Value Of Hepatocyte Specific Contrast Agent Gd-BOPTA-enhanced Magnetic Resonance Imaging In Assessing Liver Function

Objectives:To investigate the relationships between liver function parameters and the degree of liver parenchymal enhancement on the hepatocyte phase on gadobenate dimeglumine(Gd-BOPTA)-enhanced magnetic resonance(MR) imaging, and clinical predictive factors affecting the degree of liver parenchymal enhancement,as well as to clarify whether Gd-BOPTA-enhanced MR imaging in the hepatocyte phase could be used to evaluate liver function and liver function reserve.Materials and methods:In this study, 238 patients were classified into the following 4 groups: patients with normal liver function without liver cirrhosis(the NLF group) and cirrhosis patients with Child–Pugh Classes A, B, and C(the LCA, LCB, and LCC groups, respectively). The relative enhancement ratio(RE) of the liver parenchyma in the T1-vibe sequence was calculated from measurements of the signal intensity before(SI pre) and 90 min after(SI post) the intravenous administration of Gd-BOPTA,using the following formula: RE =(SI post-SI pre)/SI pre. Statistical analysis was used to evaluate the relationship between the RE of the liver parenchyma and liver function parameters and clinical predictive factors affecting the degree of liver parenchymal enhancement on the hepatocyte phase on Gd-BOPTA-enhanced MR imaging,as well as the different RE of the liver parenchyma among the NLF, LCA, LCB, and LCC groups.Results:Increased RE of the hepatic parenchyma showed correlations with decreased serum levels oftotal bilirubin(r=-0.402,P<0.01), prothrombin time(r=-0.363,P<0.01), international normalized ratio(r=-0.352,P<0.01), alanine aminotransferase(r=-0.201,P<0.01), aspartate aminotransferase( r=-0.261,P<0.01), alkaline phosphatase(r=-0.336,P<0.01), Child-Pugh scorces(r=-0.634,P<0.01) and elevated serum levels of albumin(r=0.458,P<0.01) cholinesterase(r=0.379,P<0.01) for all of the patients. The RE of the liver parenchyma were significantly higher for the NLF groups compared with the LCA(P<0.001) LCB(P<0.001) and LCC(P<0.001) groups, respectively. The RE of the liver parenchyma were significantly higher for the LCA groups compared with the LCB P<0.001) and LCC(P<0.001) groups, respectively. No significant differences were observed between the LCB and LCC groups(P=0.09), with regard to the RE of the liver parenchyma. A multiple stepwise regression analysis revealed that total bilirubin,albumin,alkaline phosphatase,and the presence of ascites were the only factors that predicted liver parenchymal enhancement on hepatocyte phase images.Conclusions:This study demonstrates that there was a significantly correlations between the RE of the liver parenchyma and liver functional parameters and the total bilirubin,albumin,ALP,and the presence of ascites were the only factors that predicted liver parenchymal enhancement on hepatocyte phase images.The intracellular uptake of Gd-BOPTA decreased with impaired liver function. Measurement of the degree of the liver parenchymal contrast enhancement on Gd-BOPTA-enhanced MR imaging in the hepatocyte phase might be a non-invasive technique for assessing liver function and liver function reserve.