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Quantitative Evaluation of Contrast Agent Dynamics in Liver MRI
Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-4111-1693
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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1196
Keyword [en]
Liver, spleen, hepatobiliary system, liver function, MRI, DCE-MRI, Gd-EOBDTPA, Gd-BOPTA, pharmacokinetic, hepatocyte, relaxivity.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-60264ISBN: 978-91-7393-338-4 (print)OAI: oai:DiVA.org:liu-60264DiVA: diva2:355848
Public defence
2010-11-05, Elsa Brändströmsalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2010-10-08 Created: 2010-10-08 Last updated: 2017-01-31Bibliographically approved
List of papers
1. Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects
Open this publication in new window or tab >>Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects
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2007 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 48, no 4, 362-368 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the biliary enhancement dynamics of the two gadolinium chelates Gd-BOPTA (MultiHance) and Gd-EOB-DTPA (Primovist) in normal healthy subjects. MATERIAL AND METHODS: Ten healthy volunteers were evaluated with both agents by magnetic resonance (MR) imaging at 1.5T using a breath-hold gradient-echo T1-weighted VIBE sequence. The relative signal intensity (SI) differences between the common hepatic duct (CHD) and liver parenchyma were measured before and 10, 20, 30, 40, 130, 240, and 300 min after contrast medium injection. RESULTS: Biliary enhancement was obvious 10 min post-injection for Gd-EOB-DTPA and was noted at 20 min for Gd-BOPTA. At 40 min delay, Gd-BOPTA reached its peak biliary enhancement, but at neither 30 nor 40 min delay was there any significant difference compared with that of Gd-EOB-DTPA. At later delays, the contrast between CHD and liver continued to increase for Gd-EOB-DTPA, whereas it decreased for Gd-BOPTA. CONCLUSION: The earlier onset and longer duration of a high contrast between CHD and liver for Gd-EOB-DTPA facilitates examination of hepatobiliary excretion. Therefore, Gd-EOB-DTPA may provide adequate hepatobiliary imaging within a shorter time span than Gd-BOPTA and facilitate scheduling at the MR unit. Further studies in patients are required to compare the imaging advantages of Gd-EOB-DTPA and Gd-BOPTA in clinical practice.

Place, publisher, year, edition, pages
Informa Healthcare, 2007
Keyword
Bile ducts; biliary; comparative studies; intravenous contrast agents; liver; MR imaging
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-17916 (URN)10.1080/02841850701196922 (DOI)000246782700002 ()
Note

This is an electronic version of an article published in: Nils Dahlström, Anders Persson, Nils Albiin, Örjan Smedby and Torkel Brismar, Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects, 2007, Acta Radiologica, (48), 4, 362-368. Acta Radiologica is available online at informaworldTM: http://dx.doi.org/10.1080/02841850701196922 Copyright: Taylor & Francis http://www.tandf.co.uk/journals/default.asp

Available from: 2009-04-24 Created: 2009-04-24 Last updated: 2017-12-13Bibliographically approved
2. Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA- a comparison in healthy volunteers
Open this publication in new window or tab >>Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA- a comparison in healthy volunteers
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2006 (English)In: ISMRM 2006,2006, 2006Conference paper, Published paper (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-34967 (URN)24315 (Local ID)24315 (Archive number)24315 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-06-27
3. Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study
Open this publication in new window or tab >>Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study
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2012 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 22, no 3, 642-653 p.Article in journal (Refereed) Published
Abstract [en]

Objectives   To develop and evaluate a procedure for quantifying the hepatocyte-specific uptake of Gd-BOPTA and Gd-EOB-DTPA using dynamic contrast-enhanced (DCE) MRI. Methods   Ten healthy volunteers were prospectively recruited and 21 patients with suspected hepatobiliary disease were retrospectively evaluated. All subjects were examined with DCE-MRI using 0.025 mmol/kg of Gd-EOB-DTPA. The healthy volunteers underwent an additional examination using 0.05 mmol/kg of Gd-BOPTA. The signal intensities (SI) of liver and spleen parenchyma were obtained from unenhanced and enhanced acquisitions. Using pharmacokinetic models of the liver and spleen, and an SI rescaling procedure, a hepatic uptake rate, K Hep, estimate was derived. The K Hep values for Gd-EOB-DTPA were then studied in relation to those for Gd-BOPTA and to a clinical classification of the patient’s hepatobiliary dysfunction. Results   K Hep estimated using Gd-EOB-DTPA showed a significant Pearson correlation with K Hep estimated using Gd-BOPTA (r = 0.64; P < 0.05) in healthy subjects. Patients with impaired hepatobiliary function had significantly lower K Hep than patients with normal hepatobiliary function (K Hep = 0.09 ± 0.05 min-1 versus K Hep = 0.24 ± 0.10 min−1; P < 0.01). Conclusions   A new procedure for quantifying the hepatocyte-specific uptake of T 1-enhancing contrast agent was demonstrated and used to show that impaired hepatobiliary function severely influences the hepatic uptake of Gd-EOB-DTPA. Key Points   • The liver uptake of contrast agents may be measured with standard clinical MRI.Calculation of liver contrast agent uptake is improved by considering splenic uptake.Liver function affects the uptake of the liver-specific contrast agent Gd-EOB-DTPA.Hepatic uptake of two contrast agents (Gd-EOB-DTPA, Gd-BOPTA) is correlated in healthy individuals.This method can be useful for determining liver function, e.g. before hepatic surgery

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2012
Keyword
Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid – Gadobenate Dimeglumine – Dynamic contrast-enhanced MRI – Pharmacokinetics – Liver
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-73624 (URN)10.1007/s00330-011-2302-4 (DOI)000299768000018 ()21984449 (PubMedID)
Funder
Swedish Research Council, VR/M 2007-2884Medical Research Council of Southeast Sweden (FORSS), 12621Linköpings universitet
Note

The previous status of this article was Manuscript and the working titles was Liver Specific Gd-EOB-DTPA vs. Gd-BOPTA Uptake in Healthy Subjects: A Novel and Quantitative MRI Analysis of Hepatic Uptake and Vascular Enhancement and Hepatic Uptake of Gd-EOB-DTPA in Patients with Varying Degree of Hepatobiliary Disease.

Available from: 2012-01-10 Created: 2012-01-10 Last updated: 2017-12-08

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