Davide Ippolito1,2, Anna Pecorelli3,4, Simone Famularo3,5, Davide Bernasconi6, Eleonora Benedetta Orsini3,4, Alessandro Giani3,5, Fabrizio Romano3,5, Cammillo Talei Franzesi3,4, Sandro Sironi7,8. 1. School of Medicine, University of Milano-Bicocca, Milan, Italy. davide.atena@tiscalinet.it. 2. Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy. davide.atena@tiscalinet.it. 3. School of Medicine, University of Milano-Bicocca, Milan, Italy. 4. Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy. 5. Department of Surgery, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy. 6. Center of Biostatistics for Clinical Epidemiology, Department of Health Sciences, University Milano-Bicocca, Monza, Italy. 7. Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy. 8. University of Milano-Bicocca, Milan, Italy.
Abstract
AIM: To assess the efficacy of signal intensity in interstitial and hepatobiliary phase normalized for liver volume, on gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) study, for the evaluation of liver function through the comparison with Child-Pugh (CP), model for end-stage liver disease (MELD), and biochemical tests. METHODS: All dynamic Gd-EOB-DTPA MRI studies performed in patients with suspected liver lesions were retrospectively reviewed. The rate of liver-to-muscle ratio on T1 sequence 70 s (interstitial phase) and 20 min (hepatobiliary phase) after injection of Gd-EOB-DTPA was calculated for each MRI study and then normalized for liver volume (irINTnorm and irHEPnorm). Pearson correlation coefficient was computed to assess the correlation among these values and CP and MELD scores, and biochemical tests. RESULTS: A total of 303 MRI studies, performed on 221 patients, were included. Mean age was 63.8 years ± 12.9 with a majority of male patients (186; 61.4%). A total of 186 out of 303 (61.4%) were cirrhotic patients. The irHEPnorm was significantly lower in cirrhotic than non-cirrhotic patients (0.0004 ± 0.0002 to 0.0005 ± 0.0003, p = 0.010). This value had a moderate, significant correlation with Child-Pugh and MELD scores (R = - 0.292, p < 0.0001 and R = - 0.192, p = 0.010, respectively). In particular, irHEPnorm progressively decreased from Child-Pugh A to C (0.0004-0.0002, p < 0.0001) and from MELD ≤ 10 to 19-24 (0.0004-0.0003, p = 0.018). Among biochemical parameters, total bilirubin, GOT, and albumin had the strongest correlation with irHEPnorm (R = - 0.258, - 0.291, and 0.262, p < 0.0001, respectively). No correlations were found between irINTnorm and CP and MELD scores. CONCLUSION: irHEPnorm value derived from Gd-EOB-DTPA-enhanced MRI is a reliable, non-invasive, useful tool to quantify liver function and to assess the degree of cirrhosis, offering a strict relationship with clinical scores and biochemical parameters. This could help surgeons in clinical decision-making, allowing them to choose the more suitable surgical approach for cirrhotic patients.
AIM: To assess the efficacy of signal intensity in interstitial and hepatobiliary phase normalized for liver volume, on gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) study, for the evaluation of liver function through the comparison with Child-Pugh (CP), model for end-stage liver disease (MELD), and biochemical tests. METHODS: All dynamic Gd-EOB-DTPA MRI studies performed in patients with suspected liver lesions were retrospectively reviewed. The rate of liver-to-muscle ratio on T1 sequence 70 s (interstitial phase) and 20 min (hepatobiliary phase) after injection of Gd-EOB-DTPA was calculated for each MRI study and then normalized for liver volume (irINTnorm and irHEPnorm). Pearson correlation coefficient was computed to assess the correlation among these values and CP and MELD scores, and biochemical tests. RESULTS: A total of 303 MRI studies, performed on 221 patients, were included. Mean age was 63.8 years ± 12.9 with a majority of male patients (186; 61.4%). A total of 186 out of 303 (61.4%) were cirrhotic patients. The irHEPnorm was significantly lower in cirrhotic than non-cirrhotic patients (0.0004 ± 0.0002 to 0.0005 ± 0.0003, p = 0.010). This value had a moderate, significant correlation with Child-Pugh and MELD scores (R = - 0.292, p < 0.0001 and R = - 0.192, p = 0.010, respectively). In particular, irHEPnorm progressively decreased from Child-Pugh A to C (0.0004-0.0002, p < 0.0001) and from MELD ≤ 10 to 19-24 (0.0004-0.0003, p = 0.018). Among biochemical parameters, total bilirubin, GOT, and albumin had the strongest correlation with irHEPnorm (R = - 0.258, - 0.291, and 0.262, p < 0.0001, respectively). No correlations were found between irINTnorm and CP and MELD scores. CONCLUSION: irHEPnorm value derived from Gd-EOB-DTPA-enhanced MRI is a reliable, non-invasive, useful tool to quantify liver function and to assess the degree of cirrhosis, offering a strict relationship with clinical scores and biochemical parameters. This could help surgeons in clinical decision-making, allowing them to choose the more suitable surgical approach for cirrhotic patients.
Entities:
Keywords:
Cirrhosis; Liver; Magnetic resonance; Surgery
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