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Gd-EOB-DTPA-enhanced T1 relaxometry for assessment of liver function determined by real-time 13C-methacetin breath test

  • Gastrointestinal
  • Published:
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Abstract

Objectives

To determine whether liver function as determined by intravenous administration of 13C-methacetin and continuous real-time breath analysis can be estimated quantitatively from gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) relaxometry.

Methods

Sixty-six patients underwent a 13C-methacetin breath test (13C-MBT) for evaluation of liver function and Gd-EOB-DTPA-enhanced T1-relaxometry at 3 T. A transverse 3D VIBE sequence with an inline T1 calculation based on variable flip angles was acquired prior to (T1 pre) and 20 min post-Gd-EOB-DTPA (T1 post) administration. The reduction rate of T1 relaxation time (rrT1) and T1 relaxation velocity index (∆R1) between pre- and post-contrast images was evaluated. 13C-MBT values were correlated with T1post, ∆R1 and rrT1, providing an MRI-based estimated 13C-MBT value. The interobserver reliability was assessed by determining the intraclass correlation coefficient (ICC).

Results

Stratified by three different categories of 13C-MBT readouts, there was a constant increase of T1 post with increasing progression of diminished liver function (p ≤ 0.030) and a constant significant decrease of ∆R1 (p ≤ 0.025) and rrT1 (p < 0.018) with progression of liver damage as assessed by 13C-methacetin breath analysis. ICC for all T1 relaxation values and indices was excellent (> 0.88). A simple regression model showed a log-linear correlation of 13C-MBT values with T1post (r = 0.57; p < 0.001), ∆R1 (r = 0.59; p < 0.001) and rrT1 (r = 0.70; p < 0.001).

Conclusion

Liver function as determined using real-time 13C-methacetin breath analysis can be estimated quantitatively from Gd-EOB-DTPA-enhanced MR relaxometry.

Key Points

• Gd-EOB-DTPA-enhanced T1 relaxometry quantifies liver function

• Gd-EOB-DTPA-enhanced MR relaxometry may provide parameters for assessing liver function before surgery

• Gd-EOB-DTPA-enhanced MR relaxometry may be useful for monitoring liver disease progression

• Gd-EOB-DTPA-enhanced MR relaxometry has the potential to become a novel liver function index

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Abbreviations

13C-MBT:

13C-methacetin breath test

Gd-EOB-DTPA :

Gadoxetic acid

HCC:

Hepatocellular carcinoma

CYP1A2:

Hepatocyte-specific cytochrome P450 1A2

ICG:

Indocyanine green

LiMAx:

Liver maximum capacity

NASH:

Non-alcoholic steatohepatitis

OATP:

Organic anion transporting peptide

rrT1:

Reduction rate of T1 relaxation times

ROI:

Region of interest

SI:

Signal intensities

∆R1:

T1 relaxation velocity index

T1 post:

T1-relaxometry measurements 20 min after Gd-EOB-DTPA administration

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, University Hospital Regensburg, 93042, Regensburg, Germany

    Michael Haimerl, Irene Fuhrmann, Stefanie Poelsterl, Claudia Fellner, Niklas Verloh, Christian Stroszczynski & Philipp Wiggermann

  2. MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany

    Marcel D. Nickel

  3. Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany

    Kilian Weigand

  4. Department of Surgery, University Hospital Regensburg, Regensburg, Germany

    Marc H. Dahlke

Authors
  1. Michael Haimerl
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  2. Irene Fuhrmann
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  3. Stefanie Poelsterl
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  4. Claudia Fellner
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  5. Marcel D. Nickel
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  6. Kilian Weigand
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  7. Marc H. Dahlke
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  8. Niklas Verloh
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  10. Philipp Wiggermann
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Corresponding author

Correspondence to Michael Haimerl.

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Guarantor

The scientific guarantor of this publication is PD Dr. Philipp Wiggermann.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Haimerl, M., Fuhrmann, I., Poelsterl, S. et al. Gd-EOB-DTPA-enhanced T1 relaxometry for assessment of liver function determined by real-time 13C-methacetin breath test. Eur Radiol 28, 3591–3600 (2018). https://doi.org/10.1007/s00330-018-5337-y

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  • DOI: https://doi.org/10.1007/s00330-018-5337-y

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