Abstract
Gadoxetic acid (Gd-EOB-DTPA) is a paramagnetic MRI contrast agent with raising popularity and has been used for evaluation of imaging-based liver function in recent years. In order to verify whether liver function as determined by real-time breath analysis using the intravenous administration of 13C-methacetin can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using signal intensity (SI) values. 110 patients underwent Gd-EOB-DTPA-enhanced 3-T MRI and, for the evaluation of liver function, a 13C-methacetin breath test (13C-MBT). SI values from before (SIpre) and 20 min after (SIpost) contrast media injection were acquired by T1-weighted volume-interpolated breath-hold examination (VIBE) sequences with fat suppression. The relative enhancement (RE) between the plain and contrast-enhanced SI values was calculated and evaluated in a correlation analysis of 13C-MBT values to SIpost and RE to obtain a SI-based estimation of 13C-MBT values. The simple regression model showed a log-linear correlation of 13C-MBT values with SIpost and RE (p < 0.001). Stratified by 3 different categories of 13C-MBT readouts, there was a constant significant decrease in both SIpost (p ≤ 0.002) and RE (p ≤ 0.033) with increasing liver disease progression as assessed by the 13C-MBT. Liver function as determined using real-time 13C-methacetin breath analysis can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using SI-based indices.
Highlights
To monitor patients with hepatic dysfunction, various liver function tests are used routinely in clinical practice
The purpose of this retrospective analysis was to evaluate the diagnostic performance of the Gd-EOBDTPA-enhanced signal intensity (SI)-based quantification of liver function compared with an established liver function test, the 13C-methacetin breath test (13C-MBT)
SI in T1-weighted magnetic resonance imaging (MRI) scans compared with 13C-MBT readout
Summary
To monitor patients with hepatic dysfunction, various liver function tests are used routinely in clinical practice. A novel approach, which is already used in clinical routine, is the 13C-methacetin breath test (13C-MBT) established by Stockmann et al.[11] The principle underlying this real-time test is the ability to metabolize 13C-labeled methacetin by the hepatocyte endoplasmic reticulum-located cytochrome P450 1A2 (CYP1A2) into paracetamol and 13C-labeled formaldehyde, which will be eliminated as 13CO25,11–13. No studies have yet compared the direct assessment of hepatic metabolic capacity and the indirect estimation of liver function based on MRI. The purpose of this retrospective analysis was to evaluate the diagnostic performance of the Gd-EOBDTPA-enhanced signal intensity (SI)-based quantification of liver function compared with an established liver function test, the 13C-MBT
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