title: Development and validation of a predictor of insufficient enhancement during the hepatobiliary phase of Gd-EOB-DTPA-enhanced magnetic resonance imaging.
abstract: 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.
authors.affiliation: 1 Jinan University, Guangzhou, Guangdong, PR China.|2 Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China.|3 Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China.
authors.forename: Enming
authors.initials: E
authors.lastname: Cui
authors.affiliation: 1 Jinan University, Guangzhou, Guangdong, PR China.|3 Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China.
authors.forename: Wansheng
authors.initials: W
authors.lastname: Long
authors.affiliation: 1 Jinan University, Guangzhou, Guangdong, PR China.|2 Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China.
authors.forename: Liangping
authors.initials: L
authors.lastname: Luo
authors.affiliation: 3 Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China.
authors.forename: Maoqing
authors.initials: M
authors.lastname: Hu
authors.affiliation: 3 Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China.
authors.forename: Liebin
authors.initials: L
authors.lastname: Huang
authors.affiliation: 3 Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong, PR China.
authors.forename: Xiangmeng
authors.initials: X
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Liver function test; gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA); liver disease; magnetic resonance imaging (MRI)