Quantitative evaluation of functional liver reserve using the liver-to-spleen ΔR₁ ratio based on gadoxetic acid-enhanced MRI: corrected for the effect of gadoxetic acid dose

Abstract

Background The liver T1 reduction rate can be used to assess liver function. However, higher doses of gadoxetic acid may shorten the liver T1 value in the hepatobiliary phase and increase the T1 reduction rate in patients with severe liver dysfunction, potentially overestimating liver function. Purpose To verify the relationship between the gadoxetic acid dose and the liver T1 reduction rate and ΔR1 of the liver and spleen, and to clarify whether the ΔR1 of hepatocytes, corrected for the effect of gadoxetic acid dose, could be used as an index of functional liver reserve. Material and Methods We enrolled 13 patients with normal liver function (NLF); and 18, 8, and 3 patients with Child-Pugh classes A (CPA), B (CPB), and C (CPC) who underwent gadoxetic acid-enhanced magnetic resonance imaging. Phase-sensitive inversion recovery sequence was performed before and at 15 min after injection and T1 maps were calculated. Liver and spleen ΔR1, liver T1 reduction rate, and the liver-to-spleen ΔR1 ratio were calculated. Results Only the liver-to-spleen ΔR1 ratio showed no correlation with gadoxetic acid dose in any group. The T1 reduction rate was not significantly different between the CPA and CPB + CPC groups. The liver-to-spleen ΔR1 ratio significantly differed between all groups. Conclusion The liver and spleen ΔR1 was dependent on the dose of gadoxetic acid in severe liver dysfunction. The liver-to-spleen ΔR1 ratio improves the delineation of the CPA and CPB + CPC groups.