Assessment of Liver Function and Liver Fibrosis with Dynamic Gd-EOB-DTPA–Enhanced MRI

Published:January 16, 2015DOI:

      Rationale and Objectives

      To evaluate the ability of segmental linear fitting analysis of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid liver perfusion magnetic resonance imaging (MRI) to assess liver function and liver fibrosis.

      Materials and Methods

      Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid liver perfusion MRI was performed in 41 patients, and perfusion estimates were generated by segmental linear fitting analysis of the time-intensity curves. The relationships of Tin, Tout, Kup, and the ratio between the signal intensities of the peak and the last phase with liver fibrosis stage and laboratory measurements of liver function were evaluated.


      Serum prealbumin concentration was significantly positively correlated with Kup and the signal intensity ratio and was significantly negatively correlated with Tin and Tout. Tin and Tout were significantly higher and Kup and the signal intensity ratio were significantly lower in patients with advanced fibrosis than those without. Tout was the best predictor of advanced fibrosis, with an area under the receiving operating characteristic curve of 0.843, a sensitivity of 100%, and a specificity of 80%.


      A new procedure of quantifying the hepatocyte-specific uptake of a T1-enhancing contrast agent can be used to assess impaired hepatobiliary function. The parameters obtained from perfusion MRI have the potential to predict advanced fibrosis.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jonas E.
        • Hultcrantz R.
        • Slezak P.
        • et al.
        Dynamic 99Tcm-HIDA SPET: non-invasive measuring of intrahepatic bile flow. Description of the method and a study in primary sclerosing cholangitis.
        Nucl Med Commun. 2001; 22: 127-134
        • Jonas E.
        • Naslund E.
        • Freedman J.
        • et al.
        Measurement of parenchymal function and bile duct flow in primary sclerosing cholangitis using dynamic 99mTc-HIDA SPECT.
        J Gastroenterol Hepatol. 2006; 21: 674-681
        • Huppertz A.
        • Balzer T.
        • Blakeborough A.
        • et al.
        Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings.
        Radiology. 2004; 230: 266-275
        • Zech C.J.
        • Herrmann K.A.
        • Reiser M.F.
        • et al.
        MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA.
        Magn Reson Med Sci. 2007; 6: 43-52
        • Clement O.
        • Siauve N.
        • Lewin M.
        • et al.
        Contrast agents in magnetic resonance imaging of the liver: present and future.
        Biomed Pharmacother. 1998; 52: 51-58
        • Schuhmann-Giampieri G.
        Liver contrast media for magnetic resonance imaging. Interrelations between pharmacokinetics and imaging.
        Invest Radiol. 1993; 28: 753-761
        • Hamm B.
        • Staks T.
        • Muhler A.
        • et al.
        Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging.
        Radiology. 1995; 195: 785-792
        • Verloh N.
        • Haimerl M.
        • Zeman F.
        • et al.
        Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla.
        Eur Radiol. 2014; 24: 1013-1019
        • Nilsson H.
        • Blomqvist L.
        • Douglas L.
        • et al.
        Assessment of liver function in primary biliary cirrhosis using Gd-EOB-DTPA-enhanced liver MRI.
        HPB (Oxford). 2010; 12: 567-576
        • Kamimura K.
        • Fukukura Y.
        • Yoneyama T.
        • et al.
        Quantitative evaluation of liver function with T1 relaxation time index on Gd-EOB-DTPA-enhanced MRI: comparison with signal intensity-based indices.
        J Magn Reson Imaging. 2014; 40: 884-889
        • Hagiwara M.
        • Rusinek H.
        • Lee V.S.
        • et al.
        Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging–initial experience.
        Radiology. 2008; 246: 926-934
        • Sourbron S.
        • Sommer W.H.
        • Reiser M.F.
        • et al.
        Combined quantification of liver perfusion and function with dynamic gadoxetic acid-enhanced MR imaging.
        Radiology. 2012; 263: 874-883
        • Saito K.
        • Ledsam J.
        • Sourbron S.
        • et al.
        Assessing liver function using dynamic Gd-EOB-DTPA-enhanced MRI with a standard 5-phase imaging protocol.
        J Magn Reson Imaging. 2013; 37: 1109-1114
        • Saito K.
        • Ledsam J.
        • Sourbron S.
        • et al.
        Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI: a preliminary study comparing galactosyl human serum albumin scintigraphy with indocyanine green retention.
        Eur Radiol. 2014; 24: 112-119
        • Batts K.P.
        • Ludwig J.
        Chronic hepatitis: an update on terminology and reporting.
        Am J Surg Pathol. 1995; 19: 1409-1417
        • Verloh N.
        • Haimerl M.
        • Rennert J.
        • et al.
        Impact of liver cirrhosis on liver enhancement at Gd-EOB-DTPA enhanced MRI at 3 Tesla.
        Eur J Radiol. 2013; 82: 1710-1715
        • Gulberg V.
        • Haag K.
        • Rossle M.
        • et al.
        Hepatic arterial buffer response in patients with advanced cirrhosis.
        Hepatology. 2002; 35: 630-634
        • Orrego H.
        • Blendis L.M.
        • Crossley I.R.
        • et al.
        Correlation of intrahepatic pressure with collagen in the Disse space and hepatomegaly in humans and in the rat.
        Gastroenterology. 1981; 80: 546-556
        • Martinez-Hernandez A.
        The hepatic extracellular matrix. II. Electron immunohistochemical studies in rats with CCl4-induced cirrhosis.
        Lab Invest. 1985; 53: 166-186
        • Van Beers B.E.
        • Leconte I.
        • Materne R.
        • et al.
        Hepatic perfusion parameters in chronic liver disease: dynamic CT measurements correlated with disease severity.
        AJR Am J Roentgenol. 2001; 176: 667-673
        • Vogl T.J.
        • Kummel S.
        • Hammerstingl R.
        • et al.
        Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA.
        Radiology. 1996; 200: 59-67
        • Reichen J.
        • Egger B.
        • Ohara N.
        • et al.
        Determinants of hepatic function in liver cirrhosis in the rat.
        J Clin Invest. 1988; 82: 2069-2076
        • Varin F.
        • Huet P.M.
        Hepatic microcirculation in the perfused cirrhotic rat liver.
        J Clin Invest. 1985; 76: 1904-1912
        • Huet P.M.
        • Goresky C.A.
        • Villeneuve J.P.
        • et al.
        Assessment of liver microcirculation in human cirrhosis.
        J Clin Invest. 1982; 70: 1234-1244
        • Dahlqvist Leinhard O.
        • Dahlström N.
        • Kihlberg J.
        • et al.
        Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study.
        Eur Radiol. 2012; 22: 642-653
        • Beck F.K.
        • Rosenthal T.C.
        Prealbumin: a marker for nutritional evaluation.
        Am Fam Physician. 2002; 65: 1575-1758
        • Materne R.
        • Smith A.M.
        • Peeters F.
        • et al.
        Assessment of hepatic perfusion parameters with dynamic MRI.
        Magn Reson Med. 2002; 47: 135-142
        • Sourbron S.P.
        • Buckley D.L.
        Tracer kinetic modelling in MRI: estimating perfusion and capillary permeability.
        Phys Med Biol. 2012; 57: R1-R33
        • Koh T.S.
        • Bisdas S.
        • Koh D.M.
        • et al.
        Fundamentals of tracer kinetics for dynamic contrast-enhanced MRI.
        J Magn Reson Imaging. 2011; 34: 1262-1276
        • Yoshioka K.
        • Hashimoto S.
        Can non-invasive assessment of liver fibrosis replace liver biopsy?.
        Hepatol Res. 2012; 42: 233-240
        • Do R.K.
        • Rusinek H.
        • Taouli B.
        Dynamic contrast-enhanced MR imaging of the liver: current status and future directions.
        Magn Reson Imaging Clin N Am. 2009; 17: 339-349
        • Geisel D.
        • Lüdemann L.
        • Wagner C.
        • et al.
        Evaluation of gadolinium-EOB-DTPA uptake after portal vein embolization: value of an increased flip angle.
        Acta Radiol. 2014; 55: 149-154