Portal hypertension may influence the registration of hypointensity of small hepatocellular carcinoma in the hepatobiliary phase in gadoxetic acid MR

Formulas used for qualitative assessment of liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the hepatobiliary phase (HPB)

	Formula	Variables definition
Relative Liver Enhancement (RLE)	$R L E 10 = \frac{(LSI10 - LSIPRE)}{LSIPRE}$	RLE₁₀ and RLE₂₀: RLE at 10- and 20-min HBP
Relative Liver Enhancement (RLE)	$R L E 20 = \frac{(LSI20 - LSIPRE)}{LSIPRE}$	LSI_pre, LSI₁₀ and LSI₂₀: Liver signal intensity pre-contrast, at 10- and 20-min HBP, respectively
Liver to Spleen Contrast Ratio (LSCR)	$L S C R p r e = \frac{LSIPRE}{SSIPRE}$	LSCR_pre LSCR₁₀ and LSCR_20r: LSCR pre-contrast, at 10- and 20- min HBP, respectively
	$L S C R 10 = \frac{LSI 10}{SSI 10}$	LSI_pre, LSI₁₀ and LSI₂₀: Liver signal intensity pre-contrast, at 10- and 20- min HBP, respectively
	$L S C R 20 = \frac{LSI20}{SSI20}$	SSI_pre, SSI₁₀ and SSI₂₀: Spleen signal intensity pre-contrast, at 10- and 20- min HBP, respectively
Liver to muscle Contrast Ratio (LMCR)	$L M C R p r e = \frac{LSIPRE}{MSIPRE}$	LMCR_pre, LMCR₁₀ and LMCR_20r: LMCR pre-contrast, at 10- and 20- min HBP, respectively
	$L M C R 10 = \frac{LSI 10}{MSI 10}$	LSI_pre, LSI₁₀ and LSI₂₀: Liver signal intensity pre-contrast, at 10- and 20- min HBP, respectively
	$L M C R 20 = \frac{LSI 20}{MSI 20}$	MSI_pre, MSI₁₀ and MSI₂₀: Muscle signal intensity pre-contrast, at 10- and 20- min HBP, respectively
Liver to Kidney Contrast Ratios (LKCR)	$L K C R p r e = \frac{LSIPRE}{KSIPRE}$	LKCR LKCR and LKCR: LKCR pre-contrast, at 10- and 20- min HBP, respectively _{pre, 10 20r}
	$L K C R 10 = \frac{LSI10}{KSI10}$	LSI_pre, LSI₁₀ and LSI₂₀: Liver signal intensity pre-contrast, at 10- and 20- min HBP, respectively
	$L K C R 20 = \frac{LSI20}{KSI20}$	KSI_pre, KSI₁₀ and KSI₂₀: Kidney signal intensity pre-contrast, at 10- and 20- min HBP, respectively
Contrast Enhancement Index (CEI)	$CEI10 = \frac{L M C R 10}{LMCRPRE}$	- LMCR_pre, LMCR₁₀ and LMCR_20r: LMCR pre-contrast, at 10- and 20- min HBP, respectively
Contrast Enhancement Index (CEI)	$CEI20 = \frac{L M C R 20}{LMCRPRE}$	- CEI₁₀ and CEI₂₀: Contrast Enhancement Index at 10- and 20- min HBP, respectively
Hepatic Uptake index (HUI)	${HUI}_{10} = {VOL}_{LIVER} (\frac{LSI10}{SSI10}) - 1$	- HUI₁₀ and HUI₂₀: Hepatic Uptake index at 10- and 20- min HBP, respectively
	${HUL}_{20} = {VOL}_{LIVER} (\frac{5120}{58120}) = 1$	LSI₁₀ and LSI₂₀: Liver signal intensity at 10- and 20- min HBP, respectively
		SSI₁₀ and SSI₂₀: Spleen signal intensity at 10- and 20- min HBP, respectively

Location of the 6 regions of interest (ROIs) in the liver parenchyma, to calculate the liver signal intensity (LSI) in the pre-contrast sequence (LSI_pre) **(A)**, at 10 minutes (LSI₁₀) **(B)** and at 20 minutes (LSI₂₀) hepatobiliary phase **(C)**. Four of the ROIs were located in the anterior and posterior segments respectively of the right hepatic lobe, and two more were placed in the lateral and medial segments of the left lobe respectively. ROIs were drawn avoiding the inclusion of vascular structures and possible focal liver lesions.

Location of the region of interest in the 20 minutes hepatobiliary phase in the spleen **(A)**, in the right paravertebral muscle **(B)**, and in the upper pole of the right kidney **(C)** to calculate the different quantitative parameters of contrast liver uptake: spleen-liver intensity (SLI) and liver-spleen contrast ratio (LSCR), muscle-liver intensity (MLI) and the liver-muscle contrast ratio (LMCR) and kidney-liver intensity (KLI) and the liver-kidney contrast ratio (LKCR), respectively.

Table 2

Quantitative assessment of liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) during the hepatobiliary phase (HPB) at 10 and 20 minutes considering the degree of liver function impairment according to Child-Pugh classification. Variables described as median and interquartile range

INDEX	Study group	Child-Pugh A	Child-Pugh B	P value	Child-Pugh A-5 points	Child-Pugh A-6 points + B	P value
N	62	53	9		44	18
RLE₁₀	0.65 [0.49-0.75]	0.68 [0.51-0.81]	0.41 [0.30-0.52]	<0.001	0.68 [0.52-0.82]	0.50 [0.40-0.58]	0.005
RLE₂₀	0.63 [0.51-0.78]	0.67 [0.55-0.82]	0.41 [0.30-0.52]	<0.001	0.68 [0.56-0.83]	0.52 [0.40-0.61]	0.006
LSCR₁₀	1.32 [1.17-1.55]	1.35 [1.11-1.59]	1.20 [0.99-1.28]	0.016	1.43 [1.19-1.61]	1.20 [1,11-1.28]	0.001
LSCR₂₀	1.48 [1.23-1.71]	1.51 [1.30-1.80]	1.20 [1.01-1.43]	0.006	1.54 [1.32-1.81]	1.25 [1.17-1.53]	0.008
LMCR₁₀	2.14 [1.78-2.51]	2.16 [1.81-2.62]	1.78 [1.52-2.13]	0.030	2.26 [1.81-2.71]	2.08 [1.73-2.16]	NS
LMCR₂₀	2.25 [1.86-2.63]	2.29 [1.89-2.69]	1.79 [1.52-2.23]	0.030	2.34 [1.88-2.70]	2.05 [1.75-2.31]	NS
LKCR₁₀	1.02 [0.85-1.17]	1.04 [0.89-1.21]	0.83 [0.74-0.90]	0.005	1.06 [0.91-1.25]	0.87 [0.76-1.05]	0.008
LKCR₂₀	1.14 [0.90-1.13]	1.19 [0.96-1.33]	0.89 [0.80-0.96]	0.009	1.20 [0.96-1.38]	0.91 [0.81-1.22]	0.012
CEI₁₀	1.39 [1.27-1.57]	[1.341.43 -1.1.58]	1.26 [1.22-1.32]	0.006	1.47 [1.34-1.58]	1.33 [1.25-1.38]	0.003
CEI₂₀	1.43 [1.30-1.61]	1.45 [1.35-1.63]	1.32 [1.19-1.37]	0.007	1.50 [1.39-1.66]	1.35 [1.19-1.42]	0.001
HUI₁₀	407.3 [223.7-640.9]	486.2 [235.3-845.4]	312.4 [-3.31- 400]	0.022	522.4 [284.9-1036.4]	265.7 [130.5-383.7]	<0.001
HUI₂₀	660.5 [301.5-956.5]	697.8 [367.1-1028.9]	265 [72.5-620.4]	0.009	720.1 [450.5-1062.4]	327.2 [198.1-772.2]	0.004

[i] CEI10 and CEI20 = contrast enhancement index at 10-20 min; HUI = hepatic uptake index; LKCR10 and LKCR20 = liver-kidney contrast ratio at 10-20 min; LMCR10 and LMCR20 = liver-muscle contrast ratio at 10-20 min; LSCR10 and LSCR20 = liver-spleen contrast ratio at 10-20 min; N = number; NS = non-significant; RLE10 and RLE20 = relative liver enhancement at 10-20

Table 3

Quantitative assessment of liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) during hepatobiliary phase (HPB) at 10 and 20 minutes in the study group considering the presence of clinically significant portal hypertension (CSPH). On the left, including all study cohort and on the right, considering only cirrhotic patients with preserved liver function (Child-Pugh A 5 points). Variables described as median and interquartile range

INDEX	No CSPH (all CP A-5 points)	CSPH	P value	No CSPH (all CP A-5 points)	CP A-5 points and CSPH	P value
N	19	43		19	25
RLE₁₀	0.73 [0.52-0.89]	0.57 [0.47-0.69]	0.027	0.73 [0.52-0.89]	0.65 [0.51-0.77]	NS
RLE₂₀	0.73 [0.56-0.85]	0.59 [0.47-0.74]	NS	0.73 [0.56-0.85]	0.66 [0.54-0.77]	NS
LSCR₁₀	1.54 [1.37-1.67]	1.23 [1.15-1.39]	< 0.001	1.54 [1.37-1.67]	1.29 [1,15-1.51]	0.014
LSCR₂₀	1.68 [1.53-1.84]	1.35 [1.20-1.57]	0.003	1.68 [1.53-1.84]	1.37 [1.26-1.74]	0.036
LMCR₁₀	2.41 [2.12-2.83]	2.06 [1.75-2.45]	0.006	2.41 [2.12-2.83]	1.88 [1.76-2.50]	0.034
LMCR₂₀	2.49 [2.24-2.96]	1.95 [1.77-2.39]	0.005	2.49 [2.24-2.96]	1.92 [1.78-2.6]	0.036
LKCR₁₀	1.15 [0.98-1.34]	0.93 [0.81-1.13]	0.001	1.15 [0.98-1.34]	1.01 [0.84-1.21]	0.032
LKCR₂₀	1.25 [1.16-1.43]	0.98 [0.88-1.28]	0.001	1.25 [1.16-1.43]	1.05 [0.88-1.03]	0.017
CEI₁₀	1.46 [1.34-1.59]	1.36 [1.26-1.52]	NS	1.46 [1.34-1.59]	1.47 [1.31-1.58]	NS
CEI₂₀	1.50 [1.38-1.71]	1.41 [1.24-1.54]	NS	1.50 [1.38-1.71]	1.48 [1.33-1.65]	NS
HUI₁₀	609.7 [501.4-970.3]	327.8 [191.7-511.8]	0.004	609.7 [501.4-970.3]	411.4 [223.4-1210.7]	NS
HUI₂₀	803.6 [678.7-1091.2]	450.5 [274.8-864.4]	0.033	803.6 [678.7-1091.2]	569.0 [341.8-987.1]	NS

Table 4

Quantitative assessment of liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) during hepatobiliary phase (HPB) at 10 minutes in patients with normal liver (control group) compared with all Child-Pugh (CP) A 5 points patients (left panel) and with patients Child-Pugh A 5 points patients without clinically significant portal hypertension (CSPH). Variables described as median and interquartile range

INDEX	Control group	Child-Pugh A-5 points	P value	Control group	No CSPH (all CP A-5 points)	P value
N	20	44		20	19
RLE₁₀	1.06 [0.82-2.16]	0.68 [0.52-0.82]	< 0.001	1.06 [0.82-2.16]	0.73 [0.52-0.89]	< 0.001
LSCR₁₀	2,27 [2.06-2.88]	1.43 [1.19-1.61]	< 0.001	2,27 [2.06-2.88]	1.54 [1.37-1.67]	< 0.001
LMCR₁₀	3.11 [2.90-3.55]	2.26 [1.81-2.71]	< 0.001	3.11 [2.90-3.55]	2.41 [2.12-2.83]	< 0.001
LKCR₁₀	1.82 [1.51-1.99]	1.06 [0.91-1.25]	< 0.001	1.82 [1.51-1.99]	1.15 [0.98-1.34]	< 0.001
CEI₁₀	1.71 [1.55-1.85]	1.47 [1.34-1.58]	0.001	1.71 [1.55-1.85]	1.46 [1.34-1.59]	0.007
HUI₁₀	1449.6 [1259-1717.7]	522.4 [284.9-1036.4]	< 0.001	1449.6 [1259-1717.7]	609.7 [501.4-970.3]	< 0.001

[i] CEI10 = contrast enhancement index at 10 min; HUI = hepatic uptake index; LKCR10 = liver-kidney contrast ratio at 10 min; LMCR10 = liver-muscle contrast ratio at 10 min; LSCR10 = liver-spleen contrast ratio at 10 min; N = number; RLE10 = relative liver enhancement at 10 min

Table 5

Quantitative parameters evaluating the liver uptake in the 20 minutes hepatobiliary phase (HPB) of Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) according to the quality of the HBP. In one patient the HBP at 20 minutes was not available (n = 61). Variables described as median and interquartile range

INDEX	Qualitative assessment adequate	Qualitative assessment Non-adequate	P value
N	49	12
RLE₂₀	0.68 [0.57-0.83]	0.40 [0.31-0.51]	< 0.001
LSCR₂₀	1.53 [1.34-1.78]	1.19 [1.06-1.22]	< 0.001
LMCR₂₀	2.34 [1.88-2.78]	1.91 [1.50-2.11]	0.002
LKCR₂₀	1.20 [0.95-1.35]	0.89 [0.78-0.98]	0.001
CEI₂₀	1.23 [1.09-1.32]	1.00 [0.90-1.10]	0.001
HUI₂₀	744.1 [444.8-1024.1]	251.5 [65-4-331.0]	< 0.001

[i] CEI10 and CEI20 = contrast enhancement index at 10-20 min; HUI = hepatic uptake index; LKCR10 and LKCR20 = liver-kidney contrast ratio at 10-20 min; LMCR10 and LMCR20 = liver-muscle contrast ratio at 10-20 min; LSCR10 and LSCR20 = liver-spleen contrast ratio at 10-20 min; N = number; RLE10 and RLE20 = relative liver enhancement at 10-20 min

Articles in this issue

DOI: https://doi.org/10.2478/raon-2022-0024 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

Journal RSS Feed

Language: English

Page range: 292 - 302

Submitted on: Feb 4, 2022

Accepted on: Apr 24, 2022

Published on: Aug 14, 2022

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

liver cirrhosis,

magnetic resonance imaging,

hepatocellular carcinoma

Related subjects:

Medicine,

Clinical medicine,

Radiology

© 2022 Carla Caparroz, Alejandro Forner, Jordi Rimola, Anna Darnell, Ángeles García-Criado, Juan Ramón Ayuso, María Reig, Jordi Bruix, Carmen Ayuso, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 56 (2022): Issue 3 (September 2022)

Portal hypertension may influence the registration of hypointensity of small hepatocellular carcinoma in the hepatobiliary phase in gadoxetic acid MR

Figures & Tables

Figure 1

Table 1

Figure 2

Figure 3

Table 2

Table 3

Table 4

Table 5

Paradigm

My account