Quantitative evaluation of liver function with T1 mapping of MRI using Gd-EOB-DTPA

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1 Quantitative evaluation of liver function with T1 mapping of MRI using Gd-EOB-DTPA Poster No.: C-2592 Congress: ECR 2012 Type: Scientific Exhibit Authors: K. KAMIMURA, Y. Fukukura, A. Umanodan, A. Tateyama, Y. Kumagae, T. Shindo, K. Takumi, T. Yoneyama, M. Nakajo; Kagoshima/JP Keywords: DOI: Cirrhosis, Imaging sequences, Contrast agent-intravenous, MR, Liver, Contrast agents, Abdomen /ecr2012/C-2592 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9

2 Purpose The purpose of this study is to develop a noninvasive method of quantitation of the hepatic function using T1 mapping of the parenchymal enhancement of hepatocytephase imaging in Gd-EOB-DTPA-enhanced MR imaging to compare various biological markers of the liver. Methods and Materials Patient Selection From October 2009 to May 2010, 117 consecutive patients underwent Gd-EOB-DTPAenhanced MRI (EOB-MRI) for evaluation of suspected liver tumors. Among these patients, 64 patients (43 men, 21 women; age range, years; mean, 67.6 years) who had the ICG tests and blood examinations (i.e., AST, ALT, ChE, T-Bil, Alb, %PT) not more than 1 month before MR imaging, were enrolled in this study. Of these 64 patients, 32 patients had normal liver function and 32 had liver cirrhosis. The underling causes of liver cirrhosis were hepatitis C (n=22), hepatitis B (n=10). Imaging Protocols MR examinations were performed using a 3T MR scanner (Magnetom Trio; Siemens AG, Erlangen, Germany) with a fast gradient system (peak gradient amplitude, 45 mt/m; slew rate, 200 T/m/s). Standard sequences performed prior to dynamic EOB-MRI were T1-weighted GRE, T2-weighted TSE, and fat-suppressed T2-weighted TSE sequences (Table. 1). T1 mapping before and 20 min after Gd-EOB-DTPA administration were added to our routine MR imaging protocol of the liver. For T1 mapping, T1-weighted VIBE with varying flip angles sequence with the following parameters was used: TR/TE, 3.39/1.46; slice thickness, 5 mm; number of partitions, 60; bandwidth, 510 Hz/pixel; FOV, 350 x 280 mm; matrix, 128 x 102; no slice acceleration factor; acquisition time, 20 sec. The sequence was performed twice, using flip angles of 3 and 17 corresponding to an estimated T1 of 400 msec. For T1 relaxation time assessment of the liver, spleen, and paraspinal muscle and a ROI with a range of 1 to 2 cm was drawn from the same axial image manually in the liver, spleen, and paraspinal muscle on T1 mapping images obtained before and 20 min after Gd-EOB-DTPA administration. Four ROIs were sparsely placed in both lobes of liver and Page 2 of 9

3 spleen parenchyma without focal hepatic lesions, vessels, or imaging artifacts (Figures 1 and 2). For reproducible ROIs before and after Gd-EOB-DTPA administration, every effort was made to place ROIs at the same positions in the liver of each patient. Mean T1 relaxation time for the 4 ROIs were considered as the representative T1 relaxation time for the liver. Mean T1 relaxation time for the ROI were considered as the representative T1 relaxation time for the spleen and paraspinal muscle. Statistical analysis Multiple stepwise regression analysis was used to define the best predictors of the liver T1 value ratio about the liver biological makers. Correlation between the liver T1 value ratio and the change of the ICG R15 were analyzed with Pearson's correlation coefficient. Images for this section: Table 1: Sequence Parameters Page 3 of 9

4 Fig. 1: Images from a 76-year-old man with normal liver function with suspected focal liver lesion. Aspirate aminotransferase (29 IU/l), alanine aminotransferase (15 IU/l), cholinesterase (214 IU/l), total bilirubin (1.1 mg/dl), albumin (3.9 g/dl), prothrombin time (100%), and ICG R15 (6.7%).. a-b, T1 mapping images calculated from a 3D FLASH with varying flip angles sequence (TR/TE = 3.39 ms/1.46 ms, flip angles, 3 and 17 ) were obtained before Gd-EOB-DTPA administration (a) and at 20min (b) after administration. The circles placed in (a) are an example of the placement of a region of interest (ROI) for T1 relaxation time measurements of the liver in anterior and posterior segments in the right lobe and medial and lateral segments in the left lobe, and spleen (other level, not shown) parenchyma and paraspinal muscle, respectively. T1 relaxation time of liver parenchyma decrease with time after Gd-EOB-DTPA administration. At 20 min after Gd- EOB-DTPA administration, hepatic parenchyma shows homogeneous enhancement (b). Precontrast T1 relaxation time was 522 ms and postcontrast T1 relaxation time at 20 min was 214 ms. Page 4 of 9

5 Fig. 2: Images from a 77-year-old woman with viral hepatitis C-induced cirrhosis.. Aspirate aminotransferase (76 IU/l), alanine aminotransferase (70 IU/l), cholinesterase (96 IU/l), total bilirubin (2.5 mg/dl), albumin (2.1 g/dl), prothrombin time (60%), and ICG R15 (66.5%). a-b, T1 mapping images calculated from a 3D FLASH with varying flip angles sequence (TR/TE = 3.39 ms/1.46 ms, flip angles, 3 and 17 ) were obtained before Gd-EOB-DTPA administration (a) and at 20min (b) after administration. The circles placed in (a) are an example of the placement of a region of interest (ROI) for T1 relaxation time measurements of the liver in anterior and posterior segments in the right lobe and medial and lateral segments in the left lobe, and spleen (other level, not shown) parenchyma and paraspinal muscle, respectively. T1 relaxation time of liver parenchyma decrease with time after Gd-EOB-DTPA administration. At 20 min after Gd-EOB-DTPA administration, hepatic parenchyma shows homogeneous enhancement (b). Precontrast T1 relaxation time was 523 ms and postcontrast T1 relaxation time at 20 min was 296 ms. Page 5 of 9

6 Results The independent factors for increased liver T1 value ratio were ICG R15 (P < ) and total bilirubin level (P = , Table 2). Other factors were not significantly associated with liver T1 value ratio. In addition, there was a significant correlation between the liver T1 value ratio and changes of the ICG R15 by the Pearson correlation coefficient assessment (correlation coefficient = 0.642, P < , Figure 3). Images for this section: Table 2: Result of multiple stepwise regression analysis # standardized regression coefficients, AST aspartate aminotransferase, ALT alanine aminotransferase, ChE cholinesterase, T-Bil total bilirubin, Alb albumin, PT prothrombin time, ICG R15 indocyanine green retention rate at 15 min. Page 6 of 9

7 Fig. 3: Scatter plot of the correlation between the ICG R15s and T1 value ratio of hepatocyte-phase images obained 20 min after injection. There was a significant correlation between the liver T1 value ratio and the ICG R15 by the Pearson correlation coefficient assessment (correlation coefficient = 0.642, P Page 7 of 9

8 Conclusion ICG R15 was the strongest determinant of liver T1 value ratio, and the liver T1 value ratio was well correlated with changes of the ICG R15, which is the most common parameter used in the quantitative estimation of the hepatic function. The Gd-EOB-DTPA T1 value ratio is a direct, noninvasive technique for the quantitative evaluation of liver function. References 1. Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Hamm B, Staks T, Mühler A, Bollow M, Taupitz M, Frenzel T, Wolf KJ, Weinmann HJ, Lange L. Radiology Jun;195(3): Phase II clinical evaluation of Gd-EOB-DTPA: dose, safety aspects, and pulse sequence. Reimer P, Rummeny EJ, Shamsi K, Balzer T, Daldrup HE, Tombach B, Hesse T, Berns T, Peters PE. Radiology Apr;199(1): Efficacy and safety of MR imaging with liver-specific contrast agent: U.S. multicenter phase III study. Bluemke DA, Sahani D, Amendola M, Balzer T, Breuer J, Brown JJ, Casalino DD, Davis PL, Francis IR, Krinsky G, Lee FT Jr, Lu D, Paulson EK, Schwartz LH, Siegelman ES, Small WC, Weber TM, Welber A, Shamsi K. Radiology Oct;237(1): S. Kogita, Y. Imai and M. Okada, et al. Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol, 20(10) (2010), pp T. Ichikawa, K. Saito and N. Yoshioka, et al. Detection and characterization of focal liver lesions: a Japanese phase III, multicenter comparison between gadoxetic acid disodiumenhanced magnetic resonance imaging and contrast-enhanced computed tomography predominantly in patients with hepatocellular carcinoma and chronic liver disease. Invest Radiol, 45 (3) (2010), pp U. Motosugi, T. Ichikawa and H. Sou, et al. Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology, 256 (1) (2010), pp Y.K. Kim, C.S. Kim, Y.M. Han and G. Park, Detection of small hepatocellular carcinoma: can gadoxetic acid-enhanced magnetic resonance imaging replace combining gadopentetate dimeglumine-enhanced and superparamagnetic iron oxideenhanced magnetic resonance imaging?. Invest Radiol, 45 (11) (2010), pp Page 8 of 9

9 8. J.E. van Montfoort, B. Stieger, D.K. Meijer, H.J. Weinmann, P.J. Meier and K.E. Fattinger, Hepatic uptake of the magnetic resonance imaging contrast agent gadoxetate by the organic anion transporting polypeptide Oatp1. J Pharmacol Exp Ther, 290 (1) (1999), pp F.T. Tschirch, A. Struwe, H. Petrowsky, I. Kakales, B. Marincek and D. Weishaupt, Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma. Eur Radiol, 18 (8) (2008), pp T. Tajima, H. Takao and H. Akai, et al. Relationship between liver function and liver signal intensity in hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging. J Comput Assist Tomogr, 34 (3) (2010), pp Personal Information K. Kamimura, Y. Fukukura, T. Yoneyama, K. Takumi, T. Shindo, Y. Kumagae, A. Tateyama, A. Umanodan, M. Nakajo Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciencesd Dental Sciences Page 9 of 9