Experimental hepatic dysfunction: Evaluation by MRI with Gd‐EOB‐DTPA

Kim, Tonsok; Murakami, Takamichi; Hasuike, Yasunori; Gotoh, Mitsukazu; Kato, Naoki; Takahashi, Masaya; Miyazawa, Tomoaki; Narumi, Yasuo; Monden, Morito; Nakamura, Hajime

doi:10.1002/jmri.1880070413

Cited by 93 publications

(79 citation statements)

References 15 publications

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“…The mean MELD score in the patients with imaging stigmata of cirrhosis was 11.0 (SD 4.0; range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and the mean MELD score in patients without imaging stigmata of cirrhosis was 7.3 (SD 1.3; range 5-10) (P < 0.004). Because all patients in the subgroup without imaging stigmata of cirrhosis had MELD scores 10, this subgroup was compared with a subgroup that had imaging stigmata of cirrhosis and also had MELD scores 10 (n ¼ 45).…”

Section: Mri Resultsmentioning

confidence: 99%

“…Therefore, in patients with chronic parenchymal liver disease, the enhancement of the liver on the delayed images may be lower than expected in the patients with normal liver function (5)(6)(7). Several studies demonstrated that the rate and extent of excretion of Gd-EOB-DTPA into the biliary tree is reduced in patients with reduced hepatocyte function (6,7). When reviewing the hepatobiliary phase images of a patient with cirrhosis, one can be faced with a challenging question of whether the parenchymal enhancement is decreased, and, therefore, the approach to the hepatic lesion detection and characterization may need to be altered.…”

Section: Discussionmentioning

confidence: 98%

“…In patients with hepatic cirrhosis as well as in those without it, lesion detection and characterization heavily rely on comparison of the lesion's signal intensity to that of the background hepatic parenchyma (3,4). As the extent of parenchymal liver enhancement on the hepatobiliary phase has been shown to be dependent on the function of the hepatocytes, such enhancement may be lower in patients with chronic parenchymal liver disease than in patients with normal liver function (5)(6)(7). Consequently, in patients who have the decreased levels of hepatic enhancement on the hepatobiliary phase images, the algorithm for hepatic lesion characterization may need to be altered.…”

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confidence: 99%

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Hepatic enhancement during the hepatobiliary phase after gadoxetate disodium administration in patients with chronic liver disease: The role of laboratory factors

Chernyak

Kim

Rozenblit

et al. 2011

Magnetic Resonance Imaging

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Purpose: To identify factors influencing hepatobiliary phase (HBP) hepatic enhancement on gadoxetate disodium-enhanced MRI in patients with chronic liver disease (CLD). Materials and Methods:We retrospectively reviewed abdominal gadoxetate disodium-enhanced MRIs and medical records of patients with (n ¼ 97) and without (n ¼ 48) CLD. CLD subgroups were formed based on normal/ abnormal components of liver function tests (LFTs). Hepatic enhancement coefficients (HEKs) were calculated on MRI, and compared with LFTs and Model for Endstage Liver Disease (MELD) scores.Results: The mean HEK was significantly lower (P < 0.0008) in the CLD than control group. The mean HEK was similar to controls in the subgroup with all normal LFTs (P ¼ 0.09) and subgroup with normal direct bilirubin (DB) (p ¼ 0.09), while it was significantly reduced (P < 0.0001) in the subgroup with elevated DB. For all other LFT components, regardless of normal or abnormal values, there was a significant reduction in the mean HEKs versus controls (all P values <0.01). There was a highly negative correlation between the mean HEKs in CLD subgroups and number of abnormal LFTs (r ¼ À0.93) and MELD scores (r ¼ À0.89).Conclusion: HBP hepatic enhancement in CLD patients is similar to those with no CLD as long as direct bilirubin remains normal. Higher MELD scores and higher number of abnormal LFT components are associated with reduced hepatic enhancement.

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Section: Mri Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Hepatic enhancement during the hepatobiliary phase after gadoxetate disodium administration in patients with chronic liver disease: The role of laboratory factors

Chernyak

Kim

Rozenblit

et al. 2011

Magnetic Resonance Imaging

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“…The relative enhancement correlated directly with the retransplantation-free survival rate [46]. Based on experiments in rats [47,48], Tajama et al were one of the first to be able to show the connection between reduced Gd-EOB enhancement and limited liver function in humans. Different lab values, the Child-Pugh score and the ICG test were correlated with the SNR of the liver for this purpose [49].…”

Section: Mri As Imaging-based Liver Function Testmentioning

confidence: 99%

Imaging-Based Liver Function Tests – Past, Present and Future

Geisel

Lüdemann

Hamm

et al. 2015

Fortschr Röntgenstr

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Preoperative assessment of liver function and?prediction of postoperative functional reserve are important in patients scheduled for liver resection. While determination of absolute liver function currently mostly relies on laboratory tests and clinical scores, postoperative remnant liver function is estimated volumetrically using imaging data obtained with computed tomography (CT) or magnetic resonance imaging (MRI). Accurate estimation of hepatic function is also relevant for intensive care patients, oncologic patients, and patients with diffuse liver disease. The indocyanine green (ICG) test is still the only established test for estimating true global liver function. However, more recent tools such as the LiMAx test also allow global assessment of hepatic function. These tests are limited when liver function is inhomogeneously distributed, which is the case in such conditions as unilateral cholestasis or after portal vein embolization. Imaging-based liver function tests were first developed in nuclear medicine and, compared with laboratory tests, have the advantage of displaying the spatial distribution of liver function. Nuclear medicine scans are obtained using tracers such as?99mTc galactosyl and 99mTc mebrofenin. Liver function is typically assessed using planar scintigraphy. However, three-dimensional volumetry is possible with single-photon emission computed tomography (SPECT-CT). Another technique for image-based liver function estimation is Gd-EOB-enhanced MRI. While metabolization of Gd-EOB in the body is similar to that of ICG and mebrofenin, its distribution in the liver can be displayed by MRI with higher temporal and spatial resolution. Moreover, MRI-based determination of liver function can be integrated into routine preoperative imaging. This makes MRI an ideal candidate for preoperative determination of?liver function, though the best pulse sequence and the parameter to be derived from the image information remain to be identified. Another question to be answered is how the results may be affected by renal function and the presence of hyperbilirubinemia. As more results from clinical evaluation including comparison with postoperative liver function data become available, image-based liver function tests, especially with use of Gd-EOB as the contrast medium, have the potential to add another dimension to preoperative imaging. Key Points: ??Liver function consists of a multitude of subfunctions such as biotransformation, excretion and storage. ??Global liver function tests are score-based tests such as Child-Pugh or MELD as well as the ICG- and LiMAx-test. ??Imaging-based liver function tests add spatial information. Current clinical standard is the 99mTc-Mebrofenin-scintigraphy. ??MRI-based function tests with Gd-EOB-DTPA have the potential to integrate seamlessly into clinical workup, feature a higher temporal and spatial resolution and do not rely on ionizing radiation. Citation Format: ??Geisel D, L?demann L, Hamm B et?al. Imaging-Based Liver Function Tests ? Past, Present and F...

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“…Dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) has previously been used in animal models for the evaluation of hepatic function in various experimental settings, either using semi-quantitative parameters or using deconvolutional analysis (DA) [22][23][24][25]. In human studies, liver parenchymal enhancement after administration of Gd-EOB-DTPA has been shown to correlate with ICG clearance and with liver cirrhosis as assessed by the CPS [26,27], and subsequent biliary excretion has been shown to be delayed in patients with impaired liver function [28].…”

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confidence: 99%