA-enhanced MR Imaging: Comparison between 1.5T and 3.0T. Magn Reson Med Sci 2016; 16:109-114. [PMID: 27151747 PMCID: PMC5600069 DOI: 10.2463/mrms.mp.2015-0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: We quantitatively investigated hepatic enhancement in gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging at 1.5T and 3.0T. Methods: A total of 40 patients who underwent Gd-EOB-DTPA-enhanced MR imaging were included in the study. Precontrast and hepatobiliary-phase images acquired at a low flip angle (FA, 12°) and hepatobiliary-phase images acquired at a high FA (30°) were analyzed. From these images, the liver-to-muscle signal intensity ratio (LMR) and liver-to-spleen signal intensity ratio (LSR) were estimated, and the contrast enhancement ratio (CER) was calculated from the liver signal, LMR, and LSR as the ratio of the low-FA hepatobiliary-phase value to the precontrast value. The coefficient of variance in the liver signal was determined to represent image noise. Results: LMR and LSR indicated similar image contrast between 1.5T and 3.0T. A higher FA provided larger LMRs and LSRs, and the degree of the FA-dependent increase was similar between 1.5T and 3.0T. CER did not differ significantly between 1.5T and 3.0T, regardless of the calculation method. A better correlation to CER calculated from the liver signal was found for the LMR-based CER values than for the LSR-based CER. The coefficient of variance in the liver signal was significantly smaller at 3.0T for precontrast and low-FA hepatobiliary-phase images, but not for high-FA hepatobiliary-phase images. Conclusion: The indices of hepatic enhancement were similar between 1.5T and 3.0T, indicating that the magnetic field strength does not substantially influence image contrast after administration of Gd-EOB-DTPA.
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Affiliation(s)
- Hirofumi Hata
- Department of Radiology, Kitasato University Hospital
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Barth BK, Fischer MA, Kambakamba P, Lesurtel M, Reiner CS. Liver-fat and liver-function indices derived from Gd-EOB-DTPA-enhanced liver MRI for prediction of future liver remnant growth after portal vein occlusion. Eur J Radiol 2016; 85:843-9. [PMID: 26971433 DOI: 10.1016/j.ejrad.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the use of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI)-derived fat- and liver function-measurements for prediction of future liver remnant (FLR) growth after portal vein occlusion (PVO) in patients scheduled for major liver resection. METHODS Forty-five patients (age, 59 ± 13.9 y) who underwent Gd-EOB-DTPA-enhanced liver MRI within 24 ± 18 days prior to PVO were included in this study. Fat-Signal-Fraction (FSF), relative liver enhancement (RLE) and corrected liver-to-spleen ratio (corrLSR) of the FLR were calculated from in- and out-of-phase (n=42) as well as from unenhanced T1-weighted, and hepatocyte-phase images (n=35), respectively. Kinetic growth rate (KGR, volume increase/week) of the FLR after PVO was the primary endpoint. Receiver operating characteristics analysis was used to determine cutoff values for prediction of impaired FLR-growth. RESULTS FSF (%) showed significant inverse correlation with KGR (r=-0.41, p=0.008), whereas no significant correlation was found with RLE and corrLSR. FSF was significantly higher in patients with impaired FLR-growth than in those with normal growth (%FSF, 8.1 ± 9.3 vs. 3.0 ± 5.9, p=0.02). ROC-analysis revealed a cutoff-FSF of 4.9% for identification of patients with impaired FLR-growth with a specificity of 82% and sensitivity of 47% (AUC 0.71 [95%CI:0.54-0.87]). Patients with impaired FLR-growth according to the FSF-cutoff showed a tendency towards higher postoperative complication rates (posthepatectomy liver failure in 50% vs. 19%). CONCLUSIONS Liver fat-content, but not liver function derived from Gd-EOB-DTPA-enhanced MRI is a predictor of FLR-growth after PVO. Thus, liver MRI could help in identifying patients at risk for insufficient FLR-growth, who may need re-evaluation of the therapeutic strategy.
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Affiliation(s)
- Borna K Barth
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Michael A Fischer
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Patryk Kambakamba
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Mickael Lesurtel
- Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Caecilia S Reiner
- Institute for Diagnostic and Interventional Radiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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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: 1.9] [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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Wu J, Li H, Lin Y, Chen Z, Zhong Q, Gao H, Fu L, Sandrasegaran K. Value of gadoxetate biliary transit time in determining hepatocyte function. ACTA ACUST UNITED AC 2015; 40:95-101. [PMID: 25056714 DOI: 10.1007/s00261-014-0200-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine if transit time for excretion of gadoxetate into major bile ducts and duodenum correlates with clinical models of hepatocellular function. METHODS This retrospective research was approved by the Institutional Review Board with waiver of informed consent. Search of the radiology database from January 1, 2013 to March 4, 2014 revealed 84 patients with chronic liver disease (65 males, mean age 47 years). Eighteen control subjects with no known liver disease or risk factors were also enrolled for analysis (9 males, mean age 43 years). MRI was performed with hepatobiliary phases at 10, 15, 20, and 25 min after injection of 0.025 mmol/kg of gadoxetate (Primovist, Bayer HealthCare, Shanghai, China). The time of excreted contrast appearing in the biliary tree and in the duodenum was recorded. Linear trend analysis was performed to determine the relationship between excretion time and hepatic function. RESULTS The patient cohort was stratified by Child-Pugh classification (A, B, and C with n = 53, 27, and 4, respectively). Arrival of gadoxetate in the gall bladder at 10-min hepatobiliary phase was seen in 87% of control group and 45% of Child-Pugh A group (p = 0.02). There was no difference between these groups for later hepatobiliary phases. The arrival of biliary contrast in the right hepatic duct, common bile duct, and gall bladder were significantly earlier in the Child-Pugh A group compared to the Child-Pugh B/C group at all hepatobiliary phases after 10 min (p < 0.05). Linear trend analysis showed that biliary transit times were significantly delayed with worsening liver function (p = 0.01). There was no difference in entry time of gadoxetate into the duodenum between the normal, Child-Pugh A, and Child-Pugh B/C groups. CONCLUSIONS The transit time for gadoxetate to appear in extrahepatic duct is a reasonable indicator of liver function, and may be included in radiology reports. The appearance in the duodenum, however, may depend on factors other than liver function, such as the physiology of the gallbladder and sphincter of Oddi.
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Affiliation(s)
- Jianwei Wu
- Department of Radiology, Nanjing Jingdu Hospital, Nanjing, Jiangsu, China
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