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Simeth J, Aryal M, Owen D, Cuneo K, Lawrence TS, Cao Y. Gadoxetic Acid Uptake Rate as a Measure of Global and Regional Liver Function as Compared to Indocyanine Green Retention, Albumin-Bilirubin Score, and Portal Venous Perfusion. Adv Radiat Oncol 2022; 7:100942. [PMID: 35496263 PMCID: PMC9048078 DOI: 10.1016/j.adro.2022.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/26/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose Global and regional liver function assessments are important for defining the magnitude and spatial distribution of dose to preserve functional liver parenchyma and reduce incidence of hepatotoxicity from radiation therapy for intrahepatic cancer treatment. This individualized liver function-guided radiation therapy strategy is critical for patients with heterogeneous and poor liver function, often observed in cirrhotic patients treated for hepatocellular carcinoma. This study aimed to validate k1 as a measure of global and regional function through comparison with 2 well-regarded global function measures: indocyanine green retention (ICGR) and albumin-bilirubin (ALBI). Methods and Materials Seventy-nine dynamic gadoxetic acid enhanced magnetic resonance imaging scans were acquired in 40 patients with hepatocellular carcinoma in institutional review board approved prospective protocols. Portal venous perfusion (kpv) was quantified from gadoxetic acid enhanced magnetic resonance imaging using a dual-input 2-compartment model, and gadoxetic acid uptake rate (k1) was fitted using a linearized single-input 2-compartment model chosen for robust k1 estimation. Four image-derived measures of global liver function were tested: (1) mean k1 multiplied by liver volume (k1VL) (functional volume), (2) mean k1 multiplied by blood distribution volume (k1Vdis), (3) mean kpv, and (4) liver volume (VL). The measure's correlation with corresponding ICGR and ALBI tests was assessed using linear regression. Voxel-wise similarity between k1 and kpv was compared using Spearman ranked correlation. Results Significant correlations (P < .05) with ICGR and ALBI were found for k1VL, k1Vdis, and VL (in order of strength), but not for mean kpv. The mean ranked correlation coefficient between k1 and kpv maps was 0.09. k1 and kpv maps were predominantly mismatched in patients with poor liver function. Conclusions The metric combining function and liver volume (k1VL) was a stronger measure of global liver function compared with perfusion or liver volume alone, especially in patients with poor liver function. Gadoxetic acid uptake rate is promising for both global and regional liver function.
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Affiliation(s)
- Josiah Simeth
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
- Biomedical Engineering, University of Michigan, Ann Arbor, MI
- Department of Medical Physics, Memorial Sloan Kettering, New York, NY
- Corresponding author: Josiah Simeth, PhD
| | - Madhava Aryal
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Kyle Cuneo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
- Biomedical Engineering, University of Michigan, Ann Arbor, MI
- Department of Radiology, University of Michigan, Ann Arbor, MI
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Hall RC, Qin J, Laney V, Ayat N, Lu ZR. Manganese(II) EOB-Pyclen Diacetate for Liver-Specific MRI. ACS APPLIED BIO MATERIALS 2022; 5:451-458. [PMID: 35148050 DOI: 10.1021/acsabm.1c01259] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
MRI is increasingly utilized for the diagnosis of liver disease and focal liver lesions. Although liver-targeted gadolinium-based contrast agents (GBCAs) have high efficacy, there continue to be safety concerns regarding release of toxic Gd(III) ions. Herein, Mn(EOB-PC2A) is synthesized as a nongadolinium alternative for liver-specific MRI. Mn(EOB-PC2A) has an r1 relaxivity of 2.8 mM-1 s-1 in Dulbecco's phosphate-buffered saline (DPBS) and 5.9 mM-1 s-1 in saline containing human serum albumin at 1.5 T. It has a strong uptake in hepatocytes with minimal toxicity and demonstrated robust liver-specific enhancement at a dose of 60 μmol/kg. Mn(EOB-PC2A) is a promising liver-specific contrast agent for liver MRI.
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Affiliation(s)
- Ryan C Hall
- Department of Biomedical Engineering, Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Jingcan Qin
- Department of Biomedical Engineering, Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Victoria Laney
- Department of Biomedical Engineering, Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Nadia Ayat
- Department of Biomedical Engineering, Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Zheng-Rong Lu
- Department of Biomedical Engineering, Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio 44106, United States
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Huang M, Shen S, Cai H, Peng Z, Chiu WHK, Li ZP, Peng B, Feng ST. Regional liver function analysis with gadoxetic acid-enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC. Eur Radiol 2021; 31:4720-4730. [PMID: 33449173 DOI: 10.1007/s00330-020-07606-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore the role of quantitative regional liver function assessed by preoperative gadoxetic acid-enhanced MRI with computer-aided virtual hepatectomy to predict short-term outcomes after major hepatectomy for HCC. METHODS We retrospectively reviewed the records of 133 consecutive patients with HCC who underwent preoperative gadoxetic acid-enhanced MRI and indocyanine green (ICG) test. Forty-five patients received open major hepatectomy. Liver function reserve and the future liver remnant were evaluated by computer-aided virtual hepatectomy. Global liver functional parameters included the T1 relaxation time reduction rate (T1ratio) and functional liver volume (FV), whereas regional parameters included the rT1pos, rT1ratio, remnant FV (rFV), and remnant FV ratio (rFVratio) of the remnant liver. The functional parameters of the MRI and ICG were used to predict the short-term outcomes (liver failure and major complications) after major hepatectomy. RESULTS The T1ratio and FV were correlated with the ICG test (rho = - 0.304 and - 0.449, p < 0.05). FV < 682.8 ml indicated preoperative ICG-R15 ≥ 14% with 0.765 value of the area under the curve (AUC). No patient who underwent major resection with good liver functional reserve (ICG < 14%) and enough future remnant volume (> 30% standard LV) developed liver failure. Low rT1ratio (< 66.5%) and high rT1pos (> 217.5 ms) may predict major complications (AUC = 0.831 and 0.756, respectively; p < 0.05). The rT1ratio was an independent risk factor for postoperative major complications (odds ratio [OR] = 0.845, 95% CI, 0.736-0.966; p < 0.05). CONCLUSION Preoperative gadoxetic acid-enhanced MRI with computer-aided virtual hepatectomy may facilitate optimal assessment of regional liver functional reserve to predict short-term outcomes after major hepatectomy for HCC. KEY POINTS • Preoperative gadoxetic acid-enhanced MRI with virtual hepatectomy and volumetric analysis can provide precise liver volume and regional functional assessment. • Quantitative regional liver function assessed by gadoxetic acid-enhanced MRI can predict the short-term outcomes after major hepatectomy in patients with HCC. • The regional liver function assessed by gadoxetic acid-enhanced MRI is an independent risk factor for postoperative major complications.
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Affiliation(s)
- Mengqi Huang
- Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Shunli Shen
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Huasong Cai
- Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Zhenpeng Peng
- Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Wan Hang Keith Chiu
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Zi-Ping Li
- Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Baogang Peng
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
| | - Shi-Ting Feng
- Department of Diagnostic Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58th the second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
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