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

Abstract

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.

Magnetic Resonance Imaging with Gadoxetic Acid Disodium for the Detection of Hepatocellular Carcinoma

“…In patients with cirrhosis, the delay of contrast medium uptake and biliary excretion may affect imaging of gadoxetic acid disodium. However, there was a recent evidence that the HBP hepatic enhancement in chronic liver disease patients is similar to those with no chronic liver disease as long as direct bilirubin remains normal (44). Our results also showed that the accuracy of two subgroups with or without chronic liver disease only was almost the same.…”

Value of gadoxetate biliary transit time in determining hepatocyte function

“…Chernyak et al [10] found that enhancement in the hepatobiliary phase was inversely correlated with model for end stage liver disease scores and the number of abnormal liver enzyme panels. Okada et al found that the ratio of liver/muscle enhancement was substantially higher in control groups and Child-Pugh A group compared to Child-Pugh B and C patients.…”

“…The signal intensity (SI) changes of liver after injection of gadoxetate have been investigated to determine correlation with grade of fibrosis [4,8,9], hepatic function [10][11][12] and outcome after liver-directed intervention [13][14][15]. However, such SI changes are dependent on extraneous factors including the injected dose, relative renal function, and the presence of hepatic steatosis [16][17][18].…”

Does gadoxetate disodium affect MRE measurements in the delayed hepatobiliary phase?

“…Thus, in compromised liver parenchyma (e.g. fibrotic or cirrhotic) the hepatobiliary phase may be delayed due to the reduced liver function [6,30,31]. For this reason, at our centre, whenever liver MRI is performed on patients with clinical suspicion of impaired liver function, a second imaging session with new patient positioning in the scanner is performed 40-50 min after the first examination.…”