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Yang R, Chen Z, Pan J, Yang S, Hu F. Non-contrast T1ρ dispersion versus Gd-EOB-DTPA-enhanced T1mapping for the risk stratification of non-alcoholic fatty liver disease in rabbit models. Magn Reson Imaging 2024; 107:130-137. [PMID: 38278311 DOI: 10.1016/j.mri.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To investigate the diagnostic efficacy of T1ρ dispersion and Gd-EOB-DTPAenhanced T1mapping in the identification of early liver fibrosis (LF) and non-alcoholic steatohepatitis (NASH) in a non-alcoholic fatty liver disease (NAFLD) rabbit model induced by a high-fat diet using histopathological findings as the standard reference. METHODS A total of sixty rabbits were randomly allocated into the standard control group (n = 12) and the NAFLD model groups (8 rabbits per group) corresponding to different high-fat high cholesterol diet feeding weeks. All rabbits underwent noncontrast transverse T1ρ mapping with varying spin-locking frequencies (FSL = 0 Hz and 500 Hz), native T1 mapping, and Gd-EOB-DTPA-enhanced T1 mapping during the hepatobiliary phase. The histopathological findings were assessed based on the NASH CRN Scoring System. Statistical analyses were conducted using the intraclass correlation coefficient, analysis of variance, multiple linear regression, and receiver operating characteristics. RESULTS Except for native T1, T1ρ, T1ρ dispersion, HBP T1, and △T1 values significantly differed among different liver fibrosis groups (F = 14.414, 18.736, 10.15, and 9.799, respectively; all P < 0.05). T1ρ, T1ρ dispersion, HBP T1, and △T1 values also exhibited significant differences among different NASH groups (F = 4.138, 4.594, 21.868, and 22.678, respectively; all P < 0.05). In the multiple regression analysis, liver fibrosis was the only factor that independently influenced T1ρ dispersion (R2 = 0.746, P = 0.000). Among all metrics, T1ρ dispersion demonstrated the best area under curve (AUC) for identifying early LF (≥ F1 stage) and significant LF (≥ F2 stage) (AUC, 0.849 and 0.916, respectively). The performance of △T1 and HBP T1 (AUC, 0.948 and 0.936, respectively) were better than that of T1ρ and T1ρ dispersion (AUC, 0.762 and 0.769, respectively) for diagnosing NASH. CONCLUSION T1⍴ dispersion may be suitable for detecting liver fibrosis in the complex background of NAFLD, while Gd-EOB-DTPA enhanced T1 mapping is superior to nonenhanced T1⍴ mapping (T1⍴ and T1⍴ dispersion) for identifying NASH.
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Affiliation(s)
- Ru Yang
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, No.278, Baoguang Road, Xindu District, Chengdu, Sichuan, China
| | - Zhongshan Chen
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, No.278, Baoguang Road, Xindu District, Chengdu, Sichuan, China
| | - Jin Pan
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, No.278, Baoguang Road, Xindu District, Chengdu, Sichuan, China
| | - Shimin Yang
- Shanghai United Imaging Healthcare Co., Ltd., No.2258, Chengbei Road, Shanghai, China
| | - Fubi Hu
- Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, No.278, Baoguang Road, Xindu District, Chengdu, Sichuan, China.
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Amorim VB, Parente DB, Paiva FF, Oliveira Neto JA, Miranda AA, Moreira CC, Fernandes FF, Campos CFF, Leite NC, Perez RDM, Rodrigues RS. Can gadoxetic acid–enhanced magnetic resonance imaging be used to avoid liver biopsy in patients with nonalcoholic fatty liver disease? World J Hepatol 2020; 12:661-671. [PMID: 33033571 PMCID: PMC7522564 DOI: 10.4254/wjh.v12.i9.661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/29/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. The diagnosis of nonalcoholic steatohepatitis (NASH), the most severe form of NAFLD, is crucial and has prognostic and therapeutic implications. However, currently this diagnosis is based on liver biopsy and has several limitations.
AIM To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging (GA-MRI) in differentiating isolated steatosis from NASH in patients with NAFLD.
METHODS In this prospective study, 56 patients with NAFLD (18 with isolated steatosis and 38 with NASH) underwent GA-MRI. The contrast enhancement index (CEI) was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA administration. Between-group differences in mean CEI were examined using Student's t test. The area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were evaluated.
RESULTS The mean CEI for all subjects was 1.82 ± 0.19. The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis (P = 0.008). Two CEI cut-off points were used: < 1.66 (94% specificity) to characterize NASH and > 2.00 (89% sensitivity) to characterize isolated steatosis. CEI values between 1.66 and 2.00 indicated liver biopsy, and the procedure could be avoided in 40% of patients with NAFLD.
CONCLUSION GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis, and could help to avoid liver biopsy in patients with NAFLD.
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Affiliation(s)
- Viviane Brandão Amorim
- Research Department, D’Or Institute for Research and Education, Rio de Janeiro 22281, Brazil
- Radiology Department, Brazilian National Cancer Institute, Rio de Janeiro 20230-130, Brazil
- Radiology Department, Fleury Group S.A., Rio de Janeiro 20765-000, Brazil
| | - Daniella Braz Parente
- Research Department, D’Or Institute for Research and Education, Rio de Janeiro 22281, Brazil
- Radiology Department, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
| | | | - Jaime Araújo Oliveira Neto
- Research Department, D’Or Institute for Research and Education, Rio de Janeiro 22281, Brazil
- Radiology Department, Quinta D'Or Hospital, Rio de Janeiro 20941-150, Brazil
| | - Amanda Almeida Miranda
- Radiology Department, Centro de Diagnóstico Médico do Maranhão, Maranhão 65074-441, Brazil
| | - Cláudia Cravo Moreira
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
| | - Flávia Ferreira Fernandes
- Gastroenterology and Hepatology Department, Hospital Federal de Bonsucesso, Rio de Janeiro 21041-030, Brazil
| | | | - Nathalie Carvalho Leite
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
| | - Renata de Mello Perez
- Research Department, D’Or Institute for Research and Education, Rio de Janeiro 22281, Brazil
- Internal Medicine Department, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
- Gastroenterology Department, Hospital Universitário Pedro Ernesto, University of the State of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
| | - Rosana Souza Rodrigues
- Research Department, D’Or Institute for Research and Education, Rio de Janeiro 22281, Brazil
- Radiology Department, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
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How Do Different Indices of Hepatic Enhancement With Gadoxetic Acid Compare in Predicting Liver Failure and Other Major Complications After Hepatectomy? J Comput Assist Tomogr 2018; 42:380-386. [DOI: 10.1097/rct.0000000000000691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Ba-Ssalamah A, Bastati N, Wibmer A, Fragner R, Hodge JC, Trauner M, Herold CJ, Bashir MR, Van Beers BE. Hepatic gadoxetic acid uptake as a measure of diffuse liver disease: Where are we? J Magn Reson Imaging 2016; 45:646-659. [PMID: 27862590 DOI: 10.1002/jmri.25518] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
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. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:646-659.
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Affiliation(s)
- Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Nina Bastati
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, General Hospital of Vienna (AKH), Austria
| | - Andreas Wibmer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Romana Fragner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, General Hospital of Vienna (AKH), Austria
| | - Christian J Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Mustafa R Bashir
- Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, UMR 1149, INSERM - University Paris Diderot and Department of Radiology, University Hospital Paris Nord - Beaujon, France
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Schwope RB, May LA, Reiter MJ, Lisanti CJ, Margolis DJA. Gadoxetic acid: pearls and pitfalls. ACTA ACUST UNITED AC 2016; 40:2012-29. [PMID: 25613332 DOI: 10.1007/s00261-015-0354-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Ryan B Schwope
- Department of Radiology, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA,
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Bastati N, Feier D, Wibmer A, Traussnigg S, Balassy C, Tamandl D, Einspieler H, Wrba F, Trauner M, Herold C, Ba-Ssalamah A. Noninvasive differentiation of simple steatosis and steatohepatitis by using gadoxetic acid-enhanced MR imaging in patients with nonalcoholic fatty liver disease: a proof-of-concept study. Radiology 2014; 271:739-47. [PMID: 24576046 DOI: 10.1148/radiol.14131890] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine whether gadoxetic acid-enhanced magnetic resonance (MR) imaging can be used to distinguish between simple steatosis and nonalcoholic steatohepatitis (NASH) in patients with nonalcoholic fatty liver disease (NAFLD), defined according to the steatosis activity and fibrosis (SAF) scoring system, which is based on the semiquantitative scoring of steatosis activity and liver fibrosis. MATERIALS AND METHODS The local institutional review committee approved this study and waived written informed consent. This was a retrospective study of gadoxetic acid-enhanced 3-T MR imaging performed in 81 patients with NAFLD (45 men [56%]; mean age, 56 years; range, 25-78 years). The MR images were analyzed by using the relative enhancement (the ratio of signal intensities of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid). Univariate and multiple regression analyses were applied to identify variables associated with relative enhancement measurements. The ability of relative enhancement to allow differentiation between simple steatosis and NASH was assessed by using area under the receiver operating characteristic (ROC) curve analysis. RESULTS Relative enhancement negatively correlated with the degree of lobular inflammation (r = -0.59, P < .0001), ballooning (r = -0.44, P < .0001), and fibrosis (r = -0.59, P ≤ .0001), but not with steatosis (r = -0.16, P = .15). Patients with NASH had a significantly lower relative liver enhancement (0.82 ± 0.22) than those with simple steatosis (1.39 ± 0.52) (P < .001). Relative enhancement measurements performed well in the differentiation between simple steatosis and NASH, with an area under the ROC curve of 0.85 (95% confidence interval: 0.75, 0.91) (cutoff = 1.24, sensitivity = 97%, specificity = 63%). CONCLUSION Gadoxetic acid relative enhancement was significantly lower in patients with NASH than in patients with simple steatosis, but further prospective studies are warranted.
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Affiliation(s)
- Nina Bastati
- From the Department of Radiology (N.B., D.F., A.W., C.B., D.T., H.E., C.H., A.B.S.), Division of Gastroenterology and Hepatology, Department of Internal Medicine III (S.T., M.T.), and Department of Pathology (F.W.), Medical University Vienna, General Hospital of Vienna, Vienna, Austria
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Ding Y, Rao SX, Meng T, Chen C, Li R, Zeng MS. Usefulness of T1 mapping on Gd-EOB-DTPA-enhanced MR imaging in assessment of non-alcoholic fatty liver disease. Eur Radiol 2014; 24:959-66. [PMID: 24463697 DOI: 10.1007/s00330-014-3096-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/18/2013] [Accepted: 01/10/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study evaluates the value of Gd-EOB-DTPA-enhanced MRI for diagnosis and staging of non-alcoholic fatty liver disease (NAFLD) in an animal model by T1 relaxation time measurement. METHODS Thirty-four rabbits were divided into the control group (n = 10) and NAFLD group, which was split into four groups (n = 6) with a high-fat diet for an interval of 3 weeks. A dual flip angle was performed before and at the hepatobiliary phase (HBP). T1 relaxation times of the liver parenchyma and the decrease rate (∆%) were calculated. Histological findings according to semi-quantitative scoring of steatosis, activity and fibrosis were the standard of reference. RESULTS HBP and ∆% T1 relaxation time measurement showed significant differences between normal and NAFLD groups, between non-alcoholic steatohepatitis (NASH) and NAFLD without NASH (p = 0.000-0.049), between fibrosis groups (p = 0.000-0.019), but no difference between F1 and F2 (p = 0.834). The areas under the receiver operating characteristic curves (AUCs) of T1 relaxation time for HBP and ∆% were 0.86-0.93 for the selection of NASH and activity score ≥2, and 0.86-0.95 for the selection of F ≥ 1, 2, 3. No significant difference was found for diagnostic performance between HBP and ∆% T1 relaxation time. CONCLUSIONS HBP T1 relaxation time measurement of Gd-EOB-DTPA-enhanced MRI was useful to evaluate NAFLD according to the SAF score. HBP T1 relaxation time measurement was as accurate as ∆% T1 relaxation time. KEY POINTS • Gd-EOB-DTPA-enhanced MRI could give useful information on NAFLD. •HBP T 1 relaxation time measurement was useful for the evaluation of NAFLD. • HBP T 1 relaxation time measurement was as accurate as ∆%.
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Affiliation(s)
- Ying Ding
- Department of Radiology, Zhongshan/Hospital of Fudan University, No 180/Fenglin Road, Xuhui District, Shanghai, China, 200032,
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Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A. Liver Failure after Major Liver Resection: Risk Assessment by Using Preoperative Gadoxetic Acid–enhanced 3-T MR Imaging. Radiology 2013. [DOI: 10.1148/radiology.13130210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wibmer A, Prusa AM, Nolz R, Gruenberger T, Schindl M, Ba-Ssalamah A. Liver failure after major liver resection: risk assessment by using preoperative Gadoxetic acid-enhanced 3-T MR imaging. Radiology 2013; 269:777-86. [PMID: 23942606 DOI: 10.1148/radiol.13130210] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine if gadoxetic acid-enhanced magnetic resonance (MR) imaging with measurement of relative liver enhancement (RLE) on hepatobiliary phase images can allow preoperative assessment of the risk of liver failure after major liver resection. MATERIALS AND METHODS The local institutional review committee approved this retrospective analysis and waived written informed consent. The study included 73 patients (39 men; median age, 64.4 years) who underwent gadoxetic acid-enhanced 3-T MR imaging before resection of three or more liver segments. RLE was calculated as the ratio of signal intensity measurements of the liver parenchyma before and 20 minutes after intravenous administration of gadoxetic acid. RLE was assessed in each liver segment and the mean value of all segments was used for analysis. Posthepatectomy liver failure was defined according to the "50-50 criteria" (ie, prothrombin time <50% and serum bilirubin >50 µmol/L on postoperative day 5) and the International Study Group of Liver Surgery (ISGLS) classification. The association of RLE and liver failure was tested with univariate and multivariate logistic regression analysis. In addition to RLE, the latter also included demographic, clinical, operative, and histologic variables. RESULTS Patients with liver failure according to the 50-50 criteria (n = 3) had significantly lower RLE (54.5%) than those without (125.6%) (P = .009). According to ISGLS criteria, RLE was 112.5% in patients with grade A liver failure (n = 20), 88.4% in patients with grade B (n = 7), 41.7% (n = 2) in patients with grade C, and 136.5% (P < .001) in those without liver failure. In a logistic regression analysis, RLE was inversely related to the probability of liver failure according to the 50-50 (P = .02) and ISGLS (P < .001) criteria. In a multivariate analysis, RLE was independently associated with a higher probability of liver failure according to ISGLS classification (P = .003). CONCLUSION Gadoxetic acid-enhanced MR imaging can help with the assessment of the risk for liver failure after major liver resection.
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Affiliation(s)
- Andreas Wibmer
- From the Departments of Radiology (A.W., R.N., A.B.S.) and Surgery (A.M.P., T.G., M.S.), Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Onishi H, Theisen D, Dietrich O, Reiser MF, Zech CJ. Hepatic steatosis: effect on hepatocyte enhancement with gadoxetate disodium-enhanced liver MR imaging. J Magn Reson Imaging 2013; 39:42-50. [PMID: 24339365 DOI: 10.1002/jmri.24136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/26/2013] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To investigate the effect of hepatic steatosis on enhancement of liver parenchyma with gadoxetate disodium-enhanced MR imaging. MATERIALS AND METHODS Gadoxetate disodium-enhanced MR images of 166 patients were analyzed. Liver-spleen contrast and liver-spleen relative enhancement ratio on three-dimensional gradient echo T1-weighted images with fat suppression 20 minutes after injection of gadoxetate disodium were evaluated in correlation with fat signal fraction using the Pearson correlation coefficient and also compared between patients with normal liver parenchyma (n = 115) and with liver steatosis (n = 51) using the Student t-test. RESULTS The liver-spleen contrast at hepatobiliary phase showed inverse correlations with the fat signal fraction (r = -0.36; P < 0.01), while the liver-spleen relative enhancement ratio showed no statistical correlation with the fat signal fraction (P = 0.80). The liver-spleen contrast in the group with steatotic liver was significantly lower than that in the group with normal livers (P < 0.001). There was no significant difference in the relative enhancement ratio between the two groups (P = 0.85). CONCLUSION Our results may suggest that hepatic steatosis does not affect the uptake of gadoxetate disodium into hepatocytes and are considered crucial as background knowledge in extending the use of gadoxetate disodium-enhanced MR imaging to quantitate liver function.
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Affiliation(s)
- Hiromitsu Onishi
- Institute for Clinical Radiology, Ludwig Maximilians-University Hospital Munich, Germany; Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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Wu Z, Matsui O, Kitao A, Kozaka K, Koda W, Kobayashi S, Ryu Y, Minami T, Sanada J, Gabata T. Usefulness of Gd-EOB-DTPA-enhanced MR imaging in the evaluation of simple steatosis and nonalcoholic steatohepatitis. J Magn Reson Imaging 2012; 37:1137-43. [PMID: 23172731 DOI: 10.1002/jmri.23921] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/27/2012] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MR imaging (EOB-MRI) in differentiating between simple steatosis and nonalcoholic steatohepatitis (NASH), as compared with MR in-phase/out-of-phase imaging. The correlations between the MR features and histological characteristics were preliminarily investigated. MATERIALS AND METHODS From April 2008 to October 2011, 25 patients (13 simple steatosis and 12 NASH) who underwent both EOB-MRI and in-phase/out-of-phase imaging were analyzed. The hepatobiliary-phase enhancement ratio and signal intensity loss on opposed-phase T1-weighted images (fat fraction) were compared between the simple steatosis and NASH groups. In the simple steatosis and NASH groups, the correlations between enhancement ratio and histological grade/stage were explored. In the NASH group, fat fraction was correlated with the steatosis score. RESULTS The enhancement ratio in NASH was significantly lower than that in simple steatosis (P = 0.03). In the simple steatosis and NASH groups, the enhancement ratio was significantly correlated with the fibrosis stage (r = -0.469, P = 0.018). Fat fraction in NASH was strongly correlated with the steatosis score (r = 0.728, P = 0.007). CONCLUSION In simple steatosis and NASH, the hepatobiliary-phase enhancement ratio of EOB-MRI showed significant association with fibrosis stage, and may be a useful discriminating parameter compared with the fat fraction measured by in-phase/out-of-phase imaging.
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Affiliation(s)
- Zhuo Wu
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
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Miyaaki H, Ichikawa T, Taura N, Miuma S, Kawaguchi M, Kohno R, Isomoto H, Takeshima F, Nakashima O, Nakao K. Imaging of focal nodular hyperplastic-like nodules in alcoholic liver cirrhosis patients using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging. Clin J Gastroenterol 2011; 4:266-272. [PMID: 26189532 DOI: 10.1007/s12328-011-0244-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 06/14/2011] [Indexed: 10/18/2022]
Abstract
We report on two patients with a history of alcohol abuse who presented with multiple hepatic nodules. Dynamic computed tomography revealed multiple nodular lesions, which were enhanced at the early contrast phase and washed out at the portal phase. In the hepatobiliary phase using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA MRI), these tumors did not show any uptake, thus suggesting the presence of hepatocellular carcinoma. An ultrasound-guided biopsy revealed a slight increase in cell density, sinusoidal dilatation, and contained unpaired small arteries. According to immunohistochemical analyses, these arteries were positive for CD34 and alpha-smooth muscle actin. From these findings, the nodules were diagnosed to be focal nodular hyperplastic (FNH)-like nodules arising in alcoholic-cirrhosed livers. The differential diagnosis of FNH-like nodules arising in alcoholic liver cirrhosis and hepatocellular carcinoma is difficult with Gd-EOB-DTPA MRI, and therefore histological confirmation is necessary.
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Affiliation(s)
- Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Tatsuki Ichikawa
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Naota Taura
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Satoshi Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Makiko Kawaguchi
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Ryota Kohno
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hajime Isomoto
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Osamu Nakashima
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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