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Agarwal S, Gordon J, Bok RA, von Morze C, Vigneron DB, Kurhanewicz J, Ohliger MA. Distinguishing metabolic signals of liver tumors from surrounding liver cells using hyperpolarized 13 C MRI and gadoxetate. Magn Reson Med 2024; 91:2114-2125. [PMID: 38270193 DOI: 10.1002/mrm.29918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To use the hepatocyte-specific gadolinium-based contrast agent gadoxetate combined with hyperpolarized (HP) [1-13 C]pyruvate MRI to selectively suppress metabolic signals from normal hepatocytes while preserving the signals arising from tumors. METHODS Simulations were performed to determine the expected changes in HP 13 C MR signal in liver and tumor under the influence of gadoxetate. CC531 colon cancer cells were implanted into the livers of five Wag/Rij rats. Liver and tumor metabolism were imaged at 3 T using HP [1-13 C] pyruvate chemical shift imaging before and 15 min after injection of gadoxetate. Area under the curve for pyruvate and lactate were measured from voxels containing at least 75% of normal-appearing liver or tumor. RESULTS Numerical simulations predicted a 36% decrease in lactate-to-pyruvate (L/P) ratio in liver and 16% decrease in tumor. In vivo, baseline L/P ratio was 0.44 ± 0.25 in tumors versus 0.21 ± 0.08 in liver (p = 0.09). Following administration of gadoxetate, mean L/P ratio decreased by an average of 0.11 ± 0.06 (p < 0.01) in normal-appearing liver. In tumors, mean L/P ratio post-gadoxetate did not show a statistically significant change from baseline. Compared to baseline levels, the relative decrease in L/P ratio was significantly greater in liver than in tumors (-0.52 ± 0.16 vs. -0.19 ± 0.25, p < 0.05). CONCLUSIONS The intracellular hepatobiliary contrast agent showed a greater effect suppressing HP 13 C MRI metabolic signals (through T1 shortening) in normal-appearing liver when compared to tumors. The combined use of HP MRI with selective gadolinium contrast agents may allow more selective imaging in HP 13 C MRI.
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Affiliation(s)
- Shubhangi Agarwal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Cornelius von Morze
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- Liver Center, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Milana F, Famularo S, Diana M, Mishima K, Reitano E, Cho HD, Kim KH, Marescaux J, Donadon M, Torzilli G. How Much Is Enough? A Surgical Perspective on Imaging Modalities to Estimate Function and Volume of the Future Liver Remnant before Hepatic Resection. Diagnostics (Basel) 2023; 13:2726. [PMID: 37685264 PMCID: PMC10486462 DOI: 10.3390/diagnostics13172726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/19/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Liver resection is the first curative option for most hepatic primary and secondary malignancies. However, post-hepatectomy liver failure (PHLF) still represents a non-negligible postoperative complication, embodying the most frequent cause of hepatic-related mortality. In the absence of a specific treatment, the most effective way to deal with PHLF is its prevention through a careful preoperative assessment of future liver remnant (FLR) volume and function. Apart from the clinical score and classical criteria to define the safe limit of resectability, new imaging modalities have shown their ability to assist surgeons in planning the best operative strategy with a precise estimation of the FLR amount. New technologies leading to liver and tumor 3D reconstruction may guide the surgeon along the best resection planes combining the least liver parenchymal sacrifice with oncological appropriateness. Integration with imaging modalities, such as hepatobiliary scintigraphy, capable of estimating total and regional liver function, may bring about a decrease in postoperative complications. Magnetic resonance imaging with hepatobiliary contrast seems to be predominant since it simultaneously integrates hepatic function and volume information along with a precise characterization of the target malignancy.
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Affiliation(s)
- Flavio Milana
- Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Division of Hepatobiliary and General Surgery, Department of Hepatobiliary and General Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Simone Famularo
- Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Division of Hepatobiliary and General Surgery, Department of Hepatobiliary and General Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Michele Diana
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- Photonics Instrumentation for Health, iCube Laboratory, University of Strasbourg, 67000 Strasbourg, France
- Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, 67200 Strasbourg, France
| | - Kohei Mishima
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Elisa Reitano
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Hwui-Dong Cho
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Matteo Donadon
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, NO, Italy
- Department of General Surgery, University Maggiore Hospital, 28100 Novara, NO, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090 Pieve Emanuele, MI, Italy
- Division of Hepatobiliary and General Surgery, Department of Hepatobiliary and General Surgery, Humanitas Research Hospital-IRCCS, Humanitas University, Via Manzoni 56, 20089 Rozzano, MI, Italy
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Lee JH, Calcagno C, Feuerstein IM, Solomon J, Mani V, Huzella L, Castro MA, Laux J, Reeder RJ, Kim DY, Worwa G, Thomasson D, Hagen KR, Ragland DR, Kuhn JH, Johnson RF. Magnetic Resonance Imaging for Monitoring of Hepatic Disease Induced by Ebola Virus: a Nonhuman Primate Proof-of-Concept Study. Microbiol Spectr 2023; 11:e0353822. [PMID: 37184428 PMCID: PMC10269877 DOI: 10.1128/spectrum.03538-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/14/2023] [Indexed: 05/16/2023] Open
Abstract
Severe liver impairment is a well-known hallmark of Ebola virus disease (EVD). However, the role of hepatic involvement in EVD progression is understudied. Medical imaging in established animal models of EVD (e.g., nonhuman primates [NHPs]) can be a strong complement to traditional assays to better investigate this pathophysiological process in vivo and noninvasively. In this proof-of-concept study, we used longitudinal multiparametric magnetic resonance imaging (MRI) to characterize liver morphology and function in nine rhesus monkeys after exposure to Ebola virus (EBOV). Starting 5 days postexposure, MRI assessments of liver appearance, morphology, and size were consistently compatible with the presence of hepatic edema, inflammation, and congestion, leading to significant hepatomegaly at necropsy. MRI performed after injection of a hepatobiliary contrast agent demonstrated decreased liver signal on the day of euthanasia, suggesting progressive hepatocellular dysfunction and hepatic secretory impairment associated with EBOV infection. Importantly, MRI-assessed deterioration of biliary function was acute and progressed faster than changes in serum bilirubin concentrations. These findings suggest that longitudinal quantitative in vivo imaging may be a useful addition to standard biological assays to gain additional knowledge about organ pathophysiology in animal models of EVD. IMPORTANCE Severe liver impairment is a well-known hallmark of Ebola virus disease (EVD), but the contribution of hepatic pathophysiology to EVD progression is not fully understood. Noninvasive medical imaging of liver structure and function in well-established animal models of disease may shed light on this important aspect of EVD. In this proof-of-concept study, we used longitudinal magnetic resonance imaging (MRI) to characterize liver abnormalities and dysfunction in rhesus monkeys exposed to Ebola virus. The results indicate that in vivo MRI may be used as a noninvasive readout of organ pathophysiology in EVD and may be used in future animal studies to further characterize organ-specific damage of this condition, in addition to standard biological assays.
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Affiliation(s)
- Ji Hyun Lee
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Claudia Calcagno
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Irwin M. Feuerstein
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Jeffrey Solomon
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Venkatesh Mani
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Louis Huzella
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Marcelo A. Castro
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Joseph Laux
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Rebecca J. Reeder
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gabriella Worwa
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - David Thomasson
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Katie R. Hagen
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Danny R. Ragland
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Jens H. Kuhn
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
| | - Reed F. Johnson
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland, USA
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Tang G, Liu J, Liu P, Huang F, Shao X, Chen Y, Xie A. Evaluation of liver function in patients with liver cirrhosis and chronic liver disease using functional liver imaging scores at different acquisition time points. Front Genet 2022; 13:1071025. [PMID: 36561314 PMCID: PMC9765309 DOI: 10.3389/fgene.2022.1071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: This paper aims to explore whether functional liver imaging score (FLIS) based on Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) images at 5, 10, and 15 min can predict liver function in patients with liver cirrhosis or chronic liver disease and its association with indocyanine green 15-min retention rate (ICG-R15), Child-Pugh (CP) score, albumin-bilirubin (ALBI) score, and model for end-stage liver disease (MELD) score. In addition, it also examines the inter- and intra-observer consistency of FLIS and three FLIS parameters at three different time points. Methods: This study included 110 patients with chronic liver disease (CLD) or liver cirrhosis (LC) (93 men, 17 women; mean ± standard deviation = 56.96 ± 10.16) between July 2019 and May 2022. FLIS was assigned in accordance with the sum of the three hepatobiliary phase characteristics, all of which were scored on the 0-2 ordinal scale, including the biliary excretion, hepatic enhancement and portal vein signal intensity. FLIS was calculated independently by two radiologists using transitional and hepatobiliary phase images at 5, 10, and 15 min after enhancement. The relationship between FLIS and three FLIS quality scores and the degree of liver function were evaluated using Spearman's rank correlation coefficient. The ability of FLIS to predict hepatic function was investigated using receiver operating characteristic (ROC) curves. Results: Intra- and inter-observer intraclass correlation coefficients (ICCs) (ICC = 0.937-0.978, 95% CI = 0.909-0.985) for FLIS at each time point indicated excellent agreement. At each time point, FLIS had a moderate negative association with liver function classification (r = [-0.641]-[-0.428], p < 0.001), and weak to moderate correlation with some other clinical parameters except for creatinine (p > 0.05). FLIS showed moderate discriminatory ability between different liver function levels. The area under the ROC curves (AUCs) of FLIS at 5, 10, and 15 min after enhancement to predict ICG-R15 of 10% or less were 0.838, 0.802, and 0.723, respectively; those for predicting ICG-R15 greater than 20% were 0.793, 0.824, and 0.756, respectively; those for predicting ICG-R15 greater than 40% were 0.728, 0.755, and 0.741, respectively; those for predicting ALBI grade 1 were 0.734, 0.761, and 0.691, respectively; those for predicting CP class A cirrhosis were 0.806, 0.821, and 0.829, respectively; those for predicting MELD score of 10 or less were 0.837, 0.877, and 0.837, respectively. No significant difference was found in the AUC of FLIS at 5, 10 and 15 min (p > 0.05). Conclusion: FLIS presented a moderate negative correlation with the classification system of hepatic function at a delay of 5, 10, and 15 min, and patients with LC or CLD were appropriately stratified based on ICG-R15, ALBI grade, MELD score, and CP classification. In addition, the use of FLIS to evaluate liver function can reduce the observation time of the hepatobiliary period.
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Affiliation(s)
- Guixiang Tang
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Jianbin Liu
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Feng Huang
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Xunuo Shao
- School of Mathematics and Statistics, Hunan Normal University, Changsha, China
| | - Yao Chen
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | - An Xie
- Department of Radiology, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China,*Correspondence: An Xie,
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Hwang JA, Min JH, Kim SH, Choi SY, Lee JE, Moon JY. Total Bilirubin Level as a Predictor of Suboptimal Image Quality of the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI in Patients with Extrahepatic Bile Duct Cancer. Korean J Radiol 2022; 23:389-401. [PMID: 35029076 PMCID: PMC8961017 DOI: 10.3348/kjr.2021.0407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/16/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to determine a factor for predicting suboptimal image quality of the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI in patients with extrahepatic bile duct (EHD) cancer before MRI examination. Materials and Methods We retrospectively evaluated 259 patients (mean age ± standard deviation: 68.0 ± 8.3 years; 162 male and 97 female) with EHD cancer who underwent gadoxetic acid-enhanced MRI between 2011 and 2017. Patients were divided into a primary analysis set (n = 184) and a validation set (n = 75) based on the diagnosis date of January 2014. Two reviewers assigned the functional liver imaging score (FLIS) to reflect the HBP image quality. The FLIS consists of the sum of three HBP features, each scored on a 0–2 scale: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified into low-FLIS (0–3) or high-FLIS (4–6) groups. Multivariable analysis was performed to determine a predictor of low FLIS using serum biochemical and imaging parameters of cholestasis severity. The optimal cutoff value for predicting low FLIS was obtained using receiver operating characteristic analysis, and validation was performed. Results Of the 259 patients, 140 (54.0%) and 119 (46.0%) were classified into the low-FLIS and high-FLIS groups, respectively. In the primary analysis set, total bilirubin was an independent factor associated with low FLIS (adjusted odds ratio per 1-mg/dL increase, 1.62; 95% confidence interval [CI], 1.32–1.98). The optimal cutoff value of total bilirubin for predicting low FLIS was 2.1 mg/dL with a sensitivity of 95.1% (95% CI: 88.9–98.4) and a specificity of 89.0% (95% CI: 80.2–94.9). In the validation set, the total bilirubin cutoff showed a sensitivity of 92.1% (95% CI: 78.6–98.3) and a specificity of 83.8% (95% CI: 68.0–93.8). Conclusion Serum total bilirubin before acquisition of gadoxetic acid-enhanced MRI may help predict suboptimal HBP image quality in patients with EHD cancer.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Yoon Moon
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
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Liu C, Sun Y, Yang Y, Feng Y, Xie X, Qi L, Liu K, Wang X, Zhu Q, Zhao X. Gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase can predict progression in patients with liver cirrhosis. Eur Radiol 2021; 31:5840-5850. [PMID: 33533990 DOI: 10.1007/s00330-021-07702-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/02/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the value of gadobenate dimeglumine (Gd-BOPTA)-enhanced biliary imaging from the hepatobiliary phase in predicting hepatic decompensation and insufficiency for patients with cirrhosis. METHODS This single-center retrospective study included 270 patients who underwent Gd-BOPTA-enhanced magnetic resonance imaging. The relative enhancement ratios of the biliary system (REB) and liver parenchyma (REL) in patients with normal liver function without underlying chronic liver disease and three groups of patients with Child-Pugh A, Child-Pugh B, and Child-Pugh C disease were measured. After a mean follow-up of 38.5 ± 22.5 months, prognostic factors were evaluated using the Cox proportional hazards regression model. Receiver operating characteristic (ROC) curve analyses were performed to assess the capacity of the REB and REL to predict the development of hepatic decompensation and insufficiency. RESULTS During the follow-up period, nine of 79 patients with Child-Pugh A disease developed hepatic decompensation. The REB was a significant predictive factor (hazard ratio (HR) = 0.40 (0.19-0.84); p = 0.016), but the REL showed no association with hepatic decompensation. Moreover, the areas under the ROC curves (AUCs) were 0.83 and 0.52 for the REB and REL, respectively. Thirty-eight of 207 patients with cirrhosis developed hepatic insufficiency. The REB was a significant predictive factor (HR = 0.24 (0.13-0.46); p < 0.0001), but the REL did not show statistically significant association with hepatic insufficiency. The AUCs were 0.82 and 0.57 for the REB and REL, respectively. CONCLUSIONS Gd-BOPTA-enhanced biliary imaging from the hepatobiliary phase was valuable in predicting hepatic decompensation and insufficiency for cirrhotic patients. KEY POINTS • Gd-BOPTA-enhanced biliary imaging was a significant predictive factor for hepatic decompensation in patients with cirrhosis. • Gd-BOPTA-enhanced biliary imaging was a significant predictive factor for hepatic insufficiency in patients with cirrhosis. • Gd-BOPTA-enhanced biliary imaging showed superior predictive values for adverse clinical outcomes compared to liver parenchymal imaging at the hepatobiliary phase.
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Affiliation(s)
- Chenxi Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Yan Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Province, 324#, Jing 5 Rd, Ji'nan, 250021, Shandong Province, China
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
| | - Yao Yang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Xiaoyu Xie
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Lingyu Qi
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Keke Liu
- Shandong Academy of Clinical Medicine, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Province, 324#, Jing 5 Rd, Ji'nan, 250021, Shandong Province, China
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong province, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Province, 324#, Jing 5 Rd, Ji'nan, 250021, Shandong Province, China.
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong province, China.
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Tanaka T, Nishida H, Mie K, Yamazaki H, Lin LS, Akiyoshi H. Assessment of hepatitis and fibrosis using Gd-EOB-DTPA MRI in dogs. Vet Rec Open 2020; 7:e000371. [PMID: 32818058 PMCID: PMC7401995 DOI: 10.1136/vetreco-2019-000371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 01/27/2023] Open
Abstract
Background Gadoxetate sodium (Gd-EOB-DTPA) is taken into hepatocytes and excreted into the bile. Hepatocytes with reduced function or dysfunction due to hepatocellular carcinoma (HCC), hepatitis or hepatic fibrosis show impaired Gd-EOB-DTPA uptake. The purpose of the present retrospective case series was to assess the relationship between liver function and contrast enhancement using Gd-EOB-DTPA MRI. Methods Sixteen dogs with a histopathological diagnosis of liver disease, including six with HCC, three with nodular hyperplasia, two with hepatocellular adenoma, two with liver fibrosis and three with hepatitis were included in the study along with three dogs with suspected liver disease but no histopathological diagnosis of liver disease. Relative signal intensities (RSI) of the common bile duct and gall bladder were calculated, and their relationship with the following serum biochemical parameters was assessed: total bilirubin, alanine transaminase, alkaline phosphatase and albumin (Alb). To assess anatomical liver function, relative contrast enhancement indices (RCEI) of the liver were calculated, and differences were assessed between normal and diseased liver. Results RSI showed no significant differences between dogs without and with a histopathological diagnosis of liver disease (P=0.88) although they were significantly correlated with Alb (ρ=0.57, P=0.02) in dogs with a histopathological diagnosis of liver disease. RCEI was significantly higher in normal liver tissue than that in livers with hepatitis/fibrosis (P=0.048) and HCC (P=0.03) but not nodular hyperplasia/hepatocellular adenoma (P=0.51). Conclusions Gd-EOB-DTPA MRI may be potentially useful in the assessment of anatomical liver function in dogs with liver disease.
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Affiliation(s)
- Toshiyuki Tanaka
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan.,Kinki Animal Medical Training Institute & Veterinary Clinic, Higashiosaka, Osaka, Japan
| | - Hidetaka Nishida
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Keiichiro Mie
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Hiroki Yamazaki
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
| | - Lee-Shuan Lin
- Laboratory of Veterinary Diagnostic Imaging, Department of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Hideo Akiyoshi
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, Graduate School of Life and Environmental Sciences, Osaka Prefecture University - Rinku Campus, Izumisano, Osaka, Japan
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Takatsu Y, Nakamura M, Kobayashi S, Miyati T. Prediction of Sufficient Liver Enhancement on the Gadoxetate Disodium-enhanced Hepatobiliary Phase Imaging Using Transitional Phase Images and Albumin-bilirubin Grade. Magn Reson Med Sci 2020; 20:152-159. [PMID: 32461506 PMCID: PMC8203475 DOI: 10.2463/mrms.mp.2020-0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: To investigate whether the contrast enhancement effect in hepatobiliary phase (HBP) images can be predicted using transitional phase (3-min delay) images on liver magnetic resonance imaging (MRI) based on the quantitative liver–spleen contrast ratio (Q-LSC) and albumin–bilirubin (ALBI) grade. Methods: Overall, 212 patients (124 men and 88 women; mean age 66.7 ± 11.1 years) who underwent blood tests (assessed within 1 month of performing MRI) were included; patients with diffuse tumor, hepatectomy, splenectomy, Gamna–Gandy bodies in the spleen, and movement artifacts were excluded. Q-LSC was calculated using the signal intensity of the liver divided that of the spleen. Q-LSC > 1.5 (cut-off value) indicates a relatively higher sensitivity for detecting of hepatic lesions. To predict the contrast enhancement effect in HBP using Q-LSC of 3-min delay images, Q-LSC of 10- and 15-min delay images were compared for each ALBI grade based on Q-LSC of 3-min delay images. Furthermore, to verify the accuracy of this prediction, the proportion of cases with Q-LSC > 1.5 in 10- and 15 min delay images was calculated based on Q-LSC on 3-min delay images. Results: The higher the Q-LSC on the 3-min delay image, the higher was the Q-LSC on its 10- and 15-min delay images. The proportion of cases with Q-LSC > 1.5 in 10- and 15-min delay images was higher for ALBI grade 1 than for ALBI grades 2 and 3 even in the same Q-LSC on 3-min delay images. Q-LSC was <1 in a 3-min delay image and <1.5 in a 15-min delay image in 62.2% of patients with ALBI grade 1 and 82.1% of patients with ALBI grades 2 and 3. Conclusion: The liver contrast enhancement effect in HBP images could be predicted using a 3-min delay image based on Q-LSC and ALBI grade.
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Affiliation(s)
- Yasuo Takatsu
- Department of Radiological Technology, Faculty of Health and Welfare, Tokushima Bunri University.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Kobayashi
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
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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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Chuang YH, Ou HY, Lazo MZ, Chen CL, Chen MH, Weng CC, Cheng YF. Predicting post-hepatectomy liver failure by combined volumetric, functional MR image and laboratory analysis. Liver Int 2018; 38:868-874. [PMID: 28987012 DOI: 10.1111/liv.13608] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/02/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS To assess the efficacy of functional MR image with volumetric, liver function test and indocyanine green clearance (ICG) in identifying the patients who are at risk of post-hepatectomy liver failure (PHLF). METHODS We retrospectively included 115 patients undergoing gadoxetic acid-enhanced MR imaging before hepatectomy at one medical centre from January 2013 to December 2015. Contrast enhancement ratio (CER) between transitional and hepatobiliary phases (3 and 30 minutes post-contrast) was calculated. Total liver volume (TLV) and spleen volume (Sp) were measured. Post-operatively, the histological Ishak fibrosis score was collected. Potential risk factors for liver failure were analysed, and the performance was examined by receiver operating characteristic curve. RESULTS Post-hepatectomy liver failure (PHLF) occurred in 16 patients (13.9%). TLV/SLV, ADC value, CERHBP/TP and total liver contrast enhancement ratio (tCER) were associated with PHLF (P < .05). Between PHLF and non-PHLF groups, remnant liver volume (RLV), RLV/SLV, Sp/RLV, remnant liver contrast enhancement ratio (rCER) and Ishak fibrosis score showed statistical difference. rCER showed superiority in diagnostic performance (AUC = 0.78) with the optimal cut-off value of 1.23. CONCLUSIONS Gadoxetic acid-enhanced MR imaging with volumetric is a reliable method for evaluating functional liver volume and determining the risk of PHLF.
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Affiliation(s)
- Yi-Hsuan Chuang
- Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-You Ou
- Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Marirose Z Lazo
- Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Hsiang Chen
- Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Chun Weng
- Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Liver Transplantation Program and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Can functional parameters from hepatobiliary phase of gadoxetate MRI predict clinical outcomes in patients with cirrhosis? Eur Radiol 2018; 28:4215-4224. [DOI: 10.1007/s00330-018-5366-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/12/2018] [Accepted: 02/01/2018] [Indexed: 12/26/2022]
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How Do Different Indices of Hepatic Enhancement With Gadoxetic Acid Compare in Predicting Liver Failure and Other Major Complications After Hepatectomy? J Comput Assist Tomogr 2018; 42:380-386. [DOI: 10.1097/rct.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Capobianco I, Rolinger J, Nadalin S. Resection for Klatskin tumors: technical complexities and results. Transl Gastroenterol Hepatol 2018; 3:69. [PMID: 30363698 PMCID: PMC6182019 DOI: 10.21037/tgh.2018.09.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022] Open
Abstract
Klatskin's tumors, actually-redefined as perihilar cholangiocarcinoma (phCCA) do represent 50-70% of all CCAs and develop in a context of chronic inflammation and cholestasis of bile ducts. Surgical resection provides the only chance of cure for this disease but is technically challenging because of the complex, intimate and variable relationship between biliary and vascular structures at this location. Five years survival rates range between 25-45% (median 27-58 months) in case of R0 resection and 0-23% (median 12-21 months) in case of R1 resection respectively. It should be noted that the major costs of high radicality are represented by relative high morbidity and mortality rates (i.e., 20-66% and 0-9% respectively). Considering the fact that radical resection may represent the only curative treatment of phCCA, we focused our review on surgical planning and techniques that may improve resectability rates and outcomes for locally advanced phCCA. The surgical treatment of phCCA can be successful when following aspects have been fulfilled: (I) accurate preoperative diagnostic aimed to identify the tumor in all its details (localization and extension) and to study all the risk factors influencing a posthepatectomy liver failure (PHLF): i.e., liver volume, liver function, liver quality, haemodynamics and patient characteristics; (II) High end surgical skills taking in consideration the local extension of the tumor and the vascular invasion which usually require an extended hepatic resection and often a vascular resection; (III) adequate postoperative management aimed to avoid major complications (i.e., PHLF and biliary complications). These are technically challenging operations and must be performed in a high volume centres by hepato-biliary-pancreas (HBP)-surgeons with experience in microsurgical vascular techniques.
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Affiliation(s)
- Ivan Capobianco
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Jens Rolinger
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
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Bali M, Pezzullo M, Pace E, Morone M. Benign biliary diseases. Eur J Radiol 2017; 93:217-228. [DOI: 10.1016/j.ejrad.2017.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
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Zhou ZP, Long LL, Qiu WJ, Cheng G, Huang LJ, Yang TF, Huang ZK. Evaluating segmental liver function using T1 mapping on Gd-EOB-DTPA-enhanced MRI with a 3.0 Tesla. BMC Med Imaging 2017; 17:20. [PMID: 28249571 PMCID: PMC5333450 DOI: 10.1186/s12880-017-0192-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/21/2017] [Indexed: 12/21/2022] Open
Abstract
Background Assessing the liver function provides valuable information to evaluate surgical risk and plan accordingly. Current studies focus on whole liver function evaluation. However, assessment of segmental liver function is equally important in the clinical practice. The purpose of this study was to investigate whether Gd-EOB-DTPA-enhanced MRI can evaluate the liver function of each segment by using T1 mapping at 3 Tesla MRI. Methods One hundred three patients were classified into one of 4 groups: a normal liver function (NLF) group (n = 38), a liver cirrhosis with Child-Pugh A (LCA) group (n = 33), a liver cirrhosis with Child-Pugh B (LCB) group (n = 21), and a liver cirrhosis with Child-Pugh C (LCC) group (n = 11). All patients underwent Gd-EOB-DTPA-enhanced MRI scans. T1 relaxation times were measured on the liver superimposing T1 mapping images. Reduction rate (△%) of T1 relaxation time of the liver parenchyma were calculated. Results After 20 min of Gd-EOB-DTPA enhancement, the T1 relaxation time of all liver segments in the LCC group were different from those in all the other groups, and more liver segments from the LCB and LCA groups different from the NLF group (p < 0.05). For the LCB group, the areas under the receiver operating characteristic curves (AUCs) of different liver segments for hepatobiliary phase (HBP) were 0.654-0.904 on T1 relaxation time, and 0.709-0.905 on △%. For the LCC group, the AUCs of different liver segments for HBP were 0.842–0.997 on T1 relaxation time, and 0.887–0.990 on △%. Conclusions For LCB patients, segmental liver function evaluation is possible using Gd-EOB-DTPA-enhanced MRI T1 mapping. For LCC patients, all liver segments can be used to evaluate liver function and both T1 relaxation time and the △% of T1 relaxation time have good diagnostic performance. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0192-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhi-Peng Zhou
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.,Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, People's Republic of China
| | - Li-Ling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Wei-Jia Qiu
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, People's Republic of China
| | - Ge Cheng
- Department of Radiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, 541001, People's Republic of China
| | - Li-Juan Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Teng-Fei Yang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhong-Kui Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
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Ünal E, Akata D, Karcaaltincaba M. Liver Function Assessment by Magnetic Resonance Imaging. Semin Ultrasound CT MR 2016; 37:549-560. [DOI: 10.1053/j.sult.2016.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Takatsu Y, Kobayashi S, Miyati T, Shiozaki T. Hepatobiliary phase images using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI as an imaging surrogate for the albumin-bilirubin grading system. Eur J Radiol 2016; 85:2206-2210. [PMID: 27842668 DOI: 10.1016/j.ejrad.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/06/2016] [Accepted: 10/10/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To clarify the correlation between hepatobiliary phase (HBP) images using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) and albumin-bilirubin (ALBI) grading system. MATERIALS AND METHODS We evaluated 220 consecutive patients who underwent liver magnetic resonance imaging with Gd-EOB-DTPA. Quantitative liver-spleen contrast ratio (Q-LSC) was calculated in HBP images approximately 20min after Gd-EOB-DTPA administration. To evaluate the degree of association between Q-LSC and ALBI grade, the Child-Pugh (C-P) score was used for comparison. Correlation coefficients were calculated, and median Q-LSC values were compared with the C-P scores and ALBI grades. The Steel-Dwass multiple comparison test was used for statistical analysis. RESULTS The correlation coefficient between Q-LSC and C-P score was -0.35, P<0.0001, and the ALBI grade was -0.61, P<0.0001. Q-LSC of overall median, C-P A, B, and C were 1.94, 1.91, 1.96, and 1.33, respectively. The differences between C-P A and C-P B, C-P B and C-P C, and C-P A and C-P C were P=0.999, 0.126, and 0.149, respectively. Q-LSC of the overall median, ALBI grade 1, 2, and 3 were 1.94, 2.12, 1.69, and 1.30, respectively. The differences between ALBI grades 1 and 2, 2 and 3, and 1 and 3 were P<0.0001, P=0.0466, and P=0.0035, respectively. Q-LSC was better correlated and discriminated by ALBI grade than C-P score. CONCLUSION A strong correlation was observed between Q-LSC of an HBP image with Gd-EOB-DTPA and ALBI grade; HBP imaging could be a surrogate for the ALBI grade.
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Affiliation(s)
- Yasuo Takatsu
- Department of Radiology, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, Osaka, 543-8555, Japan; Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Satoshi Kobayashi
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Tosiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Toshiki Shiozaki
- Department of Radiology, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, Osaka, 543-8555, Japan.
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Rao SX, Zeng MS. Assessment of liver function by Gd-EOB-DTPA enhanced magnetic resonance imaging. Shijie Huaren Xiaohua Zazhi 2016; 24:3940-3945. [DOI: 10.11569/wcjd.v24.i28.3940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), a liver-specific magnetic resonance imaging (MRI) contrast agent, is increasingly used for imaging-based liver function tests. Like indocyanine green and mebrofenin, Gd-EOB-DTPA is taken up by hepatocytes through organic anion-transporting polypeptides 1 (OATP1) B1 and B3 and is then excreted into the bile by multi-drug resistance protein (MRP2). The advantages of Gd-EOB-DTPA-based liver function tests include function measurement integrated in an existing MRI protocol, ability of evaluating segmental liver function, and no ionizing radiation. The approaches based on Gd-EOB-DTPA for function measurement are as follows: measurement of biliary elimination, hepatic parenchymal enhancement, MR relaxometry, and MR perfusion. These approaches have potential value for assessing liver reserve, hepatic fibrosis, non-alcoholic fatty liver disease and so on.
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Noda Y, Goshima S, Kajita K, Kawada H, Kawai N, Koyasu H, Matsuo M, Bae KT. Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers. Eur J Radiol 2016; 85:2001-2007. [PMID: 27776652 DOI: 10.1016/j.ejrad.2016.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the association between gadoxetic-acid-enhanced magnetic resonance (MR) imaging measurements and laboratory and clinical biomarkers of liver function and fibrosis. MATERIALS AND METHODS One hundred thirty nine consecutive patients with suspected liver disease or liver tumor underwent gadoxetic-acid-enhanced MR imaging. MR imaging measurements during the hepatobiliary phase included biliary tract structure-to-muscle signal intensity ratio (SIR). These measurements were compared with Child-Pugh classification, end-stage liver disease (MELD) score, and aspartate aminotransferase-to-platelet ratio index (APRI). RESULTS The SIRs of cystic duct and common bile duct were significantly correlated with Child-Pugh classification (P=0.012 for cystic duct and P<0.0001 for common bile duct), MELD score (P=0.0016 and P=0.0033), and APRI (P=0.0022 and P=0.0015). The sensitivity, specificity, and area under the receiver-operating-characteristic curve were: (74%, 88%, 0.86) with the SIR of common bile duct for the detection of patients with Child-Pugh class B or C; (100%, 87%, 0.94) with the SIR of cystic duct for MELD score (>10); (65%, 76%, 0.70) with the SIR of common bile duct for APRI (>1.5). CONCLUSION Gadoxetic-acid contrast enhancement of cystic duct and common bile duct could be used as biomarkers to assess liver function.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kimihiro Kajita
- Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiromi Koyasu
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Boraschi P, Della Pina MC, Donati F. Graft complications following orthotopic liver transplantation: Role of non-invasive cross-sectional imaging techniques. Eur J Radiol 2016; 85:1271-83. [DOI: 10.1016/j.ejrad.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/10/2016] [Accepted: 04/13/2016] [Indexed: 02/07/2023]
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Boraschi P, Donati F, Gigoni R, Filipponi F. Biliary complications following orthotopic liver transplantation: May contrast-enhanced MR Cholangiography provide additional information? Eur J Radiol Open 2016; 3:108-16. [PMID: 27331082 PMCID: PMC4906040 DOI: 10.1016/j.ejro.2016.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/07/2016] [Accepted: 05/07/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess whether contrast-enhanced T1-weighted MR Cholangiography may provide additional information in the evaluation of biliary complications in orthotopic liver transplant recipients. MATERIAL AND METHODS Eighty liver transplant patients with suspicion of biliary adverse events underwent MR imaging at 1.5 T scanner. After acquisition of axial T1-/T2-weighted images and conventional T2-weighted MR Cholangiography (image set 1), 3D gradient-echo T1-weighted fat-suppressed LAVA (Liver Acquisition with Volume Acceleration) sequences were obtained about 30 min after intravenous infusion of mangafodipir trisodium (Mn-DPDP,Teslascan(®)) (image set 2). The diagnostic value of mangafodipir trisodium-enhanced MR Cholangiography in the detection of biliary complications was tested by separate analysis results of image set 1 alone and image set 1 and 2 together. MRI results were correlated with direct cholangiography in 46 patients, surgery in 14 and/or clinical-radiological follow-up in the remaining 20 cases. RESULTS The level of confidence in the assessment of biliary adverse events was significantly increased by the administration of mangafodipir trisodium (p < 0.05). Particularly, contrast-enhanced T1-weighted LAVA sequences tended to out-perform conventional T2-weighted MR Cholangiography in the delineation of anastomotic and non-anastomotic biliary strictures and in the diagnosis of biliary leak. CONCLUSIONS Contrast-enhanced T1-weighted MR Cholangiography may improve the level of diagnostic confidence provided by conventional T2-weighted MR Cholangiography in the evaluation of biliary complications after orthotopic liver transplantation.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Francescamaria Donati
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Roberto Gigoni
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Franco Filipponi
- Hepatobiliary Surgery and Liver Transplantation-Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
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Doi H, Shiomi H, Masai N, Tatsumi D, Igura T, Imai Y, Oh RJ. Threshold doses and prediction of visually apparent liver dysfunction after stereotactic body radiation therapy in cirrhotic and normal livers using magnetic resonance imaging. JOURNAL OF RADIATION RESEARCH 2016; 57:294-300. [PMID: 26983986 PMCID: PMC4915544 DOI: 10.1093/jrr/rrw008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/07/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
The purpose of the present study was to investigate the threshold dose for focal liver damage after stereotactic body radiation therapy (SBRT) in cirrhotic and normal livers using magnetic resonance imaging (MRI). A total of 64 patients who underwent SBRT for liver tumors, including 54 cirrhotic patients with hepatocellular carcinoma (HCC) and 10 non-cirrhotic patients with liver metastases, were analyzed. MRI was performed 3-6 months after SBRT, using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced T1-weighted sequences. All MRI datasets were merged with 3D dosimetry data. All dose distributions were corrected to the biologically effective dose using the linear-quadratic model with an assumed α/β ratio of 2 Gy. The development of liver dysfunction was validly correlated with isodose distribution. The median biologically effective dose (BED2) that provoked liver dysfunction was 57.3 (30.0-227.9) and 114.0 (70.4-244.9) Gy in cirrhotic and normal livers, respectively (P = 0.0002). The BED2 associated with a >5% risk of liver dysfunction was 38.5 in cirrhotic livers and 70.4 Gy in normal livers. The threshold BED2 for liver dysfunction was not significantly different between Child-Pugh A and B patients (P = 0.0719). Moreover, the fractionation schedule was not significantly correlated with threshold BED2 for liver dysfunction in the cirrhotic liver (P = 0.1019). In the cirrhotic liver, fractionation regimen and Child-Pugh classification did not significantly influence the threshold BED2 for focal liver damage after SBRT. We suggest that the threshold BED2 for liver dysfunction after SBRT is 40 and 70 Gy in the cirrhotic and normal liver, respectively.
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Affiliation(s)
- Hiroshi Doi
- Miyakojima IGRT Clinic, 1-16-22 Miyakojima-ku, Osaka, 534-0021, Japan Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroya Shiomi
- Miyakojima IGRT Clinic, 1-16-22 Miyakojima-ku, Osaka, 534-0021, Japan Department of Radiology, Saito Yukoukai Hospital, 7-2-18 Asagi, Saito, Ibaraki, Osaka, 567-0085, Japan
| | - Norihisa Masai
- Miyakojima IGRT Clinic, 1-16-22 Miyakojima-ku, Osaka, 534-0021, Japan
| | - Daisaku Tatsumi
- Miyakojima IGRT Clinic, 1-16-22 Miyakojima-ku, Osaka, 534-0021, Japan
| | - Takumi Igura
- Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka, 563-8510, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Ikeda Municipal Hospital, 3-1-18 Johnan, Ikeda, Osaka, 563-8510, Japan
| | - Ryoong-Jin Oh
- Miyakojima IGRT Clinic, 1-16-22 Miyakojima-ku, Osaka, 534-0021, Japan
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Chouhan MD, Lythgoe MF, Mookerjee RP, Taylor SA. Vascular assessment of liver disease-towards a new frontier in MRI. Br J Radiol 2016; 89:20150675. [PMID: 27115318 PMCID: PMC5124867 DOI: 10.1259/bjr.20150675] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Complex haemodynamic phenomena underpin the pathophysiology of chronic liver disease. Non-invasive MRI-based assessment of hepatic vascular parameters therefore has the potential to yield meaningful biomarkers for chronic liver disease. In this review, we provide an overview of vascular sequelae of chronic liver disease amenable to imaging evaluation and describe the current supportive evidence, strengths and the limitations of MRI methodologies, including dynamic contrast-enhanced, dynamic hepatocyte-specific contrast-enhanced, phase-contrast, arterial spin labelling and MR elastography in the assessment of hepatic vascular parameters. We review the broader challenges of quantitative hepatic vascular MRI, including the difficulties of motion artefact, complex post-processing, long acquisition times, validation and limitations of pharmacokinetic models, alongside the potential solutions that will shape the future of MRI and deliver this new frontier to the patient bedside.
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Affiliation(s)
- Manil D Chouhan
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL, London, UK
| | - Mark F Lythgoe
- 2 University College London (UCL) Centre for Advanced Biomedical Imaging, Division of Medicine, UCL, London, UK
| | - Rajeshwar P Mookerjee
- 3 University College London (UCL) Institute for Liver and Digestive Health, Division of Medicine, UCL, London, UK
| | - Stuart A Taylor
- 1 University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL, London, UK
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Jung SH, Yu JI, Park HC, Lim DH, Han Y. A feasibility study evaluating the relationship between dose and focal liver reaction in stereotactic ablative radiotherapy for liver cancer based on intensity change of Gd-EOB-DTPA-enhanced magnetic resonance images. Radiat Oncol J 2016; 34:64-75. [PMID: 27104169 PMCID: PMC4831971 DOI: 10.3857/roj.2016.34.1.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/03/2015] [Accepted: 01/08/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In order to evaluate the relationship between the dose to the liver parenchyma and focal liver reaction (FLR) after stereotactic ablative body radiotherapy (SABR), we suggest a novel method using a three-dimensional dose distribution and change in signal intensity of gadoxetate disodium-gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) hepatobiliary phase images. MATERIALS AND METHODS In our method, change of the signal intensity between the pretreatment and follow-up hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI was calculated and then threshold dose (TD) for developing FLR was obtained from correlation of dose with the change of the signal intensity. For validation of the method, TDs for six patients, who had been treated for liver cancer with SABR with 45-60 Gy in 3 fractions, were calculated using the method, and we evaluated concordance between volume enclosed by isodose of TD by the method and volume identified as FLR by a physician. RESULTS The dose to normal liver was correlated with change in signal intensity between pretreatment and follow-up MRI with a median R(2) of 0.935 (range, 0.748 to 0.985). The median TD by the method was 23.5 Gy (range, 18.3 to 39.4 Gy). The median value of concordance was 84.5% (range, 44.7% to 95.9%). CONCLUSION Our method is capable of providing a quantitative evaluation of the relationship between dose and intensity changes on follow-up MRI, as well as determining individual TD for developing FLR. We expect our method to provide better information about the individual relationship between dose and FLR in radiotherapy for liver cancer.
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Affiliation(s)
- Sang Hoon Jung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi Y, Huh J, Woo DC, Kim KW. Use of gadoxetate disodium for functional MRI based on its unique molecular mechanism. Br J Radiol 2015; 89:20150666. [PMID: 26693795 DOI: 10.1259/bjr.20150666] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gadolinium ethoxybenzyl dimeglumine (gadoxetate) is a recently developed hepatocyte-specific MRI contrast medium. Gadoxetate demonstrates unique pharmacokinetic and pharmacodynamic properties, because its uptake in hepatocytes occurs via the organic anion transporting polypeptide (OATP) transporter expressed at the sinusoidal membrane, and its biliary excretion via the multidrug resistance-associated proteins (MRPs) at the canalicular membrane. Based on these characteristics, gadoxetate-enhanced MRI can provide functional information on hepatobiliary diseases, including liver function estimation, biliary drainage evaluation and characterization of hepatocarcinogenesis. In addition, understanding its mode of action can provide an opportunity to use gadoxetate for cellular and molecular imaging. Radiologists and imaging scientists should be familiar with the basic mechanism of gadoxetate and OATP/MRP transporters.
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Affiliation(s)
- YoonSeok Choi
- 1 Bioimaging Center, Asan Life Science Institution, Asan Medical Centre, Seoul, Republic of Korea
| | - Jimi Huh
- 1 Bioimaging Center, Asan Life Science Institution, Asan Medical Centre, Seoul, Republic of Korea.,2 Department of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Cheol Woo
- 1 Bioimaging Center, Asan Life Science Institution, Asan Medical Centre, Seoul, Republic of Korea.,2 Department of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Kim
- 1 Bioimaging Center, Asan Life Science Institution, Asan Medical Centre, Seoul, Republic of Korea.,2 Department of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Chen BB, Murakami T, Shih TTF, Sakamoto M, Matsui O, Choi BI, Kim MJ, Lee JM, Yang RJ, Zeng MS, Chen RC, Liang JD. Novel Imaging Diagnosis for Hepatocellular Carcinoma: Consensus from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014). Liver Cancer 2015; 4:215-27. [PMID: 26734577 PMCID: PMC4698631 DOI: 10.1159/000367742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Current novel imaging techniques in the diagnosis of hepatocellular carcinoma (HCC), with the latest evidence in this field, was discussed at the Asia-Pacific Primary Liver Cancer Expert (APPLE) meeting held in Taipei, Taiwan, in July 2014. Based on their expertise in a specific area of research, the novel imaging group comprised 12 participants from Japan, South Korea, Taiwan, and China and it included 10 abdominal radiologists, one hepatologist, and one pathologist. The expert participants discussed topics related to HCC imaging that were divided into four categories: (i) detection method, (ii) diagnostic method, (iii) evaluation method, and (iv) functional method. Consensus was reached on 10 statements; specific comments on each statement were provided to explain the rationale for the voting results and to suggest future research directions.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Takamichi Murakami
- Department of Radiology, Kinki University, Faculty of Medicine, Osaka, Japan,*Takamichi Murakami, MD, PhD, Department of Radiology, Kinki University, Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama-City, Osaka 589-8511 (Japan), TEL. +81 72 366 0221, E-Mail
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine
| | - Jeong Min Lee
- Department of Radiology, Seoul National University, Seoul, Republic of Korea
| | - Ren-jie Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Heping Fuyou Branch, Taipei City Hospital, Taiwan (ROC)
| | - Ja-Der Liang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
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Wu J, Li H, Lin Y, Chen Z, Zhong Q, Gao H, Fu L, Sandrasegaran K. Value of gadoxetate biliary transit time in determining hepatocyte function. ACTA ACUST UNITED AC 2015; 40:95-101. [PMID: 25056714 DOI: 10.1007/s00261-014-0200-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine if transit time for excretion of gadoxetate into major bile ducts and duodenum correlates with clinical models of hepatocellular function. METHODS This retrospective research was approved by the Institutional Review Board with waiver of informed consent. Search of the radiology database from January 1, 2013 to March 4, 2014 revealed 84 patients with chronic liver disease (65 males, mean age 47 years). Eighteen control subjects with no known liver disease or risk factors were also enrolled for analysis (9 males, mean age 43 years). MRI was performed with hepatobiliary phases at 10, 15, 20, and 25 min after injection of 0.025 mmol/kg of gadoxetate (Primovist, Bayer HealthCare, Shanghai, China). The time of excreted contrast appearing in the biliary tree and in the duodenum was recorded. Linear trend analysis was performed to determine the relationship between excretion time and hepatic function. RESULTS The patient cohort was stratified by Child-Pugh classification (A, B, and C with n = 53, 27, and 4, respectively). Arrival of gadoxetate in the gall bladder at 10-min hepatobiliary phase was seen in 87% of control group and 45% of Child-Pugh A group (p = 0.02). There was no difference between these groups for later hepatobiliary phases. The arrival of biliary contrast in the right hepatic duct, common bile duct, and gall bladder were significantly earlier in the Child-Pugh A group compared to the Child-Pugh B/C group at all hepatobiliary phases after 10 min (p < 0.05). Linear trend analysis showed that biliary transit times were significantly delayed with worsening liver function (p = 0.01). There was no difference in entry time of gadoxetate into the duodenum between the normal, Child-Pugh A, and Child-Pugh B/C groups. CONCLUSIONS The transit time for gadoxetate to appear in extrahepatic duct is a reasonable indicator of liver function, and may be included in radiology reports. The appearance in the duodenum, however, may depend on factors other than liver function, such as the physiology of the gallbladder and sphincter of Oddi.
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Affiliation(s)
- Jianwei Wu
- Department of Radiology, Nanjing Jingdu Hospital, Nanjing, Jiangsu, China
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Hinrichs H, Hinrichs JB, Gutberlet M, Lenzen H, Raatschen HJ, Wacker F, Ringe KI. Functional gadoxetate disodium-enhanced MRI in patients with primary sclerosing cholangitis (PSC). Eur Radiol 2015. [PMID: 26205638 DOI: 10.1007/s00330-015-3913-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To assess the value of variable flip angle-based T1 liver mapping on gadoxetate disodium-enhanced MRI in patients with primary sclerosing cholangitis (PSC) for evaluation of global and segmental liver function, and determine a possible correlation with disease severity. METHODS Sixty-one patients (19 female, 42 male; mean age 41 years) with PSC were included in this prospective study. T1 mapping was performed using a 3D-spoiled GRE sequence (flip angles 5°, 15°, 20°, 30°) before, 16 (HP1) and 132 min (HP2) after contrast injection. T1 values were measured and compared (Wilcoxon-Test) by placing ROIs in each liver segment. The mean reduction of T1 relaxation time at HP1 and HP2 was calculated and correlated with liver function tests (LFTs), MELD, Mayo Risk and Amsterdam Scores (Spearman correlation). RESULTS Significant changes of T1 relaxation times between non-enhanced and gadoxetate disodium-enhanced MRI at HP1 and HP2 could be observed in all liver segments (p < 0.0001). A significant correlation of T1 reduction could be observed with LFTs, MELD and Mayo Risk Score (p < 0.05). CONCLUSIONS T1 mapping of the liver using a variable flip angle-based sequence is a feasible technique to evaluate liver function on a global level, and may be extrapolated on a segmental level in patients with PSC. KEY POINTS • T1 mapping enables evaluation of global liver function in PSC. • T1 relaxation time reduction correlates with the MELD and MayoRisk Score. • Extrapolated, T1 mapping may allow for segmental evaluation of liver function.
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Affiliation(s)
- Heiko Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Henrike Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Hans-Juergen Raatschen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
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Lee Y, Kim SY, Kim KW, Lee SS, Park SH, Byun JH, Lee MG. Contrast-enhanced MR cholangiography with Gd-EOB-DTPA for preoperative biliary mapping: correlation with intraoperative cholangiography. Acta Radiol 2015; 56:773-81. [PMID: 25080516 DOI: 10.1177/0284185114542298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/11/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gd-EOB-DTPA-enhanced magnetic resonance (MR) could be used for preoperative evaluation of bile duct anatomy in addition to conventional information of focal hepatic lesions. PURPOSE To evaluate accuracy of contrast-enhanced MR cholangiography (CE MRC) reconstructed from Gd-EOB-DTPA-enhanced MR images for depicting biliary anatomy with intraoperative cholangiography. MATERIAL AND METHODS We retrospectively identified 71 patients who underwent both preoperative Gd-EOB-DTPA-enhanced MR imaging (MRI) and intraoperative cholangiography for hepatic resections. Two readers independently analyzed biliary anatomy using CE MRC reconstructed from transverse and coronal images separately in 4 weeks. The accuracy and diagnostic confidence were evaluated in correlation with intraoperative cholangiography. The accuracy and confidence score (3-point scale) were compared on CE MRCs from transverse versus coronal images. RESULTS CE MRCs correctly depicted biliary anatomy in 91.5% and 88.7% with coronal images and in 81.7% and 73.2% with transverse images for readers 1 and 2, respectively. CE MRCs from coronal images tended to show greater accuracy (P = 0.12 and 0.01, for readers 1 and 2) and higher confidence score (P = 0.11 and P = 0.04, for readers 1 and 2) than those from transverse images. CONCLUSION Accurate preoperative biliary mapping can be achieved on CE MRC reconstructed from Gd-EOB-DTPA-enhanced MR images. The diagnostic performance was better on CE MRC reconstructed from coronal than those from transverse images.
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Affiliation(s)
- Yedaun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Merkle EM, Zech CJ, Bartolozzi C, Bashir MR, Ba-Ssalamah A, Huppertz A, Lee JM, Ricke J, Sakamoto M, Sirlin CB, Ye SL, Zeng M. Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 2015; 26:674-82. [PMID: 26070500 PMCID: PMC4747985 DOI: 10.1007/s00330-015-3873-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 12/13/2022]
Abstract
Objectives Liver-specific MRI is a fast-growing field, with technological and protocol advancements providing more robust imaging and allowing a greater depth of information per examination. This article reports the evidence for, and expert thinking on, current challenges in liver-specific MRI, as discussed at the 7th International Forum for Liver MRI, which was held in Shanghai, China, in October 2013. Methods Topics discussed included the role of gadoxetic acid-enhanced MRI in the differentiation of focal nodular hyperplasia from hepatocellular adenoma and small hepatocellular carcinoma (HCC) from small intrahepatic cholangiocarcinoma (in patients with chronic liver disease), the differentiation of low-grade dysplastic nodule (DN) from pre-malignant high-grade DN and early HCC, and treatment planning and assessment of treatment response for patients with HCC and colorectal liver metastasis. Optimization of the gadoxetic acid-enhanced MRI protocol to gain robust arterial and hepatobiliary phase images was also discussed. Results and conclusions Gadoxetic acid-enhanced MRI demonstrates added value for the detection and characterization of focal liver lesions and shows promise in a number of new indications, including regional liver functional assessment and patient monitoring after therapy; however, more data are needed in some areas, and further developments are needed to translate cutting-edge techniques into clinical practice. Key Points • Liver-specific MRI is a fast-growing field, with many technological and protocol advancements. • Gadoxetic acid-enhanced MRI demonstrates value for detecting and characterizing focal liver lesions. • Gadoxetic acid-enhanced MRI shows promise in regional functional assessment and patient monitoring. • Further developments are needed to translate cutting-edge techniques into clinical practice.
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Affiliation(s)
- Elmar M Merkle
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | - Christoph J Zech
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | | | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Ba-Ssalamah
- Department of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | | | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, California, USA
| | - Sheng-Long Ye
- Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Mengsu Zeng
- Radiologic Diagnostic Department, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Feng ST, Wu L, Cai H, Chan T, Luo Y, Dong Z, Zheng K, Li ZP. Cholangiocarcinoma: spectrum of appearances on Gd-EOB-DTPA-enhanced MR imaging and the effect of biliary function on signal intensity. BMC Cancer 2015; 15:38. [PMID: 25655565 PMCID: PMC4324426 DOI: 10.1186/s12885-015-1039-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/23/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To describe the Gd-EOB-DTPA-enhanced MRI appearances of cholangiocarcinoma, and evaluate the relative signal intensities (RSIs) changes of major abdominal organs, and investigate the effect of total bilirubin (TB) levels on the RSI. METHODS 25 patients with pathologically-proven cholangiocarcinoma underwent Gd-EOB-DTPA-enhanced MRI. The visualization of the biliary system during biliary phase (BP) was observed. RSIs of the abdominal aorta (A), portal vein (V), liver (L), and spleen (S) were measured. RESULTS On hepatocellular phase (HP), exophytic tumors (n =10) and infiltrative tumors (n =10) were hypointense, polypoid tumors (n = 2) were hypointense, and combined type tumors (n = 3) had mixed appearances. While patients with normal TB levels (≤22 μmol/L, n = 12) had clear visualization of the biliary tree during BP, those with elevated TB levels (>22 μmol/L, n = 13) had obscured or no visualization. In addition, patients with normal TB levels had higher RSIA, RSIV and RSIS than those with elevated TB levels on all dynamic phases (P <0.001), and lower RSIA, RSIV and RSIS on HP and BP (P <0.001). Patients with normal TB levels had higher RSIL than those with elevated TB levels on all phases (P <0.001). CONCLUSIONS RSIs of major abdominal organs reflected underlying biliary function. Cholangiocarcinoma patients with elevated TB levels had delayed excretion of Gd-EOB-DTPA compared with patients with normal TB levels.
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Affiliation(s)
- Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Ling Wu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Tao Chan
- Medical Imaging Department, Union Hospital, Hong Kong, 18 Fu Kin Street, Tai Wai, Shatin, NT, Hong Kong.
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Keguo Zheng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, Guangdong, 510080, China.
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Accumulation of Bile in the Gallbladder: Evaluation by means of Serial Dynamic Contrast-Enhanced Magnetic Resonance Cholangiography with Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid. Gastroenterol Res Pract 2015; 2014:479067. [PMID: 25580112 PMCID: PMC4280652 DOI: 10.1155/2014/479067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/30/2014] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to evaluate the process of biliary excretion of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) into the biliary tract and to assess the accumulation patterns in the gallbladder using MR cholangiography obtained with Gd-EOB-DTPA which is a liver-specific hepatobiliary contrast agent. Seventy-five patients underwent Gd-EOB-DTPA enhanced MR imaging. Serial multiphasic hepatobiliary phase imaging was qualitatively reviewed to evaluate the process of the biliary excretion of contrast agent into the bile duct and the gallbladder. The accumulation pattern of contrast agent into gallbladder was classified into two groups (group 1 = orthodromic type and group 2 = delayed type). Furthermore, the results in differences of the presence of T1 hyperintense bile or sludge of gallbladder, gall stones, wall thickening of gallbladder, chronic liver disease, and liver cirrhosis between two groups were compared. Forty-eight of 75 patients (64%) were included in group 1, and remaining 27 (36%) were in group 2. The frequency of the presence of T1 hyperintense bile or sludge of gallbladder was significantly higher in patients with group 2 than that in patients with group 1 (P = 0.041). MR cholangiography obtained with Gd-EOB-DTPA showed that there may be an association between the biliary accumulation pattern in the gallbladder and the pathological condition.
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Imura S, Shimada M, Utsunomiya T. Recent advances in estimating hepatic functional reserve in patients with chronic liver damage. Hepatol Res 2015; 45:10-9. [PMID: 24606181 DOI: 10.1111/hepr.12325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 02/16/2014] [Accepted: 03/05/2014] [Indexed: 12/17/2022]
Abstract
Preoperative estimation of liver functional reserve is important in liver surgery to prevent postoperative liver failure. Although the hepatic functional reserve of patients with chronic liver disease is generally evaluated by measuring indocyanine green dye retention at 15 min, no standard method of estimating regional liver function has been established to date. Several recently introduced imaging modalities, such as hepatobiliary scintigraphy and magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, may be used to evaluate liver function. Here, we review recent advances in estimating hepatic functional reserve, mainly by radiological modalities, in patients with chronic liver damage.
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Affiliation(s)
- Satoru Imura
- Department of Surgery, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
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Xiao YD, Paudel R, Liu H, Zhang B, Ma C, Zhou SK. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging: A potential utility for the evaluation of regional liver function impairment following transcatheter arterial chemoembolization. Oncol Lett 2014; 9:1191-1196. [PMID: 25663880 PMCID: PMC4315072 DOI: 10.3892/ol.2014.2826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/02/2014] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to evaluate regional liver function impairment following transcatheter arterial chemoembolization (TACE), assessed by magnetic resonance imaging (MRI) enhanced by gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA). Additionally, this study evaluated the associations between signal intensity and various clinical factors. A prospective study was conducted between March 2012 and May 2013 with a total of 35 patients. Gd-EOB-DTPA-enhanced MRI was performed 3–5 days after TACE therapy. The signal to noise ratio (SNR) was subsequently calculated for healthy liver tissue regions and peritumoral regions, prior to and 20 min after Gd-EOB-DTPA administration. The correlation between clinical factors and relative SNR was assessed using Pearson’s correlation coefficient or Spearman’s rank correlation coefficient. Prior to Gd-EOB-DTPA administration, the SNR values showed no significant difference (t=1.341, P=0.191) in healthy liver tissue regions (50.53±15.99; range, 11.25–83.46) compared with peritumoral regions (49.81±15.85; range, 12.34–81.53). On measuring at 20 min following Gd-EOB-DTPA administration, the SNR in healthy liver tissue regions (82.55±33.33; range, 31.45–153.02) was significantly higher (t=3.732, P<0.001) compared with that in peritumoral regions (75.77±27.41; range, 31.42–144.49). The relative SNR in peritumoral regions correlated only with the quantity of iodized oil used during TACE therapy (r=0.528, P=0.003); the age, gender, diameter and blood supply of the tumor, or Child-Pugh class of the patient did not correlate with relative SNR. Gd-EOB-DTPA-enhanced MRI may be an effective way to evaluate regional liver function impairment following TACE therapy.
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Affiliation(s)
- Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Ramchandra Paudel
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Huan Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Bin Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Cong Ma
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Shun-Ke Zhou
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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Cieslak KP, Runge JH, Heger M, Stoker J, Bennink RJ, van Gulik TM. New perspectives in the assessment of future remnant liver. Dig Surg 2014; 31:255-68. [PMID: 25322678 DOI: 10.1159/000364836] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 05/24/2014] [Indexed: 12/20/2022]
Abstract
In order to achieve microscopic radical resection margins and thus better survival, surgical treatment of hepatic tumors has become more aggressive in the last decades, resulting in an increased rate of complex and extended liver resections. Postoperative outcomes mainly depend on the size and quality of the future remnant liver (FRL). Liver resection, when performed in the absence of sufficient FRL, inevitably leads to postresection liver failure. The current gold standard in the preoperative assessment of the FRL is computed tomography volumetry. In addition to the volume of the liver remnant after resection, postoperative function of the liver remnant is directly related to the quality of liver parenchyma. The latter is mainly influenced by underlying diseases such as cirrhosis and steatosis, which are often inaccurately defined until microscopic examination after the resection. Postresection liver failure remains a point of major concern that calls for accurate methods of preoperative FRL assessment. A wide spectrum of tests has become available in the past years, attesting to the fact that the ideal methodology has yet to be defined. The aim of this review is to discuss the current modalities available and new perspectives in the assessment of FRL in patients scheduled for major liver resection.
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Affiliation(s)
- Kasia P Cieslak
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Boraschi P, Donati F. Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography. World J Gastroenterol 2014; 20:11080-11094. [PMID: 25170197 PMCID: PMC4145751 DOI: 10.3748/wjg.v20.i32.11080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 03/24/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance (MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, non-invasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. On the basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents (in particular using Gd-EOB-DTPA) in order to improve the diagnostic accuracy in the adverse events’ detection such as bile leakage and strictures, especially in selected patients with biliary-enteric anastomosis.
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Boraschi P, Donati F. Biliary-enteric anastomoses: spectrum of findings on Gd-EOB-DTPA-enhanced MR cholangiography. ACTA ACUST UNITED AC 2014; 38:1351-9. [PMID: 23820693 DOI: 10.1007/s00261-013-0007-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Biliary-enteric anastomosis is a common surgical procedure performed for the management of a variety of benign and malignant diseases. This procedure presents a high risk of developing complications such as anastomotic leak, hemorrhage, cholangitis, stones, stricture formation, that have been reported as ranging from 3 % to 43 %. Because the endoscopic approach of the biliary tract is generally precluded in this setting, there is clearly a role for a non-invasive imaging technique to follow up these patients and to detect the possible complications. T2-weighted MR cholangiography has been shown to be effective in the evaluation of patients with biliary-enteric anastomosis. Some of these patients may have mild duct dilatation in spite of a patent anastomosis, and stenosis should be considered only when duct dilatation is associated with narrowing of the anastomotic site. T2-weighted MRC depicts the site of biliary-enteric anastomosis, the cause of obstruction, and the status of the biliary ducts upstream. However, the disadvantages of conventional MRC are that it lacks functional information and so, differentiation between obstructive and non-obstructive dilatation of the bile ducts is often extremely difficult. T1-weighted contrast-enhanced MR cholangiography using Gd-EOB-DTPA is a recently emerging technique that is useful for delineating the anatomy of biliary-enteric anastomoses and detecting complications such as strictures, intraductal stones, and biliary leaks; besides, this technique can provide functional information that are extremely promising in the grading of biliary obstruction. We present the spectrum of findings of biliary-enteric anastomoses on Gd-EOB-DTPA-enhanced MR cholangiography focusing on the main clinical applications.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124, Pisa, Italy,
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Lee SW, Cha SH, Chung HH, Kim KH, Yeom SK, Seo BK, Je BK, Kim BH. Functional magnetic resonance cholangiography with Gd-EOB-DTPA: a study in healthy volunteers. Magn Reson Imaging 2014; 32:385-91. [PMID: 24529920 DOI: 10.1016/j.mri.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/18/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe the patterns of bile distribution in the biliary tree, duodenum, jejunum, and stomach, and to determine the gallbladder ejection fraction (GBEF) by using functional magnetic resonance cholangiography (MRC) with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in healthy volunteers. MATERIALS AND METHODS Forty subjects were included in this study. After conventional MRC, pre-fatty meal MRC (PRFM) was obtained at 30, 40, 50, and 60min after contrast agent injection. Then, post-fatty meal MRC (POFM) was obtained every 10min for 1h. We assessed the PRFM and POFM for opacification of contrast agent in the first- and second-order intrahepatic ducts (IHDs) and the common bile duct (CBD). Contrast agent opacification in the cystic duct was assessed, and the percentage volume of contrast agent filling in the gallbladder (GB) was calculated on PRFM. We calculated the GBEF and assessed the presence of contrast agent in the GB, duodenum, jejunum, and stomach. RESULTS Thirty-six (90%) subjects showed grade 3 CBD opacification (visible contrast and well-defined bile duct border) on 60-min PRFM. Thirty-four (85%) subjects showed grade 3 first-order IHD opacification on 60-min PRFM. All (100%) subjects showed cystic duct opacification of contrast agent, and the average percentage volume of contrast agent filling in the GB was 68.81%±16.84% on 60-min PRFM. The GBEF at 30-min POFM was 35.00%±18.26%. Ten (25%) subjects had no contrast agent in the stomach and small bowel on all PRFMs. Twelve (30%) subjects had contrast medium in the stomach on PRFM and/or POFM. CONCLUSIONS Functional MRC with Gd-EOB-DTPA can allow determining the distribution of bile in the biliary tree and small intestine, as well as the GBEF.
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Affiliation(s)
- Seung Wha Lee
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707.
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Kee Hwan Kim
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Suk Keu Yeom
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Bo Kyung Seo
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Bo Kyung Je
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hopsital, # 516 GoJan 1-dong, Ansan-si, Gyeonggi-do, Korea, 425-707
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Characterization of the Intestinal and Hepatic Uptake/Efflux Transport of the Magnetic Resonance Imaging Contrast Agent Gadolinium-Ethoxylbenzyl-Diethylenetriamine-Pentaacetic Acid. Invest Radiol 2014; 49:78-86. [DOI: 10.1097/rli.0b013e3182a70043] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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40
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Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: Comparison of 20–25min delayed and 60–180min delayed images. Eur J Radiol 2013; 82:2176-82. [DOI: 10.1016/j.ejrad.2013.08.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 11/22/2022]
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Choi IY, Yeom SK, Cha SH, Lee SH, Chung HH, Hyun JJ, Kim BH. Diagnosis of biliary stone disease: T1-weighted magnetic resonance cholangiography with Gd-EOB-DTPA versus T2-weighted magnetic resonance cholangiography. Clin Imaging 2013; 38:164-9. [PMID: 24359645 DOI: 10.1016/j.clinimag.2013.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/08/2013] [Accepted: 11/04/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to compare diagnostic performance of gadoxetic-acid-enhanced-T1-weighted-MR cholangiography (MRC) with that of conventional T2-weighted-MRC in diagnosing biliary stone disease. MATERIALS AND METHODS Ninety patients who underwent MRC for evaluation of biliary disease were included. Presence of stones in extrahepatic duct, gallbladder and intrahepatic duct, and presence of acute cholecystitis were evaluated. Sensitivity, specificity, and accuracy of biliary stone disease diagnosis in each biliary duct location according to each image sets were measured. RESULTS There was no significant difference in diagnostic performance between two sets of MRC in diagnosing biliary stone disease. CONCLUSIONS Diagnostic performance of T1-MRC with gadoxetic-acid in diagnosing biliary stone disease is comparable to that of T2-MRC.
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Affiliation(s)
- In Young Choi
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Suk Keu Yeom
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea.
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Jong Jin Hyun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University Ansan Hospital, 425-707, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do, Korea
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Feng ST, Wu L, Chan T, Cai H, Luo Y, Zheng K, Tang D, Li ZP. Functional magnetic resonance cholangiography enhanced with Gd-EOB-DTPA: effect of liver function on biliary system visualization. J Magn Reson Imaging 2013; 39:1254-8. [PMID: 24115466 DOI: 10.1002/jmri.24277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/17/2013] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate effect of liver function on biliary system visualization using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (CE-MRC). MATERIALS AND METHODS In all, 39 patients were divided into three groups according to their Child-Pugh classification: group A, Child-Pugh class A (23); group B, class B (11); and group C, class C (5). They underwent Gd-EOB-DTPA CE-MRC. Biliary system visualization was qualitatively rated on a 5-point scale. Relative signal intensity (RSI) of common bile duct (CBD) and liver was quantitatively measured. Laboratory findings and the Model of Endstage Liver Disease (MELD) score were recorded. RESULTS Visualization ratings of CBD, left hepatic duct, right hepatic duct, segmental branches of intrahepatic ducts, cystic duct, and gallbladder of group A were: 3.61 ± 0.58, 2.87 ± 0.97, 2.96 ± 0.77, 1.17 ± 0.58, 3.04 ± 0.83, 3.00 ± 0.95, respectively; group B: 2.00 ± 0.61, 1.09 ± 0.64, 0.91 ± 0.54, 0.27 ± 0.13, 1.36 ± 0.62, 1.45 ± 0.54, respectively; group C: 1.40 ± 0.73, 1.00 ± 0.51, 1.00 ± 0.51, 0.00 ± 0.00, 0.60 ± 0.39, 0.60 ± 0.39, respectively. RSI of CBD of groups A to C were 17.12 ± 0.41, 3.95 ± 0.63, 3.33 ± 0.30, respectively. RSI of liver of groups A to C were 6.73 ± 0.72, 2.53 ± 1.02, 2.05 ± 0.11, respectively. CE-MRC images of group A were significantly better than those of group B and C in terms of both visualization ratings and RSI of CBD. CBD RSI positively correlated with liver RSI (r = 0.99, P < 0.001). The total serum bilirubin level and MELD score were significant predictors of RSI of CBD. CONCLUSION Different liver function according to Child-Pugh classification significantly affects biliary system visualization of Gd-EOB-DTPA CE-MRC.
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Affiliation(s)
- Shi-Ting Feng
- Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Abstract
Magnetic resonance (MR) imaging is an effective and noninvasive modality for evaluating hepatobiliary pathologic conditions. This article provides an up-to-date review of anatomy, indications, and imaging goals and protocols, including patient preparation, pulse sequences, and contrast agents used in pediatric MR hepatobiliary imaging. This article also highlights some of the common MR features of pediatric liver pathologic conditions, including tumors, congenital biliary ductal plate malformations, trauma, fibrosis, and infection.
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Gonoi W, Akahane M, Watanabe Y, Isono S, Maeda E, Hagiwara K, Ohtomo K. Visualization of Bile Movement Using MRI Spin-Labeling Technique: Preliminary Results. AJR Am J Roentgenol 2013; 201:133-141. [PMID: 23789667 DOI: 10.2214/ajr.12.8928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masaaki Akahane
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasushi Watanabe
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Sachiko Isono
- MRI Applications, Toshiba Medical Systems, Tochigi, Japan
| | - Eriko Maeda
- Department of Computational Diagnostic Radiology and Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuchika Hagiwara
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Dym RJ, Chernyak V, Rozenblit AM. MR imaging of renal collecting system with gadoxetate disodium: Feasibility for MR urography. J Magn Reson Imaging 2013; 38:816-23. [DOI: 10.1002/jmri.24059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 01/07/2012] [Indexed: 11/06/2022] Open
Affiliation(s)
- R. Joshua Dym
- Department of Radiology; Albert Einstein College of Medicine and Montefiore Medical Center; Bronx New York USA
| | - Victoria Chernyak
- Department of Radiology; Albert Einstein College of Medicine and Montefiore Medical Center; Bronx New York USA
| | - Alla M. Rozenblit
- Department of Radiology; Albert Einstein College of Medicine and Montefiore Medical Center; Bronx New York USA
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Effect of Flip Angle for Optimization of Image Quality of Gadoxetate Disodium–Enhanced Biliary Imaging at 1.5 T. AJR Am J Roentgenol 2013; 200:90-6. [DOI: 10.2214/ajr.12.8722] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sun HY, Lee JM, Park HS, Yoon JH, Baek JH, Han JK, Choi BI. Gadoxetic acid-enhanced MRI with MR cholangiography for the preoperative evaluation of bile duct cancer. J Magn Reson Imaging 2012; 38:138-47. [PMID: 23281093 DOI: 10.1002/jmri.23957] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 10/16/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess the diagnostic accuracy of gadoxetic acid-enhanced biliary MRI with MR cholangiography (MRC) in the preoperative evaluation of bile duct cancer (BDC) staging and resectability. MATERIALS AND METHODS Seventy-three patients with BDC who underwent gadoxetic acid-enhanced biliary MRI and MRC, were included in this study. Two abdominal radiologists evaluated the biliary MRI findings regarding the tumor extent, vascular involvement, lymph node metastasis, and tumor resectability. The results were compared with the surgical and pathology findings which were used as the standard reference. The diagnostic performance of the MRI was evaluated using receiver operating characteristics (ROC) analysis. In addition, to determine whether the hepatobiliary phase images had been successfully obtained, the enhancement percentage of the hepatic parenchyma was measured on the portal venous images (PVI) and hepatobiliary phase images (HBPI), respectively. RESULTS The overall accuracy of the two reviewers for determining the tumor resectability was 61.6% and 83.5%, respectively. The Az values were 0.802 for reviewer 1 and 0.892 for reviewer 2 in the evaluation of the secondary biliary confluence tumor involvement and 0.773 for reviewer 1 and 0.846 for reviewer 2 in the evaluation of the intrapancreatic bile duct involvement. In the evaluation of the vascular involvement, the Az values were 0.718 and 0.906, respectively, for the hepatic artery evaluation and 0.55 and 0.88, respectively, for the portal vein evaluation. For assessment of lymph node metastasis, the overall accuracy was 69.6% and 79.7%, respectively. The mean enhancement percentages of hepatic parenchyma on PVI and HBPI were 39.3% and 65.9%, respectively (P % 0.05), and 49 of 73 patients (67.1%) showed higher enhancement percentage on HBPI than on PVI CONCLUSION: Gadoxetic acid-enhanced MRI with MRC is a reliable diagnostic method for assessing the tumor extent and resectability of BDC.
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Affiliation(s)
- Hye Young Sun
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Bae KE, Kim SY, Lee SS, Kim KW, Won HJ, Shin YM, Kim PN, Lee MG. Assessment of hepatic function with Gd-EOB-DTPA-enhanced hepatic MRI. Dig Dis 2012; 30:617-22. [PMID: 23258104 DOI: 10.1159/000343092] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Assessment of hepatic function is essential in determining the prognosis and clinical management of a patient who has chronic liver disease or undergoes liver surgery. For a patient with locally varying hepatic parenchymal abnormalities, a regional assessment of hepatic function mapped onto hepatic anatomy is clinically more meaningful than conventional global metrics of hepatic function. Of late, hepatic magnetic resonance imaging has been increasingly used because of its superb tissue contrast and delineation of hepatic morphology and underlying abnormalities. The introduction of hepatocyte-specific contrast agents such as Gd-EOB-DTPA allows us to view not only the hepatic anatomy but also assess regional hepatic function. In this article, we review and discuss recently published studies that used Gd-EOB-DTPA-enhanced magnetic resonance imaging to evaluate hepatic function.
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Affiliation(s)
- Kyung Eun Bae
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
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