title: Visual assessment of biliary excretion of Gd-EOB-DTPA in patients with suspected diffuse liver disease - A biopsy-verified prospective study.
abstract: OBJECTIVE
  To qualitatively evaluate late dynamic contrast phases, 10, 20 and 30 min, after administration of Gd-EOB-DTPA with regard to biliary excretion in patients presenting with elevated liver enzymes without clinical signs of cirrhosis or hepatic decompensation and to compare the visual assessment of contrast agent excretion with histo-pathological fibrosis stage, contrast uptake parameters and blood tests.
  
  
  METHODS
  29 patients were prospectively examined using 1.5 T MRI. The visually assessed presence or absence of contrast agent for each of five anatomical regions in randomly reviewed time-series was summarized on a four grade scale for each patient. The scores, including a total visual score, were related to the histo-pathological findings, the quantitative contrast agent uptake parameters, expressed as K Hep or LSC_N, and blood tests.
  
  
  RESULTS
  No relationship between the fibrosis grade or contrast uptake parameters could be established. A negative correlation between the visual assessment and alkaline phosphatase (ALP) was found. Comparing a sub-group of cholestatic patients with fibrosis score and Gd-EOB-DTPA dynamic parameters did not add any additional significant correlation.
  
  
  CONCLUSIONS
  No correlation between visually assessed biliary excretion of Gd-EOB-DTPA and histo-pathological or contrast uptake parameters was found. A negative correlation between the visual assessment and alkaline phosphatase (ALP) was found.
authors.affiliation: Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences (IMH) and Radiology, Linköping University, Linköping, Sweden; Department of Radiology, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Norén
authors.affiliation: Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences (IMH) and Radiology, Linköping University, Linköping, Sweden; Department of Radiology, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Dahlström
authors.affiliation: Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Wolfram MathCore AB, Linköping SE-58330, Sweden; Department of Medical and Health Sciences (IMH) and Radiation Physics, Linköping University, Linköping, Sweden; Department of Radiation Physics, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Mikael Fredrik
authors.initials: MF
authors.lastname: Forsgren
authors.affiliation: Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences (IMH) and Radiation Physics, Linköping University, Linköping, Sweden; Department of Radiation Physics, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Dahlqvist Leinhard
authors.affiliation: Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden; Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden.
authors.forename: Stergios
authors.initials: S
authors.lastname: Kechagias
authors.affiliation: Karolinska Institutet, Department of Medicine, 171 76 Stockholm, Sweden; GastroCentrum, Division of Gastroenterology and Hepatology, Karolinska University Hospital, 141 86 Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Almer
authors.affiliation: Department of Medical and Health Sciences (IMH) and Radiology, Linköping University, Linköping, Sweden; Department of Radiology, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Wirell
authors.affiliation: Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences (IMH) and Radiology, Linköping University, Linköping, Sweden; Department of Radiology, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Smedby
authors.affiliation: Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Medical and Health Sciences (IMH) and Radiation Physics, Linköping University, Linköping, Sweden; Department of Radiation Physics, UHL, County Council of Östergotland, Linköping, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Lundberg
keywords: AAT deficiency, α1-antitrypsin deficiency; AIH, autoimmune hepatitis; ALP, alkaline phosphatase; ALT, alanine aminotransferase; AUROC, area under the receiver operating characteristic curve; Bile; CLD, chronic liver disease; DCE-MRI, Dynamic Contrast Enhanced Magnetic Resonance Imaging; DILI, drug induced liver injury; Dynamic contrast enhanced MRI; Excretion; FA, flip angle; Gd-EOB-DTPA; Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid; HCV, hepatitis C; KHep, contrast uptake rate; LSC_N, normalised liver-to-spleen contrast ratio; Liver; MANA, multi scale adaptive normalizing averaging; MRP, multidrug resistance protein; NAFLD, non-alcoholic fatty liver disease; OATP, organic anion transporting polypeptides; PSC, primary sclerosing cholangitis; RE, relative enhancement; SNR, signal to noise ratio