Original Article—Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, Volume 48, Issue 10, pp 1180-1187

Clinical factors predictive of insufficient liver enhancement on the hepatocyte-phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging in patients with liver cirrhosis

  • Hee Yeon KimAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Jong Young ChoiAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea Email author 
  • , Chung-Hwa ParkAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Myeong Jun SongAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Do Seon SongAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Chang Wook KimAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Si Hyun BaeAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Seung Kew YoonAffiliated withDivision of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea
  • , Young Joon LeeAffiliated withDepartment of Radiology, College of Medicine, The Catholic University of Korea
    • , Sung Eun RhaAffiliated withDepartment of Radiology, College of Medicine, The Catholic University of Korea

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Abstract

Background

Estimating liver parenchymal enhancement prior to gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging is crucial to accurate detection and characterization of focal hepatic lesions. We aimed to clarify the factors predictive of liver enhancement in a relatively large sample of patients.

Methods

Gd-EOB-DTPA-enhanced MR images of 328 patients with liver cirrhosis (Child–Pugh class A in 223 patients, class B in 71 patients, and class C in 34 patients) were analyzed retrospectively. The liver parenchymal signal intensity (SI) was measured in pre-contrast T1-weighted images and hepatocyte phase images. The relative enhancement (RE) was calculated: (hepatocyte phase SI–pre-contrast SI)/pre-contrast SI. We analyzed the correlation between hepatic function parameters and RE.

Results

RE of patients with Child–Pugh A cirrhosis was significantly higher than that of patients with Child–Pugh B or C cirrhosis (both P < 0.001). Among various clinical factors, platelet count, prothrombin activity, albumin, sodium, total bilirubin, aspartate aminotransferase, Model for End-stage Liver Disease (MELD) score, MELD-Na score, Child–Pugh score, and the presence of ascites were significantly correlated with RE. A multiple stepwise regression analysis revealed that MELD-Na, albumin, and the presence of ascites were the only factors that predicted liver parenchymal enhancement on hepatocyte-phase images.

Conclusion

The degree of liver parenchymal enhancement after Gd-EOB-DTPA administration was correlated with liver function parameters. Gd-EOB-DTPA-enhanced MR images require careful interpretation, particularly in patients with cirrhosis and clinical factors such as high MELD-Na score, hypoalbuminemia, or ascites.

Keywords

Gd-EOB-DTPA Liver cirrhosis Liver function Magnetic resonance imaging