Clinical and Histologic Implications of Delayed Hepatobiliary Enhancement on Magnetic Resonance Imaging With Gadolinium Ethoxybenzyl Diethylenetriaminepentaacetic Acid

Purpose: The aim of this study was to evaluate the serial signal changes in hepatobiliary enhancement on gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid or gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging and its correlation with clinical parameters. Method: Under institutional review board approval, Gd-EOB-DTPA-enhanced magnetic resonance imaging was performed in 77 subjects (21 healthy volunteers and 56 biopsy-proven chronic hepatitis patients), and the signal intensities of the liver and common hepatic ducts (CHD) were measured every 2 minutes up to 50 minutes postcontrast. The associations among hepatic and CHD signals, physiological and hematological variables, histological activity index, and Metavir scores were analyzed with Pearson correlation and multiple linear stepwise regressions. The predictive ability of contrast enhancement index (CEI) of the liver with histological activity index and fibrosis scores at different time points were studied using nonparametric receiver operating characteristic curves. Results: Among the clinical parameters, body weight and body mass index had the highest negative correlation with hepatobiliary enhancement between 2 and 50 minutes postcontrast (P < 0.001). Multiple regressions showed that creatinine level, body weight, and body mass index were independent predictors for both mean hepatic and CHD signal intensity (P < 0.05). Patients with more severe fibrosis or moderate necrosis tended to have lower CEIs than other patients were. The predictive ability of CEI for the best differentiation between no fibrosis and any fibrosis (F >= 1) was at 10 minutes postcontrast (area under the receiver operating characteristic curve, 0.797). Conclusions: Delayed hepatobiliary enhancement with Gd-EOB-DTPA could be possibly used for staging liver fibrosis. Contrast enhancement index of the liver at 10 minutes is useful for differentiating between no fibrosis and any degree of fibrosis in chronic hepatitis patients.