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Relative enhancement index can be used to quantify liver function in cirrhotic patients that undergo gadoxetic acid–enhanced MRI

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate MRI with gadoxetic acid to quantify liver function in cirrhotic patients using the relative enhancement index (REI) compared with Child–Pugh score (CPS), MELD score, and indocyanine green plasma disappearance rate (ICG-PDR) and to establish cutoffs for REI to stratify cirrhotic patients into good and poor liver function groups.

Methods

We prospectively evaluated 60 cirrhotic patients and calculated CPS, MELD score, ICG-PDR, and REI for each patient. Spearman’s correlation coefficient was used to assess correlation between REI, CPS, MELD, and ICG-PDR. Good and poor liver function groups were created by k-means clustering algorithm using CPS, MELD, and ICG-PDR. ROC curve analysis was performed and optimal cutoff was identified for group differentiation.

Results

Good correlations were found between REI and other liver function biomarkers: REI and CPS (rho =  − 0.816; p < 0.001); REI and MELD score (rho =  − 0.755; p < 0.001); REI and ICG-PDR (rho = 0.745; p < 0.001)]. REI correlation was stronger for patients with Child–Pugh A (rho = 0.642, p = 0.002) and B (rho = 0.798, p < 0.001) than for those with Child–Pugh C (rho = 0.336, p = 0.148). REI is significantly lower in patients with poor liver function (p < 0.001). ROC curve showed an AUC 0.94 to discriminate patients with poor liver function (REI cutoff < 100; 100% sensitivity; 76% specificity).

Conclusions

REI is a valuable non-invasive index for liver function quantification that has good correlations with other liver function biomarkers. REI can be easily calculated and can be used to estimate liver function in clinical practice in the routine evaluation of cirrhotic patients that undergo MR imaging with gadoxetic acid contrast.

Key Points

• REI is a valuable non-invasive index for liver function quantification that has good correlations with other liver function biomarkers.

• REI can be easily calculated in the routine evaluation of cirrhotic patients that undergo gadoxetic acid–enhanced MRI.

• The REI enables stratification of cirrhotic patients into good and poor liver function groups and can be used as additional information, together with morphological and focal liver lesion evaluation.

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Data Availability

All data is available upon request.

Abbreviations

ASSET:

Array coil spatial sensitivity encoding

CPS:

Child-Pugh score

EFGRE:

Dynamic enhanced fast gradient echo

GA:

Gadoxetic acid

Gd-EOB-DTPA:

Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid

HBP 20:

Hepatobiliary phase 20 min after injection of gadoxetic acid

HBP:

Hepatobiliary phase

ICG:

Indocyanine green

ICG-PDR:

Indocyanine green plasma disappearance rate

LAVA:

Liver imaging with volume acceleration

LV:

Liver volume

MELD score:

Model of end-stage liver disease

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

MRP2:

Multidrug resistance–associated proteins 2

MRP3:

Multidrug resistance–associated proteins 3

OATP:

Organic anion transporter proteins

RE:

Relative enhancement

REI:

Relative enhancement index

ROI:

Region of interest

SI HBP 20:

Signal intensity 20 min after injection of gadoxetic acid

SI pre:

Signal intensity before contrast injection

SI:

Signal intensity

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Acknowledgements

We thank Carolina Braz Parente for the English revision.

Funding

This study has received funding by the Research Support Foundation of the State of Rio de Janeiro (FAPERJ–E-26/111.229/2013), the National Council for Scientific and Technological Development of Brazil (CNPq 307143/2015–5), and the D’Or Institute for Research and Education (IDOR–Departamental funding).

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Authors and Affiliations

  1. D’Or Institute for Research and Education Rua Diniz Cordeiro 30, 3º Andar, CEP, 22281-100, Rio de Janeiro, Brazil

    Antonio Luis Eiras-Araújo, Daniella Braz Parente, Rosana Souza Rodrigues & Renata Mello Perez

  2. Federal University of Rio de Janeiro, Cidade Universitária. Ilha Do Fundão. CEP, Av. Professor Rodolpho Paulo Rocco 255, 21941-913, Rio de Janeiro. Rio de Janeiro, Brazil

    Antonio Luis Eiras-Araújo, Daniella Braz Parente, Alexandre Cerqueira da Silva, Guilherme Ferreira da Motta Rezende, Gustavo Braga Mendes, Rebecca de Oliveira Souza, Stefanos da Costa Generalis, Rosana Souza Rodrigues & Renata Mello Perez

  3. Instituto de Estudos Em Saúde Coletiva, Federal University of Rio de Janeiro, Cidade Universitária. Ilha Do Fundão, CEP, 21941-592, Rio de Janeiro, Brazil

    Ronir Raggio Luiz

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  1. Antonio Luis Eiras-Araújo
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Correspondence to Antonio Luis Eiras-Araújo.

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Guarantor

The scientific guarantor of this publication is Renata de Mello Perez.

Conflict of interest

Daniella Braz Parente, MD, PhD, is a member of the scientific magnetic resonance editorial board of European Radiology and a member of the editorial board of Radiologia Brasileira. 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

Two authors (Ronir Raggio Luiz and Rebecca de Oliveira Souza) have significant statistical expertise.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained (CAAE: 06343212.8.0000.5257; CAAE: 06343212.8.3001.5249).

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  • prospective

  • cross sectional study

  • performed at one institution

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Eiras-Araújo, A.L., Parente, D.B., da Silva, A.C. et al. Relative enhancement index can be used to quantify liver function in cirrhotic patients that undergo gadoxetic acid–enhanced MRI. Eur Radiol 33, 5142–5149 (2023). https://doi.org/10.1007/s00330-023-09402-9

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  • DOI: https://doi.org/10.1007/s00330-023-09402-9

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