gadoxetic-acid-disodium and Cholestasis

The implementation of radiomics in radiology is gaining interest due to its wide range of applications. To develop a radiomics-based model for classifying the etiology of liver cirrhosis using gadoxetic acid-enhanced MRI, 248 patients with a known etiology of liver cirrhosis who underwent 306 gadoxetic acid-enhanced MRI examinations were included in the analysis. MRI examinations were classified into 6 groups according to the etiology of liver cirrhosis: alcoholic cirrhosis, viral hepatitis, cholestatic liver disease, nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, and other. MRI examinations were randomized into training and testing subsets. Radiomics features were extracted from regions of interest segmented in the hepatobiliary phase images. The fivefold cross-validated models (2-dimensional-(2D) and 3-dimensional-(3D) based) differentiating cholestatic cirrhosis from noncholestatic etiologies had the best accuracy (87.5%, 85.6%), sensitivity (97.6%, 95.6%), predictive value (0.883, 0.877), and area under curve (AUC) (0.960, 0.910). The AUC was larger in the 2D-model for viral hepatitis, cholestatic cirrhosis, and NASH-associated cirrhosis (P-value of 0.05, 0.05, 0.87, respectively). In alcoholic cirrhosis, the AUC for the 3D model was larger (P = 0.01). The overall intra-class correlation coefficient (ICC) estimates and their 95% confident intervals (CI) for all features combined was 0.68 (CI 0.56-0.87) for 2D and 0.71 (CI 0.61-0.93) for 3D measurements suggesting moderate reliability. Radiomics-based analysis of hepatobiliary phase images of gadoxetic acid-enhanced MRI may be a promising noninvasive method for identifying the etiology of liver cirrhosis with better performance of the 2D- compared with the 3D-generated models.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Cholestasis; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Young Adult

The aim of this study was to evaluate the potential of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI for assessment of bile duct ligation (BDL)-induced chelostatic liver injury in an animal model by T1 relaxation time measurements and first-pass perfusion analyses.. Twenty-four rabbits were classified into three groups as follows: control group (N group), n = 8; BDL group studied on the 5th postoperative day (BDL-5d group), n = 8; BDL group studied on the 14th postoperative day (BDL-14d group), n = 8. A dual flip angle three-dimensional gradient echo sequence with volumetric interpolated breath-hold examination was performed before and at 20 min [hepatobiliary phase (HBP)] after Gd-EOB-DTPA administration. Besides, early dynamic contrast-enhanced MRI was performed for 4.32 min with a temporal resolution of 2.2 s. T1 relaxation times of liver parenchyma were measured and perfusion parameters were calculated.. Dilatation of intra-hepatic bile duct was found only in the BDL-14d group. HBP T1 relaxation times of the BDL-5d and BDL-14d groups were significantly prolonged (p < 0.001) and the enhancement slope percentage of BDL-5d and BDL-14d groups were significantly lowered in comparison with that of the N group (p < 0.001). There were no differences between the BDL-5d group and the BDL-14d group for HBP T1 relaxation times and the enhancement slope percentage (p > 0.05). Area under the receiver operating characteristic curve of HBP T1 relaxation time and the enhancement slope percentage for the selection of chelostatic liver were 0.98 and 0.92 for the BDL-5d group, and 0.96 and 0.98 for the BDL-14d group, respectively.. HBP T1 relaxation time measurement in combination with first-pass enhancement slope percentage withhold promise to assess extrahepatic chelostatic liver injury.

Topics: Animals; Area Under Curve; Bile Ducts, Intrahepatic; Cholestasis; Contrast Media; Dilatation, Pathologic; Gadolinium DTPA; Image Processing, Computer-Assisted; Ligation; Liver Diseases; Magnetic Resonance Imaging; Rabbits; ROC Curve; Time Factors

To investigate the feasibility of gadoxetate disodium-enhanced magnetic resonance (MR) cholangiography in chronic obstructive cholestatic biliary disease in the clinical setting.. Twenty-three patients with dilated bile duct trees and ten volunteers underwent gadoxetate disodium-enhanced liver MR cholangiography and were enrolled in the present retrospective study. Gadoxetate disodium was given in a standardized manner as a bolus injection at a dose of 0.25 mmol/kg of body weight (0.1 ml/kg). Region of interest-based measurement of mean enhancement of the dilated bile ducts was performed in series before gadoxetate disodium administration and during hepatobiliary phases.. Direct comparison of mean bile duct enhancement during hepatobiliary phases in the clinical imaging window between healthy volunteers [4.7 ± 2.2 arbitrary units (au)] and patients with dilated bile ducts (0.1 ± 0.3 au) revealed significantly lower or absent enhancement in dilated bile ducts (p = 0.001).. Standard clinical gadoxetate disodium-enhanced MR cholangiography is not a reliable technique for the evaluation of the biliary trees, because of altered biliary gadoxetate disodium elimination in patients with chronic obstructive biliary diseases.

Topics: Adult; Bile Duct Diseases; Bile Ducts; Cholangiography; Cholestasis; Chronic Disease; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Retrospective Studies

The goal of the present study was to determine the added value of gadolium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced magnetic resonance cholangiography (MRC) to standard liver MRI including T2-weighted MRCP in assessment of biliary ductal obstruction.. Thirty-eight patients (mean age, 48.1 ± 16.7 years) (40 total examinations) who underwent liver MRI (including T2-weighted MRCP and gadoxetate disodium-enhanced MRC) for suspicion of biliary disease were included in this institutional review board-approved, HIPAA-compliant retrospective study. Three blinded radiologists first evaluated MR images without gadoxetate disodium-enhanced MRC for presence and significance of biliary obstruction, underlying cause for obstruction, and confidence in final diagnosis. After inclusion of gadoxetate disodium-enhanced MRC, readers again determined presence and significance of biliary obstruction and confidence in final diagnosis. Reference standard was established using MRI along with ERCP, percutaneous transhepatic cholangiography, intraoperative cholangiography, or a combination thereof.. Overall sensitivity across all readers in diagnosing significance of obstruction was 60% without gadoxetate disodium-enhanced MRC and 91% with gadoxetate disodium- enhanced MRC (p < 0.001). Across all readers, assessment of significance of obstruction was changed when adding gadoxetate disodium-enhanced MRC in 40 of 120 cases (33%); significance of obstruction was correctly changed in 35 of 40 cases (87.5%). Biliary obstruction was graded of unknown significance in 27 of 120 cases (22.5%) across all readers when gadoxetate disodium-enhanced MRC was not reviewed. Significance of biliary obstruction was classified correctly after adding gadoxetate disodium-enhanced MRC in 25 of these 27 cases (93%). Confidence in final diagnosis was significantly higher with addition of gadoxetate di-sodium-enhanced MRC for two of three readers (p < 0.003).. Addition of gadoxetate disodium-enhanced MRC to liver MRI significantly improves sensitivity in assessing significance of biliary obstruction and can improve reader confidence in establishing a final diagnosis. This added information could have a substantial impact in the determination of the most appropriate therapeutic options.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cholangiopancreatography, Magnetic Resonance; Cholestasis; Contrast Media; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Statistics, Nonparametric

To assess the value of gadoxetate disodium for characterization and staging of central bile duct stenosis (CBDS).. This prospective HIPAA-compliant study was IRB approved. 14 patients (8 male, 6 female; 36-80 years) with clinical suspicion of CBDS underwent preoperative MRI. To estimate the value of hepatocyte phase images (10, 20, 120 min p.i.), only T2w images (T2), only post-contrast images (CM), or both image datasets were assessed in three reading sessions by 3 readers. Agreement of each reading session with the intraoperative findings in terms of CBDS etiology and tumor extension (weighted kappa statistic) was calculated.. CBDS was caused by hilar cholangiocarcinoma (n=9), gallbladder carcinoma (n=4) and pancreatic carcinoma (n=1). Characterization of CBDS etiology was correct by use of: T2w images in 57%, 64%, 50%; CM images in 64%, 57%, 50%; both in 71%, 64%, 64%. Agreement comparing reading sessions and intraoperative findings regarding tumor extension was fair up to moderate (κ-range=0.21-0.54) as a result of common underestimation. Interobserver agreement for tumor extension was fair (κ-range=0.31-0.33).. By means of combined evaluation of T2 and CM images a more reliable characterization of CBDS was possible. Even though CBDS tended to be underestimated assessment of exact tumor extension was improved by contrast administration.

Topics: Adult; Aged; Aged, 80 and over; Cholestasis; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

Gadolinium-EOB-DTPA (Gd-EOB-DTPA) is a hepatobiliary magnetic resonance (MR) imaging contrast medium designed to detect focal liver lesions. The objective of this study was to evaluate dynamic Gd-EOB-DTPA-enhanced MR imaging as a new method for assessing liver excretory function and to compare it with a scintigraphic method, the gold standard.. Changes in scintigraphic liver activity or MR liver signal intensity were intraindividually monitored over time after intravenous injection of 50 mumol Gd/kg of Gd-EOB-DTPA in controls and rats with common bile duct obstruction or L-ethionine-induced fatty liver (n = 6).. A comparison of liver scintigraphy and MR imaging revealed that elimination half-lives of Gd-EOB-DTPA were significantly longer in rats with common bile duct obstruction (scintigraphy: 100 +/- 27 minutes; MR imaging: 59 +/- 18 minutes) or fatty liver (scintigraphy: 94 +/- 30 minutes; MR imaging: 72 +/- 32 minutes) than in controls (scintigraphy: 20 +/- 2 minutes; MR imaging: 18 +/- 3) (P < 0.05).. Like liver scintigraphy, functional MR liver imaging using Gd-EOB-DTPA is feasible and can differentiate normal controls from models of biliary and hepatocyte disease.

Topics: Animals; Cholestasis; Common Bile Duct Diseases; Contrast Media; Fatty Liver; Female; Gadolinium; Gadolinium DTPA; Half-Life; Image Processing, Computer-Assisted; Liver; Magnetic Resonance Imaging; Organometallic Compounds; Pentetic Acid; Radioisotopes; Radionuclide Imaging; Rats; Rats, Wistar

To investigate the behavior and potential application of the hepatobiliary magnetic resonance (MR) imaging contrast agent gadolinium-ethoxybenzyl (EOB)-diethylene-triamine-pentaacetic acid (DTPA) in cholestasis.. Rat models of selective biliary obstruction (SBO) (n = 20) and total biliary obstruction (TBO) (n = 14) were used. Serial Gd-EOB-DTPA-enhanced MR images were obtained, and the findings were correlated with serologic, microcholangiographic, and histologic findings.. In SBO rats, statistically significantly prolonged enhancement of ligated lobes occurred during the acute phase (P < .01) but was absent during the chronic phase owing to bile collateral vessels. In TBO rats, statistically significantly lower liver enhancement (P < .01) was observed as long as the obstruction persisted, until collateral bile ducts developed.. The distinction between obstructed and unobstructed liver on Gd-EOB-DTPA-enhanced MR images suggests a novel application for visualizing cholestasis.

Topics: Animals; Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Cholestasis; Cholestasis, Intrahepatic; Contrast Media; Gadolinium; Gadolinium DTPA; Liver; Magnetic Resonance Imaging; Male; Organometallic Compounds; Pentetic Acid; Rats; Rats, Wistar

Gadolinium-ethoxybenzyl-DTPA (Gd-EOB-DTPA) is a new hepatobiliary magnetic resonance imaging (MRI) contrast agent with a dual elimination: 70% via the liver and bile and 30% via the kidney in normal rats. The abdominal enhancement patterns of this new compound and the uptake mechanism by the liver were studied in rats using tissue relaxometry and MRI.. Twelve normal rats, 33 rats treated with agents designed to inhibit biliary excretion of the agent, and 6 rats with surgically ligated common bile ducts received Gd-EOB-DTPA intravenously. Distribution and excretion were measured by MR relaxometry. MR signal intensity was measured over time for liver, kidney, and bowel.. In normal animals, 0.1 mmol/kg Gd-EOB-DTPA induced a significantly greater (200%) and more prolonged liver signal enhancement (100% at 30 minutes) than Gd-DTPA at the same dose. Either hyperbilirubinemia, induced by common bile duct ligation, or bromosulfophtalein (BSP) infusion inhibited liver uptake of Gd-EOB-DTPA, resulting in a preferential elimination via the kidney. Taurocholate (TC), an inhibitor of the bile acid transporter, was unable to block the liver uptake of Gd-EOB-DTPA. Blood half-lives of Gd-EOB-DTPA in rats were 2.4 minutes for the first component and 8.2 minutes for the second.. Data indicate that transport of Gd-EOB-DTPA through the liver into bile is driven by the organic anion transporter. The relation between enhancement of liver and kidney may be diagnostically useful to indirectly evaluate liver excretory function. Yet, persistent enhancement of liver, even in the presence of severe hyperbilirubinemia, should be sufficient to identify focal mass lesions.

Topics: Animals; Cholestasis; Contrast Media; Drug Evaluation, Preclinical; Female; Gadolinium; Gadolinium DTPA; Liver; Magnetic Resonance Imaging; Metabolic Clearance Rate; Organometallic Compounds; Pentetic Acid; Rats; Rats, Sprague-Dawley