Separation of advanced from mild hepatic fibrosis by quantification of the hepatobiliary uptake of Gd-EOB-DTPA
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To apply dynamic contrast-enhanced (DCE) MRI on patients presenting with elevated liver enzymes without clinical signs of hepatic decompensation in order to quantitatively compare the hepatocyte-specific uptake of Gd-EOB-DTPA with histopathological fibrosis stage.
A total of 38 patients were prospectively examined using 1.5-T MRI. Data were acquired from regions of interest in the liver and spleen by using time series of single-breath-hold symmetrically sampled two-point Dixon 3D images (non-enhanced, arterial and venous portal phase; 3, 10, 20 and 30 min) following a bolus injection of Gd-EOB-DTPA (0.025 mmol/kg). The signal intensity (SI) values were reconstructed using a phase-sensitive technique and normalised using multiscale adaptive normalising averaging (MANA). Liver-to-spleen contrast ratios (LSC_N) and the contrast uptake rate (K Hep) were calculated. Liver biopsy was performed and classified according to the Batts and Ludwig system.
Area under the receiver-operating characteristic curve (AUROC) values of 0.71, 0.80 and 0.78, respectively, were found for K Hep, LSC_N10 and LSC_N20 with regard to severe versus mild fibrosis. Significant group differences were found for K Hep (borderline), LSC_N10 and LSC_N20.
Liver fibrosis stage strongly influences the hepatocyte-specific uptake of Gd-EOB-DTPA. Potentially the normalisation technique and K Hep will reduce patient and system bias, yielding a robust approach to non-invasive liver function determination.
• In chronic liver disease, staging of hepatic fibrosis is essential for prognosis.
• The accuracy of liver biopsy for assessing fibrosis has been questioned.
• Liver fibrosis stage strongly influences the hepatocyte-specific uptake of Gd-EOB-DTPA on MRI.
• Normalisation technique and K Hep are valuable for non-invasive liver function assessment.
KeywordsQuantification Gd-EOB-DTPA Dynamic contrast-enhanced MRI Pharmacokinetics Liver
Financial support from the Swedish Research Council (VR/M 2007–2884), the Medical Research Council of Southeast Sweden (FORSS 12621), the Linköping University, Linköping University Hospital Research Foundations and the County Council of Östergötland is gratefully acknowledged.
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