Assessing liver function: diagnostic efficacy of parenchymal enhancement and liver volume ratio during hepatobiliary phase, of gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB DTPA) enhanced magnetic resonance imaging (MRI) studies

Abstract

Aim: To assess whether Gd-EOB-DTPA enhanced-MRI study is useful to determine liver function in comparison to Child Pugh (CP), Model for End-stage Liver Disease (MELD) and biochemical test. Materials and methods: We retrospectively reviewed all Gd-EOB-DTPA enhanced-MRI studies performed, between May 2011 and September 2017, to characterize focal liver lesion. Patients were divided in study and control group according to the presence/absence of liver cirrhosis. Signal intensity was calculated as the rate of liver-to-muscle ratio on contrast-enhanced T1-GE sequences in portal (SI-POR) and hepatobiliary phase (SI-HEP) and than normalized for liver volume (SI-POR/LV and SI-HEP/LV). Results: A total of 303 Gd-EOB-DTPA enhanced-MRI studies, performed in 221 consecutive patients, were included. Cirrhosis was present in 191 (63.0%) MRI studies. SI-HEP was significantly lower in cirrhotic than in non-cirrhotic patients( 0.55±0.29 vs 0.66±0.40,p=0.004), while no difference was found in SI-POR. SI-HEP progressively decreased from CP-A group to CP-C group (0.59±0.28 to 0.25±0.19, p< 0.0001) and from MELD≤10 to MELD 19-24(0.58±0.30 to 0.54±0.49, p=0.773). SI-HEP had a good performance in distinguishing CP-A from CP-B/C patients (AUC=0.75; 95%CI=0.66-0.83). Among biochemical parameters a moderate correlation was found between SI-HEP and total bilirubin (R=-0.324), GOT (R=-0318) and albumin (R= 0.320). Comparable results were observed when SI-HEP was normalized for liver volume. Conclusion: SI-HEP of Gd-EOB-DTPA enhanced-MRI studies can be effectively used to evaluate liver function. In clinical practice MRI could be performed both to correctly characterize liver lesions and to assess the severity of liver disease especially in the perspective of surgical treatment.