MR liver imaging with Gd-EOB-DTPA: The need for different delay times of the hepatobiliary phase in patients with different liver function

Abstract

Purpose: To determine the optimal hepatobiliary delay time after Gd-EOB-DTPA injection for lesion characterization in cirrhosis patients with different liver function.

Materials and methods: Ninety consecutive patients with liver cirrhosis who underwent Gd-EOB-DTPA-enhanced MRI for the evaluation of known or suspected focal liver lesions were enrolled in this retrospective study. The patients were divided into Child-Pugh A, B and C groups depending on their liver function through the Child-Pugh classification. Hepatobiliary phase images obtained at 5, 10, 15, and 20min were assessed in each group by the following items: parenchymal enhancement, contrast agent excretion into the bile ducts and ureter, and contrast- and signal-to-noise ratios for lesions.

Results: In the Child-Pugh A group, parenchymal enhancement increased significantly from 5min to 15min (P<0.05), and stabilized at 20min (P=0.22). However, there was no significant difference in parenchymal enhancement among all of the hepatobiliary phases in the Child-Pugh B and C groups. The biliary contrast agent excretion was first observed before 20min in all of the patients in the Child-Pugh A group, at 20min in 4 patients (25%) in the Child-Pugh B group, and after 20min in 11 patients (78.6%) in the Child-Pugh C group. The numbers of patients whose urethral contrast agent excretion was first observed at 5min in the Child-Pugh A, B and C groups were 38 (63.3%), 12 (75.0%) and 11 (78.6%), respectively. The CNR of the lesions increased significantly (P<0.05), up to 15min after enhancement without a further increase at 20min in the Child-Pugh A group; however, no significant change was found from 5min to 20min in the Child-Pugh B and C groups. For the SNR of lesions, there was no significant difference at 5, 10, 15 and 20min in all of the groups.

Conclusions: A delay time of 15min for the hepatobiliary phase was sufficient for patients with mild liver dysfunction who were classified as Child-Pugh A. Nevertheless, for the patients with moderate or severe liver dysfunction who were classified as Child-Pugh B or C, a delay time longer than 5min is meaningless for lesion characterization.

Keywords: Delay time; Gd-EOB-DTPA; Hepatobiliary phase; Liver cirrhosis.