J Korean Soc Magn Reson Med.  2013 Sep;17(3):215-223. 10.13104/jksmrm.2013.17.3.215.

The Effect of Gd-EOB-DPTA on the Stiffness Value of Magnetic Resonance Elastography in Evaluating Hepatic Fibrosis

• Lee JE
• Lee JM
• Lee YJ
• Yoon JH
• Lee KB
• Han JK
• Choi BI

• KMID: 2206920
• DOI: http://doi.org/10.13104/jksmrm.2013.17.3.215

Abstract

PURPOSE
To evaluate the effect of gadoxetic acid on the measurement of the stiffness value of MR elastography (MRE) used to evaluate hepatic fibrosis (HF).
MATERIALS AND METHODS
MRE was obtained in 32 patients with clinically suspected chronic liver disease, both before and after injection of gadoxetic acid. Two independent reviewers measured the stiffness values of the liver parenchyma on elastograms. The mean liver stiffness values were compared in the pre- and post-contrast MREs using the paired t-test. Intra-rater and inter-rater correlation was assessed using the intraclass correlation coefficient (ICC). The accuracy, sensitivity, and specificity of both pre- and post-contrast MREs was evaluated for the diagnosis of significant HF (> or = F2) using cut off value of 3.1 kPa.
RESULTS
There were no significant differences in the stiffness values of the liver parenchyma on pre- and post-contrast MREs (p = 0.15 and 0.38 for each reader, respectively). Regarding intra-rater correlation, excellent agreement was noted on rater 1(ICC = 0.998) and rater 2 (ICC = 0.996). Excellent correlation regarding the measured stiffness values was noted on both pre- and post-contrast MREs (ICC = 0.988 for pre-contrast, ICC = 0.993 for post-contrast). The accuracy, sensitivity, and specificity of the pre- and post-contrast MREs for differentiating significant HF (> or = F2) from < or = F1 were same as 71%, 60%, and 100%, respectively.
CONCLUSION
As there was no significant difference in the stiffness measurements seen on MREs before and after administration of gadoxetic acids, it is therefore acceptable to perform MRE after contrast injection in order to evaluate HF.

Keyword

Chronic liver disease; Hepatic fibrosis; MR elastogaphy; Gadoxetic acid; Stiffness value

MeSH Terms

Elasticity Imaging Techniques
Fibrosis
Gadolinium DTPA
Humans
Liver
Liver Diseases
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Sensitivity and Specificity
Gadolinium DTPA

Figure

• 

  Fig. 1 MR elastography (MRE) examinations before and after injection of Gadoxetic acid in a 48-year-old woman with pancreatic cancer. Pre-contrast MRE images are seen in the top row, and the post-contrast MRE images are seen in the bottom row. (a, d) a conventional abdominal MR magnitude image of a patient. (b, e) an MRE wave image at 60 Hz. (c, f) an MR elastogram. The ROI was drawn manually on the pre-contrast MRE and was copied onto the post-contrast MRE. The mean liver stiffness values of pre- and post-contrast elastograms are similar (1.84 kPa for pre-contrast MRE and 1.81 kPa for post-contrast MRE).

• 

  Fig. 2 Dot and line diagrams of the liver stiffness values for (a) reviewer 1 and (b) reviewer 2. All observations are plotted as individual dots, and the measured stiffness values of pre- and post-contrast MRE are connected by a line. For both reviewers, there was no tendency toward an increase or decrease in the stiffness values seen on post-contrast MRE compared with that seen on pre-contrast MRE.

• 

  Fig. 3 Box plots of the liver stiffness values of (a) pre-contrast and (b) post-contrast MRE for each METAVIR fibrosis stage. The boundary of the boxes closest to zero indicates the 25th percentile, while the line within boxes indicates the median, and the boundary of the boxes furthest from zero indicates the 75th percentile. The error bars indicate the smallest and largest values within 1.5 box lengths of the 25th and 75th percentiles, respectively. Outliers are represented as individual points.

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