Limitations of GD-EOB-DTPA-enhanced MRI: can clinical parameters predict suboptimal hepatobiliary phase?

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Abstract

Aim To establish cut-off levels of the clinical parameters, which would predict suboptimal 30 minutes delayed hepatobiliary phase (HBP) with high specificity. Materials and methods This retrospective study included patients with chronic liver disease who underwent hepatocellular carcinoma screening with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 30 November 2014. For each case, HBP was graded as adequate or suboptimal, based on Liver Image Reporting and Data System (LI-RADS) criteria. The following laboratory data obtained within 3 months of the MRI date was extracted: total bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic–pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, activated partial thromboplastin time (aPTT), and International normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver operating characteristic (ROC) curve analysis was used to establish cut-off values for predicting suboptimal HBP. Results Of 284 patients, 242 (85.2%) patients (91; 57.6% male) had an adequate HBP and 42 (14.8%) patients (13; 61.9% male) had suboptimal HBP, with mean ages of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC curve for predicting suboptimal HBP were 0.85 (95%CI 0.79–0.91) for the MELD score, 0.88 (95%CI 0.82–0.93) for TB, and 0.91 (95%CI 0.86–0.95) for DB. Accuracy, positive likelihood ratios and cut-off values for predicting suboptimal HBP were, respectively: 86.7% and 11.2 for the MELD score ≥16.7, 88.2% and 28.7 for TB ≥4.3 mg/dl, and 91.1% and 36.4 for DB ≥1.3 mg/dl. SGOT, SGPT, and ALP were not statistically significantly different between the groups. Conclusion Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalClinical Radiology
Volume72
Issue number1
DOIs
StatePublished - Jan 1 2017

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Pentetic Acid
Bilirubin
Magnetic Resonance Imaging
End Stage Liver Disease
International Normalized Ratio
Aspartate Aminotransferases
Transaminases
ROC Curve
Alkaline Phosphatase
Partial Thromboplastin Time
Proxy
Serum
Information Systems
Liver Diseases
Albumins
Hepatocellular Carcinoma
Creatinine
Chronic Disease
Retrospective Studies
Liver

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{5b048f40952147f3ad4c2b1ede7c438e,
title = "Limitations of GD-EOB-DTPA-enhanced MRI: can clinical parameters predict suboptimal hepatobiliary phase?",
abstract = "Aim To establish cut-off levels of the clinical parameters, which would predict suboptimal 30 minutes delayed hepatobiliary phase (HBP) with high specificity. Materials and methods This retrospective study included patients with chronic liver disease who underwent hepatocellular carcinoma screening with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 30 November 2014. For each case, HBP was graded as adequate or suboptimal, based on Liver Image Reporting and Data System (LI-RADS) criteria. The following laboratory data obtained within 3 months of the MRI date was extracted: total bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic–pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, activated partial thromboplastin time (aPTT), and International normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver operating characteristic (ROC) curve analysis was used to establish cut-off values for predicting suboptimal HBP. Results Of 284 patients, 242 (85.2{\%}) patients (91; 57.6{\%} male) had an adequate HBP and 42 (14.8{\%}) patients (13; 61.9{\%} male) had suboptimal HBP, with mean ages of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC curve for predicting suboptimal HBP were 0.85 (95{\%}CI 0.79–0.91) for the MELD score, 0.88 (95{\%}CI 0.82–0.93) for TB, and 0.91 (95{\%}CI 0.86–0.95) for DB. Accuracy, positive likelihood ratios and cut-off values for predicting suboptimal HBP were, respectively: 86.7{\%} and 11.2 for the MELD score ≥16.7, 88.2{\%} and 28.7 for TB ≥4.3 mg/dl, and 91.1{\%} and 36.4 for DB ≥1.3 mg/dl. SGOT, SGPT, and ALP were not statistically significantly different between the groups. Conclusion Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.",
author = "Mariya Kobi and V. Paroder and Milana Flusberg and Alla Rozenblit and Victoria Chernyak",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.crad.2016.10.004",
language = "English (US)",
volume = "72",
pages = "55--62",
journal = "Clinical Radiology",
issn = "0009-9260",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Limitations of GD-EOB-DTPA-enhanced MRI

T2 - can clinical parameters predict suboptimal hepatobiliary phase?

AU - Kobi, Mariya

AU - Paroder, V.

AU - Flusberg, Milana

AU - Rozenblit, Alla

AU - Chernyak, Victoria

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Aim To establish cut-off levels of the clinical parameters, which would predict suboptimal 30 minutes delayed hepatobiliary phase (HBP) with high specificity. Materials and methods This retrospective study included patients with chronic liver disease who underwent hepatocellular carcinoma screening with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 30 November 2014. For each case, HBP was graded as adequate or suboptimal, based on Liver Image Reporting and Data System (LI-RADS) criteria. The following laboratory data obtained within 3 months of the MRI date was extracted: total bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic–pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, activated partial thromboplastin time (aPTT), and International normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver operating characteristic (ROC) curve analysis was used to establish cut-off values for predicting suboptimal HBP. Results Of 284 patients, 242 (85.2%) patients (91; 57.6% male) had an adequate HBP and 42 (14.8%) patients (13; 61.9% male) had suboptimal HBP, with mean ages of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC curve for predicting suboptimal HBP were 0.85 (95%CI 0.79–0.91) for the MELD score, 0.88 (95%CI 0.82–0.93) for TB, and 0.91 (95%CI 0.86–0.95) for DB. Accuracy, positive likelihood ratios and cut-off values for predicting suboptimal HBP were, respectively: 86.7% and 11.2 for the MELD score ≥16.7, 88.2% and 28.7 for TB ≥4.3 mg/dl, and 91.1% and 36.4 for DB ≥1.3 mg/dl. SGOT, SGPT, and ALP were not statistically significantly different between the groups. Conclusion Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.

AB - Aim To establish cut-off levels of the clinical parameters, which would predict suboptimal 30 minutes delayed hepatobiliary phase (HBP) with high specificity. Materials and methods This retrospective study included patients with chronic liver disease who underwent hepatocellular carcinoma screening with Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 30 November 2014. For each case, HBP was graded as adequate or suboptimal, based on Liver Image Reporting and Data System (LI-RADS) criteria. The following laboratory data obtained within 3 months of the MRI date was extracted: total bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic–pyruvic transaminase (SGPT), alkaline phosphatase (ALP), albumin, activated partial thromboplastin time (aPTT), and International normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver operating characteristic (ROC) curve analysis was used to establish cut-off values for predicting suboptimal HBP. Results Of 284 patients, 242 (85.2%) patients (91; 57.6% male) had an adequate HBP and 42 (14.8%) patients (13; 61.9% male) had suboptimal HBP, with mean ages of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC curve for predicting suboptimal HBP were 0.85 (95%CI 0.79–0.91) for the MELD score, 0.88 (95%CI 0.82–0.93) for TB, and 0.91 (95%CI 0.86–0.95) for DB. Accuracy, positive likelihood ratios and cut-off values for predicting suboptimal HBP were, respectively: 86.7% and 11.2 for the MELD score ≥16.7, 88.2% and 28.7 for TB ≥4.3 mg/dl, and 91.1% and 36.4 for DB ≥1.3 mg/dl. SGOT, SGPT, and ALP were not statistically significantly different between the groups. Conclusion Cut-off levels of MELD score, DB, and TB can predict an suboptimal HBP with high accuracy. Prospective identification of patients with a high likelihood of an suboptimal HBP can help to avoid administering a more costly agent to patients who would not benefit from its unique properties.

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U2 - 10.1016/j.crad.2016.10.004

DO - 10.1016/j.crad.2016.10.004

M3 - Article

C2 - 27842889

AN - SCOPUS:85006292580

VL - 72

SP - 55

EP - 62

JO - Clinical Radiology

JF - Clinical Radiology

SN - 0009-9260

IS - 1

ER -