Does Hepatic Steatosis Influence the Detection Rate of Metastases in the Hepatobiliary Phase of Gadoxetic Acid-Enhanced MRI?

Ingo G Steffen,Sascha S Chopra,Dominik Geisel,Jan Holger Rothe,Timm Denecke,Johannes Kahn,Bernd Hamm,Thomas Weissmann

doi:10.3390/jcm10010098

Abstract

The aim of this exploratory study was to evaluate the influence of hepatic steatosis on the detection rate of metastases in gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). A total of 50 patients who underwent gadoxetic acid-enhanced MRI (unenhanced T1w in- and opposed-phase, T2w fat sat, unenhanced 3D-T1w fat sat and 3-phase dynamic contrast-enhanced (uDP), 3D-T1w fat sat hepatobiliary phase (HP)) were retrospectively included. Two blinded observers (O1/O2) independently assessed the images to determine the detection rate in uDP and HP. The hepatic signal fat fraction (HSFF) was determined as the relative signal intensity reduction in liver parenchyma from in- to opposed-phase images. A total of 451 liver metastases were detected (O1/O2, n = 447/411). O1/O2 detected 10.9%/9.3% of lesions exclusively in uDP and 20.2%/15.5% exclusively in HP. Lesions detected exclusively in uDP were significantly associated with a larger HSFF (area under curve (AUC) of receiver operating characteristic (ROC) analysis, 0.93; p < 0.001; cutoff, 41.5%). The exclusively HP-positive lesions were significantly associated with a smaller diameter (ROC-AUC, 0.82; p < 0.001; cutoff, 5 mm) and a smaller HSFF (ROC-AUC, 0.61; p < 0.001; cutoff, 13.3%). Gadoxetic acid imaging has the advantage of detecting small occult metastatic liver lesions in the HP. However, using non-optimized standard fat-saturated 3D-T1w protocols, severe steatosis (HSFF > 30%) is a potential pitfall for the detection of metastases in HP.

Highlights

Non-alcoholic fatty liver disease (NAFLD), ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) is considered to be the hepatic manifestation of the metabolic syndrome and has become the leading chronic liver disorder in the developed world with an estimated global prevalence up to 30% [1,2,3]
The aim of this study was to analyze the effect of hepatic steatosis on the detection rate of metastases in fatty livers in patients examined using a standard gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) protocol
Inclusion criteria were a gadoxetic acid-enhanced liver MRI in our institution with at least one histologically confirmed liver metastasis and the presence of hepatic steatosis >10% based on chemical shift method

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD), ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) is considered to be the hepatic manifestation of the metabolic syndrome and has become the leading chronic liver disorder in the developed world with an estimated global prevalence up to 30% [1,2,3]. The recommended and internationally accepted MRI protocol with gadoxetic acid consists of axial gapless three-dimensional interpolated T1-weighted fat-saturated breath-hold gradient echo sequences with a flip angle of 10◦–12◦ (3D-T1w-FS; e.g., VIBE (Siemens), THRIVE (Philips), LAVA (GE) for dynamic (arterial to equilibrium phase) and hepatobiliary phase (delay, 10–20 min) imaging [10,13]. These robust sequences require only a short breath-hold interval and have high spatial resolution (slice thickness, 2–3 mm). This could potentially impair lesion detection by reducing the SI contrast between the hepatocellular parenchyma and the metastatic tissue

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