Original contribution
Potential clinical factors affecting hepatobiliary enhancement at Gd-EOB-DTPA-enhanced MR imaging

https://doi.org/10.1016/j.mri.2012.01.004Get rights and content

Abstract

Objective

The objective was to clarify the clinical factors that might affect the degree of hepatic parenchymal enhancement at gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging.

Materials and Methods

A total of 84 patients with (n=63) and without chronic liver disease (n=21) underwent Gd-EOB-DTPA-enhanced MR imaging. Contrast-enhanced MR images of hepatobiliary phase (HP) were obtained at 20 min after Gd-EOB-DTPA administration. The relative enhancement (RE) of liver parenchyma at 20 min HP was calculated from region of interest measurements at each patient. Then, these results were correlated with various clinical parameters using Pearson correlation coefficient or Spearman rank correlation coefficient. Furthermore, the predictor of the degree of hepatic parenchymal enhancement was determined using multiple regression analysis.

Results

The presence or absence of chronic liver disease (P=.002), ascites (P=.005) and splenomegaly (P=.027), and the values of prothrombin activity (P=.008), total bilirubin (T-Bil) (P=.001), albumin (P=.001), aspartate aminotransferase (AST) (P=.002) and cholinesterase (P=.007) were significantly correlated with the RE of liver parenchyma at 20 min HP. Among these parameters, increases of T-Bil (P=.011 to .028) and AST (P=.018 to .049) were predictors of decreased hepatic parenchymal enhancement.

Conclusions

Hepatic parenchymal enhancement of Gd-EOB-DTPA was affected by various clinical parameters. Impaired hepatobiliary enhancement may be predicted by routine biochemical tests, such as T-Bil and AST.

Introduction

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a recently developed liver-specific magnetic resonance (MR) imaging contrast agent with combined perfusion and hepatocyte-selective properties. Several studies have demonstrated that this contrast agent provided differential diagnostic information comparable to extracellular Gd-chelates and is highly sensitive with regard to detecting small focal liver lesions [1], [2], [3], [4]. After injection of Gd-EOB-DTPA, hepatocyte uptake with biliary excretion occurs in 30%–50% of injection dose. The remaining 50%–70% of Gd-EOB-DTPA is eliminated through the renal systems [3], [4], [5], [6]. Therefore, it is thought that the degree and the balance of biliary and renal excretion of the Gd-EOB-DTPA will be related to hepatocyte function and/or the renal function. Recent studies have showed that hepatic parenchymal enhancement at hepatobiliary phase was related to liver function [1], [2], [3]. In fact, in our daily practice, we occasionally encountered insufficient hepatic enhancement at the hepatobiliary phase images in patients with liver dysfunction such as liver cirrhosis. In such a condition, it is sometimes difficult to detect focal liver lesions due to its poorly specific uptake of Gd-EOB-DTPA by the surrounding hepatocytes. Therefore, it is clinically important to predict an enhancement effect of liver parenchyma before MR examinations with Gd-EOB-DTPA. The purpose of this study was to clarify the clinical factors that might affect the degree of hepatic parenchymal enhancement at Gd-EOB-DTPA-enhanced MR imaging.

Section snippets

Patient population

The institutional review board approved this retrospective study and waived the requirement for patient informed consent. A total of 94 patients who underwent Gd-EOB-DTPA-enhanced MR imaging of the liver was identified in our institution between March 2008 and September 2008. Ten patients with incomplete MR examination were excluded from this study. Finally, our study population included 84 patients (47 males and 37 females with a mean age of 66.35 years, range: 37–85 years). All patients had

Results

The relationships between clinical factors and RE of liver parenchyma were summarized in Table 1. The mean values of laboratory parameters were as follows; Plt, 13.6±6.4; PT%, 84.1±15.7; APTT, 27.2±4.9; T-bil, 0.91±0.49; Alb, 3.89±0.53; BUN, 15.82±5.63; Cr, 0.78±0.23; AST, 42.63±22.69; ALT, 34.81±24.89; ALP, 354.77±145.6; ChE, 223.71±103.49; GGT, 78.82±95.11; ZTT, 16.82±8.95. Among these laboratory parameters, elevated serum levels of PT% (P=.008), T-Bil (P=.001), Alb (P=.001), AST (P=.002) and

Discussion

Some previous studies have reported that insufficient liver parenchymal enhancement of Gd-EOB-DTPA is thought to be related to liver dysfunction [7], [8], [9], [10]. Generally, liver function was evaluated by clinical symptoms such as the presence or absence of ascites, splenomegaly, coma and liver atrophy, and by performing biochemical test such as Plt, PT%, T-bil, Alb, AST, ALT, ALP, ChE, GGT and ZTT. However, among these factors, it has not been thoroughly investigated what kinds of factors

References (19)

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