Journal List > J Korean Soc Radiol > v.76(4) > 1087781

Kim, Kim, Heo, Kim, Shin, Jeong, Jeong, and Kang: Effect of Gadoxetic Acid on Quantification of Hepatic Steatosis Using Magnetic Resonance Spectroscopy: A Prospective Study

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).

Conclusion

Gadoxetic acid affects the quantification of hepatic steatosis by MRS. Hence, MRS should be performed before gadoxetic acid injection, particularly in non-cirrhotic patients.

Index terms

Magnetic Resonance Spectroscopy, Fatty Liver, Gadoxetic Acid, Liver Cirrhosis

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Fig. 1.
Flow chart of patient enrollment. HCC = hepatocellular carcinoma, MR = magnetic resonance, RFA = radiofrequency ablation, TACE = transarterial chemoembolization
jksr-76-237f1.tif
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).
jksr-76-237f2.tif
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
jksr-76-237f3.tif
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
jksr-76-237f4.tif
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
jksr-76-237f5.tif
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
jksr-76-237f6.tif
Table 1.
The Mean FFs and the Changes in the FF between Pre-Contrast MRS and Post-Contrast MRS
Group Mean FF (Mean ± SD, %) Change of FF p-Value
Pre-Contrast MRS Post-Contrast MRS (Mean ± SD, %)
Non-cirrhosis (n = 78) 5.47 ± 5.66 5.88 ± 5.94 0.41 ± 0.68 < 0.000
Cirrhosis (n = 77) 4.05 ± 4.31 4.20 ± 4.33 0.15 ± 0.59 0.032
 Child A (n = 70) 4.08 ± 4.37 4.25 ± 4.36 0.17 ± 0.59 0.020
 Child B (n = 6) 3.70 ± 4.23 3.57 ± 4.72 −0.13 ± 0.62 0.620
 Child C (n = 1) 4.0 4.30 0.30  
Total (n = 155) 4.77 ± 5.07 5.05 ± 5.26 0.28 ± 0.65 < 0.000

FF = fat fraction, MRS = magnetic resonance spectroscopy, SD = standard deviation

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

p-value < 0.05. ALT = alanine aminotransferase, APH = alkaline phosphatase, AST = aspartate aminotransferase, MELD = Model for End-Stage Liver Dis-ease, MRS = magnetic resonance spectroscopy, SD = standard deviation

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