A Study of Correlation between Gd-EOB-DTPA-enhanced MRI Using the 3T MRI System and Tc-99m-GSA Hepatic Scintigraphy/Hepatic Function Tests in Prehepatectomy Cases

Abstract

This study compared results from Gd-EOB-DTPA on two different phases of 3T MRI with those from Tc-99m-GSA hepatic scintigraphy and hepatic function tests. Twenty-four patients with liver tumor were included in this study. All patients underwent Gd-EOB-DTPA-enhanced-MRI and Tc-99m-GSA hepatic scintigraphy. Clearance index HH15 and receptor index LHL15 were calculated for the Tc-99m-GSA, while signal intensities SI of liver at pre-injection and at 4 / 20 min post-injection, and of spleen at 4 min / 20 min were measured SI pre , SI 4min , SI 20min , SI sp4min , SI sp20min , respectively for the Gd-EOB-DTPA-MRI. Liver activity at 15 min by Tc-99m-GSA scintigraphy or biochemical liver function values were compared with liver spleen contrast at 4 min LSC 4min SI 4min / SI sp4min or 20 min postinjection LSC 20min SI 4min / SI SP20min , and the increase in ratio at 4 min IR 4min SI 4min / SI sp4min or 20 min IR 20min SI 20min / SI pre. Total bilirubin levels T-bil , serum albumin levels Alb , prothrombin activity, and the indocyanine green clearance test ICG results were also analyzed. There were statistically significant correlations in all comparisons between Gd-EOB-DTPA and Tc-99m-GSA. The highest coefficient of correlation was obtained in IR 4min LHL15

Comparison of Liver Scintigraphy and the Liver-Spleen Contrast in Gd-EOB-DTPA-Enhanced MRI on Liver Function Tests

“…Therefore, we can assume that this washout is also occurring in the liver ECF space at 20 min after intravenous injection. A previous study that measured the LSC at 20 min after intravenous injection reported that the correlation between the LSC and HH15, which represents the retention of 99m Tc-GSA in the blood [5], was stronger than that between the LSC and LHL15 [12,13]. This fact may indicate that the LSC at 20 min after intravenous injection re ects enhancement by the Gd-EOB-DTPA remaining in liver ECF space rather than in the hepatocytes.…”

“…Clinicians can easily appraise a patient's liver function by converting the LSC into the LHL15, because the evaluation standards of the HH15 and LHL15 have been supported for many years [14]. However, most studies that examined the correlation between the LSC and LHL15 did not have su ciently large sample sizes [11][12][13]. In addition, the results of these correlation analyses remain controversial from the standpoint of the differences in uptake and excretion between Gd-EOB-DTPA and 99m Tc-GSA [12,13].…”

“…Recent trials have evaluated lobe or subsegment function using Gd-EOB-DTPA, and have investigated the preoperative prediction of the function of the future remnant liver after hepatic resection [1,9]. In liver function tests using Gd-EOB-DTPA-enhanced MRI, the liver-spleen contrast (LSC) [10,11] in the hepatobiliary phase has been reported to be moderately or strongly correlated with the blood clearance index (HH15) and receptor index (LHL15) calculated from 99m Tc-GSA liver scintigraphy [11][12][13]. There has also been an attempt to propose the index according to the LHL15 [11].…”

“…However, most studies that examined the correlation between the LSC and LHL15 did not have su ciently large sample sizes [11][12][13]. In addition, the results of these correlation analyses remain controversial from the standpoint of the differences in uptake and excretion between Gd-EOB-DTPA and 99m Tc-GSA [12,13].…”

“…In the present study, the correlations between the LSC in the hepatobiliary phase at 60 min and the HH15 and LHL15 were re-evaluated using a greater number of samples compared with previous studies [11][12][13]; Additionally, their indices were compared with the albumin-bilirubin (ALBI) score [18] and its related laboratory parameters. The estimated value of the LHL15 (eLHL15) was then computed using linear regression analysis formed from the LSC, and its accuracy was veri ed using the coe cient of determination (R 2 ) and by the comparison between the eLHL15 and LHL15 based on the criteria of LHL15 for determining the severity of chronic liver disease [5].…”