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Abstract
Purpose
We prospectively evaluated whether gadoxetic acid (Gd-EOB-DTPA) admin-istration for liver magnetic resonance (MR) imaging affects the quantification of hepatic steatosis using MR spectroscopy (MRS).
Materials and Methods
A total of 155 patients were included, who underwent gadoxetic acid-enhanced liver MR imaging and MRS during a 5-month period. Fast breath-hold high-speed T2-corrected multi-echo MRS was used before, and 20 min after, gadoxetic acid injection. The same location was maintained in the pre-contrast and post-contrast MRS. Changes in the fat fraction (FF) were compared between the pre- and post-contrast MRS using a paired t-test. The change in FF between cirrhotic and non-cirrhotic patients was compared using an independent t-test. In cirrhotic patients, the correlation between FF change and biochemical marker using Pearson's correlation test, was evaluated.
Results
The mean FF in the post-contrast MRS (5.05 ± 5.26%) was significantly higher than in the pre-contrast MRS (4.77 ± 0.57%) (p < 0.000). The FF change between pre-contrast and post-contrast MRS was significantly higher in non-cirrhotic patients (0.41 ± 0.77%) than in cirrhotic patients (0.14 ± 0.59) (p = 0.010). Albumin and alkaline phosphatase shows weak correlation with FF change (both p < 0.02).
Index terms
Magnetic Resonance Spectroscopy, Fatty Liver, Gadoxetic Acid, Liver CirrhosisREFERENCES
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Fig. 1.
Flow chart of patient enrollment. HCC = hepatocellular carcinoma, MR = magnetic resonance, RFA = radiofrequency ablation, TACE = transarterial chemoembolization
Fig. 2.
Hepatic steatosis spectrum of a 77-years-old female with sus-picious focal hepatic lesion. Proton of fat appears as several peaks, in-cluding a diacyl peak at 2.75 ppm (1), an α-olefinic and α-carboxyl peak at 2.1 ppm (2), a methylene peak at 1.3 ppm (3), and a methyl peak at 0.9 ppm (4). Whereas, proton in water appears as a single peak at 4.7 ppm. Fat fraction can be calculated as (Sum of fat peaks) / (Sum of fat peaks + water peak).
Fig. 3.
Relationship between the FF change and liver cirrhosis in the entire patient cohort. The mean value is significantly higher for patients in the non-cirrhotic group (∗ p < 0.000). The lower edge of each box indicates the 25th percentile, and the upper edge indicates the 75th percentile. The horizontal line in the middle of the box indicates the median. Lines extending from either end of the box indicate the extent of the data beyond the 25th and 75th percentile but within 1.5-times the interquartile range. Outliers were not noted. FF = fat fraction, MRS = magnetic resonance spectroscopy
Fig. 4.
Relationship between the changes in FF and the Child-Pugh class in the cirrhotic group (n = 77). No significant difference of FF change is observed between Child-Pugh classification A vs. B and C (Child-Pugh A, 0.17 ± 0.58; B and C, -0.71 ± 0.59) (p = 0.856). FF = fat fraction, MRS = magnetic resonance spectroscopy
Fig. 5.
Scatter plots of the correlation in the liver cirrhosis group. A. The relationship between alkaline phosphatase and FF change. B. The relationship between albumin and FF change. APH = alkaline phosphatase, FF = fat fraction, MRS = magnetic resonance spectroscopy
Fig. 6.
Molecular structure and predicted MR spectra of gadoxetic acid. Several peaks (∗) are located in similar frequencies with triglyceride in hepatocyte (Fig. 2). We hypothesize that these peaks may pro-duce overestimation of fat fraction on post-contrast MRS. MRS = magnetic resonance spectroscopy
Table 1.
The Mean FFs and the Changes in the FF between Pre-Contrast MRS and Post-Contrast MRS
Table 2.
Relationships between Clinical Factors and the Changes in the Fat Fraction between Pre-Contrast MRS and Post-Contrast MRS
| Parameter | Total Cohort | Liver Cirrhosis Group | ||||||
|---|---|---|---|---|---|---|---|---|
| Mean | SD | Correlation Coefficient | p-Value | Mean | SD | Correlation Coefficient | p-Value | |
| Age (years) | 60.4 | 11.0 | r = −0.137 | 0.089 | 62.5 | 9.7 | r = −1.149 | 0.197 |
| Platelet count (103/µL) | 212.8 | 85.3 | r = 0.146 | 0.072 | 181.1 | 88.5 | r = 0.192 | 0.097 |
| Prothorombin time (INR) | 1.1 | 0.4 | r = −0.052 | 0.554 | 1.1 | 0.19 | r = −0.029 | 0.806 |
| Total bilirubin (mg/dL) | 0.8 | 0.9 | r = −0.035 | 0.678 | 0.9 | 0.6 | r = −0.183 | 0.117 |
| Albumin (g/dL) | 4.3 | 0.8 | r = 0.151 | 0.074 | 4.2 | 0.8 | r = 0.287 | 0.012∗ |
| AST (U/L) | 45.0 | 54 | r = −0.084 | 0.305 | 54.0 | 55.7 | r = −0.145 | 0.211 |
| ALT (U/L) | 34.2 | 44.2 | r = 0.029 | 0.720 | 37.8 | 38.1 | r = −0.015 | 0.897 |
| APH (U/L) | 112.7 | 132.2 | r = −0.163 | 0.061 | 121.4 | 135.6 | r = −0.281 | 0.014∗ |
| Sodium (mEq/L) | 141.6 | 2.9 | r = 0.185 | 0.122 | 141.8 | 2.8 | r = 0.168 | 0.166 |
| Creatinine (mg/dL) | 0.9 | 0.2 | r = −0.048 | 0.554 | 0.9 | 0.2 | r = −0.157 | 0.177 |
| Child-pugh (score) | 5.3 | 0.8 | r = −0.045 | 0.579 | 5.3 | 0.8 | r = −0.132 | 0.254 |
| MELD (score) | 8.3 | 2.8 | r = −0.082 | 0.355 | 8.5 | 2.3 | r = −0.153 | 0.188 |
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