Can the biliary enhancement of Gd-EOB-DTPA predict the degree of liver function?
BACKGROUND
Excretion of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) in the bile may be related to liver function, because of elimination from the liver after preferential uptake by hepatocytes. The purpose of this study was to investigate the relation between liver and biliary enhancement in patients with or without liver dysfunction, and to compare the tumor-to-liver contrast in these patients.


METHODS
Forty patients [group 1: normal liver and Child-Pugh class A in 20 patients, group 2: Child-Pugh class B in 18 patients and Child-Pugh C in 2] were evaluated. All patients underwent MR imaging of the liver using a 1.5-Tesla system. T1-weighted 3D images were obtained at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA injection. The relation between group 3 (total bilirubin <1.8 mg/dL) and group 4 (total bilirubin ≥1.8 mg/dL) was investigated at 20 minutes. Liver and biliary signals were measured, and compared between groups 1 and 2 or groups 3 and 4. Tumor-to-liver ratio was also evaluated between groups 1 and 2. Scheffe's post-hoc test after two-way repeated-measures ANOVA and Pearson's correlation test were used for statistical analysis.


RESULTS
Liver enhancement showed significant difference at all time points between groups 1 and 2. Biliary enhancement did not show a significant difference between groups 1 and 2 at 5 minutes, but did at 10, 15 and 20 minutes. At 20 minutes, significant differences between groups 3 and 4 were seen for liver and biliary enhancement. At all time points, liver enhancement correlated with biliary enhancement in both groups. At 5 minutes and 20 minutes, statistical differences between groups 1 and 2 were seen for tumor-to-liver ratio.


CONCLUSIONS
The degree of biliary enhancement has a close correlation to that of liver enhancement. It is especially important that insufficient liver enhancement causes lower tumor-to-liver contrast in the hepatobiliary phase of Gd-EOB-DTPA.
Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan. mokada@gaia.eonet.ne.jp
Masahiro
M
Okada
Kazunari
K
Ishii
Kazushi
K
Numata
Tomoko
T
Hyodo
Seishi
S
Kumano
Masayuki
M
Kitano
Masatoshi
M
Kudo
Takamichi
T
Murakami
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001652:Bile Ducts / Q000378:metabolism / Q000473:pathology*; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage / Q000493:pharmacokinetics; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage / Q000493:pharmacokinetics; D005919:Glomerular Filtration Rate; D006801:Humans; D007262:Infusions, Intravenous; D007564:Japan; D008099:Liver / Q000378:metabolism / Q000473:pathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
D015415:Biomarkers; D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA; D001663:Bilirubin