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