Abstract
ObjectivesTo evaluate the correlation between liver enhancement on hepatobiliary phase and liver function parameters in a multicenter, multivendor study.MethodsA total of 359 patients who underwent gadoxetic acid–enhanced MRI using a standardized protocol with various scanners within a prospective multicenter phase II trial (SORAMIC) were evaluated. The correlation between liver enhancement on hepatobiliary phase normalized to the spleen (liver-to-spleen ratio, LSR) and biochemical laboratory parameters, clinical findings related to liver functions, liver function grading systems (Child-Pugh and Albumin-Bilirubin [ALBI]), and scanner characteristics were analyzed using uni- and multivariate analyses.ResultsThere was a significant positive correlation between LSR and albumin (rho = 0.193; p < 0.001), platelet counts (rho = 0.148; p = 0.004), and sodium (rho = 0.161; p = 0.002); and a negative correlation between LSR and total bilirubin (rho = −0.215; p < 0.001) and AST (rho = −0.191; p < 0.001). Multivariate analysis confirmed independent significance for each of albumin (p = 0.022), total bilirubin (p = 0.045), AST (p = 0.031), platelet counts (p = 0.012), and sodium (p = 0.006). The presence of ascites (1.47 vs. 1.69, p < 0.001) and varices (1.55 vs. 1.69, p = 0.006) was related to significantly lower LSR. Similarly, patients with ALBI grade 1 had significantly higher LSR than patients with grade 2 (1.74 ± 0.447 vs. 1.56 ± 0.408, p < 0.001); and Child-Pugh A patients had a significantly higher LSR than Child-Pugh B (1.67 ± 0.44 vs. 1.49 ± 0.33, p = 0.021). Also, LSR was negatively correlated with MELD-Na scores (rho = −0.137; p = 0.013). However, one scanner brand was significantly associated with lower LSR (p < 0.001).ConclusionsThe liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI is correlated with biomarkers of liver functions in a multicenter cohort. However, this correlation shows variations between scanner brands.Key Points• The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI and liver function is consistent in a multicenter-multivendor cohort.• Signal intensity–based indices (liver-to-spleen ratio) can be used as an imaging biomarker of liver function.• However, absolute values might change between vendors.
Highlights
Gadoxetic acid is a hepatocellular specific contrast agent showing selective hepatocyte uptake, which peaks approximately 20 min after injection [1]
The correlation between liver enhancement on the hepatobiliary phase of gadoxetic acid–enhanced MRI and liver function is consistent in a multicenter-multivendor cohort
Univariate analysis revealed a positive correlation between liver-tospleen ratio (LSR) and albumin, platelet counts, and sodium
Summary
Gadoxetic acid is a hepatocellular specific contrast agent showing selective hepatocyte uptake, which peaks approximately 20 min after injection (hepatobiliary phase) [1]. Previous studies have shown that hepatic enhancement is correlated with ALBI-score [5, 6], Child-Pugh grade [7], MELDscore [8], hypoalbuminemia [8,9,10], hyperbilirubinemia [9,10,11], INR [9], platelet count [9], serum sodium [8], and ascites [8] All of these comprised single-center cohorts with a small number of patients. A single-center study showed that signal intensity (SI)–based indices (including LSR) remained similar when the same patient underwent consecutive MRI within the same center and identified no significant difference between scanners from the same vendor [14]. Evaluation of the consistency of SI-based indices between different scanner brands lacks in the literature
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