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Hepatobiliary phase in cirrhotic patients with different Model for End-stage Liver Disease score: comparison of the performance of gadoxetic acid to gadobenate dimeglumine

  • Gastrointestinal
  • Published:
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Abstract

Objectives

The purpose of this study was to compare the performance of gadobenate dimeglumine–enhanced MRI and gadoxetic acid–enhanced MRI in the hepatobiliary phase (HBP) in cirrhotic patients with different degrees of liver dysfunction.

Methods

In this retrospective cross-sectional study, we analyzed the unenhanced phase and the HBP of 131 gadobenate dimeglumine–enhanced MRI examinations (gadobenate dimeglumine group) and 127 gadoxetic acid–enhanced MRI examinations (gadoxetic acid group) performed in 249 cirrhotic patients (181 men and 68 women; mean age, 64.8 years) from August 2011 to April 2017. For each MRI, the contrast enhancement index of the liver parenchyma was calculated and correlated to the Model For End-Stage Liver Disease (MELD) score (multiple linear regression analysis). A qualitative analysis of the adequacy of the HBP, adjusted for the MELD score (logistic regression analysis), was performed.

Results

The contrast enhancement index was inversely related (r = − 0.013) with MELD score in both gadoxetic acid and gadobenate dimeglumine group. At the same MELD score, the contrast enhancement index in the gadoxetic acid group was increased by a factor of 0.23 compared to the gadobenate dimeglumine group (p < 0.001), and the mean odds ratio to have an adequate HBP with gadoxetic acid compared to gadobenate dimeglumine was 3.64 (p < 0.001). The adequacy of the HBP in the gadoxetic acid group compared to the gadobenate dimeglumine group increased with the increase of the MELD score (exp(b)interaction = 1.233; p = 0.011).

Conclusion

In cirrhotic patients, the hepatobiliary phase obtained with gadoxetic acid–enhanced MRI is of better quality in comparison to gadobenate dimeglumine–enhanced MRI, mainly in patients with high MELD score.

Key Points

• In cirrhotic patients, the adequacy of the hepatobiliary phase with gadoxetic acid–enhanced MRI is better compared to gadobenate dimeglumine–enhanced MRI.

• Gadoxetic acid–enhanced MRI should be preferred to gadobenate dimeglumine–enhanced MRI in cirrhotic patients with MELD score > 10, if the hepatobiliary phase is clinically indicated.

• In patients with high MELD score (> 15), the administration of the hepatobiliary agent could be useless; even though, if it is clinically indicated, we recommend to use gadoxetic acid given the higher probability of obtaining clinically relevant information.

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Abbreviations

CEI:

Contrast enhancement index

HBP:

Hepatobiliary phase

MELD:

Model for end-stage liver disease

MRI:

Magnetic resonance imaging

SIR:

Signal intensity ratio

References

  1. Dahlqvist Leinhard O, Dahlström 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 22:642–653

    Article  CAS  PubMed  Google Scholar 

  2. Brismar TB, Dahlström N, Edsborg N, Persson A, Smedby O, Albiin N (2009) Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA: a comparison in healthy volunteers. Acta Radiol 50:709–715

    Article  CAS  PubMed  Google Scholar 

  3. Dahlström N, Persson A, Albiin N, Smedby O, Brismar TB (2007) Contrast-enhanced MR cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects. Acta Radiol 48:362–368

    Article  PubMed  Google Scholar 

  4. Ishak K, Baptista A, Bianchi L et al (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22:696–699

    Article  CAS  PubMed  Google Scholar 

  5. Frydrychowicz A, Lubner MG, Brown JJ et al (2012) Hepatobiliary MR imaging with gadolinium based contrast agents. J Magn Reson Imaging 35:492–511

    Article  PubMed  PubMed Central  Google Scholar 

  6. Golfieri R, Renzulli M, Lucidi V, Corcioni B, Trevisani F, Bolondi L (2011) Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to dynamic MRI in the detection of hypovascular small (≤ 2 cm) HCC in cirrhosis. Eur Radiol 21:1233–1242

    Article  PubMed  Google Scholar 

  7. Piscaglia F, Iavarone M, Galassi M et al (2015) Cholangiocarcinoma in cirrhosis: value of hepatocyte specific magnetic resonance imaging. Dig Dis 33:735–744

    Article  PubMed  Google Scholar 

  8. 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 24:1013–1019

    Article  CAS  PubMed  Google Scholar 

  9. 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 82:1710–1715

    Article  CAS  PubMed  Google Scholar 

  10. Kamath PS, Wiesner RH, Malinchoc M et al (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33:464–470

    Article  CAS  PubMed  Google Scholar 

  11. Agnello F, Dioguardi Burgio M, Picone D et al (2016) Magnetic resonance imaging of the cirrhotic liver in the era of gadoxetic acid. World J Gastroenterol 22:103–111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Tamada T, Ito K, Higaki A et al (2011) Gd-EOB-DTPA enhanced MR imaging: evaluation of hepatic enhancement effects in normal and cirrhotic livers. Eur J Radiol 80:311–316

    Article  Google Scholar 

  13. Tschirch FT, Struwe A, Petrowsky H, Kakales I, Marincek B, Weishaupt D (2008) Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma. Eur Radiol 18:1577–1586

    Article  PubMed  Google Scholar 

  14. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative (2008) The strengthening the reporting of observational studies in epidemiology (STROBE)statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349

    Article  Google Scholar 

  15. Sporea I, Sirli R, Popescu A, Danilă M (2010) Acoustic radiation force impulse (ARFI)--a new modality for the evaluation of liver fibrosis. Med Ultrason 12:26–31

    PubMed  Google Scholar 

  16. Foucher J, Chanteloup E, Vergniol J et al (2006) Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 55:403–408

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ba-Ssalamah A, Bastati N, Wibmer A et al (2017) Hepatic gadoxetic acid uptake as a measure of diffuse liver disease: where are we? J Magn Reson Imaging 45:646–659

    Article  PubMed  Google Scholar 

  18. Tamada T, Ito K, Yamamoto A et al (2013) Simple method for evaluating the degree of liver parenchymal enhancement in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging. J Magn Reson Imaging 37:1115–1121

    Article  PubMed  Google Scholar 

  19. Filippone A, Blakeborough A, Breuer J et al (2010) Enhancement of liver parenchyma after injection of hepatocyte-specific MRI contrast media: a comparison of gadoxetic acid and gadobenate dimeglumine. J Magn Reson Imaging 31:356–364

    Article  PubMed  Google Scholar 

  20. Bashir MR, Breault SR, Braun R, Do RK, Nelson RC, Reeder SB (2014) Optimal timing and diagnostic adequacy of hepatocyte phase imaging with gadoxetate-enhanced liver MRI. Acad Radiol 21:726–732

    Article  PubMed  PubMed Central  Google Scholar 

  21. Talakic E, Steiner J, Kalmar P et al (2014) Gd-EOB-DTPA enhanced MRI of the liver: correlation of relative hepatic enhancement, relative renal enhancement, and liver to kidneys enhancement ratio with serum hepatic enzyme levels and eGFR. Eur J Radiol 83:607–611

    Article  PubMed  Google Scholar 

  22. Yoneyama T, Fukukura Y, Kamimura K et al (2014) Efficacy of liver parenchymal enhancement and liver volume to standard liver volume ratio on Gd-EOB-DTPA-enhanced MRI for estimation of liver function. Eur Radiol 24:857–865

    Article  PubMed  Google Scholar 

  23. 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  PubMed  Google Scholar 

  24. Kobi M, Paroder V, Flusberg M, Rozenblit AM, Chernyak V (2017) Limitations of GD-EOB-DTPA-enhanced MRI: can clinical parameters predict suboptimal hepatobiliary phase? Clin Radiol 72:55–62

    Article  CAS  PubMed  Google Scholar 

  25. CT/MRI LI-RADS® v2018 CORE. https://www.acr.org/-/media/ACR/Files/RADS/LI-RADS/LI-RADS-2018-Core.pdf?la=en. Accessed 27 Sep 2018

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Acknowledgements

This work has been presented as an oral presentation titled “Comparison of two liver specific contrast agents in patients with different degrees of liver cirrhosis” at the European Congress of Radiology that was held in Vienna in March 2018.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Claudia Khouri Chalouhi and Federica Vernuccio contributed equally to this work.

Authors and Affiliations

  1. ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162, Milan, Italy

    Claudia Khouri Chalouhi & Angelo Vanzulli

  2. Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy

    Federica Vernuccio & Francesca Rini

  3. ‘L. Sacco’ Department of Biomedical and Clinical Sciences, University of Milan, Milan, 20122, Italy

    Piergiorgio Duca

  4. Postgraduation School of Radiodiagnostics, University of Milan, Via Festa del Perdono, 7, Milan, 20122, Italy

    Bruno Tuscano

  5. Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy

    Giuseppe Brancatelli

  6. Department of Oncology and Hemato-oncology, University of Milan, Milan, 20122, Italy

    Angelo Vanzulli

Authors
  1. Claudia Khouri Chalouhi
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  2. Federica Vernuccio
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  3. Francesca Rini
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  4. Piergiorgio Duca
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  5. Bruno Tuscano
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  6. Giuseppe Brancatelli
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  7. Angelo Vanzulli
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Corresponding author

Correspondence to Federica Vernuccio.

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Guarantor

The scientific guarantor of this publication is Angelo Vanzulli.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Giuseppe Brancatelli: Speaker for Bayer and Guerbet; Guerbet advisory Board.

Angelo Vanzulli: Invited lecture with fee at the European Congress of Radiology 2017, funded by Bracco Spa.

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

Statistics and biometry

One of the authors has significant statistical expertise: Piergiorgio Duca.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study

• multicenter study

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Khouri Chalouhi, C., Vernuccio, F., Rini, F. et al. Hepatobiliary phase in cirrhotic patients with different Model for End-stage Liver Disease score: comparison of the performance of gadoxetic acid to gadobenate dimeglumine. Eur Radiol 29, 3090–3099 (2019). https://doi.org/10.1007/s00330-018-5884-2

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  • DOI: https://doi.org/10.1007/s00330-018-5884-2

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