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Li J, Ye X, Wang J, Yuan G, He S. A comparative study of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and contrast-enhanced ultrasound in the detection of intrahepatic lesion. Medicine (Baltimore) 2022; 101:e30482. [PMID: 36086711 PMCID: PMC10980474 DOI: 10.1097/md.0000000000030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
We evaluated the diagnostic performance of both gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) and contrast-enhanced ultrasound (CEUS) for focal liver lesions, especially for the detection of small (<2 cm) intrahepatic lesions. We retrospectively reviewed patients who underwent Gd-EOB-DTPA-MRI and CEUS before liver resection and compared Gd-EOB-DTPA-MRI and CEUS in the detection of focal liver lesions. A total of 216 patients were included, and 309 lesions were found. The sensitivity values of MRI and CEUS for the main lesion were both more than 95%, and the coincidence rates were both more than 80%. Regarding lesions <2 cm, 135 such lesions were detected by MRI, whereas only 85 were detected by CEUS. For lesions <2 cm, the sensitivity, specificity, and coincidence rates of MRI were significantly better than those of CEUS. Among 27 patients, 50 more lesions were detected by MRI than CEUS, 56% (28/50) of which were malignant. For the large lesion, the diagnostic performance is similar between Gd-EOB-DTPA-MRI and CEUS, and the sensitivity and coincidence rates of both methods are high. Gd-EOB-DTPA-MRI is likely to detect small (<2 cm) focal intrahepatic lesions.
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Affiliation(s)
- Jiangfa Li
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
- Key Laboratory of high-incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor
| | - Xiaofei Ye
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiming Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guandou Yuan
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Songqing He
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of high-incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor
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Obmann VC, Catucci D, Berzigotti A, Gräni C, Ebner L, Heverhagen JT, Christe A, Huber AT. T1 reduction rate with Gd-EOB-DTPA determines liver function on both 1.5 T and 3 T MRI. Sci Rep 2022; 12:4716. [PMID: 35304554 PMCID: PMC8933426 DOI: 10.1038/s41598-022-08659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance T1 mapping before and after Gd-EOB-DTPA administration allows quantification of the T1 reduction rate as a non-invasive surrogate marker of liver function. A major limitation of T1 relaxation time measurement is its dependency on MRI field strengths. Since T1 reduction rate is calculated as the relative shortening of T1 relaxation time before and after contrast administration, we hypothesized that the T1 reduction rate is comparable between 1.5 and 3 T. We thus compared liver T1 relaxation times between 1.5 and 3 T in a total of 243 consecutive patients (124, 1.5 T and 119, 3 T) between 09/2018 and 07/2019. T1 reduction rates were compared between patients with no cirrhosis and patients with cirrhosis Child-Pugh A-C. There was no significant difference of T1 reduction rate between 1.5 and 3 T in any patient group (p-value 0.126-0.861). On both 1.5 T and 3 T, T1 reduction rate allowed to differentiate between patients with no cirrhosis and patients with liver cirrhosis Child A-C (p < 0.001). T1 reduction rate showed a good performance to predict liver cirrhosis Child A (AUC = 0.83, p < 0.001), Child B (AUC = 0.83, p < 0.001) and Child C (AUC = 0.92, p < 0.001). In conclusion, T1 reduction rate allows to determine liver function on Gd-EOB-DTPA MRI with comparable values on 1.5 T and 3 T.
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Affiliation(s)
- Verena Carola Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Damiano Catucci
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Annalisa Berzigotti
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Johannes Thomas Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Adrian Thomas Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Reizine E, Ronot M, Ghosn M, Calderaro J, Frulio N, Bioulac-Sage P, Trillaud H, Vilgrain V, Paradis V, Luciani A. Hepatospecific MR contrast agent uptake on hepatobiliary phase can be used as a biomarker of marked β-catenin activation in hepatocellular adenoma. Eur Radiol 2020; 31:3417-3426. [PMID: 33146794 DOI: 10.1007/s00330-020-07434-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the value of hepatospecific MR contrast agent uptake on hepatobiliary phase (HBP) images to detect marked activation of the β-catenin pathway in hepatocellular adenomas (HCAs). METHODS This multicentric retrospective IRB-approved study included all patients with a pathologically proven HCA who underwent gadobenate dimeglumine-enhanced liver MRI with HBP. Tumor signal intensity on HBP was first assessed visually, and lesions were classified into three distinct groups-hypointense, isointense, or hyperintense-according to the relative signal intensity to liver. Uptake was then quantified using the lesion-to-liver contrast enhancement ratio (LLCER). Finally, the accuracy of HBP analysis in depicting marked β-catenin activation in HCA was evaluated. RESULTS A total of 124 HCAs were analyzed including 12 with marked β-catenin activation (HCA B+). Visual analysis classified 94/124 (76%), 12/124 (10%), and 18/124 (14%) HCAs as being hypointense, isointense, and hyperintense on HBP, respectively. Of these, 1/94 (1%), 3/12 (25%), and 8/18 (44%) were HCA B+, respectively (p < 0.001). The LLCER of HCA B+ was higher than that of HCA without marked β-catenin activation in the entire cohort (means 4.9 ± 11.8% vs. - 19.8 ± 11.4%, respectively, p < 0.001). A positive LLCER, i.e., LLCER ≥ 0%, had 75% (95% CI 43-95%) sensitivity and 97% (95% CI 92-99%) specificity, with a LR+ of 28 (95% CI 8.8-89.6) for the diagnosis of HCA B+. CONCLUSIONS Hepatospecific contrast uptake on hepatobiliary phase is strongly associated with marked activation of the β-catenin pathway in hepatocellular adenoma, and its use might improve hepatocellular adenoma subtyping on MRI. KEY POINTS • Tumor uptake on hepatobiliary phase in both the visual and quantitative analyses had a specificity higher than 90% for the detection of marked β-catenin activation in hepatocellular adenoma. • However, the sensitivity of visual analysis alone is inferior to that of LLCER quantification on HBP due to the high number of HCAs with signal hyperintensity on HBP, especially those developed on underlying liver steatosis.
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Affiliation(s)
- E Reizine
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.
| | - M Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - M Ghosn
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France
| | - J Calderaro
- Department of Pathology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.,Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France.,INSERM Unit U 955, Equipe 18, 94010, Créteil, France
| | - N Frulio
- CHU Bordeaux Department of Diagnostic and Interventional Radiology, Université de Bordeaux, 33000, Bordeaux, France
| | - P Bioulac-Sage
- Inserm, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, Université de Bordeaux, 33076, Bordeaux, France.,Department of Pathology, Pellegrin Hospital, CHU de Bordeaux, 33076, Bordeaux, France
| | - H Trillaud
- Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - V Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - V Paradis
- INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.,Department of Pathology, Beaujon Hospital, APHP, Clichy, France
| | - A Luciani
- Department of Radiology, APHP, HU Henri Mondor, Créteil, Val-de-Marne, France.,Faculté de Médecine, Universite Paris Est Creteil, 94010, Créteil, France.,INSERM Unit U 955, Equipe 18, 94010, Créteil, France
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Apical Sodium-Dependent Bile Acid Cotransporter, A Novel Transporter of Indocyanine Green, and Its Application in Drug Screening. Int J Mol Sci 2020; 21:ijms21062202. [PMID: 32209977 PMCID: PMC7139337 DOI: 10.3390/ijms21062202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/14/2020] [Accepted: 03/19/2020] [Indexed: 01/22/2023] Open
Abstract
Bile acid plays critical roles in the elimination of inorganic compounds such as bilirubin, heavy metals, and drug metabolites. Apical sodium-dependent bile acid cotransporter (ASBT), a solute carrier membrane transport protein, transports bile acids. Several inhibitors of ASBT have been evaluated in clinical trials. Sodium taurocholate cotransporting polypeptide (NTCP), belonging to the same family as ASBT, has fluorescein 5(6)-isothiocyanate (FITC) and indocyanine green (ICG) transportability. ICG, a Food and Drug Administration-approved fluorophore at near-infrared range, has perfect optical characteristics, so it can be applied in cell tracking and drug screening. In this study, ASBT and NTCP were transduced into the HT-1080 cell line. Nude mice were subcutaneously xenografted with control and ASBT-expressing cells. ICG transportability was observed through flow cytometry, fluorescent microscopy, multi-mode plate readers, and an in vivo imaging system. Several molecules, including taurocholate, sodium deoxycholate, cyclosporine A, nifedipine, and Primovist, were used to evaluate an in vitro drug-screening platform by using the combination of ICG and ASBT through flow cytometry. ICG and FITC were validated and shown to be transported by ASBT. NTCP had a higher ICG intensity compared with ASBT. For cell tracking, the ASBT xenograft had similar ICG signals as the control. For a drug-screening platform, the ICG intensity decreased with 186 μM taurocholate (56.8%), deoxycholate (83.8%), and increased with nifedipine (133.2%). These findings are suggestive of opportunities for the high-throughput drug screening of cholestasis and other diseases that are related to the dynamics of bile acid reabsorption.
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Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers. Abdom Radiol (NY) 2019; 44:2769-2780. [PMID: 31041497 DOI: 10.1007/s00261-019-02041-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)-based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis. MATERIALS AND METHODS This retrospective study included 67 patients (55 male and 12 female; mean age 62.5 years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver-spleen contrast ratio (LSC), liver-portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard. RESULTS The fibrosis stages were F0-F1 (n = 17), F2 (n = 7), F3 (n = 20), and F4 (n = 23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r = -0.786); LSC (r = - 0.718); LPC (r = - 0.448); and SIR (r = - 0.617; all P < 0.001). For diagnosis of either significant liver fibrosis (≥ F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC = 0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC = 0.699 and 0.715; all P < 0.05). The CEI displayed similar diagnostic accuracy for ≥ F2 or F4 when using TE (AUC = 0.866 and 0.884, both P > 0.05) or ElastPQ [AUC = 0.751 (P = 0.021) and AUC = 0.786 (P = 0.234)]. CONCLUSIONS The CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.
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Theilig D, Elkilany A, Schmelzle M, Müller T, Hamm B, Denecke T, Geisel D. Consistency of hepatocellular gadoxetic acid uptake in serial MRI examinations for evaluation of liver function. Abdom Radiol (NY) 2019; 44:2759-2768. [PMID: 31025071 DOI: 10.1007/s00261-019-02036-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To assess the consistency of liver enhancement in gadoxetic acid-enhanced magnetic resonance imaging (MRI) over serial examinations. METHODS This retrospective study included 554 patients who underwent at least 2 serial gadoxetic acid-enhanced MRI scans at either 1.5 or 3.0 Tesla at our institution between 2014 and 2018. Signal intensities (SI) were measured on T1-weighted images before and approx. 20 min after intravenous injection of gadoxetic acid. Relative enhancement (RE) of the liver, liver-to-spleen SI ratio (LSR), and liver-to-muscle SI ratio (LMR) were calculated. Means were compared with the paired t test, Greenhouse-Geisser test, and linear mixed model analysis, accordingly. Multiple linear regression analysis was used to elucidate possible predictors of RE and bivariate correlation analysis of patient age with RE was performed. RESULTS No statistically significant difference in RE, LSR, and LMR between two consecutive MRI scans was found when tested with paired t test or Greenhouse-Geisser test (n = 554, 519, and 554, respectively), while the latter revealed a statistically significant difference between the first and fourth MRI scan which was not confirmed in the linear mixed model. Patient age correlated negatively with RE of the liver (p = 0.002), LSR (p < 0.001), and LMR (p = 0.006). CONCLUSIONS Relative enhancement of the liver in the hepatobiliary phase of gadoxetic acid-enhanced MRI is consistent over successive examinations, different scanner types, and field strengths while correlating negatively with age, which further underscores the validity of gadoxetic acid-enhanced MRI as an imaging-based liver function test.
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Affiliation(s)
- Dorothea Theilig
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Aboelyazid Elkilany
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tobias Müller
- Division of Hepatology and Gastroenterology, Medical Department, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Hamm
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Li J, Wang J, Lei L, Yuan G, He S. The diagnostic performance of gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced multi-detector computed tomography in detecting hepatocellular carcinoma: a meta-analysis of eight prospective studies. Eur Radiol 2019; 29:6519-6528. [PMID: 31250172 DOI: 10.1007/s00330-019-06294-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
Abstract
AIM The purpose of this study was to determine the relative diagnostic benefit of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) over contrast-enhanced multi-detector computed tomography (CEMDCT) for the detection of hepatocellular carcinoma (HCC). METHODS Two investigators searched multiple databases from inception to January 8, 2019, for studies comparing Gd-EOB-DTPA-enhanced MRI with CEMDCT in adults suspected of HCC. Two reviewers independently selected studies and extracted data. RESULTS Eight studies were included enrolling 498 patients. MRI showed significantly higher sensitivity than CT (0.85 vs. 0.68). There was no significant difference in the specificity of MRI and CT (0.94 vs. 0.93). The negative likelihood ratio and positive likelihood ratio of MRI and CT were not significantly different (0.16 vs. 0.15 and 14.7 vs. 11.2, respectively). The summary receiver operating characteristics (SROC) of MRI was higher than that of CT at 0.96 vs. 0.91. In the subgroup analysis with a lesion diameter below 2 cm, the sensitivity of MRI was significantly higher than that of CT (0.79 vs. 0.46). CONCLUSION Gd-EOB-DTPA-enhanced MRI showed higher sensitivity and overall diagnostic accuracy than CEMDCT especially for hepatocellular carcinoma lesions smaller than 2 cm. KEY POINTS • Gd-EOB-DTPA-enhanced MRI can detect small lesions of hepatocellular carcinoma. • Gd-EOB-DTPA-enhanced MRI showed higher sensitivity and overall diagnostic accuracy than CEMDCT in patients with hepatocellular carcinoma. • Eight prospective studies showed that Gd-EOB-DTPA-enhanced MRI provides greater diagnostic confidence.
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Affiliation(s)
- Jiangfa Li
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jiming Wang
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Liping Lei
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Guandou Yuan
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Songqing He
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
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Reizine E, Ronot M, Pigneur F, Purcell Y, Mulé S, Dioguardi Burgio M, Calderaro J, Amaddeo G, Laurent A, Vilgrain V, Luciani A. Iso- or hyperintensity of hepatocellular adenomas on hepatobiliary phase does not always correspond to hepatospecific contrast-agent uptake: importance for tumor subtyping. Eur Radiol 2019; 29:3791-3801. [DOI: 10.1007/s00330-019-06150-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
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9
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Li J, Li X, Weng J, Lei L, Gong J, Wang J, Li Z, Zhang L, He S. Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging is more effective than enhanced 64-slice CT for the detection of small lesions in patients with hepatocellular carcinoma. Medicine (Baltimore) 2018; 97:e13964. [PMID: 30593219 PMCID: PMC6314721 DOI: 10.1097/md.0000000000013964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This study aimed to compare the sensitivity and accuracy for the detection of small lesions in patients with hepatocellular carcinoma (HCC) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 64-slice computed tomography (CT) enhanced scanning, and to evaluate the necessity to perform MRI in patients diagnosed with HCC by CT.The clinical data from 209 patients with HCC diagnosed prior to surgery in the Affiliated Hospital of Guilin Medical University, China were retrospectively analyzed. The 64-slice dynamic contrast-enhanced multi-detector CT (MDCT) and 3.0 T Gd-EOB-DTPA DCE MRI procedures were successively carried out on all patients who were enrolled in a self-controlled study including detection and diagnosis of HCC lesions by MRI and CT, respectively.A total of 243 lesions were detected and both imaging methods could accurately detect lesions of diameter >2 cm. For lesions <2 cm, MRI detected 47, while CT detected 25 lesions indicating that the detection rate of MRI was 88% higher than that of CT. In addition, MRI detected lesions in 15 cases (7.81% in the total of 209 cases) that were not diagnosed by CT. Among these cases, 2 patients were diagnosed to have no lesion by CT.Gd-EOB-DTPA DCE-MRI performed as a routine check prior to surgery in HCC patients can improve the detection of small HCC lesions.
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Affiliation(s)
- Jiangfa Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Xiaoqing Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of General Surgery, The Third Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Jun Weng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Liping Lei
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Jianhua Gong
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Hepatobiliary Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei 443003, China
| | - Junyi Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Gastroenterology, Hospital of Xiangshui County, Xiangshui 224600, China
| | - Zhenghang Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Longmiao Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin 541001, China
| | - Songqing He
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Verloh N, Utpatel K, Zeman F, Fellner C, Schlitt HJ, Müller M, Stroszczynski C, Evert M, Wiggermann P, Haimerl M. Diagnostic performance of Gd-EOB-DTPA-enhanced MRI for evaluation of liver dysfunction: a multivariable analysis of 3T MRI sequences. Oncotarget 2018; 9:36371-36378. [PMID: 30555635 PMCID: PMC6284745 DOI: 10.18632/oncotarget.26368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic performance of a multiparametric gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI examination for the estimation of liver dysfunction classified by the Model for End-Stage Liver Disease (MELD) score. RESULTS Liver dysfunction can be assessed by different methods. In a logistic regression analysis, T1- and T2-weighted images were affected by impaired liver function. In the assessment of liver dysfunction, the reduction rate in T1 mapping sequences showed a significant correlation in simple and multiple logistic regression. CONCLUSION Changes in Gd-EOB-DTPA-enhanced MRI between plain images and images obtained during the hepatobiliary phase allowed good prediction of liver dysfunction, especially when using T1 mapping sequences. MATERIALS AND METHODS A total of 199 patients underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. In the multivariable analysis, the full range of available MRI sequences was used to estimate the liver dysfunction of patients with various MELD scores.
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Affiliation(s)
- Niklas Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Kirsten Utpatel
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Hans J. Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Endocrinology, Rheumatology, and Infectious Diseases, Regensburg University Hospital, Regensburg, Germany
| | | | - Matthias Evert
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Braunschweig, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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11
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Zhang W, Wang X, Miao Y, Hu C, Zhao W. Liver function correlates with liver-to-portal vein contrast ratio during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MR at 3 Tesla. Abdom Radiol (NY) 2018; 43:2262-2269. [PMID: 29476347 DOI: 10.1007/s00261-018-1462-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSES To determine if liver-to-portal vein contrast ratio (LPC) correlates with liver function in patients with hepatitis B virus (HBV)-related cirrhosis on gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced MR imaging. METHODS A total of 92 patients with normal (n = 20) or HBV-related cirrhotic livers graded by Child-Pugh class A (n = 50), B (n = 17) or C (n = 5) who underwent Gd-EOB-DTPA-enhanced 3Tesla MR imaging were retrospectively reviewed. LPC was defined as the signal intensity ratio of liver parenchyma to portal vein on hepatobiliary phase (HBP) acquired at 20 min, and it was compared between normal and cirrhotic livers. The correlation between LPC and hepatic function parameters at HBP after injection was quantitatively analyzed as well. RESULTS LPC differed between normal and cirrhotic livers significantly (P < 0.001). LPC constantly and significantly decreased from normal to cirrhotic livers with Child-Pugh class C at HBP imaging (P < 0.001). Multiple regression analysis revealed that total bilirubin (P = 0.011), albumin (P < 0.001), and platelet count (P = 0.007) were independent predictors of LPC at HBP imaging. A receiver operating characteristic (ROC) curve analysis revealed that the optimal cutoff value for LPC to distinguish normal group from cirrhotic groups was 2.05 (AUC 0.98) with a sensitivity of 84.1% and a specificity of 100%. CONCLUSION The level of LPC on Gd-EOB-DTPA MR imaging can efficaciously indicate the severity of liver function in patients with HBV-related cirrhosis and was correlated with liver function parameters significantly. It might be used as an alternative imaging biomarker for assessing liver function.
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12
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Reizine E, Amaddeo G, Pigneur F, Baranes L, Legou F, Mulé S, Zegai B, Roche V, Laurent A, Rahmouni A, Calderaro J, Luciani A. Quantitative correlation between uptake of Gd-BOPTA on hepatobiliary phase and tumor molecular features in patients with benign hepatocellular lesions. Eur Radiol 2018; 28:4243-4253. [PMID: 29721686 DOI: 10.1007/s00330-018-5438-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/07/2018] [Accepted: 03/19/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of our study was to correlate the quantitative analysis of benign hepatocellular tumor uptake on delayed hepatobiliary phase (HBP) imaging with the quantitative level of OATP expression. METHODS This single-center retrospective study, which took place between September 2009 and March 2015, included 20 consecutive patients with a proven pathologic and immunohistochemical (IHC) diagnosis of FNH or HCA, including quantification of the OATP expression. The patients underwent Gd-BOPTA-enhancement MRI, including an HBP. The analysis of HBP uptake was performed using the liver-to-lesion contrast enhancement ratio (LLCER). Mean LLCER and OATP expressions were compared between FNH and HCA, and the expression of OATP was correlated with the LLCER value. RESULTS Of the 23 benign hepatocellular tumors, 9 (39%) were FNH and 14 (61%) were HCA, including 6 inflammatory, 2 HNF1a inactivated, 3 β-catenin-mutated and 3 unclassified HCAs. On HBP, 100% of the FNH appeared hyper- or isointense, and 79% of the adenomas appeared hypointense. The mean OATP expression of FNH (46.67 ± 26.58%) was significantly higher than that of HCA (22.14 ± 30.74%) (p = 0.0273), and the mean LLCER of FNH (10.66 ± 7.403%) was significantly higher than that of HCA (-13.5 ± 12.25%) (p < 0.0001). The mean LLCER of β-catenin-mutated HCA was significantly higher than that of other HCAs (p = 0.011). Significant correlation was found between the OATP expression and LLCER values (r = 0.661; p = 0.001). CONCLUSION In benign hepatocellular tumors, the quantitative analysis of hepatobiliary contrast agent uptake on HBP is correlated with the level of OATP expression and could be used as an imaging biomarker of the molecular background of HCA and FNH. KEY POINTS • Gd-BOPTA uptake on HBP correlates with the OATP level in benign hepatocellular tumors • FNH and β-catenin-mutated HCA showed an increased lesion-to-liver contrast enhancement ratio (LLCER) • Increased LLCER may be explained by activation of the Wnt β-catenin pathway.
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Affiliation(s)
- Edouard Reizine
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.
| | - Giuliana Amaddeo
- Hepatology Department, AP-HP, Groupe Henri Mondor Albert Chenevier, F-94010, Creteil, France.,Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France
| | - Frederic Pigneur
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Laurence Baranes
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - François Legou
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Sebastien Mulé
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Benhalima Zegai
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Vincent Roche
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexis Laurent
- Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France.,Liver Surgery, AP-HP, Groupe Henri Mondor Albert Chenevier, F-94010, Creteil, France
| | - Alain Rahmouni
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.,Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France
| | - Julien Calderaro
- Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France.,Pathology, AP-HP, Groupe Henri Mondor Albert Chenevier, F-94010, Creteil, France
| | - Alain Luciani
- Imagerie Medicale, AP-HP, Groupe Henri Mondor Albert Chenevier, 51 avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France.,Faculté de Médecine, Universite Paris Est Creteil, F-94010, Creteil, France.,INSERM Unit U 955, Equipe 18, F-94010, Creteil, France
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13
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Li XM, Chen Z, Xiao EH, Shang QL, Ma C. Diagnostic value of gadobenate dimeglumine-enhanced hepatocyte-phase magnetic resonance imaging in evaluating hepatic fibrosis and hepatitis. World J Gastroenterol 2017; 23:3133-3141. [PMID: 28533670 PMCID: PMC5423050 DOI: 10.3748/wjg.v23.i17.3133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/16/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the diagnostic value of gadobenate dimeglumine (Gd-BOPTA)-enhanced hepatocyte-phase magnetic resonance imaging (MRI) in evaluating hepatic fibrosis and hepatitis.
METHODS Hepatocyte-phase images of Gd-BOPTA-enhanced MRI were retrospectively evaluated in 76 patients with chronic liver disease. These patients were classified into five groups according to either the histopathological fibrosis stage (S0-S4) or the histopathological hepatitis grade (G0-G4). The relative enhancement ratio (RE) of the liver parenchyma in the T1-vibe sequence was calculated by measuring the signal intensity before (SI pre) and 90 min after (SI post) intravenous injection of Gd-BOPTA using the following formula: RE = (SI post - SI pre)/SI pre. One-way analysis of variance was used to compare the difference between the relative RE in the hepatocyte phase (REh) and the stage of hepatic fibrosis and the grade of hepatitis. Pearson’s product-moment correlation analysis was used to evaluate the relationship between the REh and the levels of serologic liver functional parameters.
RESULTS According to histopathological hepatic fibrosis stage, the 76 patients were classified into five groups: 16 in S0, 15 in S1, 21 in S2, 9 in S3, and 15 in S4 group. According to histopathological hepatitis grade, the 76 patients were also classified into five groups: 0 in G0, 44 in G1, 22 in G2, 8 in G3, and 2 in G3 group. With regard to the stage of hepatic fibrosis, REh showed significant differences between the S2 and S3 groups and between the S2 and S4 groups (P < 0.05), but no significant difference was observed between the other groups. With regard to the grade of hepatitis, REh showed significant differences between the G1 and G2 groups and between the G1 and G4 groups (P < 0.05), but no significant difference was observed between the other groups. Increased REh showed correlations with decreased serum levels of TB, ALT and AST (P < 0.05).
CONCLUSION To some extent, measuring the REh using Gd-BOPTA-enhanced MRI might be a noninvasive technique for assessing the stage of hepatic fibrosis. This method is able to differentiate no/mild hepatitis from advanced hepatitis. TB, ALT and AST levels can predict the degree of liver enhancement in the hepatocyte phase of Gd-BOPTA-enhanced MRI.
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14
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Gd-EOB-DTPA-enhanced MRI for monitoring future liver remnant function after portal vein embolization and extended hemihepatectomy: A prospective trial. Eur Radiol 2016; 27:3080-3087. [DOI: 10.1007/s00330-016-4674-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/23/2016] [Accepted: 11/23/2016] [Indexed: 02/06/2023]
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15
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Kim J, Kim T, Hong KS, Moon H, Oh IK, Lee SM, Hohenwalter MD, Zimmerman MA, Cronin DC, Hong JC. Pre-Hepatectomy Assessment of Bile Transporter Expression by Gadoxetic Acid-Enhanced MRI in a Rat Model of Liver Cirrhosis. J INVEST SURG 2016; 30:265-271. [PMID: 27780379 DOI: 10.1080/08941939.2016.1238983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gadoxetic acid is a liver-specific intravenous T1 magnetic resonance (MR) contrast agent that is excreted via the hepatobiliary system. We hypothesize that hepatocyte expressions of bile transporters (OATP1 and MRP2) correlate with dynamic profile of Gadoxetic acid enhanced (GE)-MR imaging (MRI). METHODS Two groups of rats, control (n = 6) and cirrhosis (n = 12), received gadoxetic acid enhanced MRI followed by 70% hepatectomy. The change in MR signal intensity from the baseline before the contrast injection (ΔSI) was analyzed every minute for 30 min. Dynamic signal intensity retention ratio (DSR) was defined as the mean ΔSI of the third 10-minmin period divided by the first 10-minmin period. Real-time PCR was utilized to quantify mRNA expressions. RESULTS Compared to the control, cirrhosis group demonstrated lower mRNA levels of OATP1 (0.038 ± 0.020 vs. 0.232 ± 0.0979; p = 0.004), MRP2 (0.201 ± 0.084 vs. 0.7567 ± 0.254; p = 0.002), and OATP1/MRP2 mRNA ratio (0.193 ± 0.065 vs. 0.342 ± 0.206; p = 0.032). DSR was higher in the cirrhosis group (0.678 ± 0.554 vs -0.125 ± 0.839; p = 0.033). In the cirrhosis group, there was an inverse correlation between the ratios of OATP1/MRP2 mRNA and DSR (R = -0.709, p = 0.01). CONCLUSION Bile transporters OATP1/MRP2 mRNA expression ratio in rat liver tissue decreased with DMN-induced liver injury. The expressions of bile transporters correlated with GE-MRI DSR. The GE-MRI DSR has potential utility in qualifying OATP1/MRP2 mRNA expression.
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Affiliation(s)
- Joohyun Kim
- a Division of Transplant Surgery, Department of Surgery , Medical College of Wisconsin , Milwaukee , Wisconsin , USA.,b The Transplant Center at Froedtert and Medical College of Wisconsin , Children's Hospital of Wisconsin and The Blood Center of Wisconsin , Milwaukee , Wisconsin , USA
| | - Tae Kim
- c Department of Biomedical Science and Engineering , Gwangju Institute of Science and Technology , Gwangju , South Korea
| | - Kwan Soo Hong
- d Division of MR Research , Korea Basic Science Institute , Cheongwon , South Korea
| | - Hyeyoung Moon
- d Division of MR Research , Korea Basic Science Institute , Cheongwon , South Korea
| | - In-Kyung Oh
- e Department of Surgery , College of Medicine, Kyung Hee University , Seoul , South Korea
| | - Sang Mok Lee
- e Department of Surgery , College of Medicine, Kyung Hee University , Seoul , South Korea
| | - Mark D Hohenwalter
- f Department of Radiology , Medical College of Wisconsin , Wisconsin , USA
| | - Michael A Zimmerman
- a Division of Transplant Surgery, Department of Surgery , Medical College of Wisconsin , Milwaukee , Wisconsin , USA.,b The Transplant Center at Froedtert and Medical College of Wisconsin , Children's Hospital of Wisconsin and The Blood Center of Wisconsin , Milwaukee , Wisconsin , USA
| | - David C Cronin
- a Division of Transplant Surgery, Department of Surgery , Medical College of Wisconsin , Milwaukee , Wisconsin , USA.,b The Transplant Center at Froedtert and Medical College of Wisconsin , Children's Hospital of Wisconsin and The Blood Center of Wisconsin , Milwaukee , Wisconsin , USA
| | - Johnny C Hong
- a Division of Transplant Surgery, Department of Surgery , Medical College of Wisconsin , Milwaukee , Wisconsin , USA.,b The Transplant Center at Froedtert and Medical College of Wisconsin , Children's Hospital of Wisconsin and The Blood Center of Wisconsin , Milwaukee , Wisconsin , USA
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16
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Lee S, Choi D, Jeong WK. Hepatic enhancement of Gd-EOB-DTPA-enhanced 3 Tesla MR imaging: Assessing severity of liver cirrhosis. J Magn Reson Imaging 2016; 44:1339-1345. [PMID: 27197633 DOI: 10.1002/jmri.25288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the usefulness of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging in assessing the severity of cirrhosis and liver function. MATERIALS AND METHODS This retrospective study included 120 patients who underwent Gd-EOB-DTPA-enhanced 3 Tesla (T) MR imaging (normal liver, n = 30; Child-Pugh class A, n = 30; B, n = 30; and C, n = 30). Groups were matched for underlying disease, age (±5 years), gender, and creatinine (±0.05 mg/dL). Contrast enhancement index (CEI) was calculated and compared between normal and cirrhosis groups. We analyzed the correlation between hepatic function parameters and CEI at hepatobiliary phase (HP). RESULTS The degree and time course of hepatic enhancement significantly differed between normal and each cirrhosis group (P < 0.001). Mean CEI at HP constantly and significantly decreased as the severity of cirrhosis increased (P < 0.001). Total bilirubin (P = 0.022), albumin (P < 0.001), platelet count (P = 0.04), and Model for End Stage Liver Disease score (P = 0.01) were independent predictors of hepatic enhancement at HP. CONCLUSION The degree of hepatic enhancement on Gd-EOB-DTPA indicates the severity of cirrhosis and is correlated with hepatic function parameters. J. Magn. Reson. Imaging 2016;44:1339-1345.
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Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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17
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Gd-EOB-DTPA-enhanced-MR imaging in the inflammation stage of nonalcoholic steatohepatitis (NASH) in mice. Magn Reson Imaging 2016; 34:724-729. [PMID: 26979540 DOI: 10.1016/j.mri.2016.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/15/2016] [Accepted: 03/08/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the correlation between the liver kinetics of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) and liver histopathology in a mouse model of NASH by using dynamic contrast-enhanced MRI. MATERIALS AND METHODS Twenty male C57/BL6 mice aged 8weeks were fed a methionine-choline-deficient (MCD) diet for 2, 4 and 6weeks (MCD groups: MCD 2w, 4w, or 6w). Gd-EOB-DTPA-enhanced MR imaging of the liver was performed at 2, 4 and 6weeks after the MCD feeding. The signal intensity of the liver was obtained from dynamic MR images and relative enhancement (RE), and the time to maximum RE (Tmax) and half-life of elimination RE (T1/2) were calculated. After MRI scan, histopathological scores of hepatic steatosis and inflammation and blood biochemistry data, such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, were obtained. RESULTS Plasma AST and ALT levels were significantly increased in mice fed MCD. Histopathological scores indicated that steatohepatitis progressed with the MCD feeding period from 2 to 6weeks, but significant fibrosis was observed only in mice fed MCD for 6weeks. Gd-EOB-DTPA-enhanced MRI showed that Tmax was significantly prolonged in the livers of the 6-week group compared to the control group (control, 4.0±0.7min; MCD 6w, 12.1±1.6min), although there was no alteration in the 2- and 4-week groups. T1/2 was significantly prolonged in mice fed MCD for 4 and 6weeks compared to the control group (control, 19.9±2.0min; MCD 4w, 46.7±8.7min; MCD 6w, 65.4±8.8min). The parameters of Gd-EOB-DTPA kinetics (Tmax and T1/2) in the liver were positively correlated with the liver histopathological score (steatosis vs Tmax, rho=0.69, P=0.0007; inflammation vs Tmax, rho=0.66, P=0.00155; steatosis vs T1/2, rho=0.77, P<0.0001; inflammation vs T1/2, rho=0.73, P=0.0003). CONCLUSIONS The liver kinetics of Gd-EOB-DTPA correlated well with the inflammation score in the mouse model of NASH, suggesting the possibility of detecting the steatohepatitis stage without fibrosis by Gd-EOB-DTPA-enhanced MR imaging.
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18
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Schwope RB, May LA, Reiter MJ, Lisanti CJ, Margolis DJA. Gadoxetic acid: pearls and pitfalls. ACTA ACUST UNITED AC 2016; 40:2012-29. [PMID: 25613332 DOI: 10.1007/s00261-015-0354-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gadoxetic acid is a hepatocyte-specific magnetic resonance imaging contrast agent with the ability to detect and characterize focal liver lesions and provide structural and functional information about the hepatobiliary system. Knowledge of the pharmacokinetics of gadoxetic acid is paramount to understanding imaging protocol and lesion appearance and facilitates identification and avoidance of undesired effects with use of this intravenous contrast agent. This article reviews the utility of gadoxetic acid in liver and biliary imaging, with emphasis on the hepatobiliary phase.
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Affiliation(s)
- Ryan B Schwope
- Department of Radiology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA,
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19
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Liver fibrosis and Gd-EOB-DTPA-enhanced MRI: A histopathologic correlation. Sci Rep 2015; 5:15408. [PMID: 26478097 PMCID: PMC5378898 DOI: 10.1038/srep15408] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/17/2015] [Indexed: 12/15/2022] Open
Abstract
Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a hepatocyte-specific MRI contrast agent. Because the hepatic uptake of Gd-EOB-DTPA depends on the integrity of the hepatocyte mass, this uptake can be quantified to assess liver function. We report the relationship between the extent of Gd-EOB-DTPA uptake and the degree of liver fibrosis. T1-weighted volume-interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 minutes after contrast injection. Strong correlations of the uptake characteristics of Gd-EOB-DTPA with the relative enhancement (RE) of the liver parenchyma and the grade of fibrosis/cirrhosis, classified using the Ishak scoring system, were observed. The subdivisions between the grades of liver fibrosis based on RE were highly significant for all combinations, and a ROC revealed sensitivities ≥82% and specificities ≥87% for all combinations. MR imaging is a satisfactorily sensitive method for the assessment of liver fibrosis/cirrhosis.
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20
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Thomeer MG, E Bröker ME, de Lussanet Q, Biermann K, Dwarkasing RS, de Man R, Ijzermans JN, de Vries M. Genotype-phenotype correlations in hepatocellular adenoma: an update of MRI findings. Diagn Interv Radiol 2015; 20:193-9. [PMID: 24509184 DOI: 10.5152/dir.2013.13315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatocellular adenoma (HCA) is a generally benign liver tumor with the potential for malignancy and bleeding. HCAs are categorized into four subtypes on the basis of genetic and pathological features: hepatocyte nuclear factor 1α-mutated HCA, β-catenin-mutated HCA, inflammatory HCA, and unclassified HCA. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, subtype characterization, and detection of HCA complications; it is also used to differentiate HCA from focal nodular hyperplasia. In this review, we present an overview of the genetic abnormalities, oncogenesis, and typical and atypical MRI findings of specific subtypes of HCA using contrast-enhanced MRI with or without hepatobiliary contrast agents (gadobenate dimeglumine and gadoxetate disodium). We also discuss their different management implications after diagnosis.
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Affiliation(s)
- Maarten G Thomeer
- From the Departments of Radiology Medical Center Zuiderzee, Lelystad, the Netherlands.
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21
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Zhao X, Huang M, Zhu Q, Wang T, Liu Q. The relationship between liver function and liver parenchymal contrast enhancement on Gd-BOPTA-enhanced MR imaging in the hepatocyte phase. Magn Reson Imaging 2015; 33:768-73. [DOI: 10.1016/j.mri.2015.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/06/2015] [Accepted: 03/30/2015] [Indexed: 12/12/2022]
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22
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Roux M, Pigneur F, Calderaro J, Baranes L, Chiaradia M, Tselikas L, Decaens T, Costentin C, Laurent A, Azoulay D, Mallat A, Zafrani ES, Rahmouni A, Luciani A. Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI. J Magn Reson Imaging 2015; 42:1249-58. [PMID: 25851028 DOI: 10.1002/jmri.24897] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/11/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). MATERIALS AND METHODS Thirty-eight patients bearing 67 lesions (40 FNH; 27 HCA) were retrospectively included in this Institutional Review Board-approved study. The same volumetric interpolated breath-hold examination (VIBE) T1 -weighted sequences were performed before and after contrast injection on a 1.5T MRI, with HBP images acquired with a mean delay of 80 minutes (range 60-120 min). After a visual assessment of lesions enhancement (qualitative HBP analysis), the HBP signal intensity ratio (SIR) and the lesion-to-liver contrast enhancement ratio (LLCER) were calculated for each lesion by two observers (Mann-Whitney test). The sensitivities, specificities (receiver operating characteristic [ROC] curve analysis) and interobserver correlation (intraclass coefficient, ICC) of quantitative HBP analysis were determined. RESULTS All FNH and 44.4% of HCA appeared hyper- or isointense relative to the adjacent liver on qualitative HBP analysis. The mean SIR (P < 0.01) and LLCER (P < 0.0001) of FNH were significantly higher than that of HCA. The area under the ROC curve for the differentiation of FNH from HCA with LLCER was 0.98 for both observers. With a cutoff value of -0.3%-observer 1 with highest experience- LLCER assessment provided respective sensitivity and specificity values of 100% and 96.2% for the differentiation of FNH from HCA. The ICC was 0.7 for SIR measurements and 0.8 for LLCER measurements. CONCLUSION Quantitative LLCER assessment allows an accurate differentiation of FNH from HCA, even in hyper- or isointense HCA on HBP images.
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Affiliation(s)
- Marion Roux
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Frederic Pigneur
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Julien Calderaro
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Laurence Baranes
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Mélanie Chiaradia
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Lambros Tselikas
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France
| | - Thomas Decaens
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Charlotte Costentin
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Alexis Laurent
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Daniel Azoulay
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Liver Surgery Department, Creteil, France
| | - Ariane Mallat
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Hepato-Gastroenterology Department, Creteil, France
| | - Elie-Serge Zafrani
- Paris Est Creteil University, Creteil, France.,AP-HP, Groupe Henri Mondor Albert Chenevier, Pathology Department, Creteil, France
| | - Alain Rahmouni
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France
| | - Alain Luciani
- AP-HP, Groupe Henri Mondor Albert Chenevier, Radiology Department, Creteil, France.,Paris Est Creteil University, Creteil, France.,INSERM Unite U 955, Equipe 17, Molecular Mechanisms of Liver Fibrosis, Creteil, France
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23
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Shimizu A, Kobayashi A, Motoyama H, Sakai H, Yamada A, Yoshizawa A, Momose M, Kadoya M, Miyagawa SI. Features of acute liver congestion on gadoxetate disodium-enhanced MRI in a rat model: Role of organic anion-transporting polypeptide 1A1. J Magn Reson Imaging 2015; 42:828-36. [PMID: 25581836 DOI: 10.1002/jmri.24839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 12/12/2014] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate the features of hepatic congestion on gadoxetate disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and the mechanisms responsible for the radiological findings in a rat model of partial liver congestion. MATERIALS AND METHODS A conventional T1 -weighted spin-echo sequence of the liver was performed using a 1.5T magnetic resonance imager with an 80-mm magnetic aperture for animal studies. We induced regional congestion using partial left lateral hepatic vein ligation (n = 5) and evaluated the following in both congestive liver (CL) and noncongestive liver (non-CL): 1) chronological changes in the relative enhancement (RE) up to 60 minutes after Gd-EOB-DTPA administration, and 2) mRNA and protein expression of rat organic anion transporting protein 1a1 (Oatp1a1). RESULTS The RE in the CL reached a small peak (18%) at 5 minutes, corresponding to approximately half of the value observed in the non-CL, then slowly decreased in a linear manner thereafter. The degree of RE in the CL was significantly lower than that in the non-CL for up to 30 minutes (P < 0.05). An immunohistological examination showed that Oatp1a1 protein expression was downregulated in the CL. The mRNA level of Oatp1a1 in the CL was significantly upregulated, compared with that in control rat liver (P = 0.046), whereas no significant difference was observed between the CL and the non-CL (P = 0.698). CONCLUSION The reduced signal intensity in the CL on Gd-EOB-DTPA-enhanced MRI could be explained by the decreased uptake of Gd-EOB-DTPA via Oatp1a1 protein in the congestive area.
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Affiliation(s)
- Akira Shimizu
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Kobayashi
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroaki Motoyama
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Sakai
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akihiko Yoshizawa
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Masanobu Momose
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Masumi Kadoya
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ichi Miyagawa
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Gadoxetic acid-enhanced MRI and sonoelastography: non-invasive assessments of chemoprevention of liver fibrosis in thioacetamide-induced rats with Sho-Saiko-To. PLoS One 2014; 9:e114756. [PMID: 25490034 PMCID: PMC4260946 DOI: 10.1371/journal.pone.0114756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/13/2014] [Indexed: 12/17/2022] Open
Abstract
Background This study aimed to compare the performance of gadoxetic acid -enhanced magnetic resonance imaging (MRI) and sonoelastography in evaluating chemopreventive effects of Sho-Saiko-To (SST) in thioacetamide (TAA)-induced early liver fibrosis in rats. Materials and Methods Ten of Sprague-Dawley rats receiving TAA (200 mg/kg of body weight) intraperitoneal injection were divided into three groups: Group 1 (TAA only, n = 3), Group 2 (TAA +0.25 g/kg SST, n = 4) and Group 3 (TAA+1 g/kg SST, n = 3). Core needle liver biopsy at week 2 and liver specimens after sacrifice at week 6 confirmed liver fibrosis using histological examinations, including Sirius red staining, Ishak and Metavir scoring systems. Gadoxetic acid-enhanced MRI and shear-wave sonoelastography were employed to evaluate liver fibrosis. The expression of hepatic transporter organic anion transporter 1 (Oatp1), multidrug-resistant protein 2 (Mrp2) and alpha-smooth muscle actin (α-Sma) were also analyzed in each group by immunohistochemistry (IHC) and Western blot. Results According to histological grading by Sirius red staining, Ishak scores of liver fibrosis in Groups 1, 2 and 3 were 3, 2 and 1, respectively. As shown in gadoxetic acid-enhanced MRI, the ratio of relative enhancement was significantly lower in Group 1 (1.87±0.21) than in Group 2 of low-dose (2.82±0.25) and Group 3 of high-dose (2.72±0.12) SST treatment at 10 minutes after gadoxetic acid intravenous injection (p<0.05). Sonoelastography showed that the mean difference before and after experiments in Groups 1, 2 and 3 were 4.66±0.1, 4.4±0.57 and 3±0.4 KPa (p<0.1), respectively. Chemopreventive effects of SST reduced the Mrp2 protein level (p<0.01) but not Oatp1 and α-Sma levels. Conclusion Sonoelastography and gadoxetic acid-enhanced MRI could monitor the treatment effect of SST in an animal model of early hepatic fibrosis.
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25
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Prospective randomized trial of enoxaparin, pentoxifylline and ursodeoxycholic acid for prevention of radiation-induced liver toxicity. PLoS One 2014; 9:e112731. [PMID: 25393877 PMCID: PMC4231047 DOI: 10.1371/journal.pone.0112731] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/30/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIM Targeted radiotherapy of liver malignancies has found to be effective in selected patients. A key limiting factor of these therapies is the relatively low tolerance of the liver parenchyma to radiation. We sought to assess the preventive effects of a combined regimen of pentoxifylline (PTX), ursodeoxycholic acid (UDCA) and low-dose low molecular weight heparin (LMWH) on focal radiation-induced liver injury (fRILI). METHODS AND MATERIALS Patients with liver metastases from colorectal carcinoma who were scheduled for local ablation by radiotherapy (image-guided high-dose-rate interstitial brachytherapy) were prospectively randomized to receive PTX, UDCA and LMWH for 8 weeks (treatment) or no medication (control). Focal RILI at follow-up was assessed using functional hepatobiliary magnetic resonance imaging (MRI). A minimal threshold dose, i.e. the dose to which the outer rim of the fRILI was formerly exposed to, was quantified by merging MRI and dosimetry data. RESULTS Results from an intended interim-analysis made a premature termination necessary. Twenty-two patients were included in the per-protocol analysis. Minimal mean hepatic threshold dose 6 weeks after radiotherapy (primary endpoint) was significantly higher in the study treatment-group compared with the control (19.1 Gy versus 14.6 Gy, p = 0.011). Qualitative evidence of fRILI by MRI at 6 weeks was observed in 45.5% of patients in the treatment versus 90.9% of the control group. No significant differences between the groups were observed at the 12-week follow-up. CONCLUSIONS The post-therapeutic application of PTX, UDCA and low-dose LMWH significantly reduced the extent and incidence fRILI at 6 weeks after radiotherapy. The development of subsequent fRILI at 12 weeks (4 weeks after cessation of PTX, UDCA and LMWH during weeks 1-8) in the treatment group was comparable to the control group thus supporting the observation that the agents mitigated fRILI. TRIAL REGISTRATION EU clinical trials register 2008-002985-70 ClinicalTrials.gov NCT01149304.
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26
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Rokugawa T, Uehara T, Higaki Y, Matsushima S, Obata A, Arano Y, Abe K. Potential of (99m)Tc-MIBI SPECT imaging for evaluating non-alcoholic steatohepatitis induced by methionine-choline-deficient diet in mice. EJNMMI Res 2014; 4:57. [PMID: 26116119 PMCID: PMC4452628 DOI: 10.1186/s13550-014-0057-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/28/2014] [Indexed: 12/26/2022] Open
Abstract
Background Hepatic mitochondrial dysfunction has been implicated in pathological conditions leading to non-alcoholic steatohepatitis (NASH). Technetium-99 m-2-methoxyisobutyl-isonitrile (99mTc-MIBI), a lipophilic cationic myocardial perfusion agent, is retained in the mitochondria depending on membrane potential. The aim of this study was to investigate the feasibility of 99mTc-MIBI for evaluating the hepatic mitochondrial dysfunction induced by methionine-choline-deficient (MCD) diet in mice. Methods Male C57Black6J/jcl mice were fed a MCD diet for up to 4 weeks. SPECT scan (N =6) with 99mTc-MIBI was performed at 2 and 4 weeks after MCD diet. Mice were imaged with small-animal SPECT/CT under isoflurane anesthesia. Radioactivity concentrations of the liver were measured, and the time of maximum (Tmax) and the elimination half-life (T1/2) were evaluated. After SPECT scan, liver histopathology was analyzed to evaluate steatosis and inflammation. Non-alcoholic fatty liver disease (NAFLD) activity score was obtained from the histological score of hepatic steatosis and inflammation. Blood biochemistry and hepatic ATP content were also measured (N =5 to 6). Results Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were significantly elevated at 2 and 4 weeks after MCD diet. A decrease in hepatic ATP content was also observed in MCD-fed mice. 99mTc-MIBI SPECT imaging clearly showed the decrease of hepatic 99mTc-MIBI retention in MCD-fed mice compared to control mice. T1/2 after 99mTc-MIBI injection was significantly decreased in the liver of MCD-fed mice (control, MCD 2 weeks, and MCD 4 weeks, T1/2 = 57.6, 37.6, and 19.8 min, respectively), although no change in Tmax was observed in MCD-fed mice. SPECT data and histological score showed that the negative correlation (r = −0.74, p <0.05) between T1/2 and NAFLD activity score was significant. Conclusions Hepatic 99mTc-MIBI elimination was increased with increase in NAFLD activity score (NAS) in mice fed MCD diet for 2 and 4 weeks. These results suggest that 99mTc-MIBI SPECT imaging might be useful for detecting hepatic mitochondrial dysfunction induced by steatosis and inflammation such as NAFLD or NASH.
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Affiliation(s)
- Takemi Rokugawa
- Department of Drug Metabolism and Pharmacokinetics, Research Laboratory for Development, Shionogi & Co., Ltd., 3-1-1, Futaba-cho, Toyonaka, Osaka, 561-0825, Japan,
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27
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Richter C, Seco J, Hong TS, Duda DG, Bortfeld T. Radiation-induced changes in hepatocyte-specific Gd-EOB-DTPA enhanced MRI: potential mechanism. Med Hypotheses 2014; 83:477-81. [PMID: 25175713 DOI: 10.1016/j.mehy.2014.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/29/2014] [Accepted: 08/05/2014] [Indexed: 01/23/2023]
Abstract
Liver irradiation leads to a decreased uptake of a hepatobiliary directed MRI contrast agent (Gd-EOB-DTPA) as shown in studies performed 1-6 months after proton therapy, stereotactic ablative body radiation therapy and brachytherapy. Therefore, Gd-EOB-DTPA enhanced MRI could potentially be used for in vivo verification of the delivered dose distribution. Achieving this would be highly desirable, especially for particle therapy, where the accuracy and precision of the spatial dose deposition is affected by uncertainties of the range of particles in patients. However, the empirically detected effect needs to be understood before it can be used as a surrogate imaging biomarker for in vivo treatment verification or even liver functionality. Here, we propose a model of the underlying molecular mechanism of this phenomenon and discuss its implications for radiation therapy. We model the multi-step process starting from the immediate response after liver irradiation to the delayed/subsequent signal decrease in Gd-EOB-DTPA enhanced MRI. The model is based on both: (a) Evidence from different previously published reports and (b) a detailed evaluation of intra-hepatic signaling using a pathway analysis to identify potential pathways that are critical in this process. The proposed model provides mechanistic understanding of the reduced signal intensity in Gd-EOB-DTPA enhanced MRI occurring in irradiated liver. We think that establishing this comprehensive model will be of great interest for the field of radiation oncology and can trigger further research. For example, measuring the expression of involved cytokines and specific transport proteins in blood samples and biopsy derived tissue samples and correlating the results with MRI imaging could give important information and may even explain inter-patient variations in MRI signal decrease.
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Affiliation(s)
- Christian Richter
- OncoRay - National Center of Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Joao Seco
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Ted S Hong
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Dan G Duda
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
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Ogawa J, Yokota A, Araki T, Aomori T, Nakamura T, Yamamoto K, Koshiishi I. Quantitative evaluation of biliary elimination of gadoxetate, a magnetic resonance imaging contrast agent, via geometrical isomer-specific transporting system in rats. Biopharm Drug Dispos 2014; 35:362-71. [DOI: 10.1002/bdd.1907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/05/2014] [Accepted: 06/10/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Junji Ogawa
- Department of Pharmacy; Gunma University Hospital; Gunma Japan
| | - Azusa Yokota
- School of Health Sciences; Gunma University Faculty of Medicine; Gunma Japan
- Faculty of Pharmacy Nihon Pharmaceutical University
| | - Takuya Araki
- Department of Pharmacy; Gunma University Hospital; Gunma Japan
- Department of Clinical Pharmacology; Gunma University Graduate School of Medicine; Gunma Japan
| | - Tohru Aomori
- Department of Pharmacy; Gunma University Hospital; Gunma Japan
- Department of Clinical Pharmacology; Gunma University Graduate School of Medicine; Gunma Japan
- Center for Pharmacy Practice; Keio University Faculty of Pharmacy; Tokyo Japan
| | - Tomonori Nakamura
- Department of Pharmacy; Gunma University Hospital; Gunma Japan
- Department of Clinical Pharmacology; Gunma University Graduate School of Medicine; Gunma Japan
- Center for Pharmacy Practice; Keio University Faculty of Pharmacy; Tokyo Japan
| | - Koujirou Yamamoto
- Department of Pharmacy; Gunma University Hospital; Gunma Japan
- Department of Clinical Pharmacology; Gunma University Graduate School of Medicine; Gunma Japan
| | - Ichiro Koshiishi
- School of Health Sciences; Gunma University Faculty of Medicine; Gunma Japan
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Spanakis M, Marias K. In silico evaluation of gadofosveset pharmacokinetics in different population groups using the Simcyp® simulator platform. In Silico Pharmacol 2014; 2:2. [PMID: 27502621 PMCID: PMC4644137 DOI: 10.1186/s40203-014-0002-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/26/2014] [Indexed: 01/10/2023] Open
Abstract
Purpose Gadofosveset is a Gd-based contrast agent used for magnetic resonance imaging (MRI). Gadolinium kinetic distribution models are implemented in T1-weighted dynamic contrast-enhanced perfusion MRI for characterization of lesion sites in the body. Physiology changes in a disease state potentially can influence the pharmacokinetics of drugs and to this respect modify the distribution properties of contrast agents. This work focuses on the in silico modelling of pharmacokinetic properties of gadofosveset in different population groups through the application of physiologically-based pharmacokinetic models (PBPK) embedded in Simcyp® population pharmacokinetics platform. Methods Physicochemical and pharmacokinetic properties of gadofosveset were introduced into Simcyp® simulator platform and a min-PBPK model was applied. In silico clinical trials were generated simulating the administration of the recommended dose for the contrast agent (i.v., 30 mg/kg) in population cohorts of healthy volunteers, obese, renal and liver impairment, and in a generated virtual oncology population. Results were evaluated regarding basic pharmacokinetic parameters of Cmax, AUC and systemic CL and differences were assessed through ANOVA and estimation of ratio of geometric mean between healthy volunteers and the other population groups. Results Simcyp® predicted a mean Cmax = 551.60 mg/l, a mean AUC = 4079.12 mg/L*h and a mean systemic CL = 0.56 L/h for the virtual population of healthy volunteers. Obese population showed a modulation in Cmax and CL, attributed to increased administered dose. In renal and liver impairment cohorts a significant modulation in Cmax, AUC and CL of gadofosveset is predicted. Oncology population exhibited statistical significant differences regarding AUC when compared with healthy volunteers. Conclusions This work employed Simcyp® population pharmacokinetics platform in order to compute gadofosveset’s pharmacokinetic profiles through PBPK models and in silico clinical trials and evaluate possible differences between population groups. The approach showed promising results that could provide new insights regarding administration of contrast agents in special population cohorts. In silico pharmacokinetics could further be used for evaluating of possible toxicity, interpretation of MRI PK image maps and development of novel contrast agents.
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Affiliation(s)
- Marios Spanakis
- Computational Medicine Laboratory, Institute of Computer Science, Foundation of Research & Technology-Hellas (FORTH), Heraklion, GR-71110, Crete, Greece.
| | - Kostas Marias
- Computational Medicine Laboratory, Institute of Computer Science, Foundation of Research & Technology-Hellas (FORTH), Heraklion, GR-71110, Crete, Greece.
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Seidensticker M, Burak M, Kalinski T, Garlipp B, Koelble K, Wust P, Antweiler K, Seidensticker R, Mohnike K, Pech M, Ricke J. Radiation-induced liver damage: correlation of histopathology with hepatobiliary magnetic resonance imaging, a feasibility study. Cardiovasc Intervent Radiol 2014; 38:213-21. [PMID: 24610229 DOI: 10.1007/s00270-014-0872-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/27/2014] [Indexed: 01/26/2023]
Abstract
PURPOSE Radiotherapy of liver malignancies shows promising results (radioembolization, stereotactic irradiation, interstitial brachytherapy). Regardless of the route of application, a certain amount of nontumorous liver parenchyma will be collaterally damaged by radiation. The functional reserve may be significantly reduced with an impact on further treatment planning. Monitoring of radiation-induced liver damage by imaging is neither established nor validated. We performed an analysis to correlate the histopathological presence of radiation-induced liver damage with functional magnetic resonance imaging (MRI) utilizing hepatobiliary contrast media (Gd-BOPTA). METHODS Patients undergoing local high-dose-rate brachytherapy for whom a follow-up hepatobiliary MRI within 120 days after radiotherapy as well as an evaluable liver biopsy from radiation-exposed liver tissue within 7 days before MRI were retrospectively identified. Planning computed tomography (CT)/dosimetry was merged to the CT-documentation of the liver biopsy and to the MRI. Presence/absence of radiation-induced liver damage (histopathology) and Gd-BOPTA uptake (MRI) as well as the dose applied during brachytherapy at the site of tissue sampling was determined. RESULTS Fourteen biopsies from eight patients were evaluated. In all cases with histopathological evidence of radiation-induced liver damage (n = 11), no uptake of Gd-BOPTA was seen. In the remaining three, cases no radiation-induced liver damage but Gd-BOPTA uptake was seen. Presence of radiation-induced liver damage and absence of Gd-BOPTA uptake was correlated with a former high-dose exposition. CONCLUSIONS Absence of hepatobiliary MRI contrast media uptake in radiation-exposed liver parenchyma may indicate radiation-induced liver damage. Confirmatory studies are warranted.
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Affiliation(s)
- Max Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany,
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Verloh N, Haimerl M, Zeman F, Schlabeck M, Barreiros A, Loss M, Schreyer AG, Stroszczynski C, Fellner C, Wiggermann P. Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla. Eur Radiol 2014; 24:1013-9. [PMID: 24531844 DOI: 10.1007/s00330-014-3108-y] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/13/2013] [Accepted: 01/27/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the usefulness of Gd-EOB-DTPA-enhanced 3-T MRI to determine the hepatic functional reserve expressed by the model for end-stage liver disease (MELD) score. METHODS A total of 121 patients with normal liver function (NLF; MELD score ≤ 10) and 29 patients with impaired liver function (ILF; MELD score > 10) underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. T1-weighted volume interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 min after contrast injection. Relative enhancement (RE) between plain signal intensity and contrast-enhanced signal intensity was calculated and was used to determine Gd-EOB-DTPA uptake into the liver parenchyma for patients with different MELD scores. RESULTS RE differed significantly (p ≤ 0.001) between patients with NLF (87.2 ± 29.5 %) and patients with ILF (45.4 ± 26.5 %). The optimal cut-off value for RE to differentiate NLF from ILF was 47.7 % (AUC 0.87). This cut-off value showed a sensitivity of 82.8 % and a specificity of 92.7 % for the differentiation of the analysed groups. CONCLUSION Gd-EOB-DTPA uptake in hepatocytes is strongly affected by liver function. Gd-EOB-DTPA-enhanced MRI and assessment of RE during the hepatobiliary phase (HBP) may serve as a useful image-based test in liver imaging for determining regional and global liver function. KEY POINTS Hepatic uptake of Gd-EOB-DTPA is strongly affected by liver function. Relative enhancement during HBP in GD-EOB-DTPA MRI correlates with the MELD score. Assessment of relative enhancement may help improve treatment in routine clinical practice.
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Affiliation(s)
- N Verloh
- Department of Radiology, University Hospital Regensburg, 93042, Regensburg, Germany,
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Ding Y, Rao SX, Meng T, Chen C, Li R, Zeng MS. Usefulness of T1 mapping on Gd-EOB-DTPA-enhanced MR imaging in assessment of non-alcoholic fatty liver disease. Eur Radiol 2014; 24:959-66. [PMID: 24463697 DOI: 10.1007/s00330-014-3096-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/18/2013] [Accepted: 01/10/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study evaluates the value of Gd-EOB-DTPA-enhanced MRI for diagnosis and staging of non-alcoholic fatty liver disease (NAFLD) in an animal model by T1 relaxation time measurement. METHODS Thirty-four rabbits were divided into the control group (n = 10) and NAFLD group, which was split into four groups (n = 6) with a high-fat diet for an interval of 3 weeks. A dual flip angle was performed before and at the hepatobiliary phase (HBP). T1 relaxation times of the liver parenchyma and the decrease rate (∆%) were calculated. Histological findings according to semi-quantitative scoring of steatosis, activity and fibrosis were the standard of reference. RESULTS HBP and ∆% T1 relaxation time measurement showed significant differences between normal and NAFLD groups, between non-alcoholic steatohepatitis (NASH) and NAFLD without NASH (p = 0.000-0.049), between fibrosis groups (p = 0.000-0.019), but no difference between F1 and F2 (p = 0.834). The areas under the receiver operating characteristic curves (AUCs) of T1 relaxation time for HBP and ∆% were 0.86-0.93 for the selection of NASH and activity score ≥2, and 0.86-0.95 for the selection of F ≥ 1, 2, 3. No significant difference was found for diagnostic performance between HBP and ∆% T1 relaxation time. CONCLUSIONS HBP T1 relaxation time measurement of Gd-EOB-DTPA-enhanced MRI was useful to evaluate NAFLD according to the SAF score. HBP T1 relaxation time measurement was as accurate as ∆% T1 relaxation time. KEY POINTS • Gd-EOB-DTPA-enhanced MRI could give useful information on NAFLD. •HBP T 1 relaxation time measurement was useful for the evaluation of NAFLD. • HBP T 1 relaxation time measurement was as accurate as ∆%.
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Affiliation(s)
- Ying Ding
- Department of Radiology, Zhongshan/Hospital of Fudan University, No 180/Fenglin Road, Xuhui District, Shanghai, China, 200032,
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Nam KS, Jeong HJ, Kim HK, Choi G, Suh KJ, Chang Y, Kim TJ. Gadolinium Complex of 1,4,7,10-Tetraazacyclododecane-N,N',N'',N'''-1,4,7-trisacetic Acid (DO3A) Conjugate of Tranexamates: A Quest for a Liver-specific Magnetic Resonance Imaging Contrast Agent. B KOREAN CHEM SOC 2014. [DOI: 10.5012/bkcs.2014.35.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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34
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Patrick PS, Hammersley J, Loizou L, Kettunen MI, Rodrigues TB, Hu DE, Tee SS, Hesketh R, Lyons SK, Soloviev D, Lewis DY, Aime S, Fulton SM, Brindle KM. Dual-modality gene reporter for in vivo imaging. Proc Natl Acad Sci U S A 2014; 111:415-20. [PMID: 24347640 PMCID: PMC3890795 DOI: 10.1073/pnas.1319000111] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The ability to track cells and their patterns of gene expression in living organisms can increase our understanding of tissue development and disease. Gene reporters for bioluminescence, fluorescence, radionuclide, and magnetic resonance imaging (MRI) have been described but these suffer variously from limited depth penetration, spatial resolution, and sensitivity. We describe here a gene reporter, based on the organic anion transporting protein Oatp1a1, which mediates uptake of a clinically approved, Gd(3+)-based, hepatotrophic contrast agent (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid). Cells expressing the reporter showed readily reversible, intense, and positive contrast (up to 7.8-fold signal enhancement) in T1-weighted magnetic resonance images acquired in vivo. The maximum signal enhancement obtained so far is more than double that produced by MRI gene reporters described previously. Exchanging the Gd(3+) ion for the radionuclide, (111)In, also allowed detection by single-photon emission computed tomography, thus combining the spatial resolution of MRI with the sensitivity of radionuclide imaging.
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Affiliation(s)
- P. Stephen Patrick
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - Jayne Hammersley
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
| | - Louiza Loizou
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
| | - Mikko I. Kettunen
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - Tiago B. Rodrigues
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - De-En Hu
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - Sui-Seng Tee
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
| | - Robin Hesketh
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
| | - Scott K. Lyons
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - Dmitry Soloviev
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - David Y. Lewis
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
| | - Silvio Aime
- Dipartimento di Biotecnologie Molecolari e Scienze della Salute, Università degli Studi di Torino, 10126 Turin, Italy
| | - Sandra M. Fulton
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
| | - Kevin M. Brindle
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, United Kingdom; and
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Verloh N, Haimerl M, Rennert J, Müller-Wille R, Nießen C, Kirchner G, Scherer MN, Schreyer AG, Stroszczynski C, Fellner C, Wiggermann P. Impact of liver cirrhosis on liver enhancement at Gd-EOB-DTPA enhanced MRI at 3 Tesla. Eur J Radiol 2013; 82:1710-5. [PMID: 23806531 DOI: 10.1016/j.ejrad.2013.05.033] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/22/2013] [Accepted: 05/26/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to assess differences in enhancement effects of liver parenchyma between normal and cirrhotic livers on dynamic, Gd-EOB-DTPA enhanced MRI at 3T. MATERIALS AND METHODS 93 patients with normal (n=54) and cirrhotic liver (n=39; Child-Pugh class A, n=18; B, n=16; C, n=5) underwent contrast-enhanced MRI with liver specific contrast media at 3T. T1-weighted volume interpolated breath hold examination (VIBE) sequences with fat suppression were acquired before contrast injection, in the arterial phase (AP), in the late arterial phase (LAP), in the portal venous phase (PVP), and in the hepatobiliary phase (HBP) after 20 min. The relative enhancement (RE) of the signal intensity of the liver parenchyma was calculated for all phases. RESULTS Mean RE was significantly different among all evaluated groups in the hepatobiliary phase and with increasing severity of liver cirrhosis, a decreasing, but still significant reduction of RE could be shown. Phase depending changes of RE for each group were observed. In case of non-cirrhotic liver or Child-Pugh Score A cirrhosis mean RE showed a significant increase between AP, LAP, PVP and HBP. For Child-Pugh B+C cirrhosis RE increased until PVP, however, there was no change in case of B cirrhosis (p=0.501) and significantly reduced in case of C cirrhosis (p=0.043) during HBP. CONCLUSION RE of liver parenchyma is negatively affected by increased severity of liver cirrhosis, therefore diagnostic value of HBP could be limited in case of Child Pugh B+C cirrhosis.
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Affiliation(s)
- N Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
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Nakamura Y, Hirokawa Y, Kitamura S, Yamasaki W, Arihiro K, Tatsugami F, Iida M, Kakizawa H, Date S, Awai K. Effect of lapatinib on hepatic parenchymal enhancement on gadoxetate disodium (EOB)-enhanced MRI scans of the rat liver. Jpn J Radiol 2013; 31:386-92. [PMID: 23605127 DOI: 10.1007/s11604-013-0208-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/09/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of lapatinib treatment on hepatic parenchymal enhancement on Gd-EOB-MRI scans in rat. MATERIALS AND METHODS Institutional animal review board approval was received prior to the commencement of all studies. Five rats received a single oral dose of 100 mg/kg/day lapatinib for 7 consecutive days. The controls (n = 5) were given 0.5 % (w/v) aqueous hydroxypropyl methyl cellulose containing 0.1 % (v/v) Tween 80 for 7 days. After the acquisition of gadoxetate disodium-enhanced MR images using 0.025 mmol gadolinium/kg, their livers were subjected to pathologic study to determine the expression level of organic anion-transporting polypeptide 1 (oatp1) and multi-drug resistance-associated protein 2 (mrp2). RESULTS Relative enhancement of the liver was similar in both groups. At the hepatobiliary phase, which in rats occurs 3 min after the injection of Gd-EOB, it was 0.90 ± 0.06 in lapatinib-treated rats and 0.84 ± 0.08 in the controls (p = 0.30). There was also no difference in the expression level of oatp1 and mrp2. CONCLUSION In rats, the administration of lapatinib for 7 days had no effect on hepatic parenchymal enhancement on Gd-EOB-MRI scans.
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
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Roth M, Obaidat A, Hagenbuch B. OATPs, OATs and OCTs: the organic anion and cation transporters of the SLCO and SLC22A gene superfamilies. Br J Pharmacol 2012; 165:1260-87. [PMID: 22013971 DOI: 10.1111/j.1476-5381.2011.01724.x] [Citation(s) in RCA: 553] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The human organic anion and cation transporters are classified within two SLC superfamilies. Superfamily SLCO (formerly SLC21A) consists of organic anion transporting polypeptides (OATPs), while the organic anion transporters (OATs) and the organic cation transporters (OCTs) are classified in the SLC22A superfamily. Individual members of each superfamily are expressed in essentially every epithelium throughout the body, where they play a significant role in drug absorption, distribution and elimination. Substrates of OATPs are mainly large hydrophobic organic anions, while OATs transport smaller and more hydrophilic organic anions and OCTs transport organic cations. In addition to endogenous substrates, such as steroids, hormones and neurotransmitters, numerous drugs and other xenobiotics are transported by these proteins, including statins, antivirals, antibiotics and anticancer drugs. Expression of OATPs, OATs and OCTs can be regulated at the protein or transcriptional level and appears to vary within each family by both protein and tissue type. All three superfamilies consist of 12 transmembrane domain proteins that have intracellular termini. Although no crystal structures have yet been determined, combinations of homology modelling and mutation experiments have been used to explore the mechanism of substrate recognition and transport. Several polymorphisms identified in members of these superfamilies have been shown to affect pharmacokinetics of their drug substrates, confirming the importance of these drug transporters for efficient pharmacological therapy. This review, unlike other reviews that focus on a single transporter family, briefly summarizes the current knowledge of all the functionally characterized human organic anion and cation drug uptake transporters of the SLCO and the SLC22A superfamilies.
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Affiliation(s)
- Megan Roth
- Department of Pharmacology, Toxicology and Therapeutics, The University of Kansas Medical Center, Kansas City, KS 66160, USA
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Koenen A, Kroemer HK, Grube M, Meyer zu Schwabedissen HE. Current understanding of hepatic and intestinal OATP-mediated drug-drug interactions. Expert Rev Clin Pharmacol 2012; 4:729-42. [PMID: 22111859 DOI: 10.1586/ecp.11.58] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
At present, many patients are medicated with various drugs, which are, at the same time, associated with an increased risk of drug-drug interactions (DDIs). Detailed analysis of mechanisms underlying DDIs is the basis of a better prediction of adverse drug events caused by drug interactions. In the last few decades, an involvement of transporters in such processes has been more and more recognized. Indeed, uptake transporters belonging to the organic anion-transporting polypeptide (OATP) family have been shown to interact with a variety of drugs in clinical use. Particularly, the subfamily of OATP1B transporters has been extensively studied, identifying several clinical significant DDIs based on those hepatic uptake transporters. By contrast, the role of OATP2B1 in this context is rather underestimated. Therefore, in addition to known interactions based on OATP1B transporters, we have focused on DDIs probably based on OATP2B1 inhibition in the liver and those possibly owing to the inhibition of OATP2B1-mediated drug absorption in the intestine.
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Affiliation(s)
- Anna Koenen
- Institute of Pharmacology, Ernst Moritz Arndt University, Friedrich-Loeffler-Straße 23, 17487 Greifswald, Germany
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Geninatti Crich S, Cutrin JC, Lanzardo S, Conti L, Kálmán FK, Szabó I, Lago NR, Iolascon A, Aime S. Mn-loaded apoferritin: a highly sensitive MRI imaging probe for the detection and characterization of hepatocarcinoma lesions in a transgenic mouse model. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:281-8. [DOI: 10.1002/cmmi.492] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Stefania Lanzardo
- Department of Clinical and Biological Sciences; University of Turin; Turin; Italy
| | - Laura Conti
- Department of Clinical and Biological Sciences; University of Turin; Turin; Italy
| | | | - Ibolya Szabó
- Center for Molecular Imaging, Department of Chemistry IFM; University of Turin; Turin; Italy
| | - Néstor R. Lago
- Center of Experimental Pathology, School of Medicine; University of Buenos Aires; Buenos Aires; Argentina
| | - Achille Iolascon
- CEINGE Biotecnologie Avanzate; University of Naples; Naples; Italy
| | - Silvio Aime
- Center for Molecular Imaging, Department of Chemistry IFM; University of Turin; Turin; Italy
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Jia J, Keiser M, Nassif A, Siegmund W, Oswald S. 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 Sci 2012; 891-892:20-6. [DOI: 10.1016/j.jchromb.2012.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/06/2012] [Accepted: 02/12/2012] [Indexed: 11/28/2022]
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Chronological evaluation of liver enhancement in patients with chronic liver disease at Gd-EOB-DTPA-enhanced 3-T MR imaging: does liver function correlate with enhancement? Jpn J Radiol 2011; 30:25-33. [PMID: 22160649 DOI: 10.1007/s11604-011-0003-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/18/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the chronological relationship between scan delay and liver enhancement for the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI and evaluate the effects of liver function on liver enhancement. MATERIALS AND METHODS Hepatobiliary-phase images were retrospectively evaluated in 125 patients with chronic liver disease. Hepatobiliary phase images were obtained at 5, 10, 15, and 20 min after injection. We calculated relative liver enhancement (RLE) at t min after injection by dividing the signal intensity (SI) of the liver at t min by precontrast SI. We compared RLE values at 5, 10, 15, and 20 min and evaluated the detectability of focal hepatic lesions. We analyzed the effect of liver function on RLE with the generalized linear model. RESULTS There was not significant difference in RLE and lesion detectability at 15 and 20 min. RLE in the Child-Pugh C group was significantly lower than in the Child-Pugh A and B groups. The serum albumin level and prothrombin time were significantly correlated with the liver enhancement. CONCLUSION A delay time of 15 min for the hepatobiliary phase was thought to be adequate in patients with mild liver dysfunction. The serum albumin level and prothrombin time would be predictive of liver enhancement in the hepatobiliary phase.
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Tsuda N, Matsui O. Signal profile on Gd-EOB-DTPA-enhanced MR imaging in non-alcoholic steatohepatitis and liver cirrhosis induced in rats: correlation with transporter expression. Eur Radiol 2011; 21:2542-50. [PMID: 21830099 DOI: 10.1007/s00330-011-2228-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare the transporter expression and signal profile on Gd-EOB-DTPA-enhanced MRI between non-alcoholic steatohepatitis (NASH) and cirrhotic liver induced in rats, and investigate the correlation of the transporter expression and fibrosis rate in both diseases. METHODS Forty-eight rats were divided into four groups of 12: TAA (cirrhosis), NASH 7- and 10-week, and control groups. Each group was divided into two subgroups: Group 1 for MRI and Group 2 for transporter examinations. RESULTS The relative enhancement of the TAA group was significantly lower than those of other groups (p < 0.01). The T(max) and T(1/2) of the NASH 10-week group was significantly prolonged in comparison with the TAA group (p < 0.01). There was no significant difference in the oatp1 expression, whereas the mrp2 expression of the TAA group was significantly higher than those of other groups (p < 0.01). There was no significant correlation between the fibrosis rate and oatp1 expression, whereas a paradoxical correlation was found between the fibrosis rate and mrp2 expression (NASH: negative correlation, r = 0.91, p < 0.01; TAA: positive correlation, r = 0.85, p < 0.01). CONCLUSIONS Our findings showed that the mrp2 expression in cirrhosis increases in comparison with NASH, and there was a paradoxical correlation between the fibrosis rate and mrp2 expression.
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Affiliation(s)
- Natsuko Tsuda
- Diagnostic Imaging Medical Affairs, Medical Affairs, Bayer Yakuhin, Ltd., 4-9, Umeda 2-chome, Kita-ku, Osaka, Osaka 530-0001, Japan.
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Estimation of liver function using T1 mapping on Gd-EOB-DTPA-enhanced magnetic resonance imaging. Invest Radiol 2011; 46:277-83. [PMID: 21343827 DOI: 10.1097/rli.0b013e318200f67d] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate the ability of T1 mapping of liver on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the estimation of liver function. MATERIALS AND METHODS Local institutional review board approved this study. Ninety-one patients (64 men, 27 women; mean age, 67.4 years) were classified into 4 groups as follows: normal liver function (NLF), n = 16; chronic hepatitis (CH), n = 38; liver cirrhosis with Child-Pugh A (LCA), n = 20; and liver cirrhosis with Child-Pugh B (LCB), n = 17. Look-Locker sequences (single slice multiphase imaging using gradient-echo sequence with inversion recovery pulse) were obtained before and at 3, 8, 13, and 18 minutes after Gd-EOB-DTPA administration. T1 mapping of liver parenchyma was calculated from the Look-Locker sequence. T1 relaxation time of liver and reduction rate of T1 relaxation time between pre- and postcontrast enhancement were measured. The Bonferroni t test was used for comparisons between the 4 groups. RESULTS Precontrast T1 relaxation times were significantly longer for LCA and LCB than for NLF, and that of LCB was longer than that of chronic hepatitis (P < 0.05). Postcontrast T1 relaxation times were significantly longer for LCB than for other groups at all time points. Those of LCA were longer than those of NLF at all time points. Reduction rates were significantly lower for LCB than for the other groups at ≥8 minutes. CONCLUSIONS Evaluation of hepatic uptake of Gd-EOB-DTPA using T1 mapping of liver parenchyma can help estimate liver function.
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Katsube T, Okada M, Kumano S, Imaoka I, Kagawa Y, Hori M, Ishii K, Tanigawa N, Imai Y, Kudo M, Murakami T. Estimation of liver function using T2* mapping on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging. Eur J Radiol 2011; 81:1460-4. [PMID: 21514080 DOI: 10.1016/j.ejrad.2011.03.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the usefulness of T2* mapping of liver on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI for estimating liver function. MATERIALS AND METHODS 33 patients were classified into 3 groups as follows: normal liver function (NLF) (n = 7); mild liver damage (MLD) (n = 16) with Child-Pugh A; severe liver damage (SLD) (n = 10) with Child-Pugh B. T2*-weighted gradient-echo (T2*W-GRE) and T1-weighted gradient-echo (T1W-GRE) images were obtained before and after Gd-EOB-DTPA administration (3, 8, 13, and 18 min; 5, 10,15, and 20min; respectively). T2* mapping of liver was calculated from T2*W-GRE, then T2* values of liver and T2* reduction rates of T2* value between pre- and post-contrast enhancement were measured. The increase rates of liver-to-muscle signal intensity (LMS) ratio on T1W-GRE between pre- and post-contrast enhancement were calculated. RESULTS T2* values on pre- and post-contrast showed no significant differences among three groups. Significant differences in T2* reduction rates were found among groups, and those of LCB were lower than those of other groups (NLF:MLD:SLD, 3.8:6.0:0.6% at 3 min, 8.2:10.3:1.0% at 8 min, 10.7:11.5:1.2% at 13 min, and 16.1:13.2:3.5% at 18 min, respectively) (P<0.05). Significant differences in increase rates of LMS ratio on T1W-GRE were identified (NLF:MLD:SLD, 1.53:1.46:1.35 at 5 min, 1.68:1.64:1.37 at 10 min, 1.79:1.76:1.44 at 15 min, and 1.89:1.78:1.49 at 20 min, respectively). CONCLUSION T2* reduction rate and increase rate of LMS ratio on T1W-GRE may allow us estimation of liver function according to Child-Pugh score.
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Affiliation(s)
- Takashi Katsube
- Department of Radiology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan. be
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Seidensticker M, Seidensticker R, Mohnike K, Wybranski C, Kalinski T, Luess S, Pech M, Wust P, Ricke J. Quantitative in vivo assessment of radiation injury of the liver using Gd-EOB-DTPA enhanced MRI: tolerance dose of small liver volumes. Radiat Oncol 2011; 6:40. [PMID: 21496320 PMCID: PMC3090344 DOI: 10.1186/1748-717x-6-40] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 04/17/2011] [Indexed: 12/25/2022] Open
Abstract
Backround Hepatic radiation toxicity restricts irradiation of liver malignancies. Better knowledge of hepatic tolerance dose is favourable to gain higher safety and to optimize radiation regimes in radiotherapy of the liver. In this study we sought to determine the hepatic tolerance dose to small volume single fraction high dose rate irradiation. Materials and methods 23 liver metastases were treated by CT-guided interstitial brachytherapy. MRI was performed 3 days, 6, 12 and 24 weeks after therapy. MR-sequences were conducted with T1-w GRE enhanced by hepatocyte-targeted Gd-EOB-DTPA. All MRI data sets were merged with 3D-dosimetry data. The reviewer indicated the border of hypointensity on T1-w images (loss of hepatocyte function) or hyperintensity on T2-w images (edema). Based on the volume data, a dose-volume-histogram was calculated. We estimated the threshold dose for edema or function loss as the D90, i.e. the dose achieved in at least 90% of the pseudolesion volume. Results At six weeks post brachytherapy, the hepatocyte function loss reached its maximum extending to the former 9.4Gy isosurface in median (i.e., ≥9.4Gy dose exposure led to hepatocyte dysfunction). After 12 and 24 weeks, the dysfunctional volume had decreased significantly to a median of 11.4Gy and 14Gy isosurface, respectively, as a result of repair mechanisms. Development of edema was maximal at six weeks post brachytherapy (9.2Gy isosurface in median), and regeneration led to a decrease of the isosurface to a median of 11.3Gy between 6 and 12 weeks. The dose exposure leading to hepatocyte dysfunction was not significantly different from the dose provoking edema. Conclusion Hepatic injury peaked 6 weeks after small volume irradiation. Ongoing repair was observed up to 6 months. Individual dose sensitivity may differ as demonstrated by a relatively high standard deviation of threshold values in our own as well as all other published data.
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Affiliation(s)
- Max Seidensticker
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Otto-von-Guericke-Universität Magdeburg, Germany.
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Tsuda N, Harada K, Matsui O. Effect of change in transporter expression on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging during hepatocarcinogenesis in rats. J Gastroenterol Hepatol 2011; 26:568-76. [PMID: 21332553 DOI: 10.1111/j.1440-1746.2010.06494.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS To analyze the difference in signal intensity on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) among various hepatocellular nodules during hepatocarcinogenesis as correlated with the expressions of the transporters of Gd-EOB-DTPA. METHODS We received institutional animal review board approval prior to the commencement of all studies. Forty rats were divided into three groups. The rats in the tumor groups received N-nitrosomorpholine solution (n = 16), and rats in the cirrhosis group (thioacetamide [TAA] group) received thioacetamide solution (n = 12). As a control, the remaining 12 rats were fed normal water. Each group was divided into two sub-groups: Group 1 for Gd-EOB-DTPA-enhanced MRI (0.025 mmol Gd/kg, n =7) and Group 2 for reverse transcription-polymerase chain reaction to compare transporter (oatp1 and mrp2) expressions (n = 5 for control and TAA groups, n = 9 for tumor groups). RESULTS Signal enhancement of tumors decreased according to the progress of hepatocarcinogenesis. Although the relative enhancement of each tumor group was significantly lower than that of the control group (P < 0.01), and there was no significant difference between TAA, hyperplastic nodules (HPN), and HCC(well) groups. The relative enhancement of the HCC(mod) group was significantly lower than the other groups (P < 0.01). The oatp1 expression of HPN tended to be higher than those of HCC(well) and HCC(mod). The mrp2 expression of TAA was significantly higher than those of HCC(well), HCC(mod), HPN and control (P < 0.01). The mrp2 expression of HPN tended to be higher than those of HCC(well ) and HCC(mod). CONCLUSION It was suggested that the signal enhancement on Gd-EOB-DTPA-enhanced MRI would correlate with the transporter expression in various hepatocellular nodules during hepatocarcinogenesis.
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Affiliation(s)
- Natsuko Tsuda
- Diagnostic Imaging Medical Affair, Medical Affairs, Bayer Yakuhin, Ltd., Osaka, Japan.
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Chanyaputhipong J, Low SCA, Chow PKH. Gadoxetate Acid-Enhanced MR Imaging for HCC: A Review for Clinicians. Int J Hepatol 2011; 2011:489342. [PMID: 21994860 PMCID: PMC3170825 DOI: 10.4061/2011/489342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 02/28/2011] [Accepted: 03/31/2011] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is increasingly being detected at an earlier stage, owing to the screening programs and regular imaging follow-up in high-risk populations. Small HCCs still pose diagnostic challenges on imaging due to decreased sensitivity and increased frequency of atypical features. Differentiating early HCC from premalignant or benign nodules is important as management differs and has implications on both the quality of life and the overall survival for the patients. Gadoxetate acid (Gd-EOB-DTPA, Primovist(®), Bayer Schering Pharma) is a relatively new, safe and well-tolerated liver-specific contrast agent for magnetic resonance (MR) imaging of the liver that has combined perfusion- and hepatocyte-specific properties, allowing for the acquisition of both dynamic and hepatobiliary phase images. Its high biliary uptake and excretion improves lesion detection and characterization by increasing liver-to-lesion conspicuity in the added hepatobiliary phase imaging. To date, gadoxetate acid-enhanced MRI has been mostly shown to be superior to unenhanced MRI, computed tomography, and other types of contrast agents in the detection and characterization of liver lesions. This review article focuses on the evolving role of gadoxetate acid in the characterization of HCC, differentiating it from other mimickers of HCC.
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Affiliation(s)
| | - Su-Chong Albert Low
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, 169608, Singapore,*Su-Chong Albert Low:
| | - Pierce K. H. Chow
- Department of General Surgery, Singapore General Hospital, 169608, Singapore ,Duke-NUS Graduate Medical School, 169857, Singapore
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König J. Uptake transporters of the human OATP family: molecular characteristics, substrates, their role in drug-drug interactions, and functional consequences of polymorphisms. Handb Exp Pharmacol 2011:1-28. [PMID: 21103967 DOI: 10.1007/978-3-642-14541-4_1] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Organic anion transporting polypeptides (OATPs, gene family: SLC21/SLCO) mediate the uptake of a broad range of substrates including several widely prescribed drugs into cells. Drug substrates for members of the human OATP family include HMG-CoA-reductase inhibitors (statins), antibiotics, anticancer agents, and cardiac glycosides. OATPs are expressed in a variety of different tissues including brain, intestine, liver, and kidney, suggesting that these uptake transporters are important for drug absorption, distribution, and excretion. Because of their wide tissue distribution and broad substrate spectrum, altered transport kinetics, for example, due to drug-drug interactions or due to the functional consequences of genetic variations (polymorphisms), can contribute to the interindividual variability of drug effects. Therefore, the molecular characteristics of human OATP family members, the role of human OATPs in drug-drug interactions, and the in vitro analysis of the functional consequences of genetic variations in SLCO genes encoding OATP proteins are the focus of this chapter.
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Affiliation(s)
- Jörg König
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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Reimer P, Vosshenrich R. Detection and characterization of liver lesions using gadoxetic acid as a tissue-specific contrast agent. Biologics 2010; 4:199-212. [PMID: 20714357 PMCID: PMC2921257 DOI: 10.2147/btt.s6479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Indexed: 12/22/2022]
Abstract
The value of cross-sectional liver imaging is evaluated by the accuracy, sensitivity, and specificity of the specific imaging technique. Magnetic resonance imaging (MRI) has become a key technique for the characterization and detection of focal and diffuse liver disease. More recently, gadoxetic acid, the hepatocyte-specific MR contrast agent, was clinically approved and introduced in many countries. Gadoxetic acid may be considered a "molecular imaging" probe because the compound is actively taken into hepatocytes via the ATP-dependent organic anion transport system in the plasma membrane for the hepatic uptake. The transport of gadoxetic acid from the cytoplasm to the bile is mainly determined by the capacity of the transport protein glutathione-S-transferase. Gadoxetic acid enhances hepatocyte-containing lesions and improves detection of lesions devoid of normal hepatocytes, such as metastases. Innovative rapid MR acquisition techniques with near isotropic 3D pulse sequences with fat saturation parallel the technical progress made by multidetector computed tomography combined with an impressive improvement in tumor-liver contrast when used for gadoxetic acid-enhanced MRI. The purpose of this review is to provide an overview of the development, clinical testing, and applications of this novel MR contrast agent.
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Affiliation(s)
- Peter Reimer
- Department of Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
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