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European Radiology

, Volume 29, Issue 1, pp 383–391 | Cite as

A New Model for MR Evaluation of Liver Function with Gadoxetic Acid, Including Both Uptake and Excretion

  • Daniel Truhn
  • Christiane K. Kuhl
  • Alexander Ciritsis
  • Alexandra Barabasch
  • Nils A. Kraemer
Gastrointestinal

Abstract

Objectives

Most existing models that are in use to model hepatic function through assessment of hepatic gadoxetic acid enhancement kinetics do not consider quantitative measures of gadoxetic excretion. We developed a model that allows a simultaneous quantitation of uptake and excretion of liver specific contrast agents. The aim was to improve the assessment of hepatic synthetic function, and provide quantitative measures of hepatic excretion function.

Methods

Sixteen patients underwent dynamic T1-weighted turbo gradient echo imaging at 1.5 T prior and after bolus injection of gadoxetic acid at 0.1 ml/kg. DCE-images were obtained for 30 min after injection. A dual-inlet two-compartment model was then used to fit the measured liver signal values. Four tissue parameters (extracellular volume fraction, arterial flow fraction, uptake rate and excretion half-time) were extracted for each liver segment.

Results

The proposed model provided a good fit to acquired data. Mean values for arterial flow fraction (0.08+-0.04), extracellular volume (0.20±0.08) and uptake rate (4.02 ±1.32 /100 ml/min) were comparable to those obtained with the conventional model (0.08±0.05, 0.21±0.12, and 4.93±1.74), but exhibited significantly less variation and improved fit quality.

Conclusions

The proposed model is more accurate than existing conventional models and provides an additional excretion parameter.

Key Points

• Models of hepatic contrast agent uptake can be extended to include excretion.

• Including an additional excretion parameter improves accuracy of the model.

• Standard diagnostic sequences can be extended to incorporate the model.

Keywords

Hepatobiliary elimination Magnetic resonance imaging Contrast media Patient-specific modelling 

Abbreviations and acronyms

DCE

Dynamic contrast-enhanced

MRI

Magnetic resonance imaging

ROI

Region of interest

Notes

Acknowledgements

We gratefully acknowledge the continued research support by Philips Healthcare, Hamburg, Germany. In particular we would like to thank Dr. Burkhard Maedler for his guidance and advice during the project.

Funding

This research project was supported by the START program of the Faculty of Medicine, RWTH Aachen, Germany.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Christiane Kuhl.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• experimental

• performed at one institution

References

  1. 1.
    Haimerl M, Verloh N, Fellner C et al (2014) MRI-based estimation of liver function: Gd-EOB-DTPA-enhanced T1 relaxometry of 3T vs. the MELD score. Sci Rep 4:5621CrossRefGoogle Scholar
  2. 2.
    Ryeom HK, Kim SH, Kim JY et al (2004) Quantitative evaluation of liver function with MRI Using Gd-EOB-DTPA. Korean J Radiol 5:231–239CrossRefGoogle Scholar
  3. 3.
    Kim T, Murakami T, Hasuike Y et al (1997) Experimental hepatic dysfunction: evaluation by MRI with Gd-EOB-DTPA. J Magn Reson Imaging 7:683–688CrossRefGoogle Scholar
  4. 4.
    Tsuda N, Harada K, Matsui O (2011) Effect of change in transporter expression on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging during hepatocarcinogenesis in rats. J Gastroenterol Hepatol 26:568–576CrossRefGoogle Scholar
  5. 5.
    Bastati N, Feier D, Wibmer A et al (2014) Noninvasive differentiation of simple steatosis and steatohepatitis by using gadoxetic acid-enhanced MR imaging in patients with nonalcoholic fatty liver disease: a proof-of-concept study. Radiology 271:739–747CrossRefGoogle Scholar
  6. 6.
    Haimerl M, Verloh N, Zeman F et al (2013) Assessment of clinical signs of liver cirrhosis using T1 mapping on Gd-EOB-DTPA-enhanced 3T MRI. PLoS One 8:e85658CrossRefGoogle Scholar
  7. 7.
    Noren B, Forsgren MF, Dahlqvist Leinhard O et al (2013) Separation of advanced from mild hepatic fibrosis by quantification of the hepatobiliary uptake of Gd-EOB-DTPA. Eur Radiol 23:174–181CrossRefGoogle Scholar
  8. 8.
    Verloh N, Haimerl M, Rennert J et al (2013) Impact of liver cirrhosis on liver enhancement at Gd-EOB-DTPA enhanced MRI at 3 Tesla. Eur J Radiol 82:1710–1715CrossRefGoogle Scholar
  9. 9.
    Nilsson H, Blomqvist L, Douglas L, Nordell A, Jonas E (2010) Assessment of liver function in primary biliary cirrhosis using Gd-EOB-DTPA-enhanced liver MRI. HPB (Oxford) 12:567–576CrossRefGoogle Scholar
  10. 10.
    Verloh N, Haimerl M, Zeman F et al (2014) Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla. Eur Radiol 24:1013–1019CrossRefGoogle Scholar
  11. 11.
    Georgiou L, Penny J, Nicholls G et al (2017) Quantitative Assessment of Liver Function Using Gadoxetate-Enhanced Magnetic Resonance Imaging: Monitoring Transporter-Mediated Processes in Healthy Volunteers. Invest Radiol 52:111–119CrossRefGoogle Scholar
  12. 12.
    Ringe KI, Hinrichs J, Merkle EM, Weismuller TJ, Wacker F, Meyer BC (2014) Gadoxetate disodium in patients with primary sclerosing cholangitis: An analysis of hepatobiliary contrast excretion. J Magn Reson Imaging 40:106–112CrossRefGoogle Scholar
  13. 13.
    Wibmer A, Aliya Q, Steininger R et al (2012) Liver transplantation: impaired biliary excretion of gadoxate is associated with an inferior 1-year retransplantation-free survival. Invest Radiol 47:353–358CrossRefGoogle Scholar
  14. 14.
    Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A (2013) Liver failure after major liver resection: risk assessment by using preoperative Gadoxetic acid-enhanced 3-T MR imaging. Radiology 269:777–786CrossRefGoogle Scholar
  15. 15.
    Sourbron S, Sommer WH, Reiser MF, Zech CJ (2012) Combined quantification of liver perfusion and function with dynamic gadoxetic acid-enhanced MR imaging. Radiology 263:874–883CrossRefGoogle Scholar
  16. 16.
    Saito K, Ledsam J, Sourbron S et al (2013) Assessing liver function using dynamic Gd-EOB-DTPA-enhanced MRI with a standard 5-phase imaging protocol. J Magn Reson Imaging 37:1109–1114CrossRefGoogle Scholar
  17. 17.
    Sharma A, Houshyar R, Bhosale P, Choi JI, Gulati R, Lall C (2014) Chemotherapy induced liver abnormalities: an imaging perspective. Clin Mol Hepatol 20:317–326CrossRefGoogle Scholar
  18. 18.
    Kim H, Taksali SE, Dufour S et al (2008) Comparative MR study of hepatic fat quantification using single-voxel proton spectroscopy, two-point dixon and three-point IDEAL. Magn Reson Med 59:521–527CrossRefGoogle Scholar
  19. 19.
    Geisel D, Ludemann L, Keuchel T et al (2013) Increase in left liver lobe function after preoperative right portal vein embolisation assessed with gadolinium-EOB-DTPA MRI. Eur Radiol 23:2555–2560CrossRefGoogle Scholar
  20. 20.
    Yoon JH, Lee JM, Paek M, Han JK, Choi BI (2016) Quantitative assessment of hepatic function: modified look-locker inversion recovery (MOLLI) sequence for T1 mapping on Gd-EOB-DTPA-enhanced liver MR imaging. Eur Radiol 26:1775–1782CrossRefGoogle Scholar
  21. 21.
    Manizate F, Hiotis SP, Labow D, Roayaie S, Schwartz M (2010) Liver functional reserve estimation: state of the art and relevance to local treatments. Oncology 78(Suppl 1):131–134CrossRefGoogle Scholar
  22. 22.
    Dahlqvist Leinhard O, Dahlstrom N, Kihlberg J et al (2012) Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study. Eur Radiol 22:642–653CrossRefGoogle Scholar
  23. 23.
    Choi JW, Lee JM, Kim SJ et al (2013) Hepatocellular carcinoma: imaging patterns on gadoxetic acid-enhanced MR Images and their value as an imaging biomarker. Radiology 267:776–786CrossRefGoogle Scholar
  24. 24.
    Saito K, Ledsam J, Sourbron S et al (2014) Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI: a preliminary study comparing galactosyl human serum albumin scintigraphy with indocyanine green retention. Eur Radiol 24:112–119CrossRefGoogle Scholar
  25. 25.
    Rohrer M, Bauer H, Mintorovitch J, Requardt M, Weinmann HJ (2005) Comparison of magnetic properties of MRI contrast media solutions at different magnetic field strengths. Invest Radiol 40:715–724CrossRefGoogle Scholar
  26. 26.
    Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P (2010) The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 12:139–146CrossRefGoogle Scholar
  27. 27.
    Haimerl M, Schlabeck M, Verloh N et al (2016) Volume-assisted estimation of liver function based on Gd-EOB-DTPA-enhanced MR relaxometry. Eur Radiol 26:1125–1133CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyRWTH University Hospital AachenAachenGermany

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