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Hepatic Uptake of Gd-EOB-DTPA in Patients with Varying Degree of Hepatobiliary Disease
Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-4111-1693
Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Oncology Centre.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: To evaluate a method for quantifying the hepatocyte-specific uptake of GdGd-EOBDTPA in patients with hepatobiliary disease.

Methods: Gd-EOB-DTPA-enhanced liver MRI examinations of twenty-one patients with suspected hepatobiliary disease were analyzed in a novel pharmacokinetic model for quantitative assessment of hepatobiliary enhancement, using measurements in the liver and spleen. The relationship of hepatic contrast uptake rate KHep to the classification of hepatobiliary function and to the Child-Pugh and the model for end-stage liver disease (MELD) tests was studied with ordinal logistic regression and ANOVA. Comparisons were made with unadjusted liver-to-spleen ratios (LSC) and serum bilirubin. Blood clearance was evaluated via splenic measurements.

Results: KHep provided significant separation of normal hepatobiliary function from hepatobiliary disease with or without manifest biliary stasis. Goodness of fit vs. clinical classification and Child-Pugh Class was stronger for KHep than for LSC and bilirubin. The LSC and bilirubin could separate the normal group only from manifest biliary stasis. Normalization of LSC improved the results. Blood clearance was lower in hepatobiliary disease.

Conclusions: The hepatobiliary Gd-EOB-DTPA uptake test showed a significant association with the clinical grading of hepatobiliary disease and displayed significant separation of patients with affected hepatobiliary function from those with normal function.

Keyword [en]
Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid, DCE-MRI, hepatobiliary disease, pharmacokinetics, liver
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-60262OAI: diva2:355838
Available from: 2010-10-08 Created: 2010-10-08 Last updated: 2014-10-02
In thesis
1. Quantitative Evaluation of Contrast Agent Dynamics in Liver MRI
Open this publication in new window or tab >>Quantitative Evaluation of Contrast Agent Dynamics in Liver MRI
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The studies presented here evaluate the biliary, parenchymal and vascular enhancement effects of two T1-shortening liver-specific contrast agents, Gd-BOPTA and Gd-EOB-DTPA, in Magnetic Resonance Imaging (MRI) of healthy subjects and of patients.

Ten healthy volunteers were examined with both contrast agents in a 1.5 T MRI system using three-dimensional gradient echo sequences for dynamic imaging until five hours after injection. The enhancement of the common hepatic duct in contrast to the liver parenchyma was analyzed in the first study. This was followed by a study of the image contrasts of the hepatic artery, portal vein and middle hepatic vein versus the liver parenchyma.

While Gd-EOB-DTPA gave an earlier and more prolonged enhancement and image contrast of the bile duct, Gd-BOPTA achieved higher maximal enhancement and higher image contrast for all vessels studied during the arterial and portal venous phases. There was no significant difference in the maximal enhancement obtained in the liver parenchyma.

In a third study, another 10 healthy volunteers were examined with the same protocol in another 1.5 T MRI system. Using signal normalization and a more quantitative, pharmacokinetic analysis, the hepatocyte-specific uptake of Gd-EOB-DTPA and Gd-BOPTA was calculated. A significant between-subjects correlation of the uptake estimates was found and the ratio of these uptake rates was of the same magnitude as has been reported in pre-clinical studies. The procedure also enabled quantitative analysis of vascular enhancement properties of these agents. Gd-BOPTA was found to give higher vessel-to-liver contrast than Gd-EOB-DTPA when recommended doses were given.

In the final study, retrospectively gathered datasets from patients with hepatobiliary disease were analyzed using the quantitative estimation of hepatic uptake of Gd-EOB-DTPA described in the third study. The uptake rate estimate provided significant predictive ability in separating normal from disturbed hepatobiliary function, which is promising for future evaluations of regional and global liver disease.

In conclusion, the differing dynamic enhancement profiles of the liver-specific contrast agents presented here can be beneficial in one context and challenging in another. Diseases of the liver and biliary system may affect the vasculature, parenchyma or biliary excretion, or a combination of these. The clinical context in terms of the relative importance of vascular, hepatic parenchymal and biliary processes should therefore determine the contrast agent for each patient and examination. A quantitative approach to analysis of contrast-enhanced liver MRI examinations is feasible and may prove valuable for their interpretation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 93 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1196
Liver, spleen, hepatobiliary system, liver function, MRI, DCE-MRI, Gd-EOBDTPA, Gd-BOPTA, pharmacokinetic, hepatocyte, relaxivity.
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-60264 (URN)978-91-7393-338-4 (ISBN)
Public defence
2010-11-05, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Available from: 2010-10-08 Created: 2010-10-08 Last updated: 2015-09-22Bibliographically approved

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