Possible utility of MRI using Gd-EOB-DTPA for estimating liver functional reserve

Tohru Utsunomiya1, Mitsuo Shimada1, Jun Hanaoka1, Mami Kanamoto1, Tetsuya Ikemoto1, Yuji Morine1, Satoru Imura1, Masafui Harada2
1Department of Surgery, The University of Tokushima, Tokushima, Japan
2Department of Radiology, The University of Tokushima, Tokushima, Japan

Tóm tắt

Preoperative estimation of the liver functional reserve is important in liver surgery. We evaluated the role of dynamic magnetic resonance (MR) imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), i.e., EOB-MRI, for determining liver functional reserve. Fifty patients who underwent EOB-MRI to examine their liver tumors were included in this study. We first performed a pixel-by-pixel comparison of registered MR images and activity images with Tc-99m galactosyl human serum albumin (GSA) on each slice, and the correlation coefficient was calculated for 8 patients. We also determined the correlation coefficient between the relative signal intensity (SI) values of EOB-MRI and preoperative liver function, such as the GSA, indocyanine green dye retention at 15 min (ICGR15), and prothrombin time. The mean of the correlation coefficients for 512 × 512 matrices between the EOB-MRI and the GSA was 0.83 ± 0.05 (ranging from 0.73 to 0.87). The correlation coefficient between the relative SI of the EOB-MRI and the receptor index (LHL15) of GSA was 0.56 (P < 0.01). Better correlation coefficients were observed between the relative SI and the liver function test, including ICGR15 (r = −0.67, P < 0.01) and prothrombin time (r = 0.59, P < 0.01). In a patient with hilar cholangiocarcinoma whose right hepatic duct was obstructed, the relative SI in the right lobe (2.4 ± 0.3) was significantly lower than that in the left lobe (3.1 ± 0.1). EOB-MRI represents a practical and reliable imaging technique that may be used to estimate regional liver functional reserve in the clinical setting.

Từ khóa


Tài liệu tham khảo

Yamanaka N, Okamoto E, Oriyama T, Fujimoto J, Furukawa K, Kawamura E, et al. A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann Surg. 1994;219:342–6. Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188:304–9. Kwon AH, Ha-Kawa SK, Uetsuji S, Inoue T, Matsui Y, Kamiyama Y. Preoperative determination of the surgical procedure for hepatectomy using technetium-99m-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy. Hepatology. 1997;25:426–9. Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, et al. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology. 2000;32:1224–9. Kokudo N, Vera DR, Tada K, Koizumi M, Seki M, Matsubara T, et al. Predictors of successful hepatic resection: prognostic usefulness of hepatic asialoglycoprotein receptor analysis. Word J Surg. 2002;26:1342–7. Dinant S, de Graaf W, Verwer BJ, Bennink RJ, van Lienden KP, Gouma DJ, et al. Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry. J Nucl Med. 2007;48:685–92. Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000;127:512–9. Schuhmann-Giampieri G, Schmitt-Willich H, Press WR, Negishi C, Weinmann HJ, Speck U. Preclinical evaluation of Gd-EOB-MRI as a contrast agent in MR imaging of the hepatobiliary system. Radiology. 1992;183:59–64. Bluemke DA, Sahani D, Amendola M, Balzer T, Breuer J, Brown JJ, et al. Efficacy and safety of MR imaging with liver-specific contrast agent: U.S. multicenter phase III study. Radiology. 2005;237:89–98. Kudo M. Will Gd-EOB-MRI change the diagnostic algorithm in hepatocellular carcinoma? Oncology. 2010;78(Suppl 1):87–93. Kim T, Murakami T, Hasuike Y, Gotoh M, Kato N, Takahashi M, et al. Experimental hepatic dysfunction: evaluation by MR imaging with Gd-EOB-DTPA. J Magn Reson Imaging. 1997;7:683–8. Shimizu J, Dono K, Gotoh M, Hasuike Y, Kim T, Murakami T, et al. Evaluation of regional liver function by gadolinium-EOB-DTPA-enhanced MR imaging. Dig Dis Sci. 1999;44:1330–7. Ryeom HK, Kim SH, Kim JY, Kim HJ, Lee JM, Chang YM, et al. Quantitative evaluation of liver function with MRI using Gd-EOB-DTPA. Korean J Radiol. 2004;5:231–9. Motosugi U, Ichikawa T, Sou H, Sano K, Tominaga L, Kitamura T, et al. Liver parenchymal enhancement of hepatocyte-phase images in Gd-EOB-DTPA-enhanced MR imaging: which biological markers of the liver function affect the enhancement? J Magn Reson Imaging. 2009;30:1042–6. Tajima T, Takao H, Akai H, Kiryu S, Imamura H, Watanabe Y, 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. 2010;34:362–6. Nishie A, Ushijima Y, Tajima T, Asayama Y, Ishigami K, Kakihara D, et al. Quantitative analysis of liver function using superparamagnetic iron oxide- and Gd-EOB-DTPA-enhanced MRI: comparison with technetium-99m galactosyl serum albumin scintigraphy. Eur J Radiol. 2011 (Epub ahead of print). Juni JE, Reichle R. Measurement of hepatocellular function with deconvolutional analysis: application in the differential diagnosis of acute jaundice. Radiology. 1990;177:171–5. Vera DR, Stadalnik RC, Trudeau WL, Scheibe PO, Krohn KA. Measurement of receptor concentration and forward-binding rate constant via radiopharmacokinetic modeling of technetium-99m-galactosyl-neoglycoalbumin. J Nucl Med. 1991;32:1169–76. FMRIB (2011) FMRIB’s Linear Image Registration Tool (FLIRT). http://www.fmrib.ox.ac.uk/analysis/research/flirt/. Jenkinson M, Bannister P, Brady M, Smith S. Improved optimization for the robust and accurate linear registration and motion correction of brain images. Neuroimage. 2002;17:825–41. Beckmann CF, Jenkinson M, Smith SM. General multilevel linear modeling for group analysis in FMRI. Neuroimage. 2003;20:1052–63. Huppertz A, Balzer T, Blakeborough A, Breuer J, Giovagnoni A, Heinz-Peer G, et al. Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology. 2004;230:266–75. Kudo M, Todo A, Ikeguro K, Hino M. Receptor index via hepatic asialoglycoprotein receptor imaging: correlation with chronic hepatocellular damage. Am J Gastroenterol. 1992;87:865–70. Pimstone NR, Stadalnik RC, Vera DR, Hutak DP, Trudeau WL. Evaluation of hepatocellular function by way of receptor-mediated uptake of a technetium-99m-labeled asialoglycoprotein analog. Hepatology. 1994;20:917–23. Matsuzaki S, Onda M, Tajiri T, Kim DY. Hepatic lobar differences in progression of chronic liver disease: correlation of asialoglycoprotein scintigraphy and hepatic functional reserve. Hepatology. 1997;25:828–32. Narita M, Hatano E, Arizono S, Miyagawa-Hayashino A, Isoda H, Kitamura K, et al. Expression of OATP1B3 determines uptake of Gd-EOB-DTPA in hepatocellular carcinoma. J Gastroenterol. 2009;44:793–8. Okochi O, Kaneko T, Sugimoto H, Inoue S, Takeda S, Nakao A. ICG pulse spectrophotometry for perioperative liver function in hepatectomy. J Surg Res. 2002;103:109–13. de Graaf W, van Lienden KP, van Gulik TM, Bennink RJ. 99mTc-mebrofenin hepatobiliary scintigraphy with SPECT for the assessment of hepatic function and liver functional volume before partial hepatectomy. J Nucl Med. 2010;51:229–36. Akaki S, Mitsumori A, Kanazawa S, Togami I, Takeda Y, Hiraki Y. Lobar decrease in 99mTc-GSA accumulation in hilar cholangiocarcinoma. J Nucl Med. 1999;4:394–8.