Clinical factors predictive of insufficient liver enhancement on the hepatocyte-phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging in patients with liver cirrhosis.
BACKGROUND
Estimating liver parenchymal enhancement prior to gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging is crucial to accurate detection and characterization of focal hepatic lesions. We aimed to clarify the factors predictive of liver enhancement in a relatively large sample of patients.


METHODS
Gd-EOB-DTPA-enhanced MR images of 328 patients with liver cirrhosis (Child-Pugh class A in 223 patients, class B in 71 patients, and class C in 34 patients) were analyzed retrospectively. The liver parenchymal signal intensity (SI) was measured in pre-contrast T1-weighted images and hepatocyte phase images. The relative enhancement (RE) was calculated: (hepatocyte phase SI-pre-contrast SI)/pre-contrast SI. We analyzed the correlation between hepatic function parameters and RE.


RESULTS
RE of patients with Child-Pugh A cirrhosis was significantly higher than that of patients with Child-Pugh B or C cirrhosis (both P < 0.001). Among various clinical factors, platelet count, prothrombin activity, albumin, sodium, total bilirubin, aspartate aminotransferase, Model for End-stage Liver Disease (MELD) score, MELD-Na score, Child-Pugh score, and the presence of ascites were significantly correlated with RE. A multiple stepwise regression analysis revealed that MELD-Na, albumin, and the presence of ascites were the only factors that predicted liver parenchymal enhancement on hepatocyte-phase images.


CONCLUSIONS
The degree of liver parenchymal enhancement after Gd-EOB-DTPA administration was correlated with liver function parameters. Gd-EOB-DTPA-enhanced MR images require careful interpretation, particularly in patients with cirrhosis and clinical factors such as high MELD-Na score, hypoalbuminemia, or ascites.
Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, #505 Banpo-Dong, Seocho-Gu, Seoul, 137-040, Korea.
Hee Yeon
HY
Kim
Jong Young
JY
Choi
Chung-Hwa
CH
Park
Myeong Jun
MJ
Song
Do Seon
DS
Song
Chang Wook
CW
Kim
Si Hyun
SH
Bae
Seung Kew
SK
Yoon
Young Joon
YJ
Lee
Sung Eun
SE
Rha
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019786:Gadolinium DTPA; D022781:Hepatocytes / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies
C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA