Abstract
Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a paramagnetic hepatobiliary magnetic resonance (MR) contrast agent. Due to its OATP1B1/B3-dependent hepatocyte-specific uptake and paramagnetic properties increasing evidence has emerged to suggest that Gd-EOB-DTPA-enhanced MRI can be potentially used for evaluation of liver function. In this paper we compare the diagnostic performance of Gd-EOB-DTPA-enhanced relaxometry-based and commonly used signal-intensity (SI)-based indices, including the hepatocellular uptake index (HUI) and SI-based indices corrected by spleen or muscle, for evaluation of liver function, determined using the Indocyanin green clearance (ICG) test. Simple linear regression model showed a significant correlation of the plasma disappearance rate of ICG (ICG-PDR) with all Gd-EOB-DTPA-enhanced MRI-based liver function indices with a significantly better correlation of relaxometry-based indices on ICG-PDR compared to SI-based indices. Among SI-based indices, HUI achieved best correlation on ICG-PDR and no significant difference of respective correlations on ICG-PDR could be shown. Assessment of liver volume and consecutive evaluation of multiple linear regression model revealed a stronger correlation of ICG-PDR with both (SI)-based and T1 relaxometry-based indices. Thus, liver function can be estimated quantitatively from Gd-EOB-DTPA–enhanced MRI-based indices. Here, indices derived from T1 relaxometry are superior to SI-based indices, and all indices benefit from taking into account respective liver volumes.
Highlights
Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a paramagnetic hepatobiliary magnetic resonance (MR) contrast agent
In recent years, increasing evidence has emerged to suggest that Gd-EOB-DTPA- enhanced MRI can be potentially used for evaluation of global and remnant liver function[12,13,15,18,19,24,25,26,27,28,29]
The indices that have been proposed for assessment of liver function using Gd-EOB-DTPA-enhanced MRI include both SI-based indices and T1 relaxometry
Summary
Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a paramagnetic hepatobiliary magnetic resonance (MR) contrast agent. The evaluation of biochemical blood parameters and clinical scoring systems like the Model for End-Stage Liver Disease (MELD) score or Child- Pugh Score as well as the preoperative liver volumetry is used for assessing liver function and for selecting appropriate patients for liver surgery[1,2,3] In this context, considered to be the goldstandard for assessment of liver function, the indocyanine green (ICG) clearance test has been established as a valuable tool[4]. OATP1B1/B3 – MRP2 pathway, Gd-EOB-DTPA and ICG are dependent on the same transport mechnisms; similar to ICG clearance, gadoxetate disodium-enhanced MR imaging should provide information for quantitative evaluation of liver function and allow for anatomic delineation of hepatic function[7,8,9]. Yamada et al recently reported that MRI-based estimation of liver function using liver parenchymal enhancement can be improved by taking into account the respective liver volumes and introduced the hepatocellular uptake index (HUI)[18]
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