Quantification of liver function using gadoxetic acid-enhanced MRI
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SPECIAL SECTION : DIFFUSE LIVER DISEASE
Quantification of liver function using gadoxetic acid‑enhanced MRI Sarah Poetter‑Lang1 · Nina Bastati1 · Alina Messner1 · Antonia Kristic1 · Alexander Herold1 · Jacqueline C. Hodge1 · Ahmed Ba‑Ssalamah1 Received: 30 April 2020 / Revised: 20 August 2020 / Accepted: 21 September 2020 © The Author(s) 2020
Abstract The introduction of hepatobiliary contrast agents, most notably gadoxetic acid (GA), has expanded the role of MRI, allowing not only a morphologic but also a functional evaluation of the hepatobiliary system. The mechanism of uptake and excretion of gadoxetic acid via transporters, such as organic anion transporting polypeptides (OATP1,3), multidrug resistance-associated protein 2 (MRP2) and MRP3, has been elucidated in the literature. Furthermore, GA uptake can be estimated on either static images or on dynamic imaging, for example, the hepatic extraction fraction (HEF) and liver perfusion. GA-enhanced MRI has achieved an important role in evaluating morphology and function in chronic liver diseases (CLD), allowing to distinguish between the two subgroups of nonalcoholic fatty liver diseases (NAFLD), simple steatosis and nonalcoholic steatohepatitis (NASH), and help to stage fibrosis and cirrhosis, predict liver transplant graft survival, and preoperatively evaluate the risk of liver failure if major resection is planned. Finally, because of its noninvasive nature, GA-enhanced MRI can be used for long-term follow-up and post-treatment monitoring. This review article aims to describe the current role of GA-enhanced MRI in quantifying liver function in a variety of hepatobiliary disorders. Keywords MRI · Gadoxetic acid · Diffuse liver diseases · Liver function · Quantification Abbreviations ALBI Albumin-Bilirubin score AUROC Area under the receiver operator characteristic curve CACLD Compensated advanced chronic liver diseases CASH Chemotherapy-associated steatohepatitis CEI Contrast enhancement index CES Contrast enhancement spleen index CLD Chronic liver diseases CM Contrast media CPS Child–Pugh score CRC Colorectal cancer CT Computed tomography CTP Child–Turcotte–Pugh score CUI Contrast uptake index DACLD Decompensated advanced chronic liver diseases
* Ahmed Ba‑Ssalamah ahmed.ba‑[email protected] 1
Department of Biomedical Imaging and Image‑Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18‑20, 1090 Vienna, Austria
DWI Diffusion-weighted imaging ER Enhancement ratio FLIS Functional liver imaging score functFLR Functional future liver remnant GA Gadoxetic acid HBP Hepatobiliary phase HBV Hepatitis B virus HCC Hepatocellular carcinoma HCV Hepatitis C virus HE Hepatic encephalopathy HEF Hepatic extraction fraction HUI Hepatic uptake index ICG Indocyanine green clearance LSI Liver-to-spleen contrast index MDCT Multidetector computed tomography MELD Model of End-Stage Liver Disease score MRCP Magnetic resonance cholangiopancraticography MRE MR elastography MRI Magnetic r
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