gadoxetic-acid-disodium and Liver-Diseases

Topics: Child; Contrast Media; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds; Pattern Recognition, Automated

A variety of patterns of enhancement of liver lesions and liver parenchyma is observed in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI. It is becoming increasingly apparent that many lesions may exhibit HBP enhancement. Much of the literature regarding the role of gadoxetic acid-enhanced MRI in characterising liver lesions is dichotomous, focusing on whether lesions are enhancing or non-enhancing in the HBP, rather than examining the patterns of enhancement. We provide a pattern-based description of HBP enhancement of liver parenchyma and of liver lesions. The role of OATP1B3 transporters, hepatocyte function and lesion composition in influencing patterns of HBP hyperintensity are discussed.

Topics: Biliary Tract; Biliary Tract Diseases; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Parenchymal Tissue

Magnetic resonance imaging (MRI) has a well-established role as a highly specific and accurate modality for characterizing benign and malignant focal liver lesions. In particular, contrast-enhanced MRI using hepatocyte-specific contrast agents (HSCAs) improves lesion detection and characterization compared to other imaging modalities and MRI techniques. In this pictorial review, the mechanism of action of gadolinium-based MRI contrast agents, with a focus on HSCAs, is described. The clinical indications, protocols, and emerging uses of the 2 commercially available combined contrast agents available in the United States, gadoxetate disodium and gadobenate dimeglumine, are discussed. The MRI features of these agents are compared with examples of focal hepatic masses, many of which have been obtained within the same patient therefore allowing direct lesion comparison. Finally, the pitfalls in the use of combined contrast agents in liver MRI are highlighted.

Topics: Contrast Media; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

Magnetic resonance imaging is commonly used to evaluate for hepatic and biliary pathology in the pediatric population. Recently, there has been increased use of hepatocyte-specific contrast agents (HSCAs), such as Gadoxetate disodium in children. Traditionally, HSCAs have been used to characterize focal liver lesions. However, these agents can also be used to problem solve specific hepatic or biliary diagnostic dilemmas. The purpose of this manuscript is to review the practical uses of HSCA in children with both hepatic and biliary indications, and review the corresponding imaging findings. We will highlight the diagnostic uses of HSCA in children, as well as pitfalls encountered.

Topics: Biliary Tract Diseases; Child; Child, Preschool; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Infant; Liver Diseases; Magnetic Resonance Imaging; Male

MRI has emerged as the most comprehensive noninvasive diagnostic tool for focal liver lesions and diffuse hepatobiliary disorders. The introduction of hepatobiliary contrast agents, most notably gadoxetic acid (GA), has expanded the role of MRI, particularly in the functional imaging of chronic liver diseases, such as nonalcoholic fatty liver disease (NAFLD). GA-enhanced MRI (GA-MRI) may help to distinguish between the two subgroups of NAFLD, simple steatosis and nonalcoholic steatohepatitis. Furthermore, GA-MRI can be used to stage fibrosis and cirrhosis, predict liver transplant graft survival, and preoperatively estimate the risk of liver failure should major resection be undertaken. The amount of GA uptake can be estimated, using static images, by the relative liver enhancement, hepatic uptake index, and relaxometry of T1-mapping during the hepatobiliary phase. On the contrary, the hepatic extraction fraction and liver perfusion can be measured on dynamic imaging. Importantly, there is currently no clear consensus as to which of these MR-derived parameters is the most suitable for assessing liver dysfunction. This review article aims to describe the current role of GA-enhanced MRI in quantifying liver function, primarily in diffuse hepatobiliary disorders.. 3 J. Magn. Reson. Imaging 2017;45:646-659.

Topics: Computer Simulation; Contrast Media; Diffusion Magnetic Resonance Imaging; Evidence-Based Medicine; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Diseases; Liver Function Tests; Metabolic Clearance Rate; Models, Biological; Reproducibility of Results; Sensitivity and Specificity; Tissue Distribution

To date, despite many scientific evidences, the guidelines of the principal hepatological societies, such as the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver, do not recognize the diagnostic superiority of magnetic resonance imaging (MRI) over computed tomography in the diagnosis of hepatocellular carcinoma (HCC) and, for the most part, do not contemplate the use of hepatospecific contrast media, such as gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB). The aim of this paper was to analyze the recent results of EOB-MRI in the study of chronic liver disease and the differences between the American Association for the Study of Liver Diseases and the Japan Society of Hepatology guidelines, of which the latter represents the most consolidated experience on EOB-MRI use for HCC diagnosis. Finally, a new diagnostic algorithm for HCC in patients under surveillance for chronic liver disease was formulated, which contemplates the use of EOB. This new diagnostic algorithm is based on the Japan Society of Hepatology algorithm but goes beyond it by adapting it to the Western world, taking into account both the difference between the two and the latest results concerning the diagnosis of HCC. This new diagnostic algorithm for HCC is proposed in order to provide useful diagnostic tools to all those Western countries where the use of EOB (more expensive than extracellular contrast media) is widespread but in which common strategies to manage the nodules that this new contrast agent allows identifying have not been available to date.

Topics: Aged; Algorithms; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Gastroenterology; Humans; Japan; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Practice Guidelines as Topic; Societies, Medical; Western World

Gadolinium ethoxybenzyl dimeglumine (gadoxetate) is a recently developed hepatocyte-specific MRI contrast medium. Gadoxetate demonstrates unique pharmacokinetic and pharmacodynamic properties, because its uptake in hepatocytes occurs via the organic anion transporting polypeptide (OATP) transporter expressed at the sinusoidal membrane, and its biliary excretion via the multidrug resistance-associated proteins (MRPs) at the canalicular membrane. Based on these characteristics, gadoxetate-enhanced MRI can provide functional information on hepatobiliary diseases, including liver function estimation, biliary drainage evaluation and characterization of hepatocarcinogenesis. In addition, understanding its mode of action can provide an opportunity to use gadoxetate for cellular and molecular imaging. Radiologists and imaging scientists should be familiar with the basic mechanism of gadoxetate and OATP/MRP transporters.

Topics: Biliary Tract Diseases; Contrast Media; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Molecular Imaging

Liver function assessment by hepatocyte-specific contrast-enhanced magnetic resonance imaging is becoming a new biomarker. Liver function can be assessed by T1 mapping (reduction rate) and signal intensity measurement (relative enhancement ratio) before and after GD-EOB-DTPA (gadoxetic acid) administration, as alternative to Tc-99m galactosyl serum albumin scintigraphy, 99m Tc-labeled mebrofenin scintigraphy, and indocyanine green clearance test. Magnetic resonance imaging assessment of liver function can enable diagnosis of cirrhosis, nonalcoholic fatty liver disease associated fibrosis and steatohepatitis, primary sclerosing cholangitis, toxic hepatitis, and chemotherapy and radiotherapy-related changes, which may be only visible on hepatobiliary phase images. Simple visual assessment of signal intensity at hepatobiliary phase images is important for the diagnosis of different patterns of liver dysfunction including diffuse, lobar, segmental, and subsegmental forms. Furthermore, preoperative assessment of liver function is feasible before oncologic hepatic surgery, which may be important to prevent posthepatectomy liver failure and to estimate future remnant volume. Functional magnetic resonance cholangiography obtained by T1-weighted images at hepatobiliary phase can allow diagnosis of acalculous cholecystitis, biliary leakage, bile reflux to the stomach, sphincter of oddi dysfunction, and lesions with communication to biliary tree. Functional information can be easily obtained when Gd-EOB-DTPA is used for liver magnetic resonance imaging.

Topics: Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

Gadoxetic acid is extensively used in the following 3 main clinical situations: characterization of small nodules in patients with cirrhosis, preoperative staging of liver metastases, and characterization of incidentally discovered focal liver lesions. Owing to the rapid entry of gadoxetic acid into hepatocytes, the traditional features of liver tumors are modified on magnetic resonance (MR) imaging, especially during delayed phase sequences. Thus, although the added value of gadoxetic acid for the detection and characterization of focal liver lesions is now clear, its unique pharmacokinetics as well as the presence of mimicking and atypical lesions may lead to misdiagnoses. The goal of this article is to illustrate common and uncommon pitfalls associated with the use of gadoxetic acid-enhanced MR imaging. Moreover, additional MR imaging features that can help establish a correct diagnosis are described.

Topics: Contrast Media; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Magnetic Resonance Imaging; Sensitivity and Specificity

Gadoxetic acid is a hepatocyte-specific magnetic resonance imaging contrast agent with the ability to detect and characterize focal liver lesions and provide structural and functional information about the hepatobiliary system. Knowledge of the pharmacokinetics of gadoxetic acid is paramount to understanding imaging protocol and lesion appearance and facilitates identification and avoidance of undesired effects with use of this intravenous contrast agent. This article reviews the utility of gadoxetic acid in liver and biliary imaging, with emphasis on the hepatobiliary phase.

Topics: Biliary Tract; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Diseases; Magnetic Resonance Imaging

OBJECTIVE. This systematic review presents evidence-based consensus statements as reported by a multidisciplinary expert panel (six abdominal radiologists, four hepatobiliary surgeons, and two hepatologists) regarding the use of gadoxetic acid for liver MRI. CONCULSION. Although this review highlights the incremental diagnostic value of hepatobiliary phase imaging with gadoxetic acid-enhanced liver MRI in multiple clinical scenarios, there remains a need for further impact studies for some clinical applications, such as hepatocellular carcinoma in cirrhosis.

Topics: Consensus; Contrast Media; Gadolinium DTPA; Humans; Interdisciplinary Communication; Liver Diseases; Magnetic Resonance Imaging; Practice Guidelines as Topic

Gadoxetic acid disodium (Gd-EOB-DTPA) is a magnetic resonance imaging (MRI) contrast agent to target the liver cells with normal function. In clinical practice, the Gd-EOB-DTPA produces high quality hepatocyte specific image 20 minutes after intravenous injection, so DWI sequence is often performed after the conventional dynamic scanning. However, there are still some disputes about whether DWI sequence will provide more effective diagnostic information in clinical practice. This study aimed to explore the diagnostic value of combining Gd-EOB-DTPA-enhanced MRI and DWI in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.. A systematic literature search was performed in the PubMed and Cochrane library database up to March 2015. The quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of studies. Heterogeneous test on the included literature was performed by using the software Review Manager 5.3. The MetaDiSc 1.4 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio; meanwhile the summary receiver operating characteristics (SROC) curve was drawn to compare the diagnostic performance.. A total of 13 literatures were included in this study. In 8 literatures regarding HCC diagnosis based on Gd-EOB-DTPA-enhanced MRI, the pooled sensitivity: 0.90 (95% confidence interval (CI): 0.88-0.93); specificity: 0.89 (95% CI: 0.85-0.92); positive likelihood ratio: 8.60 (95% CI: 6.20-11.92); negative likelihood ratio: 0.10 (95% CI: 0.08-0.14) were obtained. The area under curve (AUC) and Q values were 0.96 and 0.90, respectively. In 5 literatures relating to HCC diagnosis by combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence, the pooled sensitivity: 0.88 (95% CI: 0.85-0.91), specificity: 0.96 (0.94-0.97), positive likelihood ratio: 19.63 (12.77-30.16), negative likelihood ratio: 0.10 (0.07-0.14) were obtained. The AUC value was 0.9833 and Q value was 0.9436. The AUC value of comprehensive evaluation method was significantly higher than that of Gd-EOB-DTPA-enhanced MRI alone(P<0.05).. Combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence significantly improves in both the diagnostic accuracy and specificity of chronic liver disease-associated HCC.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Male; Middle Aged; ROC Curve; Sensitivity and Specificity

A recent paradigm shift in radiology has focused on the globalization of so-called P4 radiology. P4 radiology represents delivery of imaging results that are predictive, personalized, pre-emptive and participatory. The combination of the P4 approach and biomarkers is particularly pertinent to MRI, especially with technological advances such as diffusion-weighted imaging. The development of new liver-specific MRI contrast media, particularly gadoxetic acid, demonstrate specific pharmacokinetic properties, which provide combined morphologic and functional information in the same setting. The evaluation of hepatobiliary pathology beyond morphology gives rise to the possibilty of using gadoxetic acid-enhanced MRI as an imaging biomarker of hepatobiliary diseases. The integration of functional imaging with an understanding of complex disease mechanisms forms the basis for P4 radiology, which may ultimately lead to individualized, cost-effective, targeted therapy for patients. This will enable radiologists to determine the prognosis of the disease and estimate early response to treatment, with the participation of all the required medical disciplines.

Topics: Biliary Tract Diseases; Biomarkers; Diagnostic Imaging; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Precision Medicine; Radiology

As the utility of liver-specific magnetic resonance imaging (MRI) increases, it is pertinent to optimize and expand protocols to improve accuracy and foster evolution of techniques; in turn, positive impacts should be seen in patient management. This article reports on the latest expert thinking and current evidence in the field of liver-specific MRI, as discussed at the 6(th) International Forum for Liver MRI, which was held in Vancouver, Canada in September 2012. Topics discussed at this forum described the use of gadoxetic acid-enhanced MRI for the assessment of liver function at the segmental level; to increase accuracy in the diagnosis of liver metastases; to overcome current challenges in patients with cirrhosis, including management of arterial hypo-/isovascular, hepatobiliary phase hypointense nodules; and the data which would be required in order to recommend the use of this modality in hepatocellular carcinoma management guidelines. Growing evidence suggests that gadoxetic acid-enhanced MRI can help to improve the management of patients with a number of different liver disorders; however, more data are needed in some areas, and there may be a case for developing an interpretation guideline for gadoxetic acid-enhanced MRI findings to aid standardization.

Topics: Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging

Diffusion-weighted magnetic resonance imaging (DW MRI) is an established technique in neuroradiology and more recently has emerged as a useful adjunct to various oncological applications of MRI. It has an expanding role in the evaluation of liver lesions, offers higher detection rates for small lesions, and can increase confidence in differentiating between benign and malignant lesions. Other applications include assessment of tumour response to therapy, differentiating tumour from bland thrombus, and assessment of liver fibrosis. DW sequences can be performed on most modern MRI machines with relative ease, in a short time period and without the need for contrast medium. DW MRI can be of value in the detection and characterization of hepatic lesions but there are pitfalls, which can potentially cause interpretative difficulty. This article will review the rationale for DW MRI in liver imaging, demonstrate the clinical utility of the technique in a spectrum of hepatic diseases, and illustrate key interpretative pearls and pitfalls.

Topics: Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms

The advent of gadolinium-based "hepatobiliary" contrast agents offers new opportunities for diagnostic magnetic resonance imaging (MRI) and has triggered great interest for innovative imaging approaches to the liver and bile ducts. In this review article we discuss the imaging properties of the two gadolinium-based hepatobiliary contrast agents currently available in the U.S., gadobenate dimeglumine and gadoxetic acid, as well as important pharmacokinetic differences that affect their diagnostic performance. We review potential applications, protocol optimization strategies, as well as diagnostic pitfalls. A variety of illustrative case examples will be used to demonstrate the role of these agents in detection and characterization of liver lesions as well as for imaging the biliary system. Changes in MR protocols geared toward optimizing workflow and imaging quality are also discussed. It is our aim that the information provided in this article will facilitate the optimal utilization of these agents and will stimulate the reader's pursuit of new applications for future benefit.

Topics: Bile Duct Diseases; Contrast Media; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

The purpose of this article is to illustrate various focal hepatic lesions that may show hyperintensity on hepatobiliary phase images on gadoxetate disodium-enhanced MRI.. Hyperintense lesions on gadoxetate disodium-enhanced MRI include focal nodular hyperplasia (FNH) or FNH-like nodules, hepatocellular adenoma, dysplastic nodules, and hepatocellular carcinoma. Understanding the contrast enhancement patterns on hepatobiliary phase images and other imaging findings is important to ensure correct diagnosis.

Topics: Biliary Tract Diseases; Contrast Media; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging

Assessment of hepatic function is essential in determining the prognosis and clinical management of a patient who has chronic liver disease or undergoes liver surgery. For a patient with locally varying hepatic parenchymal abnormalities, a regional assessment of hepatic function mapped onto hepatic anatomy is clinically more meaningful than conventional global metrics of hepatic function. Of late, hepatic magnetic resonance imaging has been increasingly used because of its superb tissue contrast and delineation of hepatic morphology and underlying abnormalities. The introduction of hepatocyte-specific contrast agents such as Gd-EOB-DTPA allows us to view not only the hepatic anatomy but also assess regional hepatic function. In this article, we review and discuss recently published studies that used Gd-EOB-DTPA-enhanced magnetic resonance imaging to evaluate hepatic function.

Topics: Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging

Superior soft-tissue contrast affords magnetic resonance imaging (MRI) some advantages compared to computed tomography (CT) in both detection and characterization of focal liver lesions. Because of its relatively recently introduction into clinical practice, a growing number of articles in the literature have demonstrated the usefulness of the hepatobiliary-specific MRI contrast agent gadoxetic acid disodium (Gd-EOB-DTPA) in liver imaging. The purpose of this review is to demonstrate the typical enhancement patterns of the most common liver lesions using Gd-EOB-DTPA in daily clinical scenarios and briefly describe its mechanism of action. Radiologists interpreting liver MRI studies with this agent must be familiar with the appearance of focal lesions in the hepatocyte phase to avoid misinterpretation.

Topics: Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed

Topics: Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Liver; Liver Diseases; Magnetic Resonance Imaging; Neovascularization, Pathologic; Organometallic Compounds

This article is a review of magnetic resonance imaging (MRI) of incidental focal liver lesions. This review provides an overview of liver MRI protocol, diffusion-weighted imaging, and contrast agents. Additionally, the most commonly encountered benign and malignant lesions are discussed with emphasis on imaging appearance and the diagnostic performance of MRI based on a review of the literature.

Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diffusion Magnetic Resonance Imaging; Focal Nodular Hyperplasia; Gadolinium DTPA; Hemangioma; Hepatocytes; Humans; Incidental Findings; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

The use of gadolinium-based hepatocyte-specific contrast agents (HSCAs) has increased markedly since their introduction, and hepatocellular phase imaging performed with an HSCA is now a key part of the standard magnetic resonance (MR) imaging work-up for focal liver lesions. An understanding of the mechanisms of action of HSCAs helps ensure their effective use. The optimal delay for hepatocellular phase image acquisition differs between the two currently available HSCAs, gadoxetic acid and gadobenate dimeglumine, and MR imaging protocols must be adjusted accordingly. In addition, familiarity with typical and atypical appearances of benign and malignant focal liver lesions at HSCA-enhanced hepatocellular phase MR imaging, along with knowledge of the processes that are most likely to produce atypical appearances, is required to achieve optimal diagnostic accuracy.

Topics: Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Hepatocytes; Humans; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

The purpose of this article is to review the pharmacokinetic and pharmacodynamic properties of gadoxetate disodium (Gd-EOB-DTPA), to describe a workflow-optimized pulse sequence protocol, and to illustrate the imaging appearance of focal lesions in the noncirrhotic liver.. Gd-EOB-DTPA allows a comprehensive evaluation of the liver with the acquisition of both dynamic and hepatocyte phase images. This provides potential additional information, especially for the detection and characterization of small liver lesions. However, protocol optimization is necessary for improved image quality and workflow.

Topics: Clinical Protocols; Contrast Media; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging

Liver specific contrast media (LSCM) can be subdivided according to different modalities of hepatic distribution: exclusive distribution to the hepatocellular compartment can be obtained using CM which accumulate within the hepatocytes after slow infusion; other CM demonstrate combined perfusion and hepatocyte-selective properties, with an initial distribution to the vascular-interstitial compartment (in an analogous manner to that of the conventional extracellular CM), thereafter, a fraction of the injected dose is taken up into the hepatocytes causing an increase in the signal intensity of the hepatic tissue. The use of the superparamagnetic effect of iron oxide particles is based on distribution in the reticuloendothelial system (RES), usually well represented in the normal parenchyma as well as in benign hepatocellular lesions, and absent in most malignant lesions. It is necessary to have an in-depth knowledge of either the biological and histological characteristics of focal liver lesions (FLL) or the enhancement mechanism of LSCM to gain significant accuracy in the differential diagnosis of FLL. Dynamic contrast-enhanced MRI is an important tool in the identification and characterization of FLL. With LSCM it is possible to differentiate benign from malignant lesions and hepatocellular lesions from non hepatocellular lesions with high accuracy. To understand the contrast behaviour after injection of LSCM it is necessary to correlate the contrast enhancement with both the biological and histological findings of FLL.

Topics: Contrast Media; Dextrans; Diagnosis, Differential; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Iron; Liver Diseases; Magnetic Resonance Imaging; Magnetite Nanoparticles; Meglumine; Organometallic Compounds; Oxides

Hepatobiliary contrast agents with uptake into hepatocytes followed by variable biliary excretion represent a unique class of cell-specific MR contrast agents. Two hepatobiliary contrast agents, mangafodipir trisodium and gadobenate dimeglumine, are already clinically approved. A third hepatobiliary contrast agent, Gd-EOB-DTPA, is under consideration. The purpose of this review is to provide an overview on the properties, clinical development and application of these three hepatobiliary contrast agents. Bolus injectable paramagnetic hepatobiliary contrast agents combine established features of extracellular agents with the advantages of hepatocyte specificity. The detection and characterisation of focal liver disease appears to be improved compared to unenhanced MRI, MRI with unspecific contrast agents and contrast-enhanced CT. To decrease the total time spent by a patient in the MR scanner, it is advisable to administer the agent immediately after acquisition of unenhanced T1-w MRI. After infusion or bolus injection (with dynamic FS-T1-w 2D or 3D GRE) of the contrast agent, moderately and heavily T2w images are acquired. Post-contrast T1-w MRI is started upon completion of T2-w MRI for mangafodipir trisodium and Gd-EOB-DTPA as early as 20 min following injection, while gadobenate dimeglumine scans are obtained >60 min following injection. Post-contrast acquisition techniques with near isotropic 3D pulse sequences with fat saturation parallel the technical progress made by MSCT combined with an unparalleled improvement in tumour-liver contrast. The individual decision that hepatobiliary contrast agent one uses is partly based on personal preferences. No comparative studies have been conducted comparing the advantages or disadvantages of all three agents directly against each other.

Topics: Contrast Media; Edetic Acid; Gadolinium; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Manganese; Meglumine; Organometallic Compounds; Pyridoxal Phosphate; Time Factors; Tomography, X-Ray Computed

Gadoxate disodium [gadolinium EOB DTPA, Gd-EOB-DTPA, gadoxetic acid, Eovist injection, Primovist] is a hydrophilic paramagnetic contrast agent being developed by Schering AG for hepatobiliary magnetic resonance imaging. In April 2004, gadoxate disodium (Primovist) was approved in Sweden, the reference member state for the EU registration. Following the Swedish approval, Schering will initiate a mutual recognition procedure for the EU with approvals expected in most countries during 2004. Gadoxate disodium is in phase III clinical trials in the US and has completed phase III studies in Japan. Submissions for approval in Japan and other Asian countries are planned for 2004. Schering AG plans to launch Eovist in Japan in 2005. Schering AG acquired a worldwide, royalty-bearing licence to EPIX Medical's patents covering liver-enhancing agents such as Eovist injection. These included a European patent (222886) and the US patents (4,899,755 and 4,888,008) that EPIX Medical exclusively licensed from the Massachusetts General Hospital (MGH). The MGH patents, a part of EPIX's extensive intellectual property, also covered albumin-targeted agents such as MS 325 (AngioMARK). Schering AG formally withdrew from the opposition proceedings against EPIX's EU patent 222886 following its acquisition of EPIX's intellectual property. These EU and US patents were also non-exclusively licensed by EPIX Medical to Bracco in September 2001. Apart from covering Eovist (Schering AG), the EU patent also covered gadobenate dimeglumine (MultiHance Bracco). Following the licensing agreement, Bracco withdrew its opposition to the patents in Europe and Japan, and both EPIX Medical and Bracco settled their European patent dispute. In its 2002 Annual Report, Schering predicted that Eovist has the potential to reach peak sales of euro50 million, three years after launch--at the time, launch in Europe was anticipated in 2004, followed by launch in Japan in 2005. This is down from earlier predictions, made at an analyst presentation in Berlin in March 2002, when the company forecast the product to reach peak sales of euro100 million.

Topics: Animals; Bile Duct Diseases; Clinical Trials, Phase III as Topic; Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Diseases; Randomized Controlled Trials as Topic

The contrast agents Gd-EOB-DTPA and Gd-BOPTA can be administered by bolus injection and are appropriate for use in MRI both as vascularization markers and markers of hepatobiliary excretion. This contribution presents an overview of the specific characteristics of contrast media and the status of clinical development. In comparison to CT and to MRI with unspecific extracellular Gd-chelates, liver-specific contrast agents offer advantages in differentiating unclear liver lesions, increasing the detection rate, and examining the bile duct system.

Topics: Chelating Agents; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds; Practice Patterns, Physicians'; Reproducibility of Results; Sensitivity and Specificity

Gd-EOB-DTPA and Gd-BOPTA/Dimeg are two paramagnetic contrast agents that are unlikely ECF contrast agents but that are selectively taken up by hepatocytes and yield a selective enhancement of the liver parenchyma on T1-weighted images. Gd-EOB-DTPA yields hepatocellular specific uptake within the biliary excretion rate of 50% of the injected dose. Gd-BOPTA/Dimeg is taken up by hepatocytes in a small portion (2%-4%); however, its high relaxivity provides a significant and sustained increase of signal intensity of the normal liver. Both compounds have demonstrated a safe pharmacologic and toxicologic profile on preclinical evaluation and phase I clinical trials. Preliminary results demonstrate that these contrast agents may improve the MR imaging capability to detect focal liver lesions, with a dramatic and selective increase of liver signal-to-noise ratio and lesion-liver contrast-to-noise ratio. The wide imaging window, allowed by the sustained enhancement achieved after injection also provides flexibility in selecting an imaging sequence.

Topics: Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Contrast Media; Female; Gadolinium; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Meglumine; Multicenter Studies as Topic; Organometallic Compounds; Pentetic Acid; Safety

Background Safety data on routine clinical use of gadoxetate disodium for liver magnetic resonance imaging (MRI) is not reported yet. Purpose To assess the safety profile of gadoxetate disodium for liver MRI in the routine clinical setting. Material and Methods Six multicenter studies were performed in Europe, USA, Australia, and Asia to evaluate the safety and efficacy of gadoxetate disodium (Primovist®/Eovist®) enhanced liver MRI. Patients received a single intravenous bolus injection of the standard approved dose of 0.025 mmol/kg body weight (0.1 mL/kg). The number of patients, the characteristics of adverse events, related adverse events, and serious adverse events were analyzed. Results A total of 8194 patients were included in the database. A total of 141 patients (1.7%) reported 230 AEs of which 129 were considered being related to the use of gadoxetate disodium by the investigators. None of the AEs in the pediatric population ( n = 52) were related. The most frequent AEs independent of relationship to the drug included dyspnea (25/0.31%), nausea (22/0.27%), liver disorders (13/0.16%), and renal disorders (9/0.11%). Nine related SAEs were recorded. No patient died during the studies. Conclusion Gadoxetate disodium for liver MRI is safe and well tolerated in the routine clinical setting.

Topics: Adolescent; Adult; Age Distribution; Aged; Chemical and Drug Induced Liver Injury; Child; Child, Preschool; Contrast Media; Drug-Related Side Effects and Adverse Reactions; Dyspnea; Female; Gadolinium DTPA; Humans; Infant; Infant, Newborn; Internationality; Kidney Diseases; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Nausea; Prevalence; Risk Factors; Sex Distribution; Treatment Outcome; Young Adult

The aim of this study was to assess whether a short breath-hold technique can improve hepatic arterial phase (HAP) image quality in gadoxetic acid-enhanced magnetic resonance (MR) imaging compared with a conventional long breath-hold technique.. Institutional review board approval and patient consent were obtained for this prospective randomized control study. One hundred nineteen patients undergoing gadoxetic acid-enhanced MR imaging were randomly assigned to groups A or B. Group A patients underwent an 18-second long breath-hold MR technique (conventional VIBE [volumetric interpolated breath-hold examination] technique with GRAPPA [generalized autocalibrating partially parallel acquisition]), and group B patients underwent a 13-second short breath-hold MR technique (VIBE technique with CAIPIRINHA [controlled aliasing in parallel imaging results in higher acceleration]). Respiratory-related graphs of the precontrast and HAP were acquired. The breath-hold degree was graded based on the standard deviation (SD) value of respiratory waveforms. Gadoxetic acid-related dyspnea was defined as when the SD value of the HAP was 200 greater than that of the precontrast phase without degraded image quality in the portal and transitional phases (SD value of the HAP - SD value of the precontrast phase). The overall image quality and motion artifacts of the precontrast and HAP images were evaluated. The groups were compared using the Student t or Fisher exact test, as appropriate.. The incidence of breath-holding difficulty (breath-hold grades 3 and 4) during the HAP was 43.6% (27/62) and 36.8% (21/57) for group A and B, respectively. The SD value during the precontrast phase and the SD value difference between the precontrast and HAP were both significantly higher in group A than in group B (P = 0.047 and P = 0.023, respectively). Gadoxetic acid-related dyspnea was seen in 19.4% (12/62) of group A and 7.0% (4/57) of group B. Group B showed better precontrast and HAP image quality than group A (P < 0.001). Degraded HAP (overall image quality ≥4) was observed in 9.7% (6/62) and 3.5% (2/57) of group A and B, respectively.. The short breath-hold MR technique, CAIPIRINHA, showed better HAP image quality with less degraded HAP and a lower incidence of breath-hold difficulty and gadoxetic acid-related dyspnea than the conventional long breath-hold technique.

Topics: Artifacts; Breath Holding; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Reproducibility of Results

To clarify the detectability of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI at 3 T with dual-source parallel radiofrequency (RF) excitation.. Twelve patients with 26 HCCs who each underwent multidetector row CT (MDCT), gadoxetic acid-enhanced MRI with dual-source parallel RF excitation, and angiography-assisted CT prior to living related-liver transplantation. Three blinded readers independently reviewed the images obtained by each imaging technique for the presence of HCC on a segment-by-segment basis using a five-point confidence scale. The area under the receiver operating characteristic curve (Az), sensitivity, and specificity were compared among the three techniques.. The Az values of gadoxetic acid-enhanced MRI were highest for all readers, although no significant difference in Az value among the three methods was obtained. No significant differences in sensitivity or specificity were observed among the three techniques for each reader.. Gadoxetic acid-enhanced MRI at 3 T with dual-source parallel RF excitation has relatively high-level diagnostic potential for the detection of HCC in patients with severe liver dysfunction, which was equivalent to that of MDCT and angiography-assisted CT. Dual-source parallel RF excitation would have a clinical impact on 3 T MRI of the liver.

Topics: Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed

The purpose of this study was to compare 5-minute delayed transitional phase imaging using a 30° flip angle (hereafter, 5 min-FA30) and 20-minute hepatocyte phase imaging using a 10° flip angle (hereafter, 20 min-FA10) in gadoxetic acid-enhanced MRI for focal hepatic lesion detection and lesion-to-liver contrast-to-noise ratio (CNR), and to determine whether 5 min-FA30 could replace 20 min-FA10 with a 15-minute time saving.. One hundred sixteen patients with 282 focal hepatic lesions (size range, 0.2-12.5 cm; malignant, n = 146; benign, n = 136) underwent gadoxetic acid-enhanced MRI with 5 min-FA30 and 20 min-FA10 with a 3D T1-weighted gradient-echo sequence. Three radiologists independently assessed the presence of focal hepatic lesions using a 4-point scale, and detection sensitivity of focal hepatic lesions was calculated. Lesion-to-liver CNRs were calculated and compared in two image groups.. There was no significant difference in detection sensitivity of focal hepatic lesions for all three readers between 5 min-FA30 (mean, 95.4%) and 20 min-FA10 (mean, 95.6%), irrespective of lesion size or malignancy. The mean CNR on 5 min-FA30 (167.9 ± 84.1) was significantly higher than that on 20 min-FA10 (160.2 ± 79.5). However, the mean CNR difference between the two image groups was relatively small (7.8 ± 41.9).. Compared with 20 min-FA10, 5 min-FA30 provided higher CNR and similar sensitivity. These findings indicate that 5 min-FA30 could replace 20-min delayed hepatocyte phase imaging using a 10° flip angle with similar diagnostic performance and 15 minutes of time saving.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Male; Reproducibility of Results; Republic of Korea; Sensitivity and Specificity; Time Factors

To determine whether acute transient dyspnea and/or arterial phase image degradation occurs more or less often after intravenous administration of gadoxetate disodium than with intravenous administration of gadobenate dimeglumine.. Institutional review board approval and patient consent were obtained for this prospective observational study. One hundred ninety-eight gadolinium-based contrast media administrations (99 with gadoxetate disodium [10 mL, n = 97; 8 mL, n = 1; 16 mL, n = 1] and 99 with gadobenate dimeglumine [0.1 mmol per kilogram of body weight, maximum dose, 20 mL]) for hepatobiliary indications were assessed in 192 patients. Subjective patient complaints were assessed. Objective respiratory motion degradation on T1-weighted precontrast and dynamic postcontrast (arterial, venous, or late dynamic or extracellular) magnetic resonance (MR) imaging datasets were independently assessed in a randomized, blinded fashion by five readers using a five-point scale, with mean scores of 4 or greater indicating severe motion. Comparisons between agents were made by using χ(2) or Fisher exact test, where appropriate.. Significantly more patient complaints of acute transient dyspnea occurred after gadoxetate disodium administration than gadobenate dimeglumine (14% [14 of 99] vs 5% [five of 99], P = .05). There were significantly more severely degraded arterial phase data sets for gadoxetate disodium than for gadobenate dimeglumine for both the general population (17% [17 of 99] vs 2% [two of 99], P = .0007) and the subpopulation with cirrhosis (19% [14 of 72] vs 3% [one of 37], P = .02). This effect did not extend to venous (1% [one of 99] vs 2% [two of 99], P > .99 [overall population]) or late dynamic or extracellular (2% [two of 99] vs 0% [zero of 99], P = .5 [overall population]) phases. No patient required treatment for self-limited dyspnea.. Intravenous gadoxetate disodium can result in acute self-limiting dyspnea that can have a deleterious effect on arterial phase MR image quality and occurs significantly more often than with intravenous gadobenate dimeglumine.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Chi-Square Distribution; Contrast Media; Dyspnea; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Injections, Intravenous; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies

To investigate the ability of T1 mapping of liver on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the estimation of liver function.. Local institutional review board approved this study. Ninety-one patients (64 men, 27 women; mean age, 67.4 years) were classified into 4 groups as follows: normal liver function (NLF), n = 16; chronic hepatitis (CH), n = 38; liver cirrhosis with Child-Pugh A (LCA), n = 20; and liver cirrhosis with Child-Pugh B (LCB), n = 17. Look-Locker sequences (single slice multiphase imaging using gradient-echo sequence with inversion recovery pulse) were obtained before and at 3, 8, 13, and 18 minutes after Gd-EOB-DTPA administration. T1 mapping of liver parenchyma was calculated from the Look-Locker sequence. T1 relaxation time of liver and reduction rate of T1 relaxation time between pre- and postcontrast enhancement were measured. The Bonferroni t test was used for comparisons between the 4 groups.. Precontrast T1 relaxation times were significantly longer for LCA and LCB than for NLF, and that of LCB was longer than that of chronic hepatitis (P < 0.05). Postcontrast T1 relaxation times were significantly longer for LCB than for other groups at all time points. Those of LCA were longer than those of NLF at all time points. Reduction rates were significantly lower for LCB than for the other groups at ≥8 minutes.. Evaluation of hepatic uptake of Gd-EOB-DTPA using T1 mapping of liver parenchyma can help estimate liver function.

Topics: Aged; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male

To prospectively evaluate the safety and efficacy of combined unenhanced and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging compared with unenhanced MR imaging and triphasic contrast-enhanced spiral computed tomography (CT) for the detection and characterization of focal liver lesions.. The study was reviewed and approved by the institutional review board at each of the 15 centers involved in the study, and informed written consent was given by all patients. In total, 178 patients with suspected focal hepatic lesions (based, in most patients, on CT, tumor marker and ultrasound examinations) underwent combined MR imaging with a single, rapid injection of Gd-EOB-DTPA 0.025 mmol/kg, including T1-weighted dynamic and delayed MR images 20 to 40 minutes postinjection. Triphasic contrast-enhanced CT, the comparator examination, was performed within 4 weeks of MR imaging. Standard of references (SOR) were resection histopathology and intraoperative ultrasonography, or combined CT during arterial portography and CT hepatic arteriography; in cases where, although the major lesions were treated, some lesion(s) were not treated, follow-up superparamagnetic iron oxide-enhanced MR imaging was additionally performed. All images were assessed for differences in lesion detection and characterization (specific lesion type) by on-site readers and 3, blinded (off-site) reviewers. All adverse events (AEs) occurring within 72 hours after Gd-EOB-DTPA administration were reported.. Overall, 9.6% of patients who received Gd-EOB-DTPA reported 21 drug-related AEs. A total of 151 patients were included in the efficacy analysis. Combined MR imaging showed statistically higher sensitivity in lesion detection (67.5%-79.5%) than unenhanced MR imaging (46.5%-59.1%; P < 0.05 for all). Combined MR imaging also showed higher sensitivity in lesion detection than CT (61.1%-73.0%), with the results being statistically significant (P < 0.05) for on-site readers and 2 of 3 blinded readers. Higher sensitivity in lesion detection with combined MR imaging compared with CT was also clearly demonstrated in the following subgroups: lesions with a diameter

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Dextrans; Female; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Image Enhancement; Japan; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged; Prospective Studies; Tomography, Spiral Computed

To assess the safety, effective dose, and efficacy of a novel hepatobiliary MR contrast agent Gd-DTPA-DeA for imaging liver tumors, from the clinical phase I and phase II trials in Japan.. In a phase I trial, 33 healthy volunteers were intravenously administered a single dose of 0.03-10 micromol/kg of Gd-DTPA-DeA. In a nationwide phase II trial, 80 patients suspected to have hepatic mass were divided into three dosing groups: 2.5, 5.0, or 7.5 micromol/kg. T1-weighted gradient echo images were obtained before and after Gd-DTPA-DeA administration at three time points. Liver signal-to-noise ratio (SNR) and lesion-liver contrast-to-noise ratio (CNR) were calculated at each time point. A reading committee evaluated the contrast, diagnostic, and overall efficacy using a five-point scale.. In a phase I trial, dosages up to 10 micromol/kg were well tolerated by healthy volunteers. In a phase II trial, the contrast, diagnostic, and overall efficacy increased dose-dependently. The overall efficacy was 63.0%, 85.2%, and 88.0%, for 2.5, 5, and 7.5 micromol/kg, respectively. Liver SNR and CNR increase was greater at late phase than at early phase. No serious adverse events occurred.. Gd-DTPA-DeA is a well-tolerated and promising contrast agent for liver MR imaging.

Topics: Contrast Media; Dose-Response Relationship, Drug; Gadolinium DTPA; Humans; Japan; Liver Diseases; Magnetic Resonance Imaging

To investigate the efficacy of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) in the detection of focal liver lesions with respect to dose, side effects, and pulse sequence.. A randomized double-blinded trial was performed in 33 patients with focal solid liver lesions. A bolus of Gd-EOB-DTPA, a liver-specific contrast agent, was intravenously administered at three different doses (12.5, 25, and 50 mumol per kilogram of body weight). Magnetic resonance imaging with different T1-weighted techniques was performed 20 and 45 minutes after administration of Gd-EOB-DTPA. Changes in liver signal intensity, lesion-liver contrast-to-noise ration (C/N), detectable liver lesions, side effects, and adverse events were evaluated.. Gd-EOB-DTPA significantly (P < .05) increased liver signal intensity and lesion-liver C/N within the dose range tested. Lesion detection was improved 20 and 45 minutes after administration of Gd-EOB-DTPA. A dose of 12.5 mumol was sufficient for the detection of focal liver lesions, and the breath-hold, T1-weighted, fast low-angle shot pulse sequence was the most useful. No significant changes in vital signs, clinical laboratory test results, and urinalysis were observed.. Gd-EOB-DTPA is an efficient, diagnostically useful, and safe contrast agent.

Topics: Contrast Media; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gadolinium; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Pentetic Acid; Time Factors

To compare the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) and gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) in the diagnosis of focal liver lesions.. Thirty-one patients with focal liver lesions underwent T2- and T1-weighted spin-echo magnetic resonance (MR) imaging and fast low-angle shot two-dimensional MR imaging before, during, and after intravenous administration of three different doses of Gd-EOB-DTPA (12.5, 25, and 50 mumol per kilogram body weight). Gd-DTPA-enhanced imaging (dose, 0.1 mmol per kilogram body weight) was performed in the same patients within 1 week of Gd-EOB-DTPA imaging.. During the perfusion phase (the 3 minutes after injection of contrast material), the dynamic enhancement characteristics seen after injection of 25 and 50 mumol of Gd-EOB-DTPA were similar to those seen with Gd-DTPA. At the lowest dose of Gd-EOB-DTPA (12.5 mumol), the dynamic enhancement characteristics were not comparable to those seen with Gd-DTPA. During the hepatobiliary phase (1.5 minutes to 4 hours after injection), Gd-EOB-DTPA-enhanced images yielded a dose-independent, statistically significant improvement in the detection rate of additional metastases, hepatocellular carcinomas, and hemangiomas compared with unenhanced and Gd-DTPA-enhanced images (P < .05).. Gd-EOB-DTPA-enhanced MR imaging enables improved detection of hepatic lesions over Gd-DTPA-enhanced MR imaging while providing comparable differential diagnostic information.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Double-Blind Method; Female; Gadolinium; Gadolinium DTPA; Hemangioma; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Pentetic Acid; Prospective Studies

The liver T. To verify the relationship between the gadoxetic acid dose and the liver T. We enrolled 13 patients with normal liver function (NLF); and 18, 8, and 3 patients with Child-Pugh classes A (CPA), B (CPB), and C (CPC) who underwent gadoxetic acid-enhanced magnetic resonance imaging. Phase-sensitive inversion recovery sequence was performed before and at 15 min after injection and T. Only the liver-to-spleen ΔR. The liver and spleen ΔR

Topics: Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Retrospective Studies; Spleen

Monitoring disease progression is particularly important for determining the optimal treatment strategy in patients with liver disease. Especially for patients with diseases that have a reversible course, there is a lack of suitable tools for monitoring liver function. The development and establishment of such tools is very important, especially in view of the expected increase in such diseases in the future. Image-based liver function parameters, such as the T1 relaxometry-based MELIF score, are ideally suited for this purpose. The determination of this new liver function score is fully automated by software developed with AI technology. In this study, the MELIF score is compared with the widely used ALBI score. The ALBI score was used as a benchmark, as it has been shown to better capture the progression of less severe liver disease than the MELD and Child‒Pugh scores. In this study, we retrospectively determined the ALBI and MELIF scores for 150 patients, compared these scores with the corresponding MELD and Child‒Pugh scores (Pearson correlation), and examined the ability of these scores to discriminate between good and impaired liver function (AUC: MELIF 0.8; ALBI 0.77) and to distinguish between patients with and without cirrhosis (AUC: MELIF 0.83, ALBI 0.79). The MELIF score performed more favourably than the ALBI score and may also be suitable for monitoring mild disease progression. Thus, the MELIF score is promising for closing the gap in the available early-stage liver disease monitoring tools (i.e., identification of liver disease at a potentially reversible stage before chronic liver disease develops).

Topics: Contrast Media; Disease Progression; Humans; Liver Diseases; Magnetic Resonance Imaging; Retrospective Studies

(1) To evaluate the efficacy of functional liver imaging score (FLIS) in predicting liver function on gadoxetic acid-enhanced MRI in patients with chronic liver disease (CLD) or liver cirrhosis (LC) and its relationship with ALBI grade. (2) To assess the intra-reader reliability and interreader agreement of readers with different levels of experience in abdominal imaging of FLIS.. We retrospectively included 131 patients (70 men, 61 women; mean ± SD, 53.7 ± 14.6 years) with CLD and LC who underwent GA-enhanced MRI between November 2019 and March 2022. FLIS was assigned as a result of the sum of three hepatobiliary phase (HBP) images features, each scored 0-2: liver parenchymal enhancement, biliary contrast excretion, and portal vein sign. FLIS was calculated using HPB images independently by three radiologists with different experience. In addition, 50 randomly selected patients were reviewed a second time by a reader to assess intra-reader reliability. Patients were divided into the following three groups according to the albumin-bilirubin (ALBI) grade: ALBI grade 1, 2, and 3. We evaluated the correlation between ALBI grade and both FLIS and its parameters using Spearman's rank correlation for each reader. Receiver operating characteristic (ROC) curve analysis was performed to show the optimal cut-off value of FLIS to distinguish between ALBI grades. Intra-reader reliability and inter-reader agreement were evaluated by intraclass correlation coefficient (ICC).. FLIS and three FLIS parameters showed very strong correlation with ALBI grade for each readers (r =  - 0.843 to 0.976, - 0.831 to 0.962, and - 0.819 to 0.902, respectively). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of ALBI grade 1 for each readers (sensitivity, 83.7% to 95.4%; specificity, 82.6% to 87%; accuracy, 88.6% to 93.6% and area under the curve (AUC), 0.882 to 0.917), and FLIS ≤ 3 was the optimal cutoff for distinguish ALBI grade 3 from other grades for each readers (sensitivity, 100%; specificity, 95.2% to 96%; accuracy, 95.4% to 96.2% and AUC, 0.974 to 0.994). Intra-reader reliability (ICC = 0.95; 95% CI 0.93-0.96) and inter-reader agreement (ICC = 0.85 to 0.90; 95% CI 0.82-0.97) for FLIS were excellent.. FLIS showed a very correlation with hepatic function level and can stratify the ALBI grades. This feature has demonstrated the potential of FLIS to be excellent radiological tools for predicting of liver function of CLD and LC patients in clinical practice. Also, the excellent agreement of FLIS among readers with different levels of experience indicates that it can be used with high accuracy and reproducibility regardless of experience.

Topics: Albumins; Bilirubin; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Reproducibility of Results; Retrospective Studies

To validate the functional liver imaging score (FLIS) for prediction of hepatic function in gadoxetic acid-enhanced MRI.. We retrospectively identified 134 patients (88 men, 46 women; mean age, 58.8 years) between January 2015 and December 2018 with the following inclusion criteria: patients diagnosed with liver cirrhosis or chronic liver disease (CLD) who underwent gadoxetic acid-enhanced MRI. Three parameters on hepatobiliary phase images were evaluated for FLIS: liver parenchymal enhancement, biliary excretion, and signal intensity of the portal vein. Patients were classified as CLD (n = 11), Child-Pugh (CP) class A (n = 87), CP B (n = 22), or CP C (n = 14). We assessed the correlation between CP score and both FLIS and its components using Spearman rank correlation. Receiver operating characteristic (ROC) curve analysis was performed to demonstrate the cutoff value of FLIS for differentiating between CP classes. The associations between patient characteristics, serum markers, FLIS, and hepatic decompensation were evaluated with Cox proportional hazard models.. FLIS and three FLIS parameters showed strong to very strong correlation with CP score (r = -0.60 to 0.82). ROC curve analysis showed that FLIS ≥ 5 was the optimal cutoff for prediction of CP class A or CLD (sensitivity, 83.7%; specificity, 94.4%; area under the curve [AUC], 0.93). FLIS < 5 was independently associated with the development of first hepatic decompensation in patients with CP A (HR, 50.0; 95% confidence interval, 6.2, 400.4).. FLIS showed a strong correlation with hepatic function and can stratify the CP class. In addition, FLIS can help prediction for the development of first decompensation.. • Functional liver imaging scores (FLIS) and its three parameters, derived from hepatobiliary phase image, have strong to very strong correlations with Child-Pugh (CP) scores. • FLIS can stratify patients with chronic liver disease or liver cirrhosis according to CP classification. • Low FLIS is an independent predictor for first hepatic decompensation in patients with CP class A.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To evaluate the correlation between HeF obtained from gadoxetic acid-enhanced MR imaging and clinical biomarkers for the assessment of liver function.. This prospective study was approved by our Institutional Review Board, and written informed consent was obtained from the patients. We recruited 48 patients carrying a known or suspected liver disease to undergo gadoxetic acid-enhanced MR imaging. The new model of the HeF was calculated from ΔR1 values of the liver and spleen. The HeF, quantitative liver-to-spleen contrast ratio (Q-LSC), and ΔT1 value (the reduction rate of the T1 value between the pre- and post-contrast images) were compared with the Child-Pugh and end-stage liver disease (MELD) scores.. Among 48 patients, 40 were in Child-Pugh class A and 8 were in class B. The median HeF (P = 0.0001), Q-LSC (P = 0.015), and ΔT1 value (P = 0.0023) in patients in Child-Pugh class A were significantly higher than those in class B. The sensitivities, specificities, and area under the receiver-operating-characteristic curves for differentiating Child-Pugh class A and B were 95.0%, 87.5%, and 0.93 in the HeF; 77.5%, 75.0%, and 0.78 in the Q-LSC; and 57.5%, 100.0%, and 0.84 in the ΔT1 value, respectively. The HeF was significantly correlated with Child-Pugh (r = - 0.58, P < 0.0001) and MELD score (r = - 0.57, P < 0.0001).. The HeF was well correlated with Child-Pugh and MELD score and could be a new biomarker to assess liver function.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies

Background Gadoxetic acid-enhanced MRI enables estimation of liver function in patients with chronic liver disease (CLD). The functional liver imaging score (FLIS), derived from gadoxetic acid-enhanced MRI, has been shown to predict transplant-free survival in liver transplant patients. Purpose To investigate the accuracy of the FLIS for predicting hepatic decompensation and transplant-free survival in patients with CLD. Materials and Methods Patients with CLD who had undergone gadoxetic acid-enhanced liver MRI, including T1-weighted volume-interpolated breath-hold examination sequences with fat suppression, performed between 2011 and 2015 were included. FLIS was assigned on the basis of the sum of three hepatobiliary phase features, each scored on an ordinal 0-2 scale: hepatic enhancement, biliary excretion, and the signal intensity in the portal vein. Patients were stratified into the following three groups according to fibrosis stage and a presence or history of hepatic decompensation: nonadvanced CLD, compensated advanced CLD (CACLD), and decompensated advanced CLD (DACLD). The predictive value of FLIS for first and/or further hepatic decompensation and for transplant-free survival was investigated by using Kaplan-Meier analysis, log-rank tests, and Cox regression analysis. Results This study evaluated 265 patients (53 years ± 14 [standard deviation]; 164 men). Intraobserver (κ = 0.98; 95% confidence interval: 0.97, 0.99) and interobserver (κ = 0.93; 95% confidence interval: 0.90, 0.95) agreement for FLIS were excellent. In patients with CACLD, the FLIS was independently predictive of a first hepatic decompensation (adjusted hazard ratio, 3.7; 95% confidence interval: 1.1, 12.6;

Topics: Adult; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies

The primary objective was to compare the performance of 3 different abbreviated MRI (AMRI) sets extracted from a complete gadoxetate-enhanced MRI obtained for hepatocellular carcinoma (HCC) screening. Secondary objective was to perform a preliminary cost-effectiveness analysis, comparing each AMRI set to published ultrasound performance for HCC screening in the USA.. This retrospective study included 237 consecutive patients (M/F, 146/91; mean age, 58 years) with chronic liver disease who underwent a complete gadoxetate-enhanced MRI for HCC screening in 2017 in a single institution. Two radiologists independently reviewed 3 AMRI sets extracted from the complete exam: non-contrast (NC-AMRI: T2-weighted imaging (T2wi)+diffusion-weighted imaging (DWI)), dynamic-AMRI (Dyn-AMRI: T2wi+DWI+dynamic T1wi), and hepatobiliary phase AMRI (HBP-AMRI: T2wi+DWI+T1wi during the HBP). Each patient was classified as HCC-positive/HCC-negative based on the reference standard, which consisted in all available patient data. Diagnostic performance for HCC detection was compared between sets. Estimated set characteristics, including historical ultrasound data, were incorporated into a microsimulation model for cost-effectiveness analysis.. The reference standard identified 13/237 patients with HCC (prevalence, 5.5%; mean size, 33.7 ± 30 mm). Pooled sensitivities were 61.5% for NC-AMRI (95% confidence intervals, 34.4-83%), 84.6% for Dyn-AMRI (60.8-95.1%), and 80.8% for HBP-AMRI (53.6-93.9%), without difference between sets (p range, 0.06-0.16). Pooled specificities were 95.5% (92.4-97.4%), 99.8% (98.4-100%), and 94.9% (91.6-96.9%), respectively, with a significant difference between Dyn-AMRI and the other sets (p < 0.01). All AMRI methods were effective compared with ultrasound, with life-year gain of 3-12 months against incremental costs of US$ < 12,000.. NC-AMRI has limited sensitivity for HCC detection, while HBP-AMRI and Dyn-AMRI showed excellent sensitivity and specificity, the latter being slightly higher for Dyn-AMRI. Cost-effectiveness estimates showed that AMRI is effective compared with ultrasound.. • Comparison of different abbreviated MRI (AMRI) sets reconstructed from a complete gadoxetate MRI demonstrated that non-contrast AMRI has low sensitivity (61.5%) compared with contrast-enhanced AMRI (80.8% for hepatobiliary phase AMRI and 84.6% for dynamic AMRI), with all sets having high specificity. • Non-contrast and hepatobiliary phase AMRI can be performed in less than 14 min (including set-up time), while dynamic AMRI can be performed in less than 17 min. • All AMRI sets were cost-effective for HCC screening in at-risk population in comparison with ultrasound.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Cost-Benefit Analysis; Diffusion Magnetic Resonance Imaging; Early Detection of Cancer; Female; Gadolinium DTPA; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Young Adult

Gadoxetic acid-enhanced hepatobiliary phase (HBP) is useful in liver MRI, but sometimes shows insufficient liver enhancement. There is no established method to predict insufficient liver enhancement before the contrast injection.. To reveal the utility of the Bayesian method for predicting patients with insufficient liver enhancement in the gadoxetic acid-enhanced HBP.. Retrospective.. In all, 576 patients with chronic liver disease.. 3T/3D gradient-echo T. The patients were divided into two groups: insufficient and sufficient liver enhancement in HBP according to the liver-to-portal vein signal intensity ratio. Various parameters, including liver function tests and liver stiffness by MRE, were evaluated as predictors of insufficient liver enhancement.. We used Chi-square/Student's t-test/logistic regression analysis to determine independent associates, and Bayes' theorem to estimate the probability of insufficient (or sufficient) liver enhancement. The feasibility of Bayesian prediction of insufficient liver enhancement was tested by leave-one-out cross-validation to calculate sensitivity and specificity for single variables and combinations of some variables in all patients and in a subpopulation showing a confidence level of >80%.. Independent associates of insufficient liver enhancement in HBP included: serum albumin (odds ratio [OR] = 4.82, P < 0.001), total bilirubin (OR = 0.30, P < 0.00), platelet count (OR = 1.54, P < 0.00), and liver stiffness by MRE (OR = 0.59, P < 0.00). The accuracy of Bayesian prediction of insufficient liver enhancement was 80.9% (466/576) for the single parameter of albumin and 79.0% (455/576) for total bilirubin, and was increased to 85.2% (487/576) for a combination of albumin, total bilirubin, and liver stiffness. In patients who showed a confidence level of >80%, the accuracy was 89.0% (439/493) for the above combination.. Bayesian prediction was useful to predict patients with insufficient enhancement by combining serum liver function tests and liver stiffness by MRE.. 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:62-69.

Topics: Aged; Bayes Theorem; Chronic Disease; Contrast Media; Elasticity Imaging Techniques; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Retrospective Studies; Sensitivity and Specificity

Topics: Acetamides; Breath Tests; Carbon Isotopes; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies

We aimed to evaluate the potential of hepatobiliary phase magnetic resonance imaging (MRI) as parameter for assessment of hepatocellular function in patients with primary sclerosing cholangitis (PSC).. We collected data from 111 patients (83 male, 28 female; median, 44 years old), from March 2012 through March 2016, with a confirmed diagnosis of PSC who underwent MRI evaluation before and after injection (hepatobiliary phase) of a hepatocyte-specific contrast agent (gadoxetate disodium). Signal intensities were measured in each liver segment. Mean relative enhancement values were calculated and correlated with findings from liver functions tests, prognostic scoring systems (model for end-stage liver disease [MELD] score; Mayo risk score; Amsterdam-Oxford-PSC score), abnormalities detected by endoscopic retrograde cholangiopancreatography (using the Amsterdam cholangiographic classification system), and clinical endpoints (liver transplantation, cholangiocarcinoma, liver-related death). Our primary aim was to associate relative enhancement values with liver function and patient outcomes.. Most patients had moderate-stage disease and had intermediate levels of risk (median MELD score, 8 and median Mayo score, 0.27). Clinical endpoints were reached by 21 patients (6 developed cholangiocarcinoma, 8 underwent liver transplantation, and 7 patients died). The highest levels of correlations were observed for relative enhancement 20 min after contrast injection and level of alkaline phosphatase (r = -0.636), bilirubin (r = -0.646), albumin (r = 0.538); as well as international normalized ratio (r = 0.456); MELD score (r = -0.587); Mayo risk score (r = -0.535), and Amsterdam-Oxford model score (r = -0.595) (P < .0001). Relative enhancement correlated with all clinical endpoints (all P < .05). A cutoff relative enhancement value of 0.65 identified patients with a clinical endpoint with 73.9% sensitivity 92.9% specificity (area under the receiver operating characteristic curve, 0.901; likelihood ratio, 10.34; P < .0001).. In an analysis of 111 patients with PSC, we found MRI-measured relative enhancement, using a hepatocyte-specific contrast agent, to identify patients with clinical outcomes with 73.9% sensitivity 92.9% specificity. Long-term, multicenter studies are needed to further evaluate this marker of PSC progression.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Cholangitis, Sclerosing; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Sensitivity and Specificity; Young Adult

To assess if the administration of gadoxetate disodium (Gd-EOB-DTPA) significantly affects hepatic magnetic resonance elastography (MRE) measurements in the delayed hepatobiliary phase (DHBP).. A total of 47 patients (15 females, 32 males; age range 23-78 years, mean 54.28 years) were assigned to standard hepatic magnetic resonance imaging (MRI) with application of Gd-EOB-DTPA and hepatic MRE. MRE was performed before injection of Gd-EOB-DTPA and after 40-50 min in the DHBP. Liver stiffness values were obtained before and after contrast media application and differences between pre- and post-Gd-EOB-DTPA values were evaluated using a Bland-Altman plot and the Mann-Whitney-Wilcoxon test. In addition, the data were compared with regard to the resulting fibrosis classification.. Mean hepatic stiffness for pre-Gd-EOB-DTPA measurements was 4.01 kPa and post-Gd-EOB-DTPA measurements yielded 3.95 kPa. We found a highly significant individual correlation between pre- and post-Gd-EOB-DTPA stiffness values (Pearson correlation coefficient of r = 0.95 (p < 0.001) with no significant difference between the two measurements (p =0.49)). Bland-Altman plot did not show a systematic effect for the difference between pre- and post-stiffness measurements (mean difference: 0.06 kPa, SD 0.81). Regarding the classification of fibrosis stages, the overall agreement was 87.23% and the intraclass correlation coefficient was 96.4%, indicating excellent agreement.. Administration of Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver in the DHBP. Therefore, MRE can be performed in the DHBP.. • MRE of the liver can reliably be performed in the delayed hepatobiliary phase. • Gd-EOB-DTPA does not significantly influence MRE stiffness measurements of the liver. • MRE performed in the delayed hepatobiliary-phase is reasonable in patients with reduced liver function.

Topics: Adult; Aged; Contrast Media; Elasticity Imaging Techniques; Female; Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Retrospective Studies; Young Adult

To identify independent imaging features and establish a diagnostic algorithm for diagnosis of cystic fibrosis (CF)-associated liver disease (CFLD) in CF patients compared to controls using gadoxetic acid-enhanced MRI.. A total of 90 adult patients were enrolled: 50 with CF, 40 controls. The CF group was composed of two subgroups: a retrospective test subgroup (n = 33) and a prospective validation subgroup (n = 17). Controls (patients with normal liver enzymes and only benign focal liver lesions) were divided accordingly (27:13). MRI variables, including quantitative and qualitative parameters, were used to distinguish CFLD from controls using clinical symptoms, laboratory tests and Debray criteria. Disease severity was classified according to Child-Pugh and Albumin-Bilirubin (ALBI) scores. Fifteen qualitative single-lesion CF descriptors were defined. Two readers independently evaluated the images. Univariate statistical analysis was performed to obtain significant imaging features that differentiate CF patients from controls. Through multivariate analysis using chi-squared automatic interaction detector (CHAID) methodology the most important descriptors were identified. Diagnostic performance was assessed by receiver-operating characteristic (ROC) analysis.. Three independent imaging descriptors distinguished CFLD from controls: (1) presence of altered gallbladder morphology; (2) periportal tracking; and (3) periportal fat deposition. Prospective validation of the classification algorithm demonstrated a sensitivity of 94.1% and specificity of 84.6% for discriminating CFLD from controls. Disease severity was well associated with the imaging features.. A short unenhanced MRI protocol can identify the three cardinal imaging features of CFLD. The hepatobiliary phase of gadoxetic acid-enhanced MRI can define CFLD progression.. • Using a multivariate classification analysis, we identified three independent imaging features, altered gallbladder morphology (GBAM), periportal tracking (PPT) and periportal fat deposition (PPFD), that could diagnose CFLD with high sensitivity, 94.1 % (95% CI: 71.3-99.9) and moderate specificity, 84.6 % (95% CI: 54.6-98.1). • Based upon the results of this study, gadoxetic acid-enhanced MRI with DWI is able to diagnose early-stage CFLD, as well as its progression.

Topics: Adult; Algorithms; Cohort Studies; Cystic Fibrosis; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Young Adult

To evaluate the effect of a spiral tube on contrast enhancement in the hepatic arterial phase (HAP) of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).. In this retrospective study, we observed 104 patients who underwent dynamic MRI of the liver between October 2017 and December 2017. Three Gd-EOB-DTPA injection protocols were compared: (A) conventional method (undiluted Gd-EOB-DTPA, injection rate 1 ml/s, n = 36); (B) spiral dilution method (1:1 diluted Gd-EOB-DTPA with saline [off-label], injection rate 2 ml/s via spiral tube, n = 38); (C) spiral-flushed method (undiluted Gd-EOB-DTPA, injection rate 1 ml/s via spiral tube, n = 30). We regarded protocol-A as a control. The signal-to-noise ratio (SNR) of the abdominal aorta was calculated using arterial phase images. Image contrast and artefacts were evaluated by two board-certified radiologists, using a four-point scale. Statistical analyses included Dunnett's test, the Kruskal-Wallis test and the Steel test.. The SNR of the aorta was significantly higher with protocol-C (25.4 ± 8.8) than protocol-A (20.8 ± 5.4, p = 0.01). There was no significant difference in SNR between protocols A and B (p = 0.47). The contrast score of protocol-C was significantly higher than that of protocol-A (p = 0.0019). There was no significant difference in contrast score between protocols A and B (p = 0.50). There was no significant difference in artefacts among the three protocols (p = 0.96).. Use of a spiral tube with a slow injection protocol contributed to improved aortic contrast enhancement in the HAP of GD-EOB-DTPA-enhanced hepatic MRI.. • Gadoxetic acid shows weaker arterial enhancement at recommended doses, compared with nonspecific gadolinium agents; selection of an appropriate injection protocol is important. • A spiral flow-generating tube improves the transport efficiency of the contrast media, and increases the signal-to-noise ratio of the aorta in hepatic arterial phase. • A spiral flow-generating tube does not contribute to artefact reduction in hepatic arterial phase.

Topics: Adult; Aged; Aged, 80 and over; Aorta, Abdominal; Artifacts; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Saline Solution

The Liver Imaging Reporting and Data System (LI-RADS) is being adapted by many clinical practices. To support continuation of its use, LI-RADS (LR) is in need of multicenter validation studies of recent LI-RADS iterations. Furthermore, while both gadoxetate and extracellular agents have been incorporated into LI-RADS, comparison of the diagnostic performance between the two has yet to be determined.. To evaluate the rate, diagnostic performance, and interreader reliability (IRR) of LI-RADS 2017 for hepatocellular carcinoma, including LR major and ancillary features, with both gadoxetate and extracellular agent-enhanced MRI against a reference standard of histopathology or imaging follow-up.. Retrospective.. In all, 114 patients with 144 observations were included who met LR 2017 criteria for at risk and had at least one hepatic observation on liver MRI performed with either gadoxetate (n = 52) or an extracellular agent (n = 92) between 2010-2016, with histopathology (n = 103) or follow-up imaging (n = 41).. 1.5 and 3.0T/T. Three radiologists independently assessed major/ancillary features and assigned overall LI-RADS category for every observation.. Diagnostic performance of LR5/TIV+LR5 for identifying hepatocellular carcinoma (HCC) was compared between contrast agents with a generalized estimating equation. Weighted kappa was performed for interrater reliability.. The frequency of HCCs among LR1, LR2, LR3, L4, LR5, LRTIV+LR5, and LRM observations were: 0% (all readers), 0-12.5%, 11.4-26.9%, 50-76%, 83.0-95.1%, 83.3-100.0%, and 45.0-65.0%, respectively. Sensitivity of LR5/LRTIV+LR5 for HCC was 59.7-71.4% and specificity 85.0-96.8%. LI-RADS specificity and positive predictive value for observations imaged with gadoxetate was higher than extracellular agent for the most inexperienced reader (R3) (P = 0.009-0.034). IRR for LI-RADS categorization was substantial (k = 0.661).. Increasing numerical LI-RADS 2017 categories demonstrate a greater percentage of HCCs. LR5/TIV+LR5 demonstrates excellent specificity and fair sensitivity for HCC. MRI with gadoxetate in liver transplant candidates may be beneficial for less experienced readers, although further large-scale prospective studies are needed.. 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:e205-e215.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Hepatocellular; Diagnosis, Computer-Assisted; Diagnostic Imaging; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Observer Variation; Reference Standards; Reproducibility of Results; Retrospective Studies; Young Adult

To compare the apparent diffusion coefficient (ADC) value of conventional diffusion-weighted imaging (cDWI) to simultaneous multislice-accelerated DWI (sDWI) and to evaluate the possibility of ADC normalization using the spleen as a reference organ.. We retrospectively evaluated 92 patients (68 men, 24 women; mean age 60.0 years) who underwent liver magnetic resonance imaging (MRI) including both cDWI and sDWI. sDWI was obtained with an acceleration factor of 2. ADC values were measured from the right liver lobe, left liver lobe, spleen, pancreas, right kidney, and left kidney. ADC values of the spleen were used for normalization. Paired sample t test, Pearson's correlation coefficient, and Bland-Altman method were used for statistical analysis.. Normalization of ADC using the spleen could be useful for comparing upper abdominal organs acquired with either cDWI or sDWI in longitudinal and follow-up studies.

Topics: Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Kidney; Liver Diseases; Male; Middle Aged; Pancreas; Reference Values; Retrospective Studies; Spleen

To compare Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) with. Patients undergoing liver surgery and preoperative assessment of future remnant liver (FRL) function using. A total of 20 patients were included. The HBS-derived MUR and the DHCE-MRI-derived mean Ki correlated strongly for both total and FRL function (Pearson r = 0.70, p = 0.001 and r = 0.89, p < 0.001 respectively). There was a strong agreement between the functional share determined with both modalities (ICC = 0.944, 95% CI 0.863-0.978, n = 20). There was a significant negative correlation between liver aminotransferases and bilirubin for both MUR and Ki.. Assessment of liver function with DHCE-MRI is comparable with that of. • Quantitative assessment of liver function using hepatobiliary scintigraphy is performed in the preoperative assessment of patients undergoing liver surgery in order to prevent posthepatectomy liver failure. • Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) is an emerging method to quantify liver function and can serve as a potential alternative to hepatobiliary scintigraphy. • Assessment of liver function with dynamic gadoxetate-enhanced MRI is comparable with that of hepatobiliary scintigraphy and has the potential to be combined with diagnostic MRI imaging.

Topics: Aged; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Pilot Projects; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to investigate the findings of diffuse periportal enhancement in the liver on hepatobiliary phase gadoxetate disodium-enhanced magnetic resonance images by comparing with the finding of periportal hyperintensity on T2-weighted images and to reveal their clinical significance.Nineteen consecutive patients with diffuse periportal enhancement on hepatobiliary phase images constituted the study population. The intrahepatic diffuse periportal enhancement finding was assessed on whether it corresponded to periportal hyperintense patterns on T2-weighted images or not in the location, and the cases were classified into 2 groups according to this characteristic. Signal intensities at the periportal areas were also assessed on T1-, T2-, diffusion-weighted and dynamic images. Furthermore, possible associations between these image findings and the final diagnoses were explored.In 7 of the 19 patients, periportal enhancement area corresponded with the periportal hyperintensity area on T2-weighted images. In the remaining 12 patients, the finding of periportal T2-hyperintensity was absent or the periportal enhancement differed from the periportal T2-hyperintensity in the location. Diseases of the former group comprised autoimmune hepatitis, acute exacerbation of chronic hepatitis and acute alcoholic steatohepatitis, and those of the latter group primary sclerosing cholangitis, autoimmune hepatitis-primary biliary cirrhosis overlap syndrome, and liver cirrhosis with miscellaneous etiology.Diffuse periportal enhancement during the hepatobiliary phase did not always correspond to periportal hyperintensity on T2-weighted images. In the classification based on whether enhancement area corresponded or not, each enhancement pattern appeared in different groups of liver diseases. Specifically, the former (corresponding) was associated with active inflammation such as hepatitis and the latter (not corresponding) was predominantly associated with a chronic change such as cirrhosis. Appropriate recognition of these periportal enhancement patterns may contribute to the improved diagnosis of diffuse liver diseases.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Young Adult

To examine inter- and intra-observer agreement for four simple hepatobiliary phase (HBP)-based scores on gadoxetic acid (GA)-enhanced MRI and their correlation with liver function in patients with mixed chronic liver disease (CLD).. This single-center, retrospective study included 287 patients (62% male, 38% female, mean age 53.5 ± 13.7 years) with mixed CLD (20.9% hepatitis C, 19.2% alcoholic liver disease, 8% hepatitis B) who underwent GA-enhanced MRI of the liver for clinical care between 2010 and 2015. Relative liver enhancement (RLE), contrast uptake index (CUI), hepatic uptake index (HUI), and liver-to-spleen contrast index (LSI) were calculated by two radiologists independently using unenhanced and GA-enhanced HPB (obtained 20 min after GA administration) images; 50 patients selected at random were reviewed twice by one reader to assess intra-observer reliability. Agreement was assessed by intraclass correlation coefficient (ICC). The albumin-bilirubin (ALBI) score, the model of end-stage liver disease (MELD), and the Child-Turcotte-Pugh (CTP) score were calculated as standards of reference for hepatic function.. Intra-observer ICCs ranged from 0.814 (0.668-0.896) for CUI to 0.969 (0.945-0.983) for RLE. Inter-observer ICCs ranged from 0.777 (0.605-0.874) for HUI to 0.979 (0.963-0.988) for RLE. All HBP-based scores correlated significantly (all p < 0.001) with the ALBI, MELD, and CTP scores and were able to discriminate patients with a MELD score ≥ 15 versus ≤ 14, with area under the curve values ranging from 0.760 for RLE to 0.782 for HUI.. GA-enhanced, MRI-derived, HBP-based parameters showed excellent inter- and intra-observer agreement. All HBP-based parameters correlated with clinical and laboratory scores of hepatic dysfunction, with no significant differences between each other.. • Radiological parameters that quantify the hepatic uptake of gadoxetic acid are highly reproducible. • These parameters can be used interchangeably because they correlate with each other and with scores of hepatic dysfunction. • Assessment of these parameters may be helpful in monitoring disease progression.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; ROC Curve; Young Adult

To assess the consistency of liver enhancement in gadoxetic acid-enhanced magnetic resonance imaging (MRI) over serial examinations.. This retrospective study included 554 patients who underwent at least 2 serial gadoxetic acid-enhanced MRI scans at either 1.5 or 3.0 Tesla at our institution between 2014 and 2018. Signal intensities (SI) were measured on T1-weighted images before and approx. 20 min after intravenous injection of gadoxetic acid. Relative enhancement (RE) of the liver, liver-to-spleen SI ratio (LSR), and liver-to-muscle SI ratio (LMR) were calculated. Means were compared with the paired t test, Greenhouse-Geisser test, and linear mixed model analysis, accordingly. Multiple linear regression analysis was used to elucidate possible predictors of RE and bivariate correlation analysis of patient age with RE was performed.. No statistically significant difference in RE, LSR, and LMR between two consecutive MRI scans was found when tested with paired t test or Greenhouse-Geisser test (n = 554, 519, and 554, respectively), while the latter revealed a statistically significant difference between the first and fourth MRI scan which was not confirmed in the linear mixed model. Patient age correlated negatively with RE of the liver (p = 0.002), LSR (p < 0.001), and LMR (p = 0.006).. Relative enhancement of the liver in the hepatobiliary phase of gadoxetic acid-enhanced MRI is consistent over successive examinations, different scanner types, and field strengths while correlating negatively with age, which further underscores the validity of gadoxetic acid-enhanced MRI as an imaging-based liver function test.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Gadoxetate disodium, utilized in hepatobiliary magnetic resonance (MR) imaging, has been associated with transient respiratory motion during the arterial phase in adults.. The purpose of this study was to determine the presence and severity of this phenomenon in children imaged awake versus under general anesthesia.. This retrospective cohort study was approved by the institutional review board; informed consent was waived. One hundred thirty exams of children ≤18 years old who underwent dynamic liver MR imaging with gadoxetate disodium between October 2010 and January 2018 were reviewed. Three pediatric radiologists scored respiratory motion artifacts on all imaging phases using a 5-point Likert scale. Differences in mean motion scores were assessed with analysis of variance and Tukey's multiple comparisons test, and multivariable regression was used to identify predictors of arterial phase motion in awake patients.. One hundred thirty patients (50% [n=65] female; mean age: 9.8±3.7 years, 48.5% [n=63] awake) were included. There were significant differences in mean motion scores between phases in the awake cohort (P<0.0001) but not in the general anesthesia cohort (P=0.051). In the awake cohort, arterial phase motion score (mean: 3.52±0.83) was significantly higher than mean motion score in all other phases (P≤0.0003). There were no significant patient-specific predictors of arterial phase motion score in the awake cohort.. Significantly increased arterial phase respiratory motion artifact in awake children undergoing dynamic liver MR imaging with gadoxetate disodium suggests that transient respiratory motion occurs in children. General anesthesia may suppress this phenomenon.

Topics: Adolescent; Artifacts; Child; Child, Preschool; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Magnetic Resonance Imaging; Male; Respiration; Retrospective Studies; Young Adult

Hepatic radiation injury severely restricts irradiation treatment for liver carcinoma. The purpose of this study was to investigate the clinical application of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI (EOB-MRI) in the assessment of liver function after external radiation therapy and to determine the relationship between focal liver reaction (FLR) and liver function.. A total of 47 patients with liver malignancies who underwent external beam radiation therapy were enrolled. EOB-MRI was performed on each patient at approximately one month post-radiotherapy. The hepatobiliary (HPB) phase images from EOB-MRI were fused with the planning CT images, and the isodose lines from the patients' treatment plans were overlaid onto the fused images. The correlation of the EOB-MR image intensity distribution with the isodose lines was studied. We also compared liver function in patients between pre-treatment and post-treatment.. Decreased uptake of Gd-EOB-DTPA, which was manifested by well-demarcated focal hypointensity of the liver parenchyma or FLR to high-dose radiation, was observed in the irradiated areas of 38 patients. The radiotherapy isodose line of decreased uptake area of Gd-EOB-DTPA was 30-46 Gy. The median corresponding dose curve of FLR was 34.4 Gy. Nine patients showed the absence of decreased uptake area of Gd-EOB-DTPA in the irradiated areas. Compared to the 38 patients with the presence of decreased uptake area of Gd-EOB-DTPA, 9 patients with the absence of decreased uptake area of Gd-EOB-DTPA showed significant higher levels of total bile acid, total bilirubin, direct bilirubin and alpha-fetoprotein (P < 0.05). There were no significant differences in alanine transaminase, aspartate aminotransferase, gamma-glutamyl transpeptidase or albumin levels between the two groups (P > 0.05).. Visible uptake of Gd-EOB-DTPA by the liver parenchyma was significantly associated with liver function parameters. EOB-MRI can be a valuable imaging biomarker for the assessment of liver parenchyma function outside of radiation area.

Topics: Aged; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Predictive Value of Tests; Radiation Dosage; Radiation Injuries; Radiotherapy; Tomography, X-Ray Computed

To provide nonrigid respiratory motion-corrected DCE-MRI images with isotropic resolution of 1.5 mm, full coverage of abdomen, and covering the entire uptake curve with a temporal resolution of 6 seconds, for the quantitative assessment of hepatic lesions.. 3D DCE-MRI data were acquired at 3 T during free breathing for 5 minutes using a 3D T. Respiratory motion produced artifacts and misalignment between dynamic volumes (lesion average motion amplitude of 3.82 ± 1.11 mm). Motion correction minimized artifacts and improved average contrast-to-noise ratio of hepatic lesions in late phase by 47% (p < .01). Quantitative endothelial permeability maps of motion-corrected data demonstrated enhanced visibility of different pathologies (e.g., metastases, hemangiomas, cysts, necrotic tumor substructure) and showed improved contrast-to-noise ratio by 62% (p < .01) compared with uncorrected data.. 3D nonrigid motion correction in DCE-MRI improves both visual and quantitative assessment of hepatic lesions by ensuring accurate alignment between 3D DCE images and reducing motion blurring. This approach does not require breath-holds and minimizes scan planning by using a large FOV with isotropic resolution.

Topics: Artifacts; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Motion

In cirrhotic patients, the characterization of hypovascular nodules, hypointense on hepatobiliary phase gadoxetic acid disodium-enhanced magnetic resonance images (Gd-EOB-DTPA-enhanced MRI), is essential to look for the proper approach strategy. Our objective was to evaluate the imaging features and risk assessment of hypovascular nodules, hypointense on Gd-EOB-DTPA-enhanced MRI, focusing on the diagnostic value of diffusion-weighted imaging (DWI).. This prospective study includes 35 patients with 50 hypovascular hypointense nodules. Signal intensity on T2-weighted images and DWI, vascular pattern on dynamic contrast-enhanced MRI and on hepatobiliary phase, and volume doubling time were analyzed for each nodule as well as patient's clinical features. Univariate and multivariate analyses were made to determine the variables associated with the development of hypervascular pattern.. On 24 months follow-up period, 40% of the hypointense nodules (mean size 14 mm ± 6.1) became hypervascular hepatocellular carcinoma (HCC) with 6 and 12 months cumulative risk of 45 and 55%. Nine/12 (75%, mean size 15.50 mm ± 7.2) that appeared hyperintense in DWI at first exam show malignant transformation (p value = 0.007). Univariate and multivariate analyses identified hyperintensity at initial DWI (OR 6.49; 95% CI 1.28-32.80; p value = 0.009) and size ≥10 mm (OR 6.22; 95% CI 1.57-24.63; p value = 0.024) as independent factors with the development of HCC.. In conclusion, hypovascular lesions ≥10 mm and those hyperintense in DWI were associated with progression to hypervascular HCC. A close follow-up or histological characterization is recommended to improve patients outcome and to develop effective treatment.

Topics: Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Disease Progression; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Neovascularization, Pathologic; Prospective Studies; Risk Assessment

The aims of this study were to observe the pattern of transient motion after gadoxetic acid administration including incidence, onset, and duration, and to evaluate the clinical feasibility of free-breathing gadoxetic acid-enhanced liver magnetic resonance imaging using golden-angle radial sparse parallel (GRASP) imaging with respiratory gating.. In this institutional review board-approved prospective study, 59 patients who provided informed consents were analyzed. Free-breathing dynamic T1-weighted images (T1WIs) were obtained using GRASP at 3 T after a standard dose of gadoxetic acid (0.025 mmol/kg) administration at a rate of 1 mL/s, and development of transient motion was monitored, which is defined as a distinctive respiratory frequency alteration of the self-gating MR signals. Early arterial, late arterial, and portal venous phases retrospectively reconstructed with and without respiratory gating and with different temporal resolutions (nongated 13.3-second, gated 13.3-second, gated 6-second T1WI) were evaluated for image quality and motion artifacts. Diagnostic performance in detecting focal liver lesions was compared among the 3 data sets.. Transient motion (mean duration, 21.5 ± 13.0 seconds) was observed in 40.0% (23/59) of patients, 73.9% (17/23) of which developed within 15 seconds after gadoxetic acid administration. On late arterial phase, motion artifacts were significantly reduced on gated 13.3-second and 6-second T1WI (3.64 ± 0.34, 3.61 ± 0.36, respectively), compared with nongated 13.3-second T1WI (3.12 ± 0.51, P < 0.0001). Overall, image quality was the highest on gated 13.3-second T1WI (3.76 ± 0.39) followed by gated 6-second and nongated 13.3-second T1WI (3.39 ± 0.55, 2.57 ± 0.57, P < 0.0001). Only gated 6-second T1WI showed significantly higher detection performance than nongated 13.3-second T1WI (figure of merit, 0.69 [0.63-0.76]) vs 0.60 [0.56-0.65], P = 0.004).. Transient motion developed in 40% (23/59) of patients shortly after gadoxetic acid administration, and gated free-breathing T1WI using GRASP was able to consistently provide acceptable arterial phase imaging in patients who exhibited transient motion.

Topics: Adult; Aged; Artifacts; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Motion; Prospective Studies; Reproducibility of Results; Respiration; Retrospective Studies; Young Adult

To determine whether CAIPIRINHA-Dixon-TWIST (CDT) volume-interpolated breath-hold examination (VIBE) improves image quality by reducing gadoxetate-disodium-associated transient arterial-phase motion artefacts in magnetic resonance imaging (MRI) of the liver.. MRI studies of the liver from 270 patients who had received gadoxetate disodium were retrospectively evaluated in regard to arterial timing accuracy and arterial phase motion artefact severity (VIBE: 90/270, CAIPIRINHA-VIBE: 90/270 and CDT-VIBE: 90/270 cases). Three independent and blinded readers assessed arterial phase timing and motion artefact severity (5-point scale). Interrater agreement was calculated by weighted kappa. Continuous variables were compared via a two-sided ANOVA, categorical variables via a χ. CDT-VIBE improved correct late arterial timing rates and reduced motion-related image deterioration rates. Successful late arterial liver visualisation was achieved in 56.7% (VIBE) compared with 66.7% (CAIPIRINHA-VIBE) and 84.4% (CDT-VIBE) (P < 0.0001). Good/excellent image quality was achieved in 56.7% vs. 66.7% and 73.3%, respectively (P = 0.03). Male sex negatively influenced image quality (P = 0.03).. CDT-VIBE increases the diagnostic utility of gadoxetate disodium-based liver MRI by reducing respiratory motion artefacts and optimising late arterial visualisation compared with VIBE and CAIPIRINHA-VIBE.. • CAIPIRINHA-Dixon-TWIST-VIBE-MRI (CDT) mitigates effects of acute transient dyspnoea caused by gadoxetate disodium. • CDT improves late arterial imaging compared with VIBE and CAIPIRINHA-VIBE. • The rate of ideal late arterial images is higher with CDT-VIBE vs. VIBE or CAIPI-VIBE. • The impact of respiratory motion artefacts on arterial phase images can be reduced.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Artifacts; Breath Holding; Child; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Motion; Reproducibility of Results; Retrospective Studies; Young Adult

The controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique can decrease scan time. The purpose of this study was to determine whether an arterial phase scan can be performed in 5 s using the CAIPIRINHA short-scan and a reference scanning technique. The generalized autocalibrating partially parallel acquisition (GRAPPA), the CAIPIRINHA routine (CAIPI-routine), and the CAIPIRINHA short-scanning (CAIPI-short) methods were compared. The scan time for each method was preset to 20 s, 15 s, and 10 s, respectively. The reference scan had a scan time of 5 s. A phantom study was used to compare the influence of artifacts during the reference scan. For comparison, the phantom was moved during the last 5 s. In the clinical studies of suspected chronic liver diseases, magnetic resonance imaging of the liver is usually performed while the patient is breath-hold. The motion artifacts of each method were compared. Artifacts were reduced in reference scans using the CAIPIRINHA method. At 5 s after initiation, the rate of change in the standard deviation value was within 30% compared to that of the original image. Motion artifacts due to the influence of the reference scan when a patient failed to hold their breath did not complicate image evaluation. The proportion of motion artifacts for each sequence was as follows: GRAPPA, 5.8%; CAIPI-routine, 1.9%; and CAIPI-short, 0.7%. The arterial phase can be scanned in 5 s using the CAIPI-short and reference scan techniques.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Artifacts; Breath Holding; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Motion; Phantoms, Imaging; Reference Standards; Retrospective Studies

To describe the effect of hepatobiliary-specific MR imaging contrast agent (HBCA) administration on the signal intensity of peritoneal and pleural fluid effusions on T1-weighted MR images.. From October 2015 to May 2016 139 patients (mean 60±10 years old, 69 % males) with peritoneal or pleural effusions without biliary leakage who underwent HBCA-MRI (Gd-BOPTA or Gd-EOB-DTPA) at 1.5T and 3T were included from two centres. The fluid signal intensity was classified as hypo/iso/hyperintense before/after HBCA administration. The relative signal enhancement (RE) was calculated.. On hepatobiliary phase (HBP), peritoneal fluids appeared hyper/isointense in 88-100 % and pleural effusions in 100 % of the patients following Gd-BOPTA administration. All fluids remained hypointense following Gd-EOB-DTPA. The signal intensity of fluids increased with both HBCA but RE was significantly higher following Gd-BOPTA (p=0.002 to <0.001). RE was correlated with HBP acquisition time-point (r=0.42, p<0.001 and r=0.50, p=0.033 for peritoneal and pleural fluids).. The signal intensity of pleural and peritoneal fluids progressively increases following HBCA administration in the absence of biliary leakage. Due to its later hepatobiliary phase, this is more pronounced after Gd-BOPTA injection, leading to fluid hyperintensity that is not observed after Gd-EOB-DTPA injection.. • Fluids appear hyper/isointense on HBP in most patients after Gd-BOPTA injection. • Fluids remain hypointense on HBP after Gd-EOB-DTPA injection. • RE of fluids increases with time after liver-specific Gd injection. • RE of fluids is higher in patients with chronic liver disease.

Topics: Adult; Aged; Ascitic Fluid; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Pleural Effusion; Retrospective Studies

To determine whether liver function as determined by intravenous administration of. Sixty-six patients underwent a. Stratified by three different categories of. Liver function as determined using real-time. • Gd-EOB-DTPA-enhanced T1 relaxometry quantifies liver function • Gd-EOB-DTPA-enhanced MR relaxometry may provide parameters for assessing liver function before surgery • Gd-EOB-DTPA-enhanced MR relaxometry may be useful for monitoring liver disease progression • Gd-EOB-DTPA-enhanced MR relaxometry has the potential to become a novel liver function index.

Topics: Acetamides; Aged; Breath Tests; Carbon Isotopes; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Reproducibility of Results; Retrospective Studies

To evaluate Gd-EOB-DTPA-enhanced MRI for quantitative assessment of liver organ damage after hepatic ischaemia reperfusion injury (IRI) in mice.. Partial hepatic IRI was induced in C57Bl/6 mice (n = 31) for 35, 45, 60 and 90 min. Gd-EOB-DTPA-enhanced MRI was performed 1 day after surgery using a 3D-FLASH sequence. A subgroup of n = 9 animals with 60 min IRI underwent follow-up with MRI and histology 7 days after IRI. The total liver volume was determined by manual segmentation of the entire liver. The volume of functional, contrast-enhanced liver parenchyma was quantified by a region growing algorithm (visual threshold) and an automated segmentation (Otsu's method). The percentages of functional, contrast-enhanced and damaged non-enhanced parenchyma were calculated according to these volumes. MRI data was correlated with serum liver enzyme concentrations and histologically quantified organ damage using periodic acid-Schiff (PAS) staining.. The percentage of functional (contrasted) liver parenchyma decreased significantly with increasing ischaemia times (control, 94.4 ± 3.3%; 35 min IRI, 89.3 ± 4.1%; 45 min IRI, 87.9 ± 3.3%; 60 min IRI, 68 ± 10.5%, p < 0.001 vs. control; 90 min IRI, 55.9 ± 11.5%, p < 0.001 vs. control). The percentage of non-contrasted liver parenchyma correlated with histologically quantified liver organ damage (r = 0.637, p < 0.01) and serum liver enzyme elevations (AST r = 0.577, p < 0.01; ALT r = 0.536, p < 0.05). Follow-up MRI visualized recovery of functional liver parenchyma (71.5 ± 8.7% vs. 84 ± 2.1%, p < 0.05), consistent with less histological organ damage on day 7.. We demonstrated the feasibility of Gd-EOB-DTPA-enhanced MRI for non-invasive quantification of damaged liver parenchyma following IRI in mice. This novel methodology may refine the characterization of liver disease and could have application in future studies targeting liver organ damage.. • Prolonged ischaemia times in partial liver IRI increase liver organ damage. • Gd-EOB-DTPA-enhanced MRI at hepatobiliary phase identifies damaged liver volume after hepatic IRI. • Damaged liver parenchyma quantified with MRI correlates with histological liver damage. • Hepatobiliary phase Gd-EOB-DTPA-enhanced MRI enables non-invasive assessment of recovery from liver injury.

Topics: Animals; Biomarkers; Contrast Media; Gadolinium DTPA; Histological Techniques; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Mice, Inbred C57BL; Reperfusion Injury

To evaluate value of gadoxetic acid-enhanced and diffusion-weighted (DW) MRI for distinguishing malignant from benign hyperintense nodules on unenhanced T1-weighted images (T1WIs) in patients with chronic liver disease.. Forty-two patients with 37 malignant and 41 benign hyperintense nodules on unenhanced T1WIs who underwent gadoxetic acid-enhanced and DW MRI, followed by histopathological examination, were included. Qualitative and quantitative analyses were conducted. Significant findings on univariate and multivariate analyses were identified and their diagnostic performances were analyzed for predicting hyperintense hepatocellular carcinomas (HCCs).. Gadoxetic acid-enhanced and DW MRI may be helpful for differentiating malignant from benign hyperintense nodules on unenhanced T1WI.

Topics: Aged; Chronic Disease; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

To evaluate transient severe respiratory motion artifacts (TSM) at gadoxetate disodium-enhanced MRI dependent on the mode of contrast agent application.. 200 patients (71f, 129m; mean 51y) were included in this retrospective IRB-approved study. Contrast application protocols (n = 4) differed with regards to injection rate (2ml or 1ml/sec), dose (weight-based or fixed 10ml) and supplemental oxygen administration (yes/no). SNR measurements were performed in the aorta and portal vein. Qualitatively, three readers assessed arterial phase image quality and TSM independently (4- and 5-point scale, respectively). Quantitative and qualitative results were compared (Kruskal-Wallis test, Dunn's multiple comparison test). The influence of different contrast agent application parameters on the occurrence of respiratory motion artifacts was assessed (univariate analysis). Interrater agreement and reliability were calculated (intraclass correlation coefficient, ICC)).. Use of a lower contrast injection rate resulted in significantly higher arterial SNR in the aorta and portal vein (p<0.05). TSM was observed in 12% of examinations. Neither injection rate, contrast dose, nor oxygen had a significant influence. Interrater agreement and reliability for evaluation of image quality and respiratory motion were substantial/ almost perfect (ICC = 0.640-0.915).. Technical factors regarding the specific mode of contrast application do not seem to significantly reduce the incidence of severe transient respiratory motion artifacts.

Topics: Aorta; Artifacts; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Movement; Portal Vein; Respiratory Mechanics; Retrospective Studies; Tissue Distribution

To retrospectively determine the frequency, natural history and factors associated with the presence of transient hepatic enhancement difference showing hypointensity on hepatobiliary phase images of gadoxetic acid-enhanced MRI.. Gadoxetic acid-enhanced MRI of 125 patients (91 men; 34 women) with transient hepatic enhancement difference were retrospectively reviewed. Three readers qualitatively and quantitatively evaluated MR imaging features and evolution at follow up. The Chi-square test, Fisher's exact test and Kruskall-Wallis rank test were used for statistical analysis.. Transient hepatic enhancement difference were hypointense on hepatobiliary phase images in 20 of 125 cases (16%). At univariate analysis there was association with wedge-shape morphology (p < 0.001), size ≥21 mm (p < 0.001), hyperintensity on T2-weighted imaging (p < 0.001), restricted diffusion (p < 0.001) and previous treatment (p < 0.005). At multivariate analysis, the following factors were associated: previous treatment (p < 0.05), hyperintensity on T2-weighted imaging (p < 0.001) and size ≥21 mm (p < 0.001). Of 12 patients with hypointense transient hepatic enhancement difference on hepatobiliary phase images who had follow-up MRI, nine showed reduction in size.. Transient hepatic enhancement difference observations showing hypointensity on hepatobiliary phase images of gadoxetic acid-enhanced MRI are not infrequent and may shrink at follow-up. They are more likely associated with size ≥21 mm, hyperintensity on T2-weighted images and previous treatment of adjacent tumor.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Retrospective Studies

We aimed to identify features that differentiate hepatic microabscess from hepatic metastasis on gadoxetic acid-enhanced MRI in patients with periampullary cancer.. We included 72 patients (31 patients with 83 hepatic microabscesses and 41 patients with 71 hepatic metastases) who had a history of periampullary cancer and underwent gadoxetic acid-enhanced MRI. Image analysis was performed for margin, signal intensity, rim enhancement, perilesional hyperaemia, pattern on DWI and dynamic phases, and size discrepancy between sequences by consensus of two observers.. Multivariate analysis revealed that the following significant parameters favour microabscess: a history of bile duct cancer, perilesional hyperaemia, persistent arterial rim enhancement through the transitional phase (TP), and size discrepancy between T1WI and T2WI and between T1WI and hepatobiliary phase image (HBPI). The diagnostic accuracy for microabscess was highest (90.9%) when showing a size discrepancy ≥30% between T1WI and HBPI or persistent arterial rim enhancement through the TP. When the lesion was positive for both these variables, specificity reached 100%.. The combination of a size discrepancy between T1WI and HBPI and persistent arterial rim enhancement through the TP represents a reliable MRI feature for distinguishing between hepatic microabscess and metastasis in patients with periampullary cancer.. • Gadoxetic acid-enhanced MRI is useful for distinguishing hepatic microabscess from metastasis. • Hepatic microabscess showed significant size discrepancy ≥30% between T1WI and HBPI. • Arterial rim enhancement persistent through the TP indicates hepatic microabscess.

Topics: Abscess; Aged; Ampulla of Vater; Bile Duct Neoplasms; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatic Neoplasms; Retrospective Studies; Sensitivity and Specificity

To assess major imaging features of Liver Imaging Reporting and Data System (LI-RADS) on contrast-enhanced CT and gadoxetic acid-enhanced MRI and to estimate whether the combination of signal intensity favouring HCC on hepatobiliary phase (HBP) and diffusion-weighted images (DWI) can act as a major feature in LI-RADS.. Four hundred twenty one patients with 445 observations were included. Major features of LI-RADS on CT and MRI as well as HBP and DWI features were assessed. Diagnostic performances of LR-5 according to LI-RADS v2014 and modified LI-RADS which incorporate combination of HBP and DWI were assessed. Pairwise comparisons of the receiver operating characteristic (ROC) curves were performed.. For HCCs, capsule appearance had the highest rate of discordance between CT and MRI (32.7%), followed by washout appearance (22.2%). Specificity (75%) of LR-5 of LI-RADS v2014 was lower than that (77.1-79.2%) of modified LI-RADS. Area under the ROC curve of modified LI-RADS (0.755-0.775) was not significantly different from that of LI-RADS v 2014 (0.709) (p > 0.05).. There were substantial discordances between CT and MRI for capsule and washout appearances in hepatic observations, and combination of gadoxetic acid-enhanced MRI and DWI might be able to be incorporated as a major feature of LI-RADS.. • Major imaging features of LI-RADS showed substantial discordances on CT and MRI. • An observation may be categorized differently depending on used imaging exam. • CT and MRI should both be performed for LR-3 and LR-4 observations. • Combination of gadoxetic acid-enhanced MRI and DWI may be a major feature.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Male; Middle Aged; Radiology Information Systems; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed; Young Adult

To compare hepatobiliary phase (HBP) images obtained 10 and 20 min after Gd-EOB-DTPA-enhanced MRI for liver function assessment in clinic on 3.0 T MR imaging.. 103 patients were separated into four groups: 38 patients for the normal liver function (NLF) group, 33 patients for the liver cirrhosis with Child-Pugh A (LCA) group, 21 patients for the liver cirrhosis with Child-Pugh B group, and 11 patients for a liver cirrhosis with Child-Pugh C group. T1 relaxation times (T1rt) were measured on T1 mapping and reduction rates of T1rt (rrT1rt) were calculated. HBP images were obtained at the 10- and 20-min mark after Gd-EOB-DTPA enhancement.. T1rt on pre-enhancement imaging showed no significant difference (p > 0.05) among all four groups. T1rt for both the 10-min HBP and the 20-min HBP showed a significant difference (p < 0.05) among all groups, but showed no significant difference (p > 0.05) between the NLF group and the LCA group. T1rt and rrT1rt showed no significant difference (p > 0.05) between 10-min HBP and 20-min HBP among all groups. The ROC analysis on 10-min HBP and 20-min HBP showed a lower diagnostic performance between NLF group and LCA group (AUC from 0.532 to 0.582), but high diagnostic performance (AUC from 0.788 to 1.000) among others group.. In comparing 10-min HBP and 20-min HBP T1 mapping after Gd-EOB-DTPA enhancement, our results suggest that 10-min HBP T1 mapping is a feasible option for quantitatively assessing liver function.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity

To assess the association between non-hypervascular hypointense nodules (NHHNs) on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and liver stiffness (LS) in patients with chronic liver disease, and analyzed their progression to overt hepatocellular carcinoma (HCC).. Between August 2012 and March 2016, a total of 714 consecutive patients who had undergone transient elastography for LS measurement and gadoxetic acid-enhanced MRI were investigated. The association between the presence of NHHNs on the hepatobiliary phase and LS, and the patient's HCC status [none, presence of treatment-naïve HCC, or a history of previous HCC treatment] was assessed. In patients with these nodules, cumulative progression rates of nodules to overt HCC were compared with rates of new HCC development in other parts of the liver.. The prevalence of NHHNs was 16.8% (120/714). The presence of these nodules was significantly associated with the log LS (Odds ratio [OR], 1.48, p=0.002) and hepatitis B virus infection (OR, 3.14, p=0.017), regardless of the patient's HCC status. The two year cumulative progression rate of overt HCC from corresponding nodules and rate of progression to HCC in other parts of the liver were 34.1% and 18.3%, respectively (p=0.071).. The presence of NHHNs on gadoxetic acid-enhanced MRI was associated with higher LS and hepatitis B virus infection. Furthermore, these lesions frequently progressed to overt HCC.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Cross-Sectional Studies; Disease Progression; Elasticity Imaging Techniques; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Young Adult

Image non-uniformity may cause substantial problems in magnetic resonance (MR) imaging especially when a 3-T scanner is used. We evaluated the effect of image non-uniformity correction in gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging using a 3-T scanner.. Two commercially available methods for image non-uniformity correction, surface coil intensity correction (SCIC), and phased-array uniformity enhancement (PURE), were applied to Gd-EOB-DTPA-enhanced images acquired at 3-T in 20 patients. The calibration images were used for PURE and not for SCIC. Uniformity in the liver signal was evaluated visually and using histogram analysis. The liver-to-muscle signal ratio (LMR) and liver-to-spleen signal ratio (LSR) were estimated, and the contrast enhancement ratio (CER) was calculated from the liver signal, LMR, and LSR.. Without non-uniformity correction, hyperintensity was consistently observed near the liver surface. Both SCIC and PURE improved uniformity in the liver signal; however, the superficial hyperintensity remained after the application of SCIC, especially in the hepatobiliary-phase images, and focal hyperintensity was shown in the lateral segment of the left hepatic lobe after the application of PURE. PURE increased LMR dramatically and LSR mildly, with no changes in CERs. SCIC depressed temporal changes in LMR and LSR and obscured contrast effects, regardless of the method used for calculation of CER.. SCIC improves uniformity in the liver signal; however, it is not suitable for a quantitative assessment of contrast effects. PURE is indicated to be a useful method for non-uniformity correction in Gd-EOB-DTPA-enhanced MR imaging using a 3-T scanner.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

Background Insufficient enhancement of liver parenchyma negatively affects diagnostic accuracy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, there is no reliable method for predicting insufficient enhancement during the hepatobiliary phase (HBP) in Gd-EOB-DTPA-enhanced MRI. Purpose To develop a predictor for insufficient enhancement of liver parenchyma during HBP in Gd-EOB-DTPA-enhanced MRI. Material and Methods In order to formulate a HBP enhancement test (HBP-ET), clinical factors associated with relative enhancement ratio (RER) of liver parenchyma were retrospectively determined from the datasets of 156 patients (Development group) who underwent Gd-EOB-DTPA-enhanced MRI between November 2012 and May 2015. The independent clinical factors were identified by Pearson's correlation and multiple stepwise regression analysis; the performance of HBP-ET was compared to Child-Pugh score (CPS), Model for End-stage Liver Disease score (MELD), and total bilirubin (TBIL) using receiver operating characteristic (ROC) curve analysis. The datasets of 52 patients (Validation group), which were examined between June 2015 and Oct 2015, were applied to validate the HBP-ET. Results Six biochemical parameters independently influenced RER and were used to develop HBP-ET. The mean HBP-ET score of patients with insufficient enhancement was significantly higher than that of patients with sufficient enhancement ( P < 0.001) in both the Development and Validation groups. HBP-ET (area under the curve [AUC] = 0.895) had better performance in predicting insufficient enhancement than CPS (AUC = 0.707), MELD (AUC = 0.798), and TBIL (AUC = 0.729). Conclusion The HBP-ET is more accurate than routine indicators in predicting insufficient enhancement during HBP, which is valuable to aid clinical decisions.

Topics: Adolescent; Adult; Aged; Area Under Curve; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Young Adult

We investigated the added value of the hypointensity on hepatocyte-phase (HP) imaging of gadoxetic acid-enhanced MRI (EOB-MRI) in the 2014 version of the Liver Imaging Reporting and Data System (LI-RADS) for distinguishing hepatocellular carcinoma (HCC) from benign hepatic lesions in patients with chronic liver disease.. We retrospectively evaluated targeted lesions (111 HCCs, 28 benign hepatic lesions) of 139 patients (101 men, 38 women; aged 18 to 89 years, mean age, 68 ± 11 years) with chronic liver disease. EOB-MRI and dynamic contrast-enhanced computed tomography (CECT) were performed within 3 months. Two abdominal radiologists independently reviewed 3 imaging datasets: (1) EOB-MRI without an HP image using the LI-RADS system (MR imaging without HP); (2) EOB-MRI with an HP image using a modified version of the LI-RADS system in which hypointensity on the HP image was used as an additional major criterion of malignancy (MR imaging with HP); and (3) dynamic contrast-enhanced computed tomography (CECT) images using the LI-RADS system. We evaluated intra- and inter-reader agreement with kappa statistics along with 95% confidence intervals and compared diagnostic sensitivity and specificity of the 3 imaging datasets with McNemar's test.. The sensitivities of MR imaging were statistically higher with HP (Reader 1, 95% [107/111]; Reader 2, 95% [106/111]) than without HP (Reader 1, 84% [93/111], P = 0.002; Reader 2, 86% [96/111], P = 0.002). Specificity was comparably high between MR imaging with HP (Reader 1, 96% [27/28]; Reader 2, 96% [27/28]) and dynamic CECT (Reader 1, 100% [28/28], P = 0.317; Reader 2, 100% [28/28], P = 0.317) and MR imaging without HP (Reader 1, 96% [27/28], P = 1.00; Reader 2, 100% [28/28], P = 0.317).. The use of an HP image from EOB-MRI as an additional major criterion improved the sensitivity of LI-RADS to distinguish HCCs from benign hepatic lesions while retaining high specificity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; False Negative Reactions; False Positive Reactions; Female; Follow-Up Studies; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Radiographic Image Enhancement; Radiology Information Systems; Retrospective Studies; Sensitivity and Specificity; Young Adult

To determine whether liver function as determined by indocyanine green (ICG) clearance can be estimated quantitatively from hepatic magnetic resonance (MR) relaxometry with gadoxetic acid (Gd-EOB-DTPA).. One hundred and seven patients underwent an ICG clearance test and Gd-EOB-DTPA-enhanced MRI, including MR relaxometry at 3 Tesla. A transverse 3D VIBE sequence with an inline T1 calculation was acquired prior to and 20 minutes post-Gd-EOB-DTPA administration. The reduction rate of T1 relaxation time (rrT1) between pre- and post-contrast images and the liver volume-assisted index of T1 reduction rate (LVrrT1) were evaluated. The plasma disappearance rate of ICG (ICG-PDR) was correlated with the liver volume (LV), rrT1 and LVrrT1, providing an MRI-based estimated ICG-PDR value (ICG-PDRest).. Simple linear regression model showed a significant correlation of ICG-PDR with LV (r = 0.32; p = 0.001), T1post (r = 0.65; p < 0.001) and rrT1 (r = 0.86; p < 0.001). Assessment of LV and consecutive evaluation of multiple linear regression model revealed a stronger correlation of ICG-PDR with LVrrT1 (r = 0.92; p < 0.001), allowing for the calculation of ICG-PDRest.. Liver function as determined using ICG-PDR can be estimated quantitatively from Gd-EOB-DTPA-enhanced MR relaxometry. Volume-assisted MR relaxometry has a stronger correlation with liver function than does MR relaxometry.. • Measurement of T1 relaxation times in Gd-EOB-DTPA-enhanced MR imaging quantifies liver function. • Volume-assisted Gd-EOB-DTPA-enhanced MR relaxometry has stronger correlation with ICG-PDR than does Gd-EOB-DTPA-enhanced MR relaxometry. • Gd-EOB-DTPA-enhanced MR relaxometry may provide robust parameters for detecting and characterizing liver disease. • Gd-EOB-DTPA-enhanced MR relaxometry may be useful for monitoring liver disease progression. • Gd-EOB-DTPA-enhanced MR relaxometry has the potential to become a novel liver function index.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Regression Analysis

To identify correlations of signal enhancements (SE) and SE normalized to reference tissues of the spleen, kidney, liver, musculus erector spinae (MES) and ductus hepatocholedochus (DHC) on hepatobiliary phase gadoxetate-enhanced MRI with patient age in non-cirrhotic patients.. A heterogeneous cohort of 131 patients with different clinical backgrounds underwent a standardized 3.0-T gadoxetate-enhanced liver MRI between November 2008 and June 2013. After exclusion of cirrhotic patients, a cohort of 75 patients with no diagnosed diffuse liver disease was selected. The ratio of signal intensity 20 min post- to pre-contrast administration (SE) in the spleen, kidney, liver, MES and DHC, and the SE of the kidney, liver and DHC normalized to the reference tissues spleen or MES were compared to patient age.. Patient age was inversely correlated with the liver SE normalized to the spleen and MES SE (both p < 0.001) and proportionally with the SE of the spleen (p = 0.043), the MES (p = 0.030) and the kidney (p = 0.022). No significant correlations were observed for the DHC (p = 0.347) and liver SE (p = 0.606).. The age dependence of hepatic SE normalized to the enhancement in the spleen and MES calls for a cautious interpretation of these quantification methods.. • Patient age was inversely correlated with spleen- and MES-corrected liver rSE (p < 0.001). • Patient age was correlated with spleen (p = 0.043) and MES SE (p = 0.030). • Patient age may confound quantitative liver function assessment using gadoxetate-enhanced liver MRI.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Muscles; Spleen; Young Adult

To determine whether multislice T1 mapping of the liver using a modified look-locker inversion recovery (MOLLI) sequence on gadoxetic acid-enhanced magnetic resonance imaging (MRI) can be used as a quantitative tool to estimate liver function and predict the presence of oesophageal or gastric varices.. Phantoms filled with gadoxetic acid were scanned three times using MOLLI sequence to test repeatability. Patients with chronic liver disease or liver cirrhosis who underwent gadoxetic acid-enhanced liver MRI including MOLLI sequence at 3 T were included (n = 343). Pre- and postcontrast T1 relaxation times of the liver (T1liver), changes between pre- and postcontrast T1liver (ΔT1liver), and adjusted postcontrast T1liver (postcontrast T1liver-T1spleen/T1spleen) were compared among Child-Pugh classes. In 62 patients who underwent endoscopy, all T1 parameters and spleen sizes were correlated with varices.. Phantom study showed excellent repeatability of MOLLI sequence. As Child-Pugh scores increased, pre- and postcontrast T1liver were significantly prolonged (P < 0.001), and ΔT1liver and adjusted postcontrast T1liver decreased (P < 0.001). Adjusted postcontrast T1liver and spleen size were independently associated with varices (R (2) = 0.29, P < 0.001).. T1 mapping of the liver using MOLLI sequence on gadoxetic acid-enhanced MRI demonstrated potential in quantitatively estimating liver function, and adjusted postcontrast T1liver was significantly associated with varices.. • T1 mapping using MOLLI sequence can be achieved within a breath-hold. • T1liver measured by MOLLI sequence provided excellent short-term repeatability. • Precontrast and postcontrast T1liver were significantly prolonged as Child-Pugh scores increased. • Adjusted postcontrast T1liver and spleen size were independently associated with varices.

Topics: Adult; Aged; Breath Holding; Contrast Media; Esophageal and Gastric Varices; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Cirrhosis; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Organ Size; Phantoms, Imaging; Reproducibility of Results; Retrospective Studies; Spleen

To investigate the cause of imaging artifacts observed during gadoxetic acid-enhanced arterial phase imaging of the liver.. This HIPAA-compliant study was approved by the institutional review board. Data were collected prospectively at two sites (site A, United States; site B, Japan) from patients undergoing contrast material-enhanced MR imaging with gadoxetic acid (site A, n = 154, dose = 0.05 mmol/kg; site B, n = 130, 0.025 mmol/kg) or gadobenate dimeglumine (only site A, n = 1666) from January 2014 to September 2014 at site A and from November 2014 to January 2015 at site B. Detailed comparisons between the two agents were made in the patients with dynamic liver acquisitions (n = 372) and age-, sex-, and baseline oxygen saturation (Spo2)-matched pairs (n = 130) at site A. Acquired data included self-reported dyspnea after contrast agent injection, Spo2, and breath-hold fidelity monitored with respiratory bellows.. Self-reported dyspnea was more frequent with gadoxetic acid than with gadobenate dimeglumine (site A, 6.5% [10 of 154] vs 0.1% [two of 1666], P < .001; site B, 1.5% [two of 130]). In the matched-pair comparison, gadoxetic acid, as compared with gadobenate dimeglumine, had higher breath-hold failure rates (site A, 34.6% [45 of 130] vs 11.7% [15 of 130], P < .0001; site B, 16.2% [21 of 130]) and more severe artifacts during arterial phase imaging (site A, 7.7% [10 of 130] vs 0% [none of 130], P < .001; site B, 2.3% [three of 130]). Severe imaging artifacts in patients who received gadoxetic acid were significantly associated with male sex (P = .023), body mass index (P = .021), and breath-hold failure (P < .001) but not with dyspnea or Spo2 decrease.. Severe motion-related artifacts in the arterial phase of gadoxetic acid-enhanced liver MR imaging are associated with breath-hold failure but not with subjective feelings of dyspnea or a substantial decrease in blood Spo2. Subjective feelings of dyspnea are not necessarily associated with imaging artifacts. The phenomenon, albeit at a lower rate, was confirmed at a second site in Japan.

Topics: Adult; Aged; Artifacts; Contrast Media; Dyspnea; Female; Gadolinium DTPA; Humans; Japan; Liver Diseases; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Movement; Organometallic Compounds; Prospective Studies; United States

To prospectively evaluate the efficacy of a new three-dimensional gradient-echo sequence (Turbo LAVA) that uses undersampled k-space acquisition combined with a two-dimensional parallel imaging technique for hepatobiliary MRI.. Sixty patients underwent T1-weighted gadoxetic acid-enhanced hepatobiliary axial MRI during a single breath-hold using both Turbo LAVA (thickness/interval=1.6/0.8mm) and conventional three-dimensional gradient-echo (4/2mm; LAVA) sequences at 3T. Axial 4-mm-thick reformation was performed from Turbo LAVA images. Portal vein-to-liver contrast (PLC), bile duct-to-liver contrast (BLC), and lesion-to-liver contrast (LLC) were compared. Two radiologists independently assessed image quality using a five-point scale. Sagittal 4-mm-thick multiplanar reconstructions (MPR) were performed from both sequences and assessed together with directly obtained 4-mm-thick sagittal LAVA images in terms of sharpness. The paired t-test was used to compare PLC, BLC, and LLC. The Wilcoxon signed rank test was used to compare five-point scales.. The mean PLC (P<0.001), BLC (P<0.001), and LLC (P<0.005) were significantly higher for Turbo LAVA than for LAVA; the scores for image noise and sharpness were inferior (P=0.000 and 0.005) and superior (0.005 and 0.157) for Turbo LAVA. There were no significant differences in the scores for bile duct visualization, artifacts, fat suppression quality, overall quality, and focal lesion conspicuity. For sagittal images, MPR Turbo LAVA showed significantly better sharpness than MPR LAVA but showed significantly worse sharpness compared with directly obtained LAVA.. High-spatial-resolution single-breath-hold hepatobiliary MRI using Turbo LAVA was feasible. Diagnostic-quality MPR images can be obtained using this sequence.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Bile Ducts; Breath Holding; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies

To determine the optimal hepatobiliary delay time after Gd-EOB-DTPA injection for lesion characterization in cirrhosis patients with different liver function.. Ninety consecutive patients with liver cirrhosis who underwent Gd-EOB-DTPA-enhanced MRI for the evaluation of known or suspected focal liver lesions were enrolled in this retrospective study. The patients were divided into Child-Pugh A, B and C groups depending on their liver function through the Child-Pugh classification. Hepatobiliary phase images obtained at 5, 10, 15, and 20min were assessed in each group by the following items: parenchymal enhancement, contrast agent excretion into the bile ducts and ureter, and contrast- and signal-to-noise ratios for lesions.. In the Child-Pugh A group, parenchymal enhancement increased significantly from 5min to 15min (P<0.05), and stabilized at 20min (P=0.22). However, there was no significant difference in parenchymal enhancement among all of the hepatobiliary phases in the Child-Pugh B and C groups. The biliary contrast agent excretion was first observed before 20min in all of the patients in the Child-Pugh A group, at 20min in 4 patients (25%) in the Child-Pugh B group, and after 20min in 11 patients (78.6%) in the Child-Pugh C group. The numbers of patients whose urethral contrast agent excretion was first observed at 5min in the Child-Pugh A, B and C groups were 38 (63.3%), 12 (75.0%) and 11 (78.6%), respectively. The CNR of the lesions increased significantly (P<0.05), up to 15min after enhancement without a further increase at 20min in the Child-Pugh A group; however, no significant change was found from 5min to 20min in the Child-Pugh B and C groups. For the SNR of lesions, there was no significant difference at 5, 10, 15 and 20min in all of the groups.. A delay time of 15min for the hepatobiliary phase was sufficient for patients with mild liver dysfunction who were classified as Child-Pugh A. Nevertheless, for the patients with moderate or severe liver dysfunction who were classified as Child-Pugh B or C, a delay time longer than 5min is meaningless for lesion characterization.

Topics: Bile Ducts; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Cirrhosis; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Signal-To-Noise Ratio; Time Factors

To evaluate the use of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI)-derived fat- and liver function-measurements for prediction of future liver remnant (FLR) growth after portal vein occlusion (PVO) in patients scheduled for major liver resection.. Forty-five patients (age, 59 ± 13.9 y) who underwent Gd-EOB-DTPA-enhanced liver MRI within 24 ± 18 days prior to PVO were included in this study. Fat-Signal-Fraction (FSF), relative liver enhancement (RLE) and corrected liver-to-spleen ratio (corrLSR) of the FLR were calculated from in- and out-of-phase (n=42) as well as from unenhanced T1-weighted, and hepatocyte-phase images (n=35), respectively. Kinetic growth rate (KGR, volume increase/week) of the FLR after PVO was the primary endpoint. Receiver operating characteristics analysis was used to determine cutoff values for prediction of impaired FLR-growth.. FSF (%) showed significant inverse correlation with KGR (r=-0.41, p=0.008), whereas no significant correlation was found with RLE and corrLSR. FSF was significantly higher in patients with impaired FLR-growth than in those with normal growth (%FSF, 8.1 ± 9.3 vs. 3.0 ± 5.9, p=0.02). ROC-analysis revealed a cutoff-FSF of 4.9% for identification of patients with impaired FLR-growth with a specificity of 82% and sensitivity of 47% (AUC 0.71 [95%CI:0.54-0.87]). Patients with impaired FLR-growth according to the FSF-cutoff showed a tendency towards higher postoperative complication rates (posthepatectomy liver failure in 50% vs. 19%).. Liver fat-content, but not liver function derived from Gd-EOB-DTPA-enhanced MRI is a predictor of FLR-growth after PVO. Thus, liver MRI could help in identifying patients at risk for insufficient FLR-growth, who may need re-evaluation of the therapeutic strategy.

Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Contrast Media; Embolization, Therapeutic; Female; Forecasting; Gadolinium DTPA; Hepatectomy; Hepatocytes; Humans; Hypertrophy; Image Enhancement; Ligation; Liver; Liver Diseases; Liver Regeneration; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Postoperative Complications; Retrospective Studies; ROC Curve; Spleen; Young Adult

To assess changes in liver proton density fat fraction (PDFF) and R 2* measurements in the presence of changes in tissue relaxation rates induced by administrating gadoxetic acid, using two different image reconstruction methods at 3T MRI.. Forty-five patients were imaged at 3T with chemical-shift-based MRI sequences before and 20 min after administration of gadoxetic acid. Image reconstructions were performed using hybrid and complex methods to obtain PDFF and R 2* images. A single radiologist measured PDFF and R 2* values on precontrast and postcontrast images. Precontrast and postcontrast PDFF values were compared using intraclass correlation coefficient (ICC), linear regression, and Bland-Altman analysis. Changes in R 2* values from precontrast to postcontrast were correlated with relative liver enhancement (RLE) based on signal intensities on T 1-weighted images using Spearman's rank correlation.. PDFF values were similar between precontrast and postcontrast images (ICC = 0.99, linear regression slopes = 0.98, mean difference = -0.21 to -0.31%). PDFF measurements were stable between precontrast and postcontrast images. Changes in R 2* values were correlated with RLE (p < 0.001, r = 0.49-0.71).. PDFF measurements from both image reconstruction methods are stable in the presence of changes in tissue relaxation rates after administering gadoxetic acid at 3T MRI. Changes in R 2* values correlate with established measures of gadoxetic acid uptake based on T 1-weighted images.

Topics: Adipose Tissue; Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Protons; Reproducibility of Results; Young Adult

Purpose To identify biochemical factors associated with liver enhancement over time on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) images and predict the optimal time point of the hepatobiliary phase in various clinical settings. Materials and Methods This study was approved by the institutional review boards, and written informed consent was obtained from the 1903 patients enrolled. Simple and multiple logistic regression analyses were performed to investigate the biochemical factors associated with liver-to-spleen contrast (LSC) of at least 1.5 in the hepatobiliary phase. Changes in LSC and lesion-to-liver contrast (LLC) of lesions over time (at 5, 10, 15, and 20 minutes) were investigated with a linear mixed-effects model in patients and lesions. For LSC, the optimal cutoff value was determined with receiver operating characteristic analysis of the most significant variable. Differences in LSC and LLC were analyzed in various clinical settings. Results Ultimately, 1870 patients were evaluated, as 33 were excluded according to study criteria. Prothrombin (PT) activity, total bilirubin level (P = .020), and total cholesterol level (P = .005) were significantly associated with LSC of at least 1.5 at 20 minutes, and PT activity was identified as the most significant factor (odds ratio, 1.271; 95% confidence interval: 1.109, 1.455; P = .001). LSC of at least 1.5 at 20 minutes with PT activity of at least 86.9% and less than 86.9% occurred in 555 of 626 patients (88.6%) and 388 of 575 patients (67.5%), respectively. Satisfactory liver enhancement at 20 minutes was significantly more likely to be achieved by patients with hepatitis B virus than by those with hepatitis C virus (P < .001) and by patients with metastasis than by those with hepatocellular carcinoma (P < .001). No significant difference in LLC was observed in patients examined at 1.5 and 3.0 T (P = .133). Conclusion Hepatic enhancement is significantly associated with PT activity, total bilirubin level, and total cholesterol level. PT activity of at least 86.9% could be used to shorten examination times at Gd-EOB-DTPA-enhanced MR imaging.

Topics: Aged; Biomarkers; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Function Tests; Male; Retrospective Studies; Spleen

To clarify the correlation between hepatobiliary phase (HBP) images using gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) and albumin-bilirubin (ALBI) grading system.. We evaluated 220 consecutive patients who underwent liver magnetic resonance imaging with Gd-EOB-DTPA. Quantitative liver-spleen contrast ratio (Q-LSC) was calculated in HBP images approximately 20min after Gd-EOB-DTPA administration. To evaluate the degree of association between Q-LSC and ALBI grade, the Child-Pugh (C-P) score was used for comparison. Correlation coefficients were calculated, and median Q-LSC values were compared with the C-P scores and ALBI grades. The Steel-Dwass multiple comparison test was used for statistical analysis.. The correlation coefficient between Q-LSC and C-P score was -0.35, P<0.0001, and the ALBI grade was -0.61, P<0.0001. Q-LSC of overall median, C-P A, B, and C were 1.94, 1.91, 1.96, and 1.33, respectively. The differences between C-P A and C-P B, C-P B and C-P C, and C-P A and C-P C were P=0.999, 0.126, and 0.149, respectively. Q-LSC of the overall median, ALBI grade 1, 2, and 3 were 1.94, 2.12, 1.69, and 1.30, respectively. The differences between ALBI grades 1 and 2, 2 and 3, and 1 and 3 were P<0.0001, P=0.0466, and P=0.0035, respectively. Q-LSC was better correlated and discriminated by ALBI grade than C-P score.. A strong correlation was observed between Q-LSC of an HBP image with Gd-EOB-DTPA and ALBI grade; HBP imaging could be a surrogate for the ALBI grade.

Topics: Aged; Aged, 80 and over; Bile Ducts; Bilirubin; Contrast Media; Female; Gadolinium DTPA; Hepatitis B; Hepatitis C; Humans; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Serum Albumin; Spleen

To assess the clinical utility of tissue-specific variable refocusing flip-angle (VRFA) turbo-spin echo imaging for three-dimensional T2-weighted imaging (3D-T2WI) of the liver.. Fifty-nine patients were scanned with three types of fat-suppressed T2WI for the comparison: two-dimensional single-shot turbo spin echo T2WI (ssT2WI), 3D-T2WI with tissue-specific VRFA (VISTA-TSV), and 3D-T2WI with low-constant VRFA (VISTA). Qualitatively, artifacts in the left and right lobes of the liver and black-blood effects in the liver were compared using the Wilcoxon signed-rank test with the Bonferroni correction. The detection and correct characterization rates of liver lesions were compared using McNemar's test.. VISTA-TSV showed reduced artifacts in the left and right lobes of the liver compared with VISTA (P < 0.017). The artifacts shown by VISTA-TSV were equivalent to those shown by ssT2WI. The black-blood effects of VISTA-TSV and VISTA were better than that of ssT2WI (P < 0.017). VISTA-TSV showed the best detection and correct characterization rate of liver lesions among the three imaging techniques (P < 0.05).. 3D-T2WI with tissue-specific VRFA can reduce artifacts of the liver, sufficiently suppress the signal in blood vessels, and has a potential to improve the detection and correct characterization rates of liver lesions.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Contrast Media; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed

With the advent of 3-T magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI), many subcentimeter hepatic nodules have been frequently detected in patients with chronic liver disease, and the prediction of subcentimeter nodules that progress to hypervascular hepatocellular carcinoma (HCC) is important.. To reveal the imaging features of subcentimeter hypointense nodules on gadoxetic acid-enhanced hepatobiliary phase MR images in patients with chronic liver disease that may be related with progression to hypervascular HCC.. This study included 109 patients with 135 subcentimeter hypointense nodules (103 hepatocellular carcinomas [HCCs] and 32 benign nodules) on gadoxetic acid-enhanced hepatobiliary phase. For each subcentimeter nodule, the following imaging features were analyzed: (i) hyperintensity on T2-weighted (T2W) image or DWI; (ii) arterial hypervascularization; and (iii) hypointensity on a portal or late phase. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of those imaging features for predicting subcentimeter nodules that progressed to hypervascular HCC were evaluated. Volume doubling time (VDT) of subcentimeter nodules that progressed to hypervascular HCC was compared to that of growing benign nodules.. Arterial hypervascularization with washout yielded the highest specificity (90.6%) and PPV (95.4%) for prediction of subcentimeter nodules that progressed to hypervascular HCC. Combining hyperintensity on T2W image or DWI and arterial hypervascularization with washout did not raise the specificity (90.6%) for prediction of subcentimeter nodules that progressed to hypervascular HCC. Mean VDT (112.2 ± 106.3 days) of subcentimeter nodules that progressed to hypervascular HCC during follow-up was significantly shorter than those of benign subcentimeter nodules (1258 ± 766.5 days, P < 0.001).. Arterial hypervascularization with washout in subcentimeter hypointense nodules on gadoxetic acid-enhanced hepatobiliary phase in patients with chronic liver disease is strongly related with progression to hypervascular HCC.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Risk Factors; Sensitivity and Specificity

The purpose of this work was to investigate the effect of a hepatocyte-specific gadolinium based contrast agent (GBCA) on quantitative hepatic fat-fraction (FF) and R2* measurements. Fifty patients were imaged at 1.5T, using chemical-shift encoded water-fat MRI with low (5°) and high (15°) flip angles (FA), both before and after administration of a hepatocyte-specific GBCA (gadoxetic acid). Low and high FA, pre- and post-contrast FF and R2* values were measured for each subject. Available serum laboratory studies related to liver disease were also recorded. Linear regression and Bland-Altman analysis were performed to compare measurements. Hepatic FF was unaffected by GBCA at low FA (slope=1.02±0.02, p=0.32). FF was overestimated at high FA pre-contrast (slope=1.33±0.03, p<10(-10)), but underestimated post-contrast (slope=0.81±0.02, p<10(-10)). Hepatic R2* was unaffected by FA (mean difference±95% CI pre-contrast:2.2±4.9s(-1), post-contrast:2.8±3.6s(-1)), but increased post-contrast in patients with total bilirubin <2.5mg/dL (ΔR2*=13.4±12.7s(-1)). Regression analysis of serum values demonstrated a correlation of post-contrast change in R2* with total bilirubin (p<0.01) and model for end-stage liver disease (MELD) score (p≈0.01). In conclusion, GBCA has no effect on hepatic FF at low FA due to a lack of T1-weighting, potentially allowing flexibility for FF imaging with hepatobiliary imaging protocols. Hepatic R2* increased significantly after GBCA administration, particularly in the biliary tree. Therefore, R2* maps should be obtained prior to contrast administration.

Topics: Adult; Aged; Aged, 80 and over; Bilirubin; Contrast Media; End Stage Liver Disease; Female; Gadolinium; Gadolinium DTPA; Hepatocytes; Humans; Image Processing, Computer-Assisted; Linear Models; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Ultrasonography; Water; Young Adult

To compare signal intensity (SI) correction using scale and rescale slopes with SI correction using SIs of spleen and muscle for quantifying multiphase hepatic contrast enhancement with Gd-EOB-DTPA by assessing their correlation with T1 values generated from Look-Locker turbo-field-echo (LL-TFE) sequence data (ER-T1).. Thirty patients underwent Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in this prospective clinical study. For each patient, breath-hold T1-weighted fat-suppressed three-dimensional (3D) gradient echo sequences (e-THRIVE) were acquired before and 2 (first phase), 10 (second phase), and 20min (third phase) after intravenous Gd-EOB-DTPA. Look-Locker turbo-field-echo (LL-TFE) sequences were acquired before and 1.5 (first phase), 8 (second phase), and 18min (third phase) postcontrast. The liver parenchyma enhancement ratios (ER) of each phase were calculated using the SI from e-THRIVE sequences (ER-SI) and the T1 values generated from LL-TFE sequence data (ER-T1) respectively. ER-SIs were calculated in three ways: (1) comparing with splenic SI (ER-SI-s), (2) comparing with muscle SI (ER-SI-m), (3) using scale and rescale slopes obtained from DICOM headers (ER-SI-c), to eliminate the effects of receiver gain and scaling. For each of the first, second and third phases, correlation and agreement were assessed between each ER-SI and ER-T1.. In the first phase, all ER-SIs correlated weakly with ER-T1. In the second and third phases, ER-SI-c showed a stronger linear correlation with ER-T1 (r(2)=0.71-0.72, p<0.01) than did ER-SI-s (r(2)=0.37-0.39, p<0.01) or ER-SI-m (r(2)=0.30-0.41, p<0.01).. SI correction using scale and rescale slopes from DICOM data is the most acceptable algorithm for evaluating delayed-phase Gd-EOB-DTPA hepatic enhancement.

Topics: Adult; Aged; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Reference Values; Sensitivity and Specificity; Spleen

This study was undertaken to quantify tissue gadolinium (Gd) deposition in hepatorenally impaired rats exposed to gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) by means of inductively coupled plasma mass spectrometry (ICP-MS) and to compare differences in Gd distribution among major organs as possible triggers for nephrogenic systemic fibrosis.. Five hepatorenally impaired rats (5/6-nephrectomized, with carbon-tetrachloride-induced liver fibrosis) were injected with Gd-EOB-DTPA. Histological assessment was conducted and Gd content of the skin, liver, kidneys, lungs, heart, spleen, diaphragm, and femoral muscle was measured by inductively coupled plasma mass spectrometry (ICP-MS) at 7 days after last injection. In addition, five renally impaired rats were injected with Gd-EOB-DTPA and the degree of tissue Gd deposition was compared with that in the hepatorenally impaired rats.. ICP-MS analysis revealed significantly higher Gd deposition in the kidneys, spleen, and liver (p = 0.009-0.047) in the hepatorenally impaired group (42.6 ± 20.1, 17.2 ± 6.1, 8.4 ± 3.2 μg/g, respectively) than in the renally impaired group (17.2 ± 7.7, 5.4 ± 2.1, 2.8 ± 0.7 μg/g, respectively); no significant difference was found for other organs. In the hepatorenally impaired group, Gd was predominantly deposited in the kidneys, followed by the spleen, liver, lungs, skin, heart, diaphragm, and femoral muscle. Histopathological investigation revealed hepatic fibrosis in the hepatorenally impaired group.. Compared with renally impaired rats, tissue Gd deposition in hepatorenally impaired rats exposed to Gd-EOB-DTPA was significantly increased in the kidneys, spleen, and liver, probably due to the impairment of the dual excretion pathways of the urinary and biliary systems.

Topics: Animals; Carbon Tetrachloride Poisoning; Contrast Media; Gadolinium; Gadolinium DTPA; Kidney Diseases; Liver Cirrhosis; Liver Diseases; Male; Mass Spectrometry; Nephrectomy; Rats; Rats, Wistar

To summarize the safety data of gadoxetate disodium, reported in 12 Phase II and III clinical development studies and in the postmarketing surveillance database.. Patients with liver lesions received gadoxetate disodium-enhanced liver magnetic resonance imaging (MRI). Adverse events (AEs) were recorded and evaluated with regard to a potential drug relationship. Subgroup analyses were run on patients with special medical history. Worldwide spontaneous AEs and adverse drug reactions (ADRs) from postmarketing safety surveillance were analyzed.. A total of 1989 patients were included in the clinical development program. A total of 1581/1989 (79.5%) patients received the finally approved dose of 0.025 mmol/kg body weight. 10.1% of patients reported AEs, 4.1% were classified as related AEs. Nausea and headache were the most frequently reported related AEs, with 1.1% each. Age, history of contrast media allergy, liver cirrhosis, or impaired liver or renal function did not significantly impact the frequency and type of AEs. The postmarketing safety surveillance database encompassed more than 2.2 million patients. Nausea was the most frequent ADR, with a reporting rate of 0.00652%; all other symptoms were below 0.004%.. Gadoxetate disodium for liver MRI has an excellent safety profile.

Topics: Adolescent; Adult; Aged, 80 and over; Body Weight; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Patient Safety; Product Surveillance, Postmarketing; Young Adult

To compare the diagnostic performance of magnetic resonance (MR) imaging features, including those on diffusion-weighted (DW) and T2-weighted images, in differentiating between hypovascular hepatocellular carcinoma (HCC) and dysplastic nodules seen as hypointense nodules at hepatobiliary phase gadoxetic acid-enhanced MR imaging.. The institutional review board approved this retrospective study and waived the need to obtain informed patient consent. There were 53 patients (39 men and 14 women; age range, 32-75 years) with histologically proven hypovascular HCCs (n = 25) and/or dysplastic nodules (n = 31) who underwent gadoxetic acid-enhanced MR imaging at 3.0-T between March 2011 and January 2014. Images of 25 HCCs and 31 dysplastic nodules were analyzed for nodule size; signal intensity on T1- and T2-weighted, portal venous phase, and DW (b value = 800 sec/mm(2)) images; and intralesional fat. Correlations between the hyperintensity grade of lesions and the liver-to-lesion signal intensity ratio at T2-weighted and DW imaging were determined by means of analysis with generalized estimating equations.. Hyperintensity at T2-weighted and DW imaging and hypointensity in the portal venous phase were significant features for differentiating hypovascular HCCs from dysplastic nodules (P < .05). The sensitivity of DW imaging tended to be higher than that of T2-weighted imaging (72.0% [18 of 25] vs 40.0% [10 of 25]; P = .008 for grade 2 and 3 hyperintensity). Use of the parameter of hyperintensity similar to or slightly lower than the signal intensity of the spleen on DW images (b value = 800 sec/mm(2)) yielded a specificity of 100% (31 of 31) for the diagnosis of hypovascular HCC by differentiating it from a dysplastic nodule.. Hyperintensity at DW imaging could be a useful MR imaging feature for differentiating hypovascular HCCs from dysplastic nodules seen as hypointense nodules at gadoxetic acid-enhanced MR imaging.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

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 whether gadoxetate disodium affects peripheral capillary oxygen saturation (SpO2) and/or heart rate (HR) during dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging in patients with liver diseases.. This retrospective study was approved by the institutional review board, who waived the requirement for informed consent. Four hundred fifty-eight patients (171 women [mean age, 66.5 years; range, 23-87 years] and 287 men [mean age, 61.1 years; range, 25-89 years]) who underwent liver DCE MR imaging with gadoxetate disodium (0.025 mmol per kilogram of body weight) from October 28, 2013, to June 24, 2014, were included in this study. They were monitored for SpO2 and HR during DCE MR imaging. Motion artifact severity was graded by using a five-point scale, and transient severe motion (TSM) was defined by a score of at least 4. The association between TSM and baseline predictors was assessed, and HR and SpO2 at each postcontrast phase were compared with those at the precontrast phase in the TSM and non-TSM groups.. Four hundred thirty-six patients were included in the non-TSM group, and 22 were included in the TSM group. Although the motion score was the worst at the arterial phase, the observed mean differences in SpO2 and HR between the precontrast phase and the arterial phase were less than 1% and 5 beats per minute, respectively (mean SpO2 ± standard deviation for the non-TSM group, 96.7% ± 1.8 vs 96.9% ± 1.8 [P = .11]; SpO2 for the TSM group, 96.4% ± 1.6 vs 96.1% ± 1.6 [P > .99]) (HR for the non-TSM group, 68.9 beats per minute ± 12.4 vs 70.9 beats per minute ± 12.1 [P < .0001]; HR for the TSM group, 75.0 beats per minute ± 11.8 vs 79.9 beats per minute ± 10.2 [P < .0001]).. Intravenous gadoxetate disodium (a weight-based dose) does not cause changes in SpO2 and HR that lead to image quality degradation.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Heart Rate; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Oxygen; Retrospective Studies; Young Adult

Our aim was to retrospectively evaluate the occurrence of respiratory motion artefacts in patients undergoing dynamic liver magnetic resonance (MR) either with gadoxetate disodium or gadobutrol.. Two hundred and thirty liver MR studies (115 with gadobutrol, 115 with gadoxetate disodium) were analysed. Respiratory motion artefacts on dynamic 3D T1-weighted MR images (pre-contrast, arterial, venous, and late-dynamic phase) were assessed using a five-point rating scale. Severe motion was defined as a score ≥ 4. Mean motion scores were compared with the Mann-Whitney-U-test. The chi-squared-test was used for dichotomous comparisons.. Mean motion scores for gadoxetate disodium and gadobutrol showed no relevant differences for each phase of the dynamic contrast series (pre-contrast: 1.85 ± 0.70 vs. 1.88 ± 0.57, arterial: 1.85 ± 0.81 vs. 1.87 ± 0.74, venous: 1.82 ± 0.67 vs. 1.74 ± 0.64, late-dynamic: 1.75 ± 0.62 vs. 1.79 ± 0.63; p = 0.469, 0.557, 0.382 and 0.843, respectively). Severe motion artefacts had a similar incidence using gadoxetate disodium and gadobutrol (11/460 [2.4%] vs. 7/460 [1.5%]; p = 0.341).. Gadoxetate disodium is associated with equivalent motion scores compared to gadobutrol in dynamic liver MRI. In addition, both contrast agents demonstrated a comparable and acceptable rate of severe respiratory motion artefacts.. • Gadobutrol and gadoxetate disodium showed comparable motion scores in dynamic phase imaging. • The incidence of severe motion artefacts was pronounced in arterial phase imaging. • Adverse respiratory side effects were not recorded in 115 examinations with gadoxetate disodium.

Topics: Adult; Aged; Aged, 80 and over; Arteries; Artifacts; Contrast Media; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Liver Cirrhosis; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Motion; Organometallic Compounds; Respiration; Retrospective Studies

To establish the effect of prolonged hepatobiliary phase (HBP) delay time on hepatic enhancement in patients with parenchymal liver disease (PLD).. Gadoxetate disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) examinations with HBP were obtained after 20- (HBP-20) and 30-minute (HBP-30) delays in patients with PLD. For each patient, the Model for End-Stage Liver Disease (MELD) score, total and direct bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), prothrombin time (PT), and partial thromboplastin time (PTT) were recorded. Signal intensities of the liver, main portal vein, and spleen on pre-contrast, HBP-20, and HBP-30 were documented. Signal intensities were used to calculate liver relative enhancement (LRE), liver-spleen index (LSI), and liver-portal vein index (LPI) for HBP-20 and HBP-30. Improved hepatic enhancement was considered if two or more indices were higher on HBP-30 than HBP-20. A logistic regression model was constructed with improved hepatic enhancement as the outcome.. One hundred and twenty-nine patients underwent 142 MRIs. Mean LRE, LSI, and LPI each increased from HBP-20 to HBP-30 (p = 0.004, p < 0.001, and p < 0.001, respectively). Seventy-two point five percent of cases demonstrated improved hepatic enhancement. The odds ratios for improved hepatic enhancement were 0.85 for MELD score (p = 0.02) and 3.2 for the 3 T scanner (p = 0.02), adjusted for age and sex.. Increasing HBP delay to 30 minutes improves hepatic enhancement in patients with PLD, particularly if using a 3 T scanner. This effect is attenuated with higher MELD scores.

Topics: Aged; Biomarkers; Contrast Media; Female; Gadolinium DTPA; Hepatobiliary Elimination; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Retrospective Studies; Spleen

The purpose of this article is to identify risk factors for arterial phase respiratory motion artifact in gadoxetate disodium-enhanced liver MRI.. We retrospectively identified 220 consecutive patients who underwent 357 MRI examinations, including 68 patients who underwent multiple MRI examinations, with gadoxetate disodium between 2010 and 2013. The arterial phase timing was determined by a fluoroscopic-triggering method. T1-weighted unenhanced and contrast-enhanced images were reviewed to record respiratory motion artifact, which was graded on a 5-point scale. Arterial phase transient severe motion was considered to be present if the motion score was 4 or greater on the arterial phase images and if the motion scores were 2 or less on unenhanced and other contrast-enhanced images. Patient characteristics and risk factors (e.g., age, sex, weight, body mass index, medical and radiologic history, allergy to MRI and iodinated contrast agents, estimated glomerular filtration rate, Child-Pugh class, and findings on current MRI examinations) were recorded. We included a history of transient severe motion on prior MRI as a predictor variable. We performed univariable and multivariable analysis using the generalized estimated equations to adjust for clustering.. The incidence of transient severe motion was 12.9% (46/357). On univariable analysis, a history of transient severe motion (odds ratio [OR] = 3.31; p = 0.04) on prior MRI and allergy to iodinated contrast agent (OR = 3.03; p = 0.01) statistically significantly increased the incidence of transient severe motion for a given MRI examination. These associations were not seen on multivariable analysis (adjusted OR = 2.38 and p = 0.23 for a history of transient severe motion; adjusted OR = 1.93 and p = 0.23 for allergy to CT contrast agent).. The occurrence of transient severe motion during arterial phase MRI with gadoxetate disodium is 12.9% and is poorly predicted on the basis of risk factors.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Radiography; Reproducibility of Results; Respiratory Mechanics; Respiratory-Gated Imaging Techniques; Risk Factors; Sensitivity and Specificity

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia (RLH) of the liver. She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however, histopathological analysis revealed RLH. The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging, which could be a useful clue for identifying RLH in the liver. Histologically, the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Diagnostic Errors; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Multimodal Imaging; Predictive Value of Tests; Pseudolymphoma; Tomography, X-Ray Computed

Topics: Adenoma, Bile Duct; Adult; Aged; Angiomyolipoma; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Pseudolymphoma; Tomography, X-Ray Computed

Sarcoidosis is a systemic disease characterized by the formation of non-caseating granulomas in multiple organs. In the diagnosis of sarcoidosis, imaging modalities such as ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) are useful;however, there are few reports of MRI imaging using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB) MRI. A 46-year-old Japanese female with suspected pulmonary sarcoidosis was admitted to our hospital because low-density mottles in the liver were observed incidentally by chest CT. The low-density mottles were not enhanced at the arterial phase or portal phase by abdominal CT and MRI, and decreased uptake was observed in the hepatobiliary phase of Gd-EOB MRI. No hematological disorder was observed except for a slight increase of biliary enzymes. The lesion was diagnosed as liver sarcoidosis by the liver biopsy. Since the patient refused steroid therapy, we prescribed ursodeoxycholic acid (UDCA). 600mg/day. The serum levels of biliary enzymes were normalized and the abdominal CT findings gradually improved after the initiation of UDCA medication. Gd-EOB MRI showed unique hypointense areas in the liver at the hepatobiliary phase, which might be useful in the diagnosis of liver sarcoidosis.

Topics: Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Middle Aged; Sarcoidosis; Tomography, X-Ray Computed; Ursodeoxycholic Acid

To evaluate effect of liver function on biliary system visualization using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (CE-MRC).. In all, 39 patients were divided into three groups according to their Child-Pugh classification: group A, Child-Pugh class A (23); group B, class B (11); and group C, class C (5). They underwent Gd-EOB-DTPA CE-MRC. Biliary system visualization was qualitatively rated on a 5-point scale. Relative signal intensity (RSI) of common bile duct (CBD) and liver was quantitatively measured. Laboratory findings and the Model of Endstage Liver Disease (MELD) score were recorded.. Visualization ratings of CBD, left hepatic duct, right hepatic duct, segmental branches of intrahepatic ducts, cystic duct, and gallbladder of group A were: 3.61 ± 0.58, 2.87 ± 0.97, 2.96 ± 0.77, 1.17 ± 0.58, 3.04 ± 0.83, 3.00 ± 0.95, respectively; group B: 2.00 ± 0.61, 1.09 ± 0.64, 0.91 ± 0.54, 0.27 ± 0.13, 1.36 ± 0.62, 1.45 ± 0.54, respectively; group C: 1.40 ± 0.73, 1.00 ± 0.51, 1.00 ± 0.51, 0.00 ± 0.00, 0.60 ± 0.39, 0.60 ± 0.39, respectively. RSI of CBD of groups A to C were 17.12 ± 0.41, 3.95 ± 0.63, 3.33 ± 0.30, respectively. RSI of liver of groups A to C were 6.73 ± 0.72, 2.53 ± 1.02, 2.05 ± 0.11, respectively. CE-MRC images of group A were significantly better than those of group B and C in terms of both visualization ratings and RSI of CBD. CBD RSI positively correlated with liver RSI (r = 0.99, P < 0.001). The total serum bilirubin level and MELD score were significant predictors of RSI of CBD.. Different liver function according to Child-Pugh classification significantly affects biliary system visualization of Gd-EOB-DTPA CE-MRC.

Topics: Adult; Aged; Biliary Tract; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Liver Diseases; Liver Function Tests; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

Diffusion-weighted (DW) imaging is commonly used to distinguish between benign and malignant liver lesions.. To prospectively evaluate the true molecular-diffusion coefficient (D), perfusion-related diffusion coefficient (D*), perfusion fraction (f), and ADC of focal hepatic lesions using a free-breathing intravoxel incoherent motion (IVIM) DW sequence, and to determine if these parameters are useful for characterizing focal hepatic lesions.. One hundred and twenty hepatic lesions (34 metastases, 32 hepatocellular carcinoma [HCC], 33 hemangiomas, and 21 liver cysts) in 74 patients were examined. Mean D, D*, f, and ADC values of hepatic lesions were compared among pathologies. ROC curve analyses were performed to assess the performances of D, D*, f, and ADC values for the characterization of liver lesions as benign or malignant.. The mean D and ADC values of benign lesions were greater than those of malignant lesions (P < 0.001). Although the mean D and ADC values of liver cysts were greater than those of hemangiomas (P < 0.001), and these values were not significantly different between metastases and HCCs (P = 0.99). Area under the ROC curve for ADC values (0.98) was significantly greater (P = 0.048) than that for D values (0.96) for the differentiation of benign and malignant lesions. Sensitivity and specificity for the detection of malignant lesion were 89% and 98%, respectively, when an ADC cut-off value of 1.40 was applied.. D and ADC values have more potential for characterizing focal hepatic lesions than D* or f values, and for the differentiation of malignancy and benignity.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Cysts; Diagnosis, Differential; Female; Gadolinium DTPA; Hemangioma; Humans; Image Enhancement; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Respiration; ROC Curve; Sensitivity and Specificity

The purpose of this article is to evaluate the added value of diffusion-weighted imaging (DWI) to the diagnostic performance of conventional MRI in diagnosing viable hepatocellular carcinoma (HCC) tumors treated with radiotherapy in patients with chronic liver disease.. Twenty-nine patients with viable tumor and 35 patients without viable tumor were enrolled. We assessed the signal intensity of viable tumor compared with irradiated liver on MRI and DWI. Signal intensity ratios and apparent diffusion coefficient (ADC) ratios of viable tumor to nonirradiated liver were also assessed on DWI with ADC maps. Two observers reviewed conventional MRI and combined MRI and DWI and rated them using a 5-point scale. Diagnostic performance was evaluated using a receiver operating characteristic (ROC) curve.. Viable tumors showed hyperintensity on T2-weighted and arterial phase images (16/29 [55.2%]) and hypointensity on portal (22/29 [75.9%]), 3-minute late (19/29 [65.5%]), and hepatobiliary phase (23/29 [79.3%]) images. Twenty-seven (93.1%) viable tumors showed hyperintensity on DWI and hypointensity on ADC maps. Mean signal intensity ratios and ADC ratios of viable tumor on DWI with ADC maps were significantly higher and lower than those of irradiated liver. Diagnostic performance (area under the ROC curve) improved significantly after adding DWI, and interobserver agreement was moderate for conventional MRI (κ = 0.450) and good after adding DWI (κ = 0.748).. Adding DWI to conventional MRI can improve the detection of viable HCC tumors treated with radiotherapy compared to conventional MRI alone.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Retrospective Studies

To determine whether the use of a multiple arterial phase imaging technique provides adequate image quality in patients experiencing transient severe motion (TSM) in the arterial phase on abdominal magnetic resonance (MR) images obtained with gadoxetate disodium.. This retrospective study was approved by the institutional review board and was compliant with HIPAA. The requirement to obtain informed consent was waived. Five hundred forty-nine consecutive MR examinations were evaluated, 345 performed with gadoxetate disodium and 204 performed with gadobenate dimeglumine. All examinations included single-breath-hold triple arterial phase acquisition. Five radiologists blinded to the contrast material rated motion on a scale of 1 (no motion) to 5 (nondiagnostic images) for the precontrast phase, the three arterial phases, the portal venous phase, and the late dynamic phase. Adequacy of late hepatic arterial timing was also rated for the each of the three arterial phases. Mean motion scores were compared by using the Wilcoxon signed rank test. The number of patients with TSM, as well as the number of those with "adequate" arterial phases, was compared with the χ(2) or Fisher exact test, as appropriate.. Mean motion scores in all three arterial phases in the gadoxetate disodium cohort were significantly worse than those in the gadobenate dimeglumine cohort (P < .005). TSM occurred at a higher rate with gadoxetate disodium than with gadobenate dimeglumine (10.7% [37 of 345 examinations] vs 0.5% [one of 204 examinations], P < .001). However, 30 of 37 examinations affected by TSM had at least one well-timed arterial phase with a mean motion score of 3 or less and were thus considered adequate.. Use of single-breath-hold multiple arterial phase acquisition in abdominal MR imaging with gadoxetate disodium recovers most arterial phases that would otherwise have been compromised by transient motion.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Artifacts; Contrast Media; Female; Gadolinium DTPA; Hepatic Artery; Humans; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Respiration; Retrospective Studies; Risk Factors

The aim of this study was to evaluate utility of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) for the detection of biliary complications after living donor liver transplantation (LDLT). A total of 18 patients with suspected biliary complications underwent MRC. T2-weighted MRC and contrast-enhanced MRC (CE-MRC) were used to identify the biliary complications. MRC included routine breath-hold T2-weighted MRC using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences and Gd-EOB-DTPA-enhanced MRC T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences. Before confirming the biliary complications, one observer reviewed the MRC images and the CE-MRC images separately. The verification procedures and MRC findings were compared, and the sensitivity, specificity, and accuracy of both techniques were calculated for the identification of biliary complications. The observer found six of seven biliary complications using CE-MRC. The sensitivity was 85.7% and the accuracy was 94.4%. Using MRC alone, sensitivity was 57.1% and accuracy was 55.5%. The accuracy of Gd-EOB-DTPA-enhanced MRC was superior to MRC in locating biliary leaks (p < 0.05). The usage of Gd-EOB-DTPA-enhanced MRC yields information that complements the MRC findings that improve the identification of biliary complications. We recommend the use of MRC in addition to Gd-EOB-DTPA-enhanced MRC to increase the preoperative accuracy when assessing the biliary complications after LDLT.

Topics: Adult; Biliary Tract Diseases; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Liver Transplantation; Living Donors; Male; Middle Aged; Prognosis; Prospective Studies; Risk Factors

The purpose of this study was to evaluate the usefulness of Gd-EOB-DTPA-enhanced 3-T MRI to determine the hepatic functional reserve expressed by the model for end-stage liver disease (MELD) score.. A total of 121 patients with normal liver function (NLF; MELD score ≤ 10) and 29 patients with impaired liver function (ILF; MELD score > 10) underwent contrast-enhanced MRI with a hepatocyte-specific contrast agent at 3T. T1-weighted volume interpolated breath-hold examination (VIBE) sequences with fat suppression were acquired before and 20 min after contrast injection. Relative enhancement (RE) between plain signal intensity and contrast-enhanced signal intensity was calculated and was used to determine Gd-EOB-DTPA uptake into the liver parenchyma for patients with different MELD scores.. RE differed significantly (p ≤ 0.001) between patients with NLF (87.2 ± 29.5 %) and patients with ILF (45.4 ± 26.5 %). The optimal cut-off value for RE to differentiate NLF from ILF was 47.7 % (AUC 0.87). This cut-off value showed a sensitivity of 82.8 % and a specificity of 92.7 % for the differentiation of the analysed groups.. Gd-EOB-DTPA uptake in hepatocytes is strongly affected by liver function. Gd-EOB-DTPA-enhanced MRI and assessment of RE during the hepatobiliary phase (HBP) may serve as a useful image-based test in liver imaging for determining regional and global liver function.. Hepatic uptake of Gd-EOB-DTPA is strongly affected by liver function. Relative enhancement during HBP in GD-EOB-DTPA MRI correlates with the MELD score. Assessment of relative enhancement may help improve treatment in routine clinical practice.

Topics: Adult; Aged; Contrast Media; End Stage Liver Disease; Evaluation Studies as Topic; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Severity of Illness Index

To compare frequency and severity of arterial phase respiratory motion-related artifact following gadoxetate disodium and gadobenate dimeglumine in matched patients administered both contrast media at different times.. Institutional review board approval was obtained, with patient consent waived, for this retrospective, HIPAA-compliant study. Ninety patients underwent gadobenate dimeglumine-enhanced abdominal magnetic resonance (MR) followed by gadoxetate disodium-enhanced abdominal MR and were matched to 90 patients who were administered the same contrast media in reverse order (180 patients). Matching was based on length of time between paired examinations. Gadobenate dimeglumine dose was weight based (0.1 mmol per kilogram body weight). Gadoxetate disodium dose was typically fixed (10 or 20 mL [off label]). Three readers blinded to contrast agent assigned a respiratory motion-related artifact score (1 [none] to 5 [nondiagnostic]) for nonenhanced, arterial, venous, and late dynamic phases. Frequency of greater new arterial phase respiratory motion-related artifact in each within-patient pair and aggregate rate of new severe transient arterial phase respiratory motion-related artifact (scores ≤ 2, nonenhanced and venous and/or late dynamic phases; ≥ 4, arterial phase) were compared (McNemar test).. For groups 1 and 2, respectively, mean dose (gadoxetate disodium, 16.6 mL vs 16.6 mL, P = .99; gadobenate dimeglumine, 18.0 mL vs 17.8 mL, P = .77) and mean time between examinations (191 days vs 191 days, P = .99) were not significantly different between matched populations. Gadoxetate disodium was associated with significantly higher incidence of new arterial phase respiratory motion-related artifact compared with gadobenate dimeglumine (39% vs 10%, P < .0001) and of new severe transient arterial phase respiratory motion-related artifact (18% vs 2%, P < .0001) in patients administered both agents at different times.. Fixed off-label dose (10 or 20 mL) of gadoxetate disodium is associated with arterial phase respiratory motion-related artifact that is sometimes severe and occurs significantly more often than after gadobenate dimeglumine in patients who received both contrast media.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Movement; Respiration; Retrospective Studies; Risk Factors

To compare radial volumetric imaging breath-hold examination with k-space weighted image contrast reconstruction (r-VIBE-KWIC) to Cartesian VIBE (c-VIBE) in arterial phase dynamic gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (DCE-MRI) of the liver.. We reviewed 53 consecutive DCE-MRI studies performed on a 3-T unit using c-VIBE and 53 consecutive cases performed using r-VIBE-KWIC with full-frame image subset (r-VIBEfull) and sub-frame image subsets (r-VIBEsub; temporal resolution, 2.5-3 s). All arterial phase images were scored by two readers on: (1) contrast-enhancement ratio (CER) in the abdominal aorta; (2) scan timing; (3) artefacts; (4) visualisation of the common, right, and left hepatic arteries.. Mean abdominal aortic CERs for c-VIBE, r-VIBEfull, and r-VIBEsub were 3.2, 4.3 and 6.5, respectively. There were significant differences between each group (P < 0.0001). The mean score for c-VIBE was significantly lower than that for r-VIBEfull and r-VIBEsub in all factors except for visualisation of the common hepatic artery (P < 0.05). The mean score of all factors except for scan timing for r-VIBEsub was not significantly different from that for r-VIBEfull.. Radial VIBE-KWIC provides higher image quality than c-VIBE, and r-VIBEsub features high temporal resolution without image degradation in arterial phase DCE-MRI.. Radial VIBE-KWIC minimised artefact and produced high-quality and high-temporal-resolution images. Maximum abdominal aortic enhancement was observed on sub-frame images of r-VIBE-KWIC. Using r-VIBE-KWIC, optimal arterial phase images were obtained in over 90 %. Using r-VIBE-KWIC, visualisation of the hepatic arteries was improved. A two-reader study revealed r-VIBE-KWIC's advantages over Cartesian VIBE.

Topics: Adult; Aged; Aged, 80 and over; Aorta, Abdominal; Artifacts; Breath Holding; Contrast Media; Databases, Factual; Female; Gadolinium DTPA; Hepatic Artery; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Image Processing, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms; Retrospective Studies

Diffuse liver disease (DLD), such as non-alcoholic fatty liver disease (NASH) and cirrhosis, is a rapidly growing problem throughout the Westernized world. Magnetic resonance imaging (MRI), based on uptake of the hepatocyte-specific contrast agent (CA) Gd-EOB-DTPA, is a promising non-invasive approach for diagnosing DLD. However, to fully utilize the potential of such dynamic measurements for clinical or research purposes, more advanced methods for data analysis are required.. A mathematical model that can be used for such data-analysis was developed. Data was obtained from healthy human subjects using a clinical protocol with high spatial resolution. The model is based on ordinary differential equations and goes beyond local diffusion modeling, taking into account the complete system accessible to the CA.. The presented model can describe the data accurately, which was confirmed using chi-square statistics. Furthermore, the model is minimal and identifiable, meaning that all parameters were determined with small degree of uncertainty. The model was also validated using independent data.. We have developed a novel approach for determining previously undescribed physiological hepatic parameters in humans, associated with CA transport across the liver. The method has a potential for assessing regional liver function in clinical examinations of patients that are suffering of DLD and compromised hepatic function.

Topics: Algorithms; Contrast Media; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Models, Theoretical; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

The purpose of this study was to elucidate the incidence and risk factors for the progression of hyperintense nodules, observed in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), to hypervascular hepatocellular carcinoma (HCC).. Hypovascular nodules (n = 157) showing hyperintensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 41 patients. All patients underwent computed tomography (CT) during hepatic arteriography and CT during arterial portography within one month of Gd-EOB-DTPA-enhanced MRI. The incidence of progression to hypervascular or classical HCC was calculated using the Kaplan-Meier method.. Tumor size was determined by univariate and multivariate analysis to be an important risk factor of hypervascularization (p = 0.041, odds ratio 1.135). The cumulative incidences of hypervascularization in hypovascular nodules showing hyperintensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were 2.4, 4.5, and 6.2 % at 12, 24, and 36 months, respectively. The incidence of hypervascularization was significantly increased in nodules >10 mm in diameter (p = 0.00035).. In patients with chronic liver disease, hypovascular nodules presenting as hyperintense in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI and >10 mm in diameter have malignant potential for progression to hypervascular HCC and require careful management.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Comorbidity; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Image Enhancement; Incidence; Kaplan-Meier Estimate; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed

The objective was to investigate the dynamic enhancement patterns in focal solid liver lesions after the administration of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) by means of dynamic magnetic resonance imaging (MRI) including hepatobiliary phase (HP) images 20 min after Gd-EOB-DTPA administration.. Non-enhanced T1/T2-weighted as well as dynamic magnetic resonance (MR) images during the arterial phase (AP), the portal venous phase (PVP), the late phase (LP), and the HP (20 min) were obtained from 83 patients (54 male, 29 female, mean age 62.01 years) with focal solid liver lesions. MRI was conducted by means of a 1.5-T system for 63 patients with malignant liver lesions (HCCs: n = 34, metastases: n = 29) and for 20 patients with benign liver lesions (FNH lesions: n = 14, hemangiomas: n = 3, adenomas: n = 3). For quantitative analysis, signal-to-noise ratios (SNR), contrast enhancement ratios (CER), lesion-to-liver contrast ratios (LLC), and signal intensity (SI) ratios were measured.. The SNR of liver parenchyma significantly increased in each dynamic phase after Gd-EOB-DTPA administration compared to the SNR of non-enhanced images (p<0.001). The CER of HCCs and metastases significantly decreased between LP and HP images (p = 0.0011, p<0.0001). However, FNH lesions did not show any significant difference, whereas an increased CER was found in hemangiomas. The mean LLCs of FNH lesions were significantly higher than those of HCCs and metastases. The LLC values of hemangiomas remained negative during the entire time course, whereas the LLC of adenomas indicated hyperintensity from the AP to the LP. Furthermore, adenomas showed hypointensity in HP images.. Gd-EOB-DTPA-enhanced MRI may help diagnose focal solid liver lesions by evaluating their enhancement patterns.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Signal-To-Noise Ratio

Gd-EOB-DTPA is a hepatocyte-specific MRI contrast agent. Due to its hepatocyte-specific uptake and paramagnetic properties, functioning areas of the liver exhibit shortening of the T1 relaxation time. We report the potential use of T1 relaxometry of the liver with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for estimating the liver function as expressed by the MELD score. 3 T MRI relaxometry was performed before and 20 min after Gd-EOB-DTPA administration. A strong correlation between changes in the T1 relaxometry and the extent of liver disease, expressed by the MELD score, was documented. Reduced liver function correlates with decreased Gd-EOB-DTPA accumulation in the hepatocytes during the hepatobiliary phase. MRI-based T1 relaxometry with Gd-EOB-DTPA may be a useful method for assessing overall and segmental liver function.

Topics: Computer Simulation; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Models, Biological; Reproducibility of Results; Sensitivity and Specificity

To evaluate hepatobiliary magnetic resonance imaging (MRI) using Gd-EOB-DTPA in relation to various liver function tests in patients with liver disorders.. Fifty-one patients with liver disease underwent Gd-EOB-DTPA-enhanced liver MRI. Based on region-of-interest (ROI) analysis, liver signal intensity was calculated using the spleen as reference tissue. Liver-spleen contrast ratio (LSCR) and relative liver enhancement (RLE) were calculated. Serum levels of total bilirubin, gamma glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glutamate dehydrogenase (GLDH), lactate dehydrogenase (LDH), serum albumin level (AL), prothrombin time (PT), creatinine (CR) as well as international normalised ratio (INR) and model for end-stage liver disease (MELD) score were tested for correlation with LSCR and RLE.. Pre-contrast LSCR values correlated with total bilirubin (r = -0.39; p = 0.005), GGT (r = -0.37; p = 0.009), AST (r = -0.38; p = 0.013), ALT (r = -0.29; p = 0.046), PT (r = 0.52; p < 0.001), GLDH (r = -0.55; p = 0.044), INR (r = -0.42; p = 0.003), and MELD Score (r = -0.53; p < 0.001). After administration of Gd-EOB-DTPA bilirubin (r = -0.45; p = 0.001), GGT (r = -0.40; p = 0.004), PT (r = 0.54; p < 0.001), AST (r = -0.46; p = 0.002), ALT (r = -0.31; p = 0.030), INR (r = -0.45; p = 0.001) and MELD Score (r = -0.56; p < 0.001) significantly correlated with LSCR. RLE correlated with bilirubin (r = -0.40; p = 0.004), AST (r = -0.38; p = 0.013), PT (r = 0.42; p = 0.003), GGT (r = -0.33; p = 0.020), INR (r = -0.36; p = 0.011) and MELD Score (r = -0.43; p = 0.003).. Liver-spleen contrast ratio and relative liver enhancement using Gd-EOB-DTPA correlate with a number of routinely used biochemical liver function tests, suggesting that hepatobiliary MRI may serve as a valuable biomarker for liver function. The strongest correlation with liver enhancement was found for the MELD Score.. • Relative enhancement (RLE) of Gd-EOB-DTPA is related to biochemical liver function tests. • Correlation of RLE with bilirubin, ALT, AST, GGT, INR and MELD Score is reverse. • The correlation of relative liver enhancement with prothrombin time is positive. • AST, ALT, GLDH, prothrombin time, INR and MELD Score correlate with pre-contrast liver-spleen contrast ratio. • Such biomarkers may help to evaluate liver function.

Topics: Adult; Aged; Aged, 80 and over; Alanine Transaminase; Bilirubin; Biomarkers; Contrast Media; Female; Gadolinium DTPA; gamma-Glutamyltransferase; Glutamate Dehydrogenase; Humans; L-Lactate Dehydrogenase; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Serum Albumin

There are pros and cons to the use of gadoxetic acid in hepatocellular carcinoma (HCC) workup due to the potential for high false positive diagnosis. This study was conducted to investigate the preoperative diagnostic performance of gadoxetic acid-enhanced MRI protocol including diffusion-weighted imaging (DWI) with emphasis on tumor characterization developed in high risk HCC patients.. We included 144 patients (102 men, 42 women; age range 33-74 years) with chronic viral hepatitis or cirrhosis and 183 focal hepatic tumors (size range, 0.4-11.0 cm; mean, 3.2 cm), including 148 HCCs, 13 cholangiocarcinomas, 12 hemangiomas, three hepatocellular adenomas, two focal nodular hyperplasias, and five other tumors. All patients underwent gadoxetic acid-enhanced MRI protocol with DWI. MRIs were independently interpreted by three observers for the detection and characterization of hepatic tumors.. Sensitivities for detecting all 183 liver tumors were 98.4%, 97.8%, and 96.2% for each observer, respectively, with a 97.5% for pooled data. Among 183 hepatic tumors, 91.3% (n=167), 87.4% (n=160), and 86.9% (n=159) were correctly characterized according to their reference standard by each observer, respectively. In 13 cholangiocarcinomas, one to three were misinterpreted as HCC, and the remaining tumors were correctly characterized by each observer. The accuracies (Az) of MRI for HCC diagnosis were 0.952 for observer 1, 0.906 for observer 2, and 0.910 for observer 3, with 0.922 for pooled data. There was good inter-observer agreement.. The gadoxetic acid-enhanced MRI including DWI showed a reasonable performance for tumor characterization with high sensitivity for tumor detection in patients with chronic liver disease, despite concerns of high false positive diagnosis of hypervascular tumors.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; False Positive Reactions; Female; Fibrosis; Gadolinium DTPA; Hepatitis; Hepatocytes; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Observer Variation; Retrospective Studies

To determine whether a controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique can improve the image quality of three-dimensional (3D), T1-weighted gradient echo (T1w-GRE) imaging compared with the use of a standard, parallel acquisition technique (PAT).. Sixty-four patients who underwent liver MR on a 3 Tesla (T) scanner, were included in this study. Twenty minutes after the injection of 0.025 mmole/kg of gadoxetic acid, 3D T1w-GRE imaging (volumetric interpolated breathhold examination [VIBE]) was acquired twice using a generalized autocalibrating partially parallel acquisition (384 × 250 matrix, acceleration factor [AF] of 2) and a CAIPIRINHA (384 × 380 matrix, AF of 4), respectively. Qualitative image analysis was performed for two image sets.. CAIPIRINHA-VIBE showed better hepatic vessel clarity and lesion conspicuity than standard VIBE (P < 0.05). CAIPIRINHA-VIBE in the coronal plane also provided better results of motion artifact and liver edge sharpness than the standard VIBE (P < 0.05). Despite the more apparent PAT artifact on CAIPIRINHA-VIBE than on standard VIBE (P < 0.05), CAIPIRINHA-VIBE showed better overall image quality.. The CAIPIRINHA-VIBE was able to provide a higher spatial resolution, T1-weighted imaging with better image quality compared with a standard VIBE.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Artifacts; Breath Holding; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Young Adult

The purpose of our study was to evaluate the process and frequency of newly developed hypervascular hepatocellular carcinoma (HCC) in serial gadoxetic acid-enhanced MRI examinations in patients with chronic liver disease during clinical follow-up periods.. After review of 341 MRI examinations in 100 patients with chronic liver diseases who underwent gadoxetic acid-enhanced MRI at least twice during the observation period, 32 newly developed hypervascular HCCs in 14 patients were retrospectively evaluated. Serial MRI examinations before detecting hypervascular HCC were evaluated to determine whether hypervascular HCC showed the presence of a hypointense nodule on the hepatobiliary phase and hypovascularity (high-risk nodule) before hyper-vascularization. The size of newly developed hypervascular HCCs and the duration of hyper-vascularization from initial detection of a high-risk nodule were compared between HCCs with and without the presence of a high-risk nodule.. Eleven (34.4%) of 32 newly developed hypervascular HCCs had the presence of high-risk nodule before hypervascularization. The size of newly developed hypervascular HCCs was significantly smaller in HCC with high-risk nodule presence (mean, 9.5 mm) than in HCC without the presence of high-risk nodule (mean, 16.4 mm) (p = 0.004). In hypervascular HCCs with high-risk nodule presence, the mean duration of hypervascularization from initial high-risk nodule was 330.7 days, with mean size change from 5.4 mm of high-risk nodules to 9.5 mm of hypervascular HCCs.. Approximately one third of newly developed hypervascular HCCs had the presence of high-risk nodule before hypervascularization in the serial gadoxetic acid-enhanced MRI examinations. High-risk nodule tended to develop into hypervascular HCC after having almost doubled in size during 1 year of high-risk nodule presence.

Topics: Aged; Aged, 80 and over; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Precancerous Conditions; Retrospective Studies; Risk Factors

Evaluate the image quality and diagnostic performance of a free-breathing 3D-gradient-echo sequence with radial acquisition (rGRE) compared with a Cartesian breath-hold 3D-GRE (cGRE) sequence on hepatobiliary phase MRI in patients with breath-holding difficulties.. Twenty-eight consecutive patients (15 males; mean age 61 ± 11.9 years) were analysed in this retrospective IRB-approved study. Breath-holding difficulties during gadoxetate-disodium-enhanced liver MRI manifested as breathing artefacts during dynamic-phase imaging. MRI included axial and coronal cGRE and a radially sampled rGRE sequence during the hepatobiliary phase. Two radiologists independently evaluated cGRE and rGRE images for image quality, liver lesion detection and conspicuity, and bile duct conspicuity on a four-point scale.. Liver edge sharpness was significantly higher on rGRE images (P < 0.001). Overall image quality was slightly but significantly higher for rGRE than for cGRE (P < 0.001 and P = 0.039). Bile duct conspicuity scores of rGRE and cGRE were not significantly different. Sensitivity for detection of the 26 liver lesions was similar for rGRE and cGRE (81-77 % and 73-77 %, P = 0.5 and 1.0). Lesion conspicuity scores were significantly higher for rGRE for one reader (P = 0.012).. In patients with breath-holding difficulties, overall image quality and liver lesion conspicuity on hepatobiliary phase MRI can be improved using the rGRE sequence.. • Patients with diminished breath-holding capacities present a major challenge in abdominal MRI. • A free-breathing sequence for hepatobiliary-phase MRI can improve image quality. • Further advances are needed to reduce acquisition time of the free-breathing gradient-echo sequence.

Topics: Adult; Aged; Aged, 80 and over; Artifacts; Biliary Tract Diseases; Breath Holding; Contrast Media; Echo-Planar Imaging; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Liver Diseases; Male; Middle Aged; Reproducibility of Results; Retrospective Studies

As a result of recent developments in imaging modalities and wide spread routine medical checkups and screening, more incidental liver lesions are found frequently on US these days. When incidental liver lesions are found on US, physicians have to make a decision whether to just follow up or to undergo additional imaging studies for lesion characterization. In order to choose the next appropriate imaging modality, the diagnostic accuracy of each imaging study needs to be considered. Therefore, we tried to compare the accuracy of contrast-enhanced multidetector CT (MDCT) and Gd-EOB-DTPA-enhanced MRI for characterization of incidental liver masses. We included 127 incidentally found focal liver lesions (94 benign and 33 malignant) from 80 patients (M∶F = 45∶35) without primary extrahepatic malignancy or chronic liver disease. Two radiologists independently reviewed Gd-EOB-DTPA-enhanced MRI and MDCT. The proportion of confident interpretations for differentiation of benign and malignant lesions and for the specific diagnosis of diseases were compared. The proportion of confident interpretations for the differentiation of benign and malignant lesions was significantly higher with EOB-MRI(94.5%-97.6%) than with MDCT (74.0%-92.9%). In terms of specific diagnosis, sensitivity and accuracy were significantly higher with EOB-MRI than with MDCT for the diagnosis of focal nodular hyperplasia (FNH) and focal eosinophilic infiltration. The diagnoses of the remaining diseases were comparable between EOB-MRI and MDCT. Hence, our results suggested that Gd-EOB-MRI may provide a higher proportion of confident interpretations than MDCT, especially for the diagnosis of incidentally found FNH and focal eosinophilic infiltration.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To determine the feasibility of evaluating surgically induced hepatocyte damage using gadoxetate disodium (Gd-EOB-DTPA) as a marker for viable hepatocytes at magnetic resonance imaging (MRI) after liver resection.. Fifteen patients were prospectively enrolled in this institutional review board-approved study prior to elective liver resection after informed consent. Three Tesla MRI was performed 3-7 days after surgery. Three-dimensional (3D) T1-weighted (W) volumetric interpolated breath-hold gradient echo (VIBE) sequences covering the liver were acquired before and 20 min after Gd-EOB-DTPA administration. The signal-to-noise ratio (SNR) was used to compare the uptake of Gd-EOB-DTPA in healthy liver tissue and in liver tissue adjacent to the resection border applying paired Student's t-test. Correlations with potential influencing factors (blood loss, duration of intervention, age, pre-existing liver diseases, postoperative change of resection surface) were calculated using Pearson's correlation coefficient.. Before Gd-EOB-DTPA administration the SNR did not differ significantly (p = 0.052) between healthy liver tissue adjacent to untouched liver borders [59.55 ± 25.46 (SD)] and the liver tissue compartment close to the resection surface (63.31 ± 27.24). During the hepatocyte-specific phase, the surgical site showed a significantly (p = 0.04) lower SNR (69.44 ± 24.23) compared to the healthy site (78.45 ± 27.71). Dynamic analyses revealed a significantly lower increase (p = 0.008) in signal intensity in the healthy tissue compared to the resection border compartment.. EOB-DTPA-enhanced MRI may have the potential to be an effective non-invasive tool for detecting hepatocyte damage after liver resection.

Topics: Adult; Aged; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Signal-To-Noise Ratio

This study aimed to investigate whether genetic polymorphisms of the organic anion transporting polypeptides influence hepatic enhancement in gadoxetic acid-enhanced MRI.. We analyzed the genotypes of SLCO1B1 388A>G, SLCO1B1 521T>C, SLCO1B3 334T>G and NR1H4 -1G>T and calculated the mean quantitative liver-spleen contrast ratio, as an index of liver parenchymal enhancement, in 226 patients with liver disease.. Multiple linear regression analysis using the mean quantitative liver-spleen contrast ratio as the dependent variable revealed that not only Child-Pugh score, but also SLCO1B1*1b haplotype (β = 0.12; p = 0.04), were significant predictors of liver parenchymal enhancement. In addition, SLCO1B3 334T>G (β = -0.18; p = 0.03) was a significant predictor when the data were analyzed in a subgroup of 117 patients, excluding the carriers of NR1H4 -1G>T, who reportedly exhibit reduced transcriptional activity of SLCO1B3.. These genetic variants, as well as hepatic function, may contribute to individual differences in hepatic enhancement with gadoxetic acid.

Topics: Aged; Female; Gadolinium DTPA; Haplotypes; Humans; Image Enhancement; Liver; Liver Diseases; Liver-Specific Organic Anion Transporter 1; Magnetic Resonance Imaging; Male; Organic Anion Transporters; Organic Anion Transporters, Sodium-Independent; Polymorphism, Genetic; Solute Carrier Organic Anion Transporter Family Member 1B3

Gadolinium ethoxybenzyl diethylenetriamine pantaacetic acid (Gd-EOB-DTPA) is incorporated into liver cells, and liver parenchyma show hyperintensity due to the T1 shortening effect. The T1 value of liver parenchyma in the hepatocyte phase changes from the pre-contrast phase. However, in patients with liver dysfunction, the difference of T1 value is generally small. In examination of hepatic disease, the optimal flip angle should be selected according to the patient's state. The definition of hepatic dysfunction based on biochemical data is diverse. Therefore, if the image findings can estimate liver dysfunction, the operator will select the optimal flip angle. Hence, we defined the criteria of liver dysfunction based on the image data; one or more of the following abnormalities-irregular liver surface, splenomegaly, and expansion of portal trunk. In classification by imaging data, we compared the T1 value of liver parenchyma in the hepatocyte phase, and found that the T1 value was significantly different between normal and cirrhotic liver. Then, in a phantom study simulating normal and cirrhotic liver, we set the optimal flip angle (FA)-21 degrees for the normal liver state, and 18 degrees for the LC state. In Gd-EOB-DTPA-enhanced study, the operator can select the optimal FA for each patient according to the image findings.

Topics: Adult; Aged; Aged, 80 and over; Female; Gadolinium DTPA; Hepatocytes; Humans; Liver Cirrhosis; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Phantoms, Imaging

To examine if liver stiffness measured by magnetic resonance elastography (MRE) is a risk factor for hepatocellular carcinoma (HCC) in patients with chronic liver disease.. By reviewing the records of magnetic resonance (MR) examinations performed at our institution, we selected 301 patients with chronic liver disease who did not have a previous medical history of HCC. All patients underwent MRE and gadoxetic acid-enhanced MR imaging. HCC was identified on MR images in 66 of the 301 patients, who were matched to controls from the remaining patients without HCC according to age. MRE images were obtained by visualising elastic waves generated in the liver by pneumatic vibration transferred via a cylindrical passive driver. Risk factors of HCC development were determined by the odds ratio with logistic regression analysis; gender and liver stiffness by MRE and serum levels of aspartate transferase, alanine transferase, alpha-fetoprotein, and protein induced by vitamin K absence-II.. Multivariate analysis revealed that only liver stiffness by MRE was a significant risk factor for HCC with an odds ratio (95 % confidence interval) of 1.38 (1.05-1.84).. Liver stiffness measured by MRE is an independent risk factor for HCC in patients with chronic liver disease.

Topics: Aged; Carcinoma, Hepatocellular; Case-Control Studies; Chi-Square Distribution; Chronic Disease; Contrast Media; Elasticity Imaging Techniques; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Logistic Models; Male; Retrospective Studies; Risk Factors; Statistics, Nonparametric

To reveal the incidence and degree of intrahepatic periportal high intensity (PHI) on hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI (EOB-MRI) in patients with or without various hepatobiliary diseases.. Patients with normal liver (N = 256) and those with hepatic disorder (N = 857) who underwent EOB-MRI were the subjects in this study. Incidence of PHI was evaluated among the patients with normal liver and those with hepatic disorder. Degree of PHI was categorized into four grades and compared among the various hepatic diseases. Enhancement ratios (ER) of the PHI area, background liver with PHI, and background liver in control cases without PHI were evaluated.. PHI was observed in 2.7 % of the patients with hepatic disorder. No PHI was observed in the patients with normal liver. The incidence rates of PHI among various hepatobiliary diseases were as follows; liver cirrhosis 3.1 %, chronic hepatitis 1.0 %, primary biliary cirrhosis 12.5 %, idiopathic portal hypertension 33.3 %. The ER of the PHI area and background liver were 3.92 and 2.48 (p = 0.0002). There were no significant differences between the ER of the PHI area and the ER of background liver in the noncirrhotic control without PHI.. In 2.7 % of the patients with a hepatic disorder, the periportal area was saved from decrease of EOB uptake and it showed PHI.

Topics: Aged; Chi-Square Distribution; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Incidence; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Prevalence; Retrospective Studies

The purpose of this study was to perform a qualitative and quantitative comparison of image quality of gadoxetate disodium-enhanced imaging of the biliary system acquired using different flip angles (FAs).. Thirty-two patients (21 men and 11 women; mean [± SD] age, 51 ± 16 years) who underwent gadoxetate disodium-enhanced 1.5-T MRI were included. A 3D fat-suppressed T1-weighted gradient-echo sequence was acquired during the hepatobiliary phase using FAs of 12°, 25°, and 40°. One radiologist, who was blinded to FA, measured signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the biliary tree. Two other blinded radiologists assessed subjective biliary duct clarity, overall image quality, background signal suppression, and ghosting artifact from the biliary tree using a scale of 1 to 4.. SNRs and CNRs of the common bile duct were significantly higher for FAs of 25° (227.5 ± 113.2 and 191.0 ± 102.2, respectively) and 40° (239.6 ± 118.7 and 201.7 ± 107.7, respectively) than for 12° (168.9 ± 73.9 and 126.7 ± 59.7, respectively; all p < 0.001). There were no significant differences in SNR or CNR between FAs of 25° and 40° (p ≥ 0.360). Clarity of first-, second-, and third-order intrahepatic ducts, background signal suppression, and overall image quality were significantly higher for both readers for FAs of 25° and 40° than for 12° (all p ≤ 0.031). None of these comparisons was significantly different for either reader between FAs 25° and 40° (all p ≥ 0.091), aside from improved depiction of third-order ducts at 40° for one reader (p = 0.030). Biliary ghosting artifact was significantly worse at 40° than at 12° for both readers (p ≤ 0.016).. The use of an FA larger than the clinical standard of approximately 12° has the potential to improve the image quality of gadoxetate disodium-enhanced biliary imaging.

Topics: Adult; Aged; Aged, 80 and over; Bile Ducts; Contrast Media; Female; Gadolinium DTPA; Hepatic Duct, Common; Humans; Image Enhancement; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged

To evaluate the effect of gadoxetic acid enhancement on the detection and characterisation of focal hepatic lesions on T(2) weighted and diffusion weighted (DW) images.. A total of 63 consecutive patients underwent T(2) weighted and DW imaging before and after gadoxetic acid enhancement. Two blinded readers independently identified all of the focal lesions using a five-point confidence scale and characterised each lesion using a three-point scale: 1, non-solid; 2, indeterminate; and 3, solid. For both T(2) weighted and DW imaging, the accuracies for detecting focal lesions were compared using the free-response receiver operating characteristic analysis; the accuracies for lesion characterisation were compared using the McNemar test between non-enhanced and gadoxetic acid-enhanced image sets. For hepatic lesions ≥ 1 cm, the lesion-to-liver contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) were compared in the non-enhanced and enhanced image sets using the generalised estimating equations.. For both T(2) weighted and DW images, the accuracies for detecting focal lesions (p ≥ 0.52) and those for lesion characterisation (p ≥ 0.63) did not differ significantly between the non-enhanced and enhanced image sets. The lesion-to-liver CNR was significantly higher on enhanced DW images than on non-enhanced DW images (p=0.02), although the difference was not significant for T(2) weighted imaging (p=0.65). The mean ADC values of lesions did not differ significantly on enhanced and non-enhanced DW imaging (p=0.75).. The acquisition of T(2) weighted and DW images after administration of gadoxetic acid has no significant effect on the detection or characterisation of focal hepatic lesions, although it improves the lesion-to-liver CNR on DW images.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Male; Middle Aged

To evaluate diffusion-weighted MR imaging (DWI), gadoxetic acid-enhanced MR imaging and the combination of both methods in the detection, classification, and characterization of focal liver lesions (FLL).. A total of 119 FLL (28 HCCs, 39 metastases, 15 FNHs, 11 adenomas, 13 hemangiomas, 13 cysts) were retrospectively analyzed in 36 patients. In those patients MR imaging of the liver comprising respiratory-triggered DWI (b values of 50, 300, and 600 s/mm(2)) and gadoxetic acid-enhanced MR imaging including image acquisition in the hepatocyte-selective phase (20 min post injection) had been performed. Three image sets were assigned and compared: DWI only (set A), gadoxetic acid-enhanced MR imaging only (set B), and both modalities in combination (set C). Two readers independently interpreted the images in random order. For each reader and image set, the area under the receiver operating characteristic curve (Az) and sensitivity in the detection of FLL was determined as well as the accuracy in the classification and characterization of FLL.. There was no significant difference between the three image sets in the detection of FLL with regards to Az. However, when only lesions with a diameter of 10 mm or less were analyzed, the Az values of set C were significantly higher than those of sets A and B for both readers. For classifying and characterizing FLL both set B and C were significantly superior to set A.. Adding DWI to gadoxetic acid-enhanced MR imaging significantly increases the accuracy in the detection of small FLL.

Topics: Adenoma; Adult; Aged; Contrast Media; Cysts; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Hemangioma; Humans; Image Processing, Computer-Assisted; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

To investigate the enhancement characteristics of liver parenchyma and portal vein as well as the portal vein-to liver contrast in Gd-EOB-DTPA- and Gd-BOPTA-enhanced abdominal MRI.. The local institutional review board approved this retrospective study. A total of 70 patients (30 female, 40 male) without relevant liver disease underwent either Gd-EOB-DTPA-enhanced (35 patients, dose 0.025 mmol/kg) or Gd-BOPTA-enhanced (35 patients, dose 0.1 mmol/kg) abdominal MRI. Signal-to-noise ratios (SNR) for the portal vein and the liver as well as portal vein-to-liver contrast-to-noise ratios (CNR) were calculated for three consecutive arterial phases, one portal venous phase and one delayed imaging phase.. The liver SNR showed higher values for the Gd-BOPTA group in the arterial and portal venous phases (statistically significant for the second and third arterial phase), while the liver SNR in the delayed phase was higher for the Gd-EOB-DTPA group. The portal venous SNR as well as the portal vein-to-liver CNR was higher in the Gd-BOPTA group in all imaging phases (statistically significant in all phases except for the first arterial phase).. The enhancement of liver parenchyma and portal vein as well as the portal vein-to-liver contrast in the arterial and portal venous imaging phases were higher for patients receiving Gd-BOPTA compared with Gd-EOB-DTPA at the respective recommended doses. Gd-BOPTA might therefore enable better evaluation of the portal vein.

Topics: Adult; Aged; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Portal Vein; Reproducibility of Results; Sensitivity and Specificity

To compare the diagnostic performances of gadoxetic acid-enhanced magnetic resonance imaging (MRI) and multiphasic multidetector computed tomography (MDCT) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.. Institutional review board approval was obtained for this study and informed consent was obtained from all patients. Fifty-one patients (43 men, eight women; age range 32-80 years) with 73 HCCs underwent gadoxetic acid-enhanced MRI and multiphasic MDCT. Two readers independently analysed each image in three separate reading sessions. The alternative free-response receiver operating characteristic (AFROC) method was used to analyse the diagnostic accuracy. Positive and negative predictive values and sensitivity were evaluated.. A total of 73 HCCs were detected in 51 patients. Although not significant (p>0.05), the areas under the receiver operating characteristic curves were 0.877 and 0.850 for MDCT, 0.918 and 0.911 for dynamic MRI, and 0.905 and 0.918 for combined interpretation of dynamic and hepatobiliary phase MR images. Differences in sensitivity, specificity, and positive and negative predictive values between the readers were not statistically significant (p>0.05). Combined interpretation of dynamic and hepatobiliary phase MRI images was more useful than MDCT in the detection of HCC lesions ≤1cm in diameter for one reader (p=0.043).. Gadoxetic acid-enhanced MRI and MDCT show similar diagnostic performances for the detection of HCC in patients with chronic liver disease. However, the combined interpretation of dynamic and hepatobiliary phase MRI images may improve diagnostic accuracy in the detection of HCC lesions ≤1cm in diameter.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Observer Variation; Reproducibility of Results; Retrospective Studies

To develop and evaluate a procedure for quantifying the hepatocyte-specific uptake of Gd-BOPTA and Gd-EOB-DTPA using dynamic contrast-enhanced (DCE) MRI.. Ten healthy volunteers were prospectively recruited and 21 patients with suspected hepatobiliary disease were retrospectively evaluated. All subjects were examined with DCE-MRI using 0.025 mmol/kg of Gd-EOB-DTPA. The healthy volunteers underwent an additional examination using 0.05 mmol/kg of Gd-BOPTA. The signal intensities (SI) of liver and spleen parenchyma were obtained from unenhanced and enhanced acquisitions. Using pharmacokinetic models of the liver and spleen, and an SI rescaling procedure, a hepatic uptake rate, K (Hep), estimate was derived. The K (Hep) values for Gd-EOB-DTPA were then studied in relation to those for Gd-BOPTA and to a clinical classification of the patient's hepatobiliary dysfunction.. K (Hep) estimated using Gd-EOB-DTPA showed a significant Pearson correlation with K (Hep) estimated using Gd-BOPTA (r = 0.64; P < 0.05) in healthy subjects. Patients with impaired hepatobiliary function had significantly lower K (Hep) than patients with normal hepatobiliary function (K (Hep) = 0.09 ± 0.05 min(-1) versus K (Hep) = 0.24 ± 0.10 min(-1); P < 0.01).. A new procedure for quantifying the hepatocyte-specific uptake of T (1)-enhancing contrast agent was demonstrated and used to show that impaired hepatobiliary function severely influences the hepatic uptake of Gd-EOB-DTPA.. • The liver uptake of contrast agents may be measured with standard clinical MRI. • Calculation of liver contrast agent uptake is improved by considering splenic uptake. • Liver function affects the uptake of the liver-specific contrast agent Gd-EOB-DTPA. • Hepatic uptake of two contrast agents (Gd-EOB-DTPA, Gd-BOPTA) is correlated in healthy individuals. • This method can be useful for determining liver function, e.g. before hepatic surgery.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Contrast Media; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Meglumine; Middle Aged; Organometallic Compounds; Pilot Projects; Prospective Studies; Retrospective Studies; Spleen; Treatment Outcome

To compare conspicuity and detection rate of hypointense lesions on T1-weighted (T1w) gradient echo (GRE) sequences with low and high flip angles (FA) in hepatocyte phase magnetic resonance imaging (MRI) using gadoxetate disodium.. This Health Insurance Portability and Accountability Act (HIPAA)-compliant study was Institutional Review Board (IRB)-approved. The study population consisted of patients with hypointense liver lesions undergoing MRI with gadoxetate disodium, with hepatocyte-phase fat suppressed 3D T1w GRE sequences at both low (10-12°) and high (30-35°) FA. Contrast-to-noise ratios (CNRs) were calculated for liver parenchyma vs. large lesions and common bile duct (CBD) vs. liver. Three radiologists each assigned a conspicuity score (CS) for each lesion detected at low or high FA. Paired Student's t-tests compared the lesion detection (LD) rate using only the hepatocyte phase data set compared with the entire MRI examination, and CS for low and high FA.. In all, 57 large and 70 small lesions were identified in 18 patients. Average LD and CS were significantly greater at high FA versus low FA overall (LD 89.0% vs. 79.5%; CS 2.8 vs. 2.2; P < 0.05) and for small lesions (81.4% vs. 65.7%; 2.5 vs. 1.8; P < 0.05). Average liver-to-lesion CNR for large lesions and CBD-to-liver CNR was significantly greater at high FA (P < 0.05).. Increasing the FA in hepatocyte phase MRI with gadoxetate disodium improves hypointense lesion detection and conspicuity, particularly for small lesions.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Contrast Media; Female; Gadolinium DTPA; Hepatocytes; Humans; Image Enhancement; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Sensitivity and Specificity

To investigate the chronological relationship between scan delay and liver enhancement for the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI and evaluate the effects of liver function on liver enhancement.. Hepatobiliary-phase images were retrospectively evaluated in 125 patients with chronic liver disease. Hepatobiliary phase images were obtained at 5, 10, 15, and 20 min after injection. We calculated relative liver enhancement (RLE) at t min after injection by dividing the signal intensity (SI) of the liver at t min by precontrast SI. We compared RLE values at 5, 10, 15, and 20 min and evaluated the detectability of focal hepatic lesions. We analyzed the effect of liver function on RLE with the generalized linear model.. There was not significant difference in RLE and lesion detectability at 15 and 20 min. RLE in the Child-Pugh C group was significantly lower than in the Child-Pugh A and B groups. The serum albumin level and prothrombin time were significantly correlated with the liver enhancement.. A delay time of 15 min for the hepatobiliary phase was thought to be adequate in patients with mild liver dysfunction. The serum albumin level and prothrombin time would be predictive of liver enhancement in the hepatobiliary phase.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Time Factors

To compare the diagnostic performance of gadoxetic acid-enhanced MRI using 3.0 T with that of multiphasic 64-multirow detector CT (MDCT) for the detection of small (≤2 cm) hepatocellular carcinoma (HCC) in patients with chronic liver disease.. A total of 54 patients (44 men, 10 women; age range, 33-81 years) with 59 HCCs (≤2 cm in diameter) who underwent both multiphasic (arterial, portal venous, equilibrium) 64-MDCT and gadoxetic acid-enhanced 3.0 T MRI were enrolled in this study. Two observers independently and randomly reviewed the MR and CT images on a lesion-by-lesion basis. The diagnostic performance of these techniques for the detection of HCC was assessed by alternative free-response receiver operating characteristic (ROC) analysis, in addition to evaluating the sensitivity and positive predictive value.. For each observer, the areas under the ROC curve were 0.874 and 0.863 for MRI, respectively, as opposed to 0.660 and 0.687 for CT, respectively. The differences between the two techniques were statistically significant for each observer (p<0.001). The sensitivities (89.8% and 86.4%) of MRI for both observers were significantly higher than those (57.6% and 61.0% for each observer, respectively) of MDCT. No significant difference was seen between the positive predictive values for the two techniques (p>0.05).. Gadoxetic acid-enhanced 3.0 T MRI shows a better diagnostic performance than that of 64-MDCT for the detection of small (≤2 cm) HCCs in patients with chronic liver disease.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Cohort Studies; Comorbidity; Contrast Media; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Incidence; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Neoplasm Staging; Observer Variation; Predictive Value of Tests; Radiographic Image Enhancement; Reproducibility of Results; Retrospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity

To assess the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MR cholangiography for the detection of bile leaks after hepatobiliary surgery.. Twenty-three patients with symptoms suggestive of bile leak underwent conventional fat-suppressed T1- and T2-weighted MR cholangiography followed by Gd-EOB-DTPA-enhanced MR cholangiography using gradient-echo (GRE) T2-weighted sequences and fat-suppressed T1-weighted 3D gradient-echo sequences 20 min after an intravenous bolus of Gd-EOB-DTPA. The results of Gd-EOB-DTPA-enhanced MR cholangiography correlated with clinical findings, surgical repair, and the results of endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.. The results of Gd-EOB-DTPA-enhanced MR cholangiography were negative in 13 patients (cholecystectomy 5, liver transplantation 2, liver resection for focal lesions 2, cholangiocarcinoma 1, and partial hepatectomy after liver injury 1). In 10 patients in whom bile leaks were detected, this complication occurred after liver resection for focal lesions in 3, cholecystectomy in 4, liver transplantation in 2, and liver resection for intrahepatic cholangiocarcinoma in 1. The diagnostic accuracy of Gd-EOB-DTPA-enhanced MR for the detection or exclusion of bile leaks was 100%.. Gd-EOB-DTPA-enhanced MR cholangiography is a highly reliable technique for the detection of bile leaks after hepatobiliary surgery and may avoid the use of other, potentially risky invasive diagnostic techniques.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Diseases; Bile Ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Male; Middle Aged; Postoperative Complications

A liver neoplasm was found in a 63-year-old man with alcoholic liver disease. Sonazoid-enhanced ultrasonography (US) showed that the neoplasm was isoechoic at the early vascular phase and hypoechoic at the post-vascular phase. Gadolinium ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging (MRI) showed that the neoplasm was hypointense at the hepatobiliary phase. We suspected that it was a malignant tumor. By needle biopsy, however, the neoplasm was diagnosed as an inflammatory pseudotumor (IPT). We encountered a rare case of hepatic IPT, the differential diagnosis of which was difficult to distinguish from malignant tumor. Here, we report new US and MRI findings of hepatic IPT.

Topics: Biopsy, Fine-Needle; Contrast Media; Diagnosis, Differential; Ferric Compounds; Gadolinium DTPA; Granuloma, Plasma Cell; Humans; Iron; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Oxides; Ultrasonography

We compared the diagnostic performance of gadoxetic acid-enhanced MRI and 16-slice multidetector CT (MDCT) with respect to their abilities to detect hepatic metastases and differentiate hepatic metastases from hepatic cysts and haemangiomas.. 67 patients with 110 liver metastases (size 0.3-2.5 cm), 33 haemangiomas (size 0.5-1.5 cm) and 17 cysts (size 0.3-1.0 cm) underwent 4-phase MDCT and gadoxetic acid-enhanced MRI, including early dynamic phases, post-contrast T(2) weighted turbo spin echo sequences and 20 min hepatocyte-selective phases. Two observers independently analysed each image in random order. Sensitivity and diagnostic accuracy for lesion detection and differentiation for MDCT and gadoxetic acid-enhanced MRI were calculated using receiver operating characteristic analysis.. For both observers, the Az values of gadoxetic acid-enhanced MRI (mean, 0.982 and 0.981) were significantly higher than the Az values of MDCT (mean, 0.839 and 0.892) (p<0.05) for the detection of metastases and for the differentiation of metastases from haemangiomas and cysts. Sensitivities of gadoxetic acid-enhanced MRI with regard to the detection and characterisation of liver metastases (mean, 96.9% and 96.0%) were significantly higher than those of MDCT (mean, 78.7% and 75.0%) (p<0.05).. Gadoxetic acid-enhanced MRI showed higher diagnostic accuracy and sensitivity than did MDCT for the detection of hepatic metastases and for the differentiation between hepatic metastases and hepatic haemangiomas or cysts.

Topics: Adult; Aged; Contrast Media; Cysts; Female; Gadolinium DTPA; Hemangioma; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity

We assessed what MR imaging parameters affected ringing artifacts during the arterial phase of gadoxetic acid-enhanced dynamic magnetic resonance (MR) imaging.. We tested various parameters, including imaging matrices, choice of either sequential or elliptical centric phase-encoding scheme, scanning time, and contrast injection rate using new simulation software on a personal computer and visually evaluated clinical MR images retrospectively using a 4-point scale to assess ringing artifacts.. The simulation study revealed that square matrices, short scanning time, slow injection rate, and sequential view ordering effectively reduced ringing artifacts, findings confirmed in clinical practice using gadoxetic acid-enhanced MR imaging. Significantly fewer artifacts resulted using a slow injection rate (P<0.05) and using square matrices in the arterial (P<0.05), portal (P<0.01), and hepatocytic (P<0.05) phases.. Choice of square matrix, slower injection rate, shorter scanning time, and sequential view ordering could reduce ringing artifacts.

Topics: Adult; Algorithms; Artifacts; Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Injections, Intra-Arterial; Liver Diseases; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Young Adult

The purpose of this study was to elucidate the incidence and risk factors for the progression of hypointense nodules observed in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) of hypervascular hepatocellular carcinoma (HCC).. Hypovascular nodules (112) showing hypointensity in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were examined in 54 patients. All patients underwent computed tomography during hepatic arteriography and computed tomography during arterial portography (CTAP) within a month after Gd-EOB-DTPA-enhanced MRI. According to the tumor size, 112 nodules were divided into two groups: those >10 mm in diameter (group A, n = 39) and those ≤10 mm in diameter (group B, n = 73). The incidence of progression to hypervascular HCC was calculated using the Kaplan-Meier method.. The incidence of hypervascularization was significantly higher in group A nodules than in group B nodules (p < 0.0001). Tumor size (p < 0.0001) and hypoattenuation in CTAP (p = 0.0004) showed significant correlation with hypervascularization.. Hypointense nodules observed in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI with diameters of >10 mm had a high probability of hypervascularization.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Disease Progression; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors

In the patient with cancer, magnetic resonance imaging is increasingly used as a diagnostic tool for disease detection, lesion characterization, as well as the assessment of treatment response. Although non-contrast T1-weighted and T2-weighted imaging, together with low molecular weight extracellular gadolinium contrast-enhanced T1-weighted magnetic resonance imaging remain the cornerstone for liver assessment, there is increasing recognition of the benefits of liver-specific contrast agents for disease evaluation.

Topics: Contrast Media; Gadolinium DTPA; Humans; Liver; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds

Tissue-specific gadolinium-based contrast agents such as Gd-BOPTA, Gd-EOB-DTPA are increasingly used for liver imaging. Despite the added value of the hepatobiliary phase a proper arterial phase is still critical, especially in patients with chronic liver diseases. So far, there are limited data in the literature about the effect of the injection speed of Gd-EOB-DTPA in liver and vessel enhancement.. To evaluate the effect of injection rate on the enhancement of liver parenchyma and vasculature in Gd-EOB-DTPA-enhanced liver MRI.. Eighty patients who underwent Gd-EOB-DTPA-enhanced liver MRI (1.5T multi-channel MR-system) were retrospectively evaluated. We used a Care Bolus technique with an injection rate of 2 mL/s in group 1 (n = 40) and a Care Bolus technique with an injection rate of 1 mL/s in group 2 (n = 40) to determine the start of the arterial-dominant phase. Signal intensities were measured in vascular structures and liver parenchyma. Signal-to-noise-ratio (SNR), SNR increase (SNRi), and percentage enhancement (PE) were calculated and compared by a students t-test.. The SNR, SNRi, and PE of the aorta in the arterial phase were significantly higher in group 2 in comparison to group 1 (P = 0.007, P = 0.0043, and P < 0.001, respectively). There were no significant differences concerning the SNR, SNRi, or PE of the portal vein and the normal liver parenchyma between both groups at all time points.. The study shows that a lower injection rate of 1 mL/s enables a higher enhancement in the aorta in the arterial phase compared with Gd-EOB-DTPA-enhanced MRI with the more commonly used injection rate of 2 mL/s.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Injections, Intravenous; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Signal-To-Noise Ratio; Statistics, Nonparametric

To quantitatively evaluate the signal intensity of the biliary tract in gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging and to investigate the effect of liver function on the signal intensity of the biliary tract.. A total of 32 patients with and without chronic liver disease (normal liver group, n = 15; chronic liver disease group, n = 17) were included in this study. All patients were prospectively enrolled for evaluation of known or suspected focal liver lesions. In the chronic liver disease group, the etiologies were chronic hepatitis C virus infection (n = 12) and chronic hepatitis B virus infection (n = 5). The median Child-Pugh score was 5 (range, 5-7). Each patient received the standard dose of Gd-EOB-DTPA (0.025 mmol/kg of body weight). Post-contrast T1-weighted MR images were obtained at 5, 10, 15, 20, 25, and 30 min after administration of Gd-EOB-DTPA. Maximum signal intensities (SIs) of the right and left hepatic ducts, common hepatic duct, and common bile duct were measured. Relative signal intensity was calculated as follows: relative SI = maximum SI(bileduct)/mean SI(muscle). Serum albumin level, serum total bilirubin level, prothrombin time, indocyanine green retention rate at 15 min (ICG-R15), and estimated glomerular filtration rate were entered into regression analysis.. The signal intensity of the bile duct reached a peak 30 min after administration of Gd-EOB-DTPA. The mean relative signal intensity of the right and left hepatic ducts at the peak time point was not significantly different between the two groups, while increase in signal intensity was delayed in the chronic liver disease group. The mean relative signal intensity of the common hepatic duct and that of the common bile duct at the peak time point were significantly different between the two groups (Wilcoxon rank-sum test, P = 0.03, respectively). Stepwise regression analysis revealed that ICG-R15 was a significant predictor of the signal intensity of the bile duct (right and left hepatic ducts, P = 0.04; common hepatic duct, P = 0.008; common bile duct, P = 0.003).. The results of our study demonstrate that the presence of chronic liver disease significantly affects the signal intensity of the bile duct in Gd-EOB-DTPA-enhanced MR imaging. ICG-R15 was only a significant predictor of the signal intensity of the bile duct. The signal intensity of the bile duct may reflect underlying liver function.

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

The purpose of this study was to determine transit times for excretion of Gd-EOB-DTPA into different segments of the hepatobiliary system in patients with normal liver function.. This retrospective study was IRB approved with a waiver of consent granted. 61 patients (39 female, 22 male, mean age 52.5 years) with normal liver and renal function who underwent contrast enhanced hepatic MRI after injection of 10 mL Gd-EOB-DTPA at 1.5T and 3T were included. Two readers evaluated all delayed images (3-20 min post contrast) for the presence of contrast agent in the intrahepatic bile ducts (IBD), the common bile duct (CBD), the gallbladder and the duodenum. A two-tailed, unpaired Student's t-test with p<0.05 deemed significant was used to determine whether transit times were affected by patient gender, age or body mass index.. 20 min after contrast initiation, Gd-EOB-DTPA could be detected in the IBD and the CBD in all patients (100%); gallbladder reflux was visible in 53 (86.9%), duodenal excretion in 40 patients (65.5%), respectively. Mean transit times for contrast appearance in the various segments were as follows: IBD 12 min 13s; CBD 12 min 27 s; gallbladder 13 min 32s. Transit times were not significantly affected by patient gender, age or BMI.. Within 20 min post contrast initiation, Gd-EOB-DTPA can be expected in the IBD and the CBD in patients with normal liver function. However, functional information about the sphincter Oddi complex can be ascertained only in about two thirds of these patients within this timeframe.

Topics: Adult; Aged; Biliary Tract Diseases; Contrast Media; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

The purpose of this study was to assess a new open system with a field-strength of 1.0 T for the feasibility of liver biopsy using the freehand technique with fast continuous imaging. Fifty patients with focal liver lesions measuring 5 to 30 mm in diameter were included in the study. Guidance and monitoring was performed using a 1.0-T open magnetic resonance (MR) scanner (Panorama HFO; Philips Healthcare, Best, The Netherlands). With fast continuous imaging using a T1-weighted (T1W) gradient echo (GRE) sequence after administration of gadolinium (Gd)-EOB-DTPA, the needle was placed into the lesion. An interface for interactive dynamic viewing in two perpendicular planes prevented needle deviations T2-weighted turbo spin echo (TSE) fat-suppressed sequence was added to rule out postinterventional hematoma or biloma. All lesions were visible on the interventional images. Biopsy was technically successful, and solid specimens were obtained in all cases. Forty-six patients showed a histopathologic pattern other than native liver tissue, thus confirming correct position of the needle. Time between determination of the lesion and performance of the control scan was on average 18 min. No major complications were recorded. MR guidance with the new 1-T open system must be considered an attractive alternative for liver punction. An interface for dynamic imaging of needle guidance and T1W-GRE imaging with administration of Gd-EOB-DTPA for contrast enhancement allows the pinpoint puncture of liver lesions.

Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Contrast Media; Feasibility Studies; Female; Gadolinium DTPA; Humans; Liver Diseases; Magnetic Resonance Imaging, Interventional; Male; Middle Aged; Punctures; Software; User-Computer Interface

determine the effect of double-dose gadoxetic-acid (Gd-EOB-DTPA) on lesion-liver contrast ratio in arterial- and hepatocyte-phase images and arterial-phase image quality in patients with chronic liver disease.. the ethics committee at our institute approved this study. This study included 28 patients (13 with Child-Pugh class A and 15 with class B) with 54 hepatocellular carcinomas. All patients received the standard Gd-EOB-DTPA dose (0.025 mmol/kg bodyweight) and double dose (0.050 mmol/kg bodyweight). The lesion-liver contrast ratio was evaluated in arterial- and hepatocyte-phase images. The artifacts in arterial-phase images were evaluated with a 4-point scale. Wilcoxon signed-rank test were used for comparisons.. the hepatocyte-phase lesion-liver contrast ratio after the double dose was significantly higher than that after the standard dose in patients with Child-Pugh class B disease(standard dose vs. double dose; 0.20 ± 0.16 vs. 0.25 ± 0.17; P < 0.0001); however, the ratio after both the standard and double doses was equivalent in patients with Child-Pugh class A disease (0.35 ± 0.18 vs. 0.35 ± 0.14; P = 0.3038). The double dose significantly increased the arterial-phase lesion-liver contrast ratio (0.34 ± 0.19 vs. 0.58 ± 0.33; P < 0.0001). The artifacts in the arterial-phase images were more prominent after the standard dose (2.7 vs. 2.4 for reader 1, 2.8 vs. 2.4 for reader 2; P = 0.0195 and 0.0010).. administration of double dose of Gd-EOB-DTPA provided better arterial enhancement of hepatocellular carcinomas in patients with chronic liver disease, and also improved the lesion-liver contrast in hepatocyte-phase images in patients with Child-Pugh class B disease.

Topics: Aged; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Statistics as Topic; Statistics, Nonparametric; Tomography, X-Ray Computed

The purpose of this study was to investigate the relative enhancement characteristics of the hepatic parenchyma and portal vein during gadoxetate disodium-enhanced abdominal MRI and to assess whether contrast between the portal vein and the hepatic parenchyma can be improved with higher doses of gadoxetate disodium.. A total of 102 patients (61 women, 41 men) underwent gadoxetate disodium-enhanced abdominal MRI. They received a weight-independent dose of 10 mL of gadoxetate disodium, corresponding to a dose spectrum of 0.02-0.06 mmol/kg body weight. The patients were assigned to one of three dose groups: recommended dose (0.02-0.03 mmol/kg), intermediate dose (0.03-0.045 mmol/kg), or high dose (0.045-0.06 mmol/kg). The signal-to-noise ratios for the portal vein, liver, and the portal vein-to-liver contrast-to-noise ratio were calculated for three consecutive arterial phases, one portal venous phase, and four delayed imaging phases.. The delayed phase images of the liver showed statistically significant dose dependency and greater enhancement in the intermediate- and high-dose groups (p < 0.01). Analogously, the portal vein also exhibited greater enhancement in the two higher-dose groups, but the difference was not statistically significant (p > 0.05). Regarding portal vein-to-liver contrast, all three groups had a dose-independent fast parallel increase from baseline toward maximum contrast followed by a steady decline in contrast with no statistically significant differences between dose groups (p > 0.05).. Portal vein-to-liver contrast during gadoxetate disodium-enhanced hepatic MRI cannot be improved within a dose spectrum of 0.025-0.06 mmol/kg body weight.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Humans; Linear Models; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Portal Vein; Retrospective Studies

Clinical application efforts for the hepatocyte-specific MRI contrast agent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) have mainly been directed toward detection and characterization of various hepatic masses in the adult population.. Here we report our initial experience with Gd-EOB-DTPA for evaluating congenital and acquired hepatobiliary pathologies in the pediatric population.. Twenty-one consecutive children receiving Gd-EOB-DTPA for functional hepatobiliary evaluation at our institution were retrospectively identified with IRB approval. The use of Gd-EOB-DTPA was classified in each case as definite, potential, or no clinical utility, focusing on the clinical value gained beyond traditional noncontrast fluid-sensitive MR cholangiopancreatography (FS-MRCP) and other imaging modalities.. Definite added value of Gd-EOB-DTPA was found in 12 patients, with potential value in 4 patients, and no value in 5 patients. Benefit was seen in cases of iatrogenic and non-iatrogenic biliary strictures, perihepatic fluid collections for biliary leak, hepatobiliary dysfunction in the absence of hyperbilirubinemia, and in the functional exclusion of cystic duct occlusion that can be seen in acute cholecystitis.. This is the first reported series of children with Gd-EOB-DTPA and this early work suggests potential pediatric applications.

Topics: Adolescent; Adult; Biliary Tract Diseases; Child; Child, Preschool; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Infant; Liver Diseases; Magnetic Resonance Imaging; Male; Retrospective Studies

The purpose of this study was to determine the finding most predictive for characterizing hypervascular hepatocellular carcinoma (HCC) measuring 1 cm or less at gadoxetic acid-enhanced MRI that includes diffusion-weighted images.. In this retrospective study, between May 2008 and June 2009, 66 patients with 108 hypervascular HCCs 1 cm or smaller underwent gadoxetic acid-enhanced 3-T MRI that included diffusion-weighted images. The diagnosis of HCC was determined by surgical resection in 32 cases, percutaneous biopsy in three cases, or interval growth to larger than 1 cm on follow-up images in accordance with the American Association for the Study of Liver Diseases guidelines in 73 cases. MRI findings of HCC and 33 benign hypervascular lesions in a control group were analyzed by two radiologists in consensus. They based their assessments on the presence or absence of the following five findings: hyperintensity on T2-weighted images, hyperintensity on diffusion-weighted images with low b values, washout pattern, capsular enhancement, and hypointensity on gadoxetic acid-enhanced hepatobiliary phase images. The findings were compared by use of univariate and multivariate analyses.. No HCC with capsular enhancement was found. Fifty-seven HCCs (52.8%) had four findings, 36 (33.3%) had three, nine (8.3%) had two findings, and six (5.6%) had one finding. Univariate analysis showed significant differences between the HCC and control groups with respect to four findings (p < 0.0001). Multivariate analysis showed that hyperintensity on T2-weighted (p < 0.0001) and diffusion-weighted (p = 0.0081) images were statistically significant MRI findings for predicting HCC.. Hyperintensity on both T2- and diffusion-weighted images is helpful in the diagnosis of hypervascular HCC smaller than 1 cm in diameter.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Hepatocellular; Chi-Square Distribution; Chronic Disease; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Predictive Value of Tests; Retrospective Studies

: The purpose of this study was to determine the pharmacokinetics (PKs), imaging properties, and safety of the liver-specific magnetic resonance (MR) imaging contrast agent gadoxetic acid disodium (Gd-EOB-DTPA) in subjects with various levels of hepatic impairment, renal impairment, or coexisting hepatic and renal impairment.. : In this single-center, open-label, parallel-group study, patients with varying degrees of renal and/or hepatic impairment were compared with healthy subjects matched for age, gender, and weight (control group). All subjects received a single intravenous bolus of Gd-EOB-DTPA (Primovist, Eovist, EOB-Primovist) 25 μmol/kg body weight. Samples of serum, urine, and feces were collected for PK analysis. MR imaging was performed before dosing and at preset times after dose administration to determine enhancement relative to predose signal intensity values. Safety was assessed by monitoring adverse events, laboratory values, vital signs, cardiac rhythm, oxygen saturation, and by physical examination findings.. : Gd-EOB-DTPA was well tolerated by all subjects. Total clearance of Gd-EOB-DTPA did not significantly change in patients with mild and moderate hepatic impairment (Child-Pugh A and B), compared with the control group. Mean urinary excretion was increased and mean fecal excretion was decreased in patients with hepatic impairment. Renal excretion was increased to between 72% and 96% of the dose administered in patients with very high bilirubin levels (>3 mg/dL), compared with 48% in the control group. Total clearance of Gd-EOB-DTPA was significantly reduced to 140 ± 45 mL/min and terminal elimination half-life (t1/2) was slightly, but not significantly, increased to 2.6 ± 0.9 hours in patients with severe hepatic impairment (Child-Pugh C), compared with the control group (209 ± 37 mL/min and 1.8 ± 0.2 hours, respectively). Liver MR signal enhancement (area under the curve of relative enhancement [%] over time) was similar in patients with mild and moderate hepatic impairment and in those in the control group, but was decreased by 38% in patients with severe hepatic impairment, compared with control. Peak liver enhancement, however, was still at a high level (118% ± 57%). PK and imaging parameters were not significantly affected in patients with moderate renal impairment (creatinine clearance, 30-50 mL/min). In patients with end-stage renal failure (ESRF), however, the PK profile of Gd-EOB-DTPA was significantly different, with an increased t1/2 (20.0 ± 7.0 hours vs. 1.8 ± 0.2 hours in the control group). During a 3-hour dialysis session that started 1 hour after administration of the intravenous dose, the serum levels in patients with ESRF declined by between 71% and 88% as a result of elimination by hemodialysis and parallel hepatobiliary excretion. This is comparable with the decline observed in healthy subjects (85%) during the 1- to 4-hour interval after injection.. : The results of the present study show that in humans with moderate renal impairment and mild-to-moderate hepatic impairment, no relevant changes in PK parameters, such as total clearance and t1/2, develop as a result of increased renal excretion to compensate in the case of hepatic impairment (or increased hepatic elimination in the case of renal impairment). The t1/2 of Gd-EOB-DTPA was markedly altered only in patients with ESRF. The high MR signal enhancement profile, observed even in patients with severe hepatic impairment, indicates that there is no need to adjust the dose of Gd-EOB-DTPA.

Topics: Adolescent; Adult; Area Under Curve; Contrast Media; Female; Gadolinium DTPA; Health Status Indicators; Humans; Kidney Diseases; Liver Diseases; Magnetic Resonance Imaging; Male; Metabolic Clearance Rate; Middle Aged; Prospective Studies; Regression Analysis; Risk Assessment; Statistics, Nonparametric; Young Adult

To determine whether liver function correlating with indocyanine green (ICG) clearance could be estimated quantitatively from gadoxetate disodium-enhanced magnetic resonance (MR) images.. This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Twenty-three consecutive patients who underwent an ICG clearance test and gadoxetate disodium-enhanced MR imaging with the same parameters as were used for a preoperative examination were chosen. The hepatocellular uptake index (HUI) from liver volume (V(L))and mean signal intensity of the liver on contrast-enhanced T1-weighted images with fat suppression (L(20)) and mean signal intensity of the spleen on contrast-enhanced T1-weighted images with fat suppression (S(20)) on 3D gradient-echo T1-weighted images with fat suppression obtained at 20 minutes after gadoxetate disodium (0.025 mmol per kilogram of body weight) administration was determined with the following equation: V(L)[(L(20)/S(20)) - 1]. The correlation of the plasma disappearance rate of ICG (ICG-PDR) and various factors derived from MR imaging, including HUI, iron and fat deposition in the liver and spleen, and spleen volume (V(S)), were evaluated with stepwise multiple regression analysis. The difference between the ratio of the remnant HUI to the HUI of the total liver (rHUI/HUI) and ratio of the liver remnant V(L) to the total V(L) (rV(L)/V(L)) was evaluated in four patients who had segmental heterogeneity of liver function.. HUI and V(S) were the factors significantly correlated with ICG-PDR (R = 0.87). The mean value and its 95% confidence interval were 0.18 and 0.01 to 0.34, respectively, for the following calculation: (rHUI/HUI) - (rV(L)/V(L)).. The liver function correlating with ICG-PDR can be estimated quantitatively from the signal intensities and the volumes of the liver and spleen on gadoxetate disodium-enhanced MR images, which may improve the estimation of segmental liver function.

Topics: Aged, 80 and over; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To examine the differential features of focal eosinophilic liver disease (FELD) from liver metastases on gadoxetic acid-enhanced MRI.. Twenty patients with 41 FELD and 20 patients with 55 metastases were enrolled in this study. Liver MRI consisted of precontrast 2D T1-weighted image (T1WI) and gadoxetic acid-enhanced 3D T1WI (arterial, portal, 20 min hepatocyte-selective phases), and a postcontrast T2WI. Images were analyzed for the margin and shape of the lesions; lesion conspicuity on T1- and T2WI; signal intensity of the lesions on 3D T1WI; presence of rim enhancement and misty signs; and presence of significant smaller lesions on the unenhanced T1WI (<50%) compared to hepatocyte phase image.. Univariate analysis revealed the following significant parameters to favor FELD: a fuzzy margin, irregular shape, subtle signal intensity changes on T1- and T2WI, absence of target signs on the hepatocyte phase image, presence of misty signs, and size discrepancies on T1WI and hepatocyte phase images. Multivariate analysis revealed only a significantly smaller lesion size on T1WI compared to hepatocyte phase images to be predictive of FELD.. A significantly smaller lesion size on T1WI relative to hepatocyte phase image is the best predictor for identifying FELD on gadoxetic acid-enhanced MRI.

Topics: Adult; Aged; Biopsy, Needle; Chi-Square Distribution; Contrast Media; Diagnosis, Differential; Eosinophilia; Female; Gadolinium DTPA; Humans; Liver Diseases; Liver Neoplasms; Logistic Models; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity

To determine the association of early changes in posttreatment apparent diffusion coefficient (ADC) and venous enhancement (VE) with tumor size change after transarterial chemoembolization (TACE) by using an investigational semiautomated software.. This retrospective HIPAA-compliant study was approved by the institutional review board, with waiver of informed consent. Patients underwent magnetic resonance (MR) imaging at 1.5 T before TACE, as well as 1 and 6 months after TACE. Volumetric analysis of change in ADC and VE 1 month after TACE compared with pretreatment values was performed in 48 patients with 71 hepatocellular carcinoma (HCC) lesions. Diagnostic accuracy was evaluated with receiver operating characteristic (ROC) analysis, using tumor response at 6 months according to Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST as end points.. According to RECIST criteria, 6 months after TACE, 30 HCC lesions showed partial response (PR), 35 showed stable disease (SD), and six showed progressive disease (PD). Increase in ADC and decrease in VE 1 month after TACE were significantly different between PR, SD, and PD. At area under the ROC curve (AUC) analysis of the ADC increase, there was an AUC of 0.78 for distinguishing PR from SD and PD and an AUC of 0.89 for distinguishing PR and SD from PD. The AUC for decrease in VE was 0.73 for discrimination of PR from SD and PD and 0.90 for discrimination of PR and SD from PD.. Volumetric analysis of increase in ADC and decrease in VE 1 month after TACE can provide an early assessment of response to treatment. Volumetric analysis of multiparametric MR imaging data may have potential as a prognostic biomarker for patients undergoing local-regional treatment of liver cancer.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

To assess the reproducibility of computed tomographic (CT) perfusion measurements in liver tumors and normal liver and effects of motion and data acquisition time on parameters.. Institutional review board approval and written informed consent were obtained for this prospective study. The study complied with HIPAA regulations. Two CT perfusion scans were obtained 2-7 days apart in seven patients with liver tumors with two scanning phases (phase 1: 30-second breath-hold cine; phase 2: six intermittent free-breathing cines) spanning 135 seconds. Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface area product (PS) for tumors and normal liver were calculated from phase 1 with and without rigid registration and, for combined phases 1 and 2, with manually and rigid-registered phase 2 images, by using deconvolution modeling. Variability was assessed with within-patient coefficients of variation (CVs) and Bland-Altman analyses.. For tumors, BF, BV, MTT, and PS values and reproducibility varied by analytical method, the former by up to 11%, 23%, 21%, and 138%, respectively. Median PS values doubled with the addition of phase 2 data to phase 1 data. The best overall reproducibility was obtained with rigidly registered phase 1 and phase 2 images, with within-patient CVs for BF, BV, MTT, and PS of 11.2%, 14.4%, 5.5% and 12.1%, respectively. Normal liver evaluations were similar, except with marginally lower variability.. Absolute values and reproducibility of CT perfusion parameters were markedly influenced by motion and data acquisition time. PS, in particular, probably requires data acquisition beyond a single breath hold, for which motion-correction techniques are likely necessary.

Topics: Aged; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Perfusion Imaging; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed

A 60-year-old woman who had had a history of renal cell carcinoma with intraperitoneal recurrence presented with multiple liver masses. Computed tomography demonstrated multiple enhancing lesions in the both lobes of the liver, and there was an apparent small vessel coursing within one of the lesions. On magnetic resonance imaging, masses showed slight T1 and T2 prolongation, and restricted diffusion: On the hepatobiliary phase of liver-specific contrast agent enhancement, lesions were shown as low signal intensity of varying degree. Liver metastases from renal cell carcinoma were suspected, and partial hepatectomy was performed for the superficially located nodules to make a definitive diagnosis. The final pathological diagnosis was reactive lymphoid hyperplasia or pseudolymphoma of the liver.

Topics: Carcinoma, Renal Cell; Contrast Media; Diagnosis, Differential; Female; Gadolinium DTPA; Humans; Kidney Neoplasms; Liver Diseases; Liver Function Tests; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Pseudolymphoma; Tomography, X-Ray Computed

To investigate whether preoperative gadoxetate-disodium-enhanced MR imaging predicts posthepatectomy liver failure (PHLF) in patients who underwent major hepatic resection.. Twenty nine patients who underwent preoperative gadoxetate-disodium-enhanced MR imaging and following major hepatic resection were enrolled. Hepatic parenchymal signal intensity (SI) on pre-contrast T1-weighted imaging and 20min hepatocyte phase was measured at each of the four liver segments by two observers using region of interest measurements. The mean value was calculated and used at each phase. The relative contrast enhancement index (RCEI) was calculated: (20min hepatocyte phase SI-pre-contrast SI)/pre-contrast SI. PHLF was determined by the International Study Group of Liver Surgery 2011 guidelines. Correlation analysis was performed between preoperative liver function test and RCEI. Diagnostic accuracy of RCEI for predicting PHLF was calculated with receiver operating characteristic curve analysis. The reproducibility of the RCEI measurement was evaluated.. There was a significant correlation between preoperative albumin (r=0.496, P=0.006), T-bilirubin (r=-0.383, P=0.041), and RCEI. Seven patients (24%) experienced PHLF, and one of these patients (3%) died. The diagnostic accuracy of RCEI was 0.838 (sensitivity 85.7%, specificity 77.3%, cut-off value: 0.7508, 95% confidence interval: 0.654, 0.947). The 95% limits of agreement and ICC between repeated RCEI measurements were 18.4% of the mean and 0.94, respectively, and between RCEI measurements by the two observers were 21.7% and 0.929, respectively.. Our results show that preoperative gadoxetate-disodium-enhanced MR imaging can predict PHLF in patients who underwent major hepatic resection.

Topics: Adult; Aged; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Hepatectomy; Humans; Liver Diseases; Liver Failure; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; ROC Curve; Statistics, Nonparametric

We aimed to reveal the difference in contrast enhancement of the abdominal organs and major vessels on dynamic contrast-enhanced magnetic resonance imaging (DCM-MRI) using gadoxetic sodium (Gd-EOB-DTPA) and gadopentetate dimeglumine (Gd-DTPA) in the same patients.. DCM-MRI using Gd-EOBDTPA and Gd-DTPA were performed in the same 17 patients. Precontrast and DCM-MRI images [arterial phase (AP), portal venous phase (PP), hepatic venous phase (HP)] were acquired before and after bolus injection of each contrast agent. The organ-to-muscle ratio [liver (L/M), spleen (S/M), aorta (A/M), portal vein (P/M), hepatic vein (V/M)] were calculated at each phase and analyzed statistically.. There was no significant difference between Gd-EOB-DTPA and Gd-DTPA images regarding the L/M or V/M mean on precontrast images or the mean of L/M at AP and L/M at the PP. At the AP, PP, and HP, the means of S/M, A/M, P/M, and V/M with Gd-EOBDTPA were lower than those with Gd-DTPA. On HP, The mean L/M with Gd-EOB-DTPA was higher than that with Gd-DTPA.. On 3-T DCM-MRI using Gd-EOB-DTPA, contrast enhancement of the organs, except for the liver, was lower than that on DCM-MRI using Gd-DTPA. The HP was already affected by hepatobiliary uptake in Gd-EOB-DTPA.

Topics: Aged; Contrast Media; Female; Gadolinium DTPA; Hepatic Veins; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Magnetics; Male; Middle Aged

To test the null hypothesis that there is no quantitative or qualitative difference between respiratory-triggered three-dimensional (3D) T2-weighted magnetic resonance (MR) cholangiography performed before or after administration of gadoxetate disodium.. For this retrospective HIPAA-compliant dual-center study, institutional review board approval was obtained, and a waiver of informed consent was granted. Between July and December 2008, 60 patients (age range, 18-82 years) who were referred for liver MR imaging with gadoxetate disodium underwent respiratory-triggered 3D MR cholangiography before and immediately after completion of portal venous phase contrast material-enhanced T1-weighted MR imaging. Quantitative signal-to-noise ratio (SNR) measurements were obtained in the extrahepatic biliary tract in both MR cholangiographic data sets in each patient. Qualitative assessment was performed by four readers with a four-point scale to assess the depiction of extra- and intrahepatic ducts up to the third order. Statistical analysis consisted of a one-sided Wilcoxon signed rank test, with a P value of less than .05 indicating a significant difference.. There was a significant decrease in mean SNR in the MR cholangiographic data set after injection of gadoxetate disodium. SNR was 96 + or - 50 [standard deviation] and 78 + or - 47 before and after contrast media administration, respectively (P < .0001). For all readers, qualitative differences were most obvious in the depiction of the common bile duct and second- and third-order biliary branches, with the precontrast MR cholangiographic data sets being preferred (P < .0001). Precontrast data sets were also significantly preferred in the assessment of the right and left hepatic ducts by all readers.. Gadoxetate disodium adversely affects respiratory-triggered 3D MR cholangiography, both qualitatively and quantitatively. We recommend that such a sequence be performed before injection of gadoxetate disodium.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Liver Diseases; Male; Middle Aged; Respiratory-Gated Imaging Techniques; Retrospective Studies; Statistics, Nonparametric

To retrospectively determine findings at gadoxetic acid-enhanced magnetic resonance (MR) imaging in hypervascular pseudolesions that were observed at computed tomography (CT) during hepatic arteriography, with special focus on distinguishing these pseudolesions from hypervascular hepatocellular carcinomas (HCCs).. The institute ethics committee deemed study approval unnecessary. The study population comprised 80 patients (55 men, 25 women) with chronic liver disease who underwent CT during hepatic arteriography and arterial portography, gadoxetic acid-enhanced MR imaging, and follow-up dynamic contrast material-enhanced CT. The diagnosis of 104 pseudolesions and 123 HCCs was confirmed by means of histopathologic or multimodality evaluation. Two radiologists assessed the MR imaging findings of HCCs and pseudolesions in consensus, including the signal intensities (SIs) of the lesions on T2-weighted, diffusion-weighted (DW), and contrast-enhanced hepatocyte-phase images. The findings of nodular pseudolesions and HCCs were compared with the Fisher exact test. Additionally, the hepatocyte-phase SI ratio (ratio of lesion SI to liver SI) for HCCs and pseudolesions was compared by means of the Mann-Whitney U test.. There were 62 wedge-shaped, 32 nodular, and 10 linear pseudolesions. On gadoxetic acid-enhanced hepatocyte-phase MR images, 15% of pseudolesions (16 of 104) were hypointense compared with surrounding liver tissue. The mean hepatocyte-phase SI ratio of HCCs (0.65 +/- 0.14 [standard deviation]) was significantly lower (P < .01) than that of the nodular pseudolesions (0.95 +/- 0.11). The optimal cutoff value of hepatocyte-phase SI ratio for distinguishing between HCC and nodular pseudolesion was 0.84. No nodular pseudolesions were visible on DW images.. Gadoxetic acid-enhanced hepatocyte-phase MR imaging and DW imaging could be used to distinguish hypervascular pseudolesions from hypervascular HCCs; a hepatocyte-phase SI ratio below 0.84 and visibility on DW images were findings specific for HCCs rather than pseudolesions.

Topics: Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Gadolinium DTPA; Humans; Image Interpretation, Computer-Assisted; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neovascularization, Pathologic; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, X-Ray Computed

The purpose of this report was to describe pseudolesions of the liver that mimicked residual hypervascular hepatocellular carcinoma (HCC), as observed on gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI) obtained shortly after transarterial chemoembolization (TACE). Between June 2008 and December 2008, three patients underwent MRI within 12 days after TACE to rule out remaining viable cancerous tissue or to assess the treatment effect. In all three patients, nontumorous liver tissue adjacent to the treated HCC exhibited focal arterial enhancement on dynamic phase and subsequent diminished uptake of gadoxetate disodium on hepatocellular phase images, which mimicked residual HCC. All three patients had mild postembolization syndrome at the time of EOB-MRI and showed no evidence of residual or recurrent tumors on follow-up. The findings of these areas may represent transient focal hyperemia and damage to the liver cell function caused by TACE. Radiologists should be aware that EOB-MRI obtained shortly after TACE may show pseudolesions around the treated tumors and should not mistake them for residual or recurrent tumors.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Diagnosis, Differential; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Imaging, Three-Dimensional; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Treatment Outcome

Topics: Adult; Aged; Female; Gadolinium DTPA; Humans; Liver; Liver Diseases; Magnetic Resonance Imaging; Male

The purpose of this study was to describe magnetic resonance (MR) findings of focal eosinophilic liver disease using gadoxetic acid (Gd-EOB-DTPA).. Nineteen patients (M:F=14:5; age range, 26-66 years; mean age, 50 years) with 35 focal eosinophilic liver lesions were included after reviewing the medical records of 482 patients who underwent Gd-EOB-DTPA-enhanced MR imaging (MRI) on a 3.0-T unit between April 2008 and June 2009. The diagnosis of focal eosinophilic liver disease was established by means of percutaneous liver biopsy or surgery and consistent clinical findings. Two radiologists retrospectively reviewed MR images with consensus. Margin, shape and distribution of the lesions were analyzed. We also evaluated signal intensity of focal hepatic lesions on T(1)- and T(2)-weighted images and patterns of enhancement in dynamic contrast study.. The mean diameter of the lesions was 1.7 cm (range, 0.7-6.1 cm). Most of the focal eosinophilic liver lesions [n=31/35 (88.6%)] had poorly defined margins. They were usually isointense or slightly hypointense [n=34/35 (97.2%)] on T(1)-weighted images and hyperintense [n=32/35 (91.4%)] on T(2)-weighted images. Dynamic study showed enhancement (rim or homogeneous) on the arterial phase [n=21/35 (60%)] and hypointensity on the late venous phase [n=31/35 (88.6%)]. All the lesions were hypointense on the hepatobiliary phase images.. Focal eosinophilic liver lesions tend to be hyperintense on the arterial phase and hypointense on the late venous phase during dynamic study of Gd-EOB-DTPA-enhanced MRI. Although these findings mimic other focal hepatic lesions, poorly defined margins of the lesions and peripheral eosinophilia might help distinguish focal eosinophilic liver disease from other hepatic lesions.

Topics: Adult; Aged; Biopsy; Contrast Media; Eosinophilia; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies

To qualitatively and quantitatively compare gadoxate-enhanced T 1-weighted MR cholangiography at magnetic field strengths of 1.5 T and 3.0 T.. A total of 40 patients with a non-dilated biliary system were retrospectively included in the study. T 1-weighted MR cholangiography 20 min after IV administration of 0.025 mmol/kg gadoxate (Primovist) was performed in 20 patients at 1.5 T and in another 20 patients at 3.0 T. Contrast-to-noise ratios (CNR) of the biliary system (common bile duct - CBD, right hepatic duct - RHD, left hepatic duct - LHD) compared to the periductal tissue were measured. Two radiologists also qualitatively assessed the visibility of the intrahepatic and extrahepatic biliary system using a six-point rating scale. The Mann-Whitney U-test and Pearson's correlation coefficient were used for statistical analysis.. The CNRs of the intrahepatic and extrahepatic hepatic bile ducts were significantly higher at 3.0 T. Qualitative analysis showed a significant superiority for 3.0 T in the delineation of the intrahepatic biliary system (RHD, LHD, segmental ducts).. Gadoxate-enhanced T 1-w MR cholangiography at 3.0 T offers better delineation of the intrahepatic biliary system in comparison to imaging at 1.5 T.

Topics: Cholangiopancreatography, Magnetic Resonance; Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver Diseases; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity

Gadoxetate Sodium (Gd-EOB-DTPA, EOB) is a new contrast agent for magnetic resonance (MR) imaging that allows both vascular and hepatobiliary imaging in one examination. Often in the arterial phase, however, appropriate scan timing is missed and contrast enhancement is not enough. In addition, to shorten the complete examination, some studies have been conducted to examine scan timing at the hepatobiliary phase earlier than 20 min after injection. We studied the optimal scan timing both at the arterial and the hepatobiliary phase. It was appropriate that multiphase acquisition of MR imaging at the arterial phase should be aimed around 25 sec after injection. Moreover, the liver-spleen contrast ratio (C(L-S)) at the hepatobiliary phase was highest at 60 min after injection, and the acquisition of an image earlier than 20 minutes lowered the C(L-S). In the future, it is desirable to establish how to use Gd-EOB-DTPA (EOB) for hepatic MR imaging after taking the extent of liver damage into consideration.

Topics: Contrast Media; Female; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Male

Discussion at the 2nd Forum for Liver MRI: The International Primovist User Meeting on the use of the hepatocyte-specific contrast agent gadolinium-ethoxybenzyl-diethylene triamine penta-acetic acid (Gd-EOB-DTPA) is reported. Changes to the currently recommended Gd-EOB-DTPA imaging protocol were identified that can reduce the overall examination time. The potential benefits of 3-T MR imaging using Gd-EOB-DTPA have yet to be fully explored. Data show that Gd-EOB-DTPA-enhanced MRI allows identification of liver lesions and provides a differential diagnosis of hepatocellular nodules in the noncirrhotic and cirrhotic liver, based on vascularity, during the dynamic arterial, portal-venous and late phases, and during the hepatocytespecific phase. Current European, American and Japanese guidelines for the diagnosis of hepatocellular carcinoma need to take into account the recent rapid advances in liver imaging. Based on published clinical trials and the experience of the attendees in the use of Gd-EOB-DTPA in liver imaging, a new simplified, non-invasive diagnostic algorithm was proposed that would be applicable to both Eastern and Western clinical practice in the evaluation of hepatocarcinogenesis and hepatocellular carcinoma. Preliminary clinical experience suggests that Gd-EOB-DTPA may also provide an innovative and cost-effective one-stop approach for staging rectal cancer using wholebody imaging.

Topics: Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; International Cooperation; Liver; Liver Diseases; Magnetic Resonance Imaging

Hepatobiliary-specific contrast agents are one of several classes of contrast agents available for magnetic resonance (MR) imaging of the liver. These agents are taken up by functioning hepatocytes and excreted in the bile, and their paramagnetic properties cause shortening of the longitudinal relaxation time (T1) of the liver and biliary tree. The three contrast agents that have been developed are mangafodipir trisodium (Mn-DPDP), gadobenate dimeglumine (Gd-BOPTA), and gadoxetic acid (Gd-EOB-DTPA). These three MR contrast agents vary in mode of administration and dose, mechanism of cellular uptake, degree of excretion through the biliary pathway, and imaging characteristics. In the liver, hepatobiliary-specific agents can be used to improve lesion detection, to characterize lesions as hepatocellular or nonhepatocellular, and to specifically characterize some hepatocellular lesions, notably focal nodular hyperplasia. Biliary excretion of these agents can be used to evaluate the anatomic structure and function of the biliary tree. In the future, hepatobiliary-specific contrast agents may have wider applications, such as grading of cirrhosis and quantification of liver function.

Topics: Bile Ducts; Contrast Media; Edetic Acid; Gadolinium DTPA; Humans; Image Enhancement; Liver; Liver Diseases; Magnetic Resonance Imaging; Meglumine; Organometallic Compounds; Pyridoxal Phosphate

In a field of contrast-enhanced magnetic resonance imaging of the liver, attention has been focused on evaluation of liver function using gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid(EOB). In this study, we examined the possibility of obtaining liver function in only one hepatobiliary phase 60 minutes after injection. First, in regard to the difference between the signal intensity of two materials, we examined the effects of slice gap, surface coil intensity correction(SCIC), and others. Secondly, we compared the difference between liver and spleen signal intensity with biochemical laboratory tests, Child-Pugh class, liver damage class, and the two indices(HH(15) and LHL(15))calculated by 99mTc-DTPA-galactosyl-human serum albumin hepatic scintigraphy in patients with chronic liver diseases. Finally, we designated the "Liver EOB uptake index(L-EOB(60))" from those results, compared with HH(15) and LHL(15). The results demonstrated that the difference between the signal intensity of two materials increased in the lack of slice gap explained by cross talk, and decreased with SCIC. The difference between liver and spleen signal intensity decreased with worsened liver and kidney function. In the case of slice gap >20% and direct bilirubin <0.5 mg/dL without SCIC, the correlation coefficient between L-EOB(60) and LHL(15) was 0.97. L-EOB(60) was strongly proportional to LHL(15). We conclude that L-EOB(60) meeting the above conditions can be employed as a useful index to determine liver function.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium DTPA; Humans; Kidney; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Male; Middle Aged; Spleen

The potential to define liver tumors at magnetic resonance (MR) imaging was compared with a positive and a negative contrast agent (gadoxetic acid disodium, or gadolinium EOB-DTPA [a hepatocyte-directed agent], and ferumoxides, or superpara-magnetic iron oxide particles [a Kupffer cell-directed agent], respectively) in normal rats and in rats with induced acute hepatitis, fatty liver, or cirrhosis.. Rats with implanted liver adenocarcinomas were divided into four groups: no diffuse liver disease ("normal" [n = 6]) and diffuse liver diseases (induced acute hepatitis [n = 6], fatty liver [n = 6], or cirrhosis [n = 6]). Rats first received gadoxetic acid disodium (50 mumol/kg) and then, 45 minutes later, ferumoxides (10 mumol/kg). Liver signal intensity enhancement and tumor-to-liver contrast-to-noise ratio (C/N) were measured in each group.. Mean liver signal intensity enhancement values with gadoxetic acid disodium and ferumoxides were excellent in the normal liver model (176% and -62%, respectively; P < .01) but were significantly reduced in the acute hepatitis model (82% and -36%, respectively). In the fatty livers compared with the normal livers, enhancement with gadoxetic acid disodium was reduced (57%) but with ferumoxides was excellent (-55%). In the cirrhotic livers compared with the normal livers, enhancement with gadoxetic acid disodium (174%) was virtually the same but was impaired with ferumoxides (-43%).. Hepatic enhancement and tumor-to-liver C/N with either positive or negative liver-enhancing agents can be impaired by the presence of underlying liver disease. Prior knowledge of the type of diffuse liver disease may influence the choice of contrast agent for tumor detection.

Topics: Acute Disease; Animals; Contrast Media; Dextrans; Fatty Liver; Female; Ferrosoferric Oxide; Gadolinium DTPA; Hepatitis, Animal; Iron; Liver; Liver Cirrhosis, Experimental; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Neoplasm Transplantation; Organometallic Compounds; Oxides; Pentetic Acid; Radiography; Rats; Rats, Inbred F344

The purpose of this work is to describe our initial clinical experience (in 66 patients) with Resovist and Eovist, two new liver-specific MR contrast agents. We focus our report on safety aspects, dose finding, and optimization and technical parameters. Both contrast agents were well tolerated and improved the detectability of focal liver lesions. With Resovist, postcontrast MRI may be started as early as 10 min following injection. The dose of 8 mumol Fe/kg bodyweight was sufficient to achieve diagnostic tumor-liver contrast levels. Since Eovist can also be administered as a bolus, dynamic enhancement patterns may be studied for tumor characterization as well. Breath-hold T1-weighted FLASH images were superior to other T1-weighted techniques with and without fat saturation.

Topics: Contrast Media; Dextrans; Dose-Response Relationship, Drug; Female; Ferrosoferric Oxide; Gadolinium DTPA; Humans; Iron; Liver; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged; Mononuclear Phagocyte System; Organometallic Compounds; Oxides; Pentetic Acid

The authors investigated whether gadolinium-ethoxybenzyl-DTPA (Gd-EOB-DTPA) can be eliminated in the absence of the two usual excretory pathways (urinary or biliary) and whether a remaining excretory pathway is able to compensate for impaired liver or kidney function.. The study was performed using two groups of animals: group A animals underwent ligation of the common bile duct, and group B animals underwent ligation of the renal blood vessels. A dose of 0.1 mmol/kg Gd-EOB-DTPA or Gd-DTPA (control) was injected via a tail vein. Bile or urine were collected in fractions of 0 to 1, 1 to 2, 2 to 4, and 4 to 8 hours after administration of either contrast agent. At the end of the experiments, detainment of the contrast agents was determined by measurement of Gd concentrations.. Most of the Gd-EOB-DTPA was rapidly cleared from the body: 89.4% +/- 7.5% of the injected dose within 4 hours after bile duct ligation (group A) and 87.0% +/- 6.0% within 1 hour after ligation of renal vessels (group B). Eight hours after injection of Gd-EOB-DTPA, 3.0% +/- 2.4% of the administered dose of this contrast agent was found in the carcasses of group A animals, and 1.3% +/- 0.6% in carcasses of group B animals. By comparison, at 8 hours after injection, 1.9% +/- 3.2% of the injected Gd-DTPA was found in the carcasses of group A animals (no statistical significant difference as compared with Gd-EOB-DTPA), and 96.3% +/- 3.3% in carcasses of group B animals.. In the rat model, the magnetic resonance imaging contrast agent Gd-EOB-DPTA is rapidly and effectively eliminated by virtue of its dual-elimination pathway. The dysfunction of liver or kidney may be fully compensated by the remaining elimination pathway.

Topics: Animals; Bile; Contrast Media; Female; Gadolinium DTPA; Kidney Diseases; Liver Diseases; Organometallic Compounds; Pentetic Acid; Rats; Rats, Wistar

Gadolinium-ethoxybenzyl-DTPA (Gd-EOB-DTPA) is a recently introduced experimental magnetic resonance (MR) contrast agent for hepatic imaging. Although liver enhancement has been investigated in a number of animal models, tolerance evaluations of Gd-EOB-DTPA injection have been limited.. The authors investigated acute hepatotoxicity in an isolated perfused rat liver model, cardiovascular effects in the anesthetized rat, and potential immunogenicity of Gd-EOB-DTPA using detection of specific antibodies.. Using perfused rat liver model, no significant deviation could be observed for functional parameters, liver enzymes, or potassium release, comparing Gd-EOB-DTPA to a control, but there was a significant choleresis (+250% bile flow). Hemodynamic effects of Gd-EOB-DTPA were observed after femoral bolus injection, but only with relatively high dosages (0.3-0.5 mmol/kg, 10-fold the likely clinical dose in humans). Experimental conditions, idealized for antibody induction, failed to cause an IgG immune response to Gd-EOB-DTPA in the intact rat.. The results further support preliminary conclusions that Gd-EOB-DTPA is a well-tolerated MR contrast agent.

Topics: Animals; Bile; Contrast Media; Enzyme-Linked Immunosorbent Assay; Female; Gadolinium DTPA; Hemodynamics; Immunoglobulin G; Liver; Liver Diseases; Magnetic Resonance Imaging; Male; Organometallic Compounds; Pentetic Acid; Rats; Rats, Sprague-Dawley

Gadolinium (4s)-4-(4-ethoxybenzyl-3,6,9-tris(carboxylato-methyl)-3,6,9- triazaudecandioic acid (EOB) diethylenetriaminepentaacetic acid (DTPA), a hepatocellular-directed magnetic resonance (MR) contrast agent, and coated superparamagnetic iron oxide particles (SPIO), a Kupffer cell-directed contrast agent, were compared for uptake and enhancement in a rodent model of radiation-induced liver injury. A single x-irradiation exposure (50-70 Gy) was delivered to one side of the liver in 18 rats. MR imaging was performed 3 days after x irradiation with sequential injections of the two contrast agents in the same rats. Additionally, biliary excretion of Gd-EOB-DTPA was quantified after whole-liver irradiation in five rats. Electron microscopy of the irradiated liver demonstrated mitochondrial injury in both hepatocyte and Kupffer cell populations. With Gd-EOB-DTPA, however, liver enhancement and biliary excretion were not affected by irradiation. Uptake of SPIO was decreased in the irradiated portion of the liver, with a precise demarcation between irradiated and nonirradiated zones at MR imaging.

Topics: Animals; Dextrans; Female; Ferrosoferric Oxide; Gadolinium DTPA; Iron; Liver; Liver Diseases; Magnetic Resonance Imaging; Magnetite Nanoparticles; Mononuclear Phagocyte System; Organometallic Compounds; Oxides; Pentetic Acid; Radiation Injuries, Experimental; Rats; Rats, Inbred Strains