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Gd-BOPTA-enhanced hepatobiliary phase MR imaging can predict the prognosis of patients with acute-on-chronic liver failure

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the value of gadobenate dimeglumine (Gd-BOPTA)–enhanced magnetic resonance imaging (MRI) from the hepatobiliary phase for predicting poor outcome in acute-on-chronic liver failure (ACLF) patients.

Methods

In this single-center retrospective study, 74 patients diagnosed as ACLF who underwent Gd-BOPTA-enhanced hepatobiliary magnetic resonance imaging were collected. The quantitative liver–spleen contrast ratio (Q-LSC) and the relative enhancement ratio of the biliary system (REB) at the hepatobiliary phase were measured. Cox proportional hazards regression models were used to evaluate prognostic factors. The capacity of the Q-LSC and REB to predict the 90-day outcome was evaluated via receiver operating characteristic (ROC) curve.

Results

During the follow-up period, twenty-eight of 74 ACLF patients (38%) had a poor outcome. The Q-LSC and REB were significant predictive factors (hazard ratio [HR] = 0.03 [0.002–0.54], p < 0.05; HR = 0.07 [0.01–0.88], p < 0.05) for prognosis in patients with ACLF. Moreover, the areas under the ROC curves of Q-LSC and REB for predicting poor outcome in patients with ACLF were 0.81 and 0.80, respectively. The most appropriate cutoff values for the Q-LSC and REB were 1.09 and 0.57, respectively. The ACLF patients with the Q-LSC ≤ 1.09 or REB ≤ 0.57 had a low cumulative survival.

Conclusions

Gd-BOPTA-enhanced hepatobiliary phase MR imaging can predict poor outcome in patients with acute-on-chronic liver failure.

Key Points

• The quantitative liver–spleen contrast ratio at the hepatobiliary phase was a significant predictive prognostic factor in patients with acute-on-chronic liver failure.

• The relative enhancement ratio of the biliary system at the hepatobiliary phase was a significant prognostic factor in patients with acute-on-chronic liver failure.

• Gadobenate dimeglumine contrast-enhanced MR imaging from the hepatobiliary phase can predict poor outcome in patients with acute-on-chronic liver failure.

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Abbreviations

ACLF:

Acute-on-chronic liver failure

AUC:

Area under the curve

CI:

Confidence interval

CLIF–C OF:

CLIF Consortium organ failure score

CLIF–C SOFA:

Chronic Liver Failure Consortium sequential organ failure assessment score

Gd-BOPTA:

Gadobenate dimeglumine

HR:

Hazard ratio

HUI:

Hepatic uptake index

ICC:

Intraclass correlation coefficient

MELD:

Model for End-Stage Liver Disease

MRI:

Magnetic resonance imaging

OATP:

Organic anion transporting polypeptides

Q-LSC:

The quantitative liver–spleen contrast ratio

REB:

The relative enhancement ratio of the biliary system

ROC:

Receiver operating characteristic

ROI:

Region of interest

SI:

Signal intensity

References

  1. Sarin SK, Choudhury A, Sharma MK et al (2019) Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): An update. Hepatol Int 13:353–390

    Article  Google Scholar 

  2. Mezzano G, Juanola A, Cardenas A et al (2021) Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis. Gut. https://doi.org/10.1136/gutjnl-2020-322161

  3. Arroyo V, Moreau R, Kamath PS et al (2016) Acute-on-chronic liver failure in cirrhosis. Nat Rev Dis Primers 2:16041

    Article  Google Scholar 

  4. Zhang J, Gao S, Duan Z, Hu KQ (2016) Overview on acute-on-chronic liver failure. Front Med 10:1–17

    Article  Google Scholar 

  5. Gustot T, Jalan R (2019) Acute-on-chronic liver failure in patients with alcohol-related liver disease. J Hepatol 70:319–327

    Article  Google Scholar 

  6. Chan AC, Fan ST, Lo CM et al (2009) Liver transplantation for acute-on-chronic liver failure. Hepatol Int 3:571–581

    Article  Google Scholar 

  7. Wiesner R, Edwards E, Freeman R et al (2003) Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 124:91–96

    Article  Google Scholar 

  8. Hernaez R, Patel A, Jackson LK, Braun UK, Walling AM, Rosen HR (2020) Considerations for prognosis, goals of care, and specialty palliative care for hospitalized patients with acute-on-chronic liver failure. Hepatology 72:1109–1116

    Article  Google Scholar 

  9. Gustot T, Fernandez J, Garcia E et al (2015) Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology 62:243–252

    Article  Google Scholar 

  10. Arroyo V, Moreau R (2017) Diagnosis and prognosis of acute on chronic liver failure (ACLF) in cirrhosis. J Hepatol 66:451–453

    Article  Google Scholar 

  11. Wang X, Sarin SK, Ning Q (2015) Definition of ACLF and inclusion criteria for extra-hepatic organ failure. Hepatol Int 9:360–365

    Article  Google Scholar 

  12. Sun Z, Liu X, Wu D et al (2019) Circulating proteomic panels for diagnosis and risk stratification of acute-on-chronic liver failure in patients with viral hepatitis B. Theranostics 9:1200–1214

    Article  CAS  Google Scholar 

  13. Bastati N, Beer L, Mandorfer M et al (2020) Does the functional liver imaging score derived from gadoxetic acid-enhanced MRI predict outcomes in chronic liver disease? Radiology 294:98–107

    Article  Google Scholar 

  14. Poetter-Lang S, Bastati N, Messner A et al (2020) Quantification of liver function using gadoxetic acid-enhanced MRI. Abdom Radiol (NY) 45:3532–3544

    Article  Google Scholar 

  15. Tsuboyama T, Onishi H, Kim T et al (2010) Hepatocellular carcinoma: hepatocyte-selective enhancement at gadoxetic acid-enhanced MR imaging–correlation with expression of sinusoidal and canalicular transporters and bile accumulation. Radiology 255:824–833

    Article  Google Scholar 

  16. Tanimoto A, Lee JM, Murakami T, Huppertz A, Kudo M, Grazioli L (2009) Consensus report of the 2nd International Forum for Liver MRI. Eur Radiol 19:S975–S989

    Article  Google Scholar 

  17. Liu C, Sun Y, Yang Y et al (2021) Gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase can predict progression in patients with liver cirrhosis. Eur Radiol 31:5840–5850

    Article  CAS  Google Scholar 

  18. Zhao X, Huang M, Zhu Q, Wang T, Liu Q (2015) The relationship between liver function and liver parenchymal contrast enhancement on Gd-BOPTA-enhanced MR imaging in the hepatocyte phase. Magn Reson Imaging 33:768–773

    Article  Google Scholar 

  19. Sandrasegaran K, Cui E, Elkady R et al (2018) Can functional parameters from hepatobiliary phase of gadoxetate MRI predict clinical outcomes in patients with cirrhosis? Eur Radiol 28:4215–4224

    Article  Google Scholar 

  20. Kudo M, Gotohda N, Sugimoto M et al (2018) Evaluation of liver function using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging based on a three-dimensional volumetric analysis system. Hepatol Int 12:368–376

    Article  Google Scholar 

  21. Yamada A, Hara T, Li F et al (2011) Quantitative evaluation of liver function with use of gadoxetate disodium-enhanced MR imaging. Radiology 260:727–733

    Article  Google Scholar 

  22. Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA (2013) A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality. Liver Int 33:40–52

    Article  Google Scholar 

  23. Hernaez R, Solà E, Moreau R, Ginès P (2017) Acute-on-chronic liver failure: an update. Gut 66:541–553

    CAS  PubMed  Google Scholar 

  24. Planchamp C, Pastor CM, Balant L, Becker CD, Terrier F, Gex-Fabry M (2005) Quantification of Gd-BOPTA uptake and biliary excretion from dynamic magnetic resonance imaging in rat livers: model validation with 153Gd-BOPTA. Invest Radiol 40:705–714

    Article  CAS  Google Scholar 

  25. Planchamp C, Gex-Fabry M, Becker CD, Pastor CM (2007) Model-based analysis of Gd-BOPTA-induced MR signal intensity changes in cirrhotic rat livers. Invest Radiol 42:513–521

    Article  Google Scholar 

  26. Noda Y, Goshima S, Kajita K et al (2016) Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers. Eur J Radiol 85:2001–2007

    Article  Google Scholar 

  27. Okada M, Ishii K, Numata K et al (2012) Can the biliary enhancement of Gd-EOB-DTPA predict the degree of liver function? Hepatobiliary Pancreat Dis Int 11:307–313

    Article  CAS  Google Scholar 

  28. Schulz M, Trebicka J (2021) Acute-on-chronic liver failure: a global disease. Gut.  https://doi.org/10.1136/gutjnl-2020-323973

  29. Zhou XP, Lu T, Wei YG, Chen XZ (2007) Liver volume variation in patients with virus-induced cirrhosis: findings on MDCT. AJR Am J Roentgenol 189:W153-159

    Article  Google Scholar 

  30. Xu Z, Ren X, Liu Y et al (2011) Association of hepatitis B virus mutations in basal core promoter and precore regions with severity of liver disease: an investigation of 793 Chinese patients with mild and severe chronic hepatitis B and acute-on-chronic liver failure. J Gastroenterol 46:391–400

    Article  Google Scholar 

  31. Huang K, Hu JH, Wang HF et al (2011) Survival and prognostic factors in hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol 17:3448–3452

    Article  Google Scholar 

  32. Radha Krishna Y, Saraswat VA, Das K et al (2009) Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis. Liver Int 29:392–398

    Article  Google Scholar 

Download references

Funding

This work was supported in part by the Natural Science Foundation of Shandong Province (No. ZR2020MH285).

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Authors and Affiliations

  1. Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China

    Chenxi Liu, Xueqi Wang, Xinyu Wang & Qiang Zhu

  2. Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China

    Chenxi Liu, Xueqi Wang, Xinyu Wang & Qiang Zhu

  3. Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, 324#, Jing 5 Rd, Jinan, 250021, Shandong Province, China

    Zijian Shen, Hui Ma, Ximing Wang & Xinya Zhao

  4. Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China

    Zijian Shen, Hui Ma, Ximing Wang & Xinya Zhao

  5. Shandong Academy of Clinical Medicine, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China

    Keke Liu

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  1. Chenxi Liu
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Correspondence to Qiang Zhu or Xinya Zhao.

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The scientific guarantor of this publication is Prof. Xinya Zhao.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Written informed consent was waived by the Institutional Review Board.

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Liu, C., Shen, Z., Ma, H. et al. Gd-BOPTA-enhanced hepatobiliary phase MR imaging can predict the prognosis of patients with acute-on-chronic liver failure. Eur Radiol 32, 3006–3015 (2022). https://doi.org/10.1007/s00330-021-08440-5

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  • DOI: https://doi.org/10.1007/s00330-021-08440-5

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