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Comparison between CT volumetry, technetium99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare the efficacy of computed tomography volumetry (CTV), technetium99m galactosyl-serum-albumin (99mTc-GSA) scintigraphy, and gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI) in estimating the liver fibrosis (LF) stage in patients undergoing liver resection.

Methods

This retrospective study included 91 consecutive patients who had undergone preoperative dynamic CT and 99mTc-GSA scintigraphy. EOB-MRI was performed in 76 patients. CTV was used to measure the total liver volume (TLV), spleen volume (SV), normalised to the body surface area (BSA), and liver-to-spleen volume ratio (TLV/SV). 99mTc-GSA scintigraphy provided LHL15, HH15, and GSA indices. The liver-to-spleen ratio (LSR) was calculated in the hepatobiliary phase of EOB-MRI. Hyaluronic acid and type 4 collagen levels were measured in 65 patients. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify useful parameters for estimating the LF stage and laboratory data.

Results

According to the multivariable logistic regression analysis, SV/BSA (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.003–1.02; p = 0.011), LSR (OR, 0.06; 95%CI, 0.004–0.70; p = 0.026), and hyaluronic acid (OR, 1.01; 95%CI, 1.001–1.02; p = 0.024) were independent variables for severe LF (F3–4). Combined SV/BSA, LSR, and hyaluronic acid correctly estimated severe LF, with an AUC of 0.91, which was significantly larger than the AUCs of the GSA index (AUC = 0.84), SV/BSA (AUC = 0.83), or LSR (AUC = 0.75) alone.

Conclusions

Combined CTV, EOB-MRI, and hyaluronic acid analyses improved the estimation accuracy of severe LF compared to CTV, EOB-MRI, or 99mTc-GSA scintigraphy individually.

Clinical relevance statement

The combined analysis of spleen volume on CT volumetry, liver-to-spleen ratio on gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI, and hyaluronic acid can identify severe liver fibrosis associated with a high risk of liver failure after hepatectomy and recurrence in patients with hepatocellular carcinoma.

Key Points

• Spleen volume of CT volumetry normalised to the body surface area, liver-to-spleen ratio of EOB-MRI, and hyaluronic acid were independent variables for liver fibrosis.

• CT volumetry and EOB-MRI enable the detection of severe liver fibrosis, which may correlate with post-hepatectomy liver failure and complications.

• Combined CT volumetry, gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI (EOB-MRI), and hyaluronic acid analyses improved the estimation of severe liver fibrosis compared to technetium99m galactosyl-serum-albumin scintigraphy.

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Abbreviations

ALT:

Alanine aminotransferase

APRI:

Aspartate aminotransferase-platelet ratio index

AST:

Aspartate aminotransferase

BMI:

Body mass index

BSA:

Body surface area

CI:

Confidence interval

Cr:

Creatinine

EOB-MRI:

Gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic-acid-enhanced MRI

FIB-4:

Fibrosis index based on four factors; fibrosis-4 score

CTV:

CT volumetry

Gd:

Gadolinium

Gd-EOB-DTPA:

Gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid

HH15:

Uptake ratio of the heart at 15 min to that at 3 min

HCC:

Hepatocellular carcinoma

ICC:

Intraclass correlation

ICG:

Indocyanine green

ICG-R15:

Indocyanine green retention rates at 15 min after injection

INR:

International normalised ratio

LF:

Liver fibrosis

LHL15:

Uptake ratio of the liver to the liver plus heart at 15 min

LSR:

Liver-to-spleen ratio

MDCT:

Multidetector computed tomography

MELD:

Model for end-stage liver disease score

OR:

Odds ratio

Plt:

Platelet count

SI:

Signal intensity

SPECT:

Single-photon emission computed tomography

SV:

Splenic volume

TLV:

Total liver volume

TLV/SV:

Ratio of TLV to SV

99 mTc-GSA:

Technetium99m galactosyl-serum-albumin

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Acknowledgements

We would like to thank all the medical staff involved in this study.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Nihon University School of Medicine, Tokyo, Japan

    Yujiro Nakazawa, Masahiro Okada, Tomoko Hyodo, Kenichiro Tago, Kazu Shibutani, Mariko Mizuno & Hiroki Yoshikawa

  2. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan

    Hayato Abe, Tokio Higaki, Yukiyasu Okamura & Tadatoshi Takayama

Authors
  1. Yujiro Nakazawa
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  2. Masahiro Okada
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  3. Tomoko Hyodo
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  4. Kenichiro Tago
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  7. Hiroki Yoshikawa
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  8. Hayato Abe
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Corresponding author

Correspondence to Masahiro Okada.

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Guarantor

The scientific guarantor of this publication is Masahiro Okada.

Conflict of interest

The authors have no conflicts of interest to declare.

Statistics and biometry

We consulted statistical experts in the preparation of this manuscript.

Hirotsugu Yasuda, statistician Kondo P.P. Inc.

Informed consent

Informed consent was waived by the Institutional Review Board, given the study’s retrospective nature.

Ethical approval

Institutional Review Board approval was obtained (Nihon University, Itabashi Hospital, RK-201110-12).

Study subjects or cohorts overlap

Two of the 91 patients in this study have been previously reported in Tago K et al (2022) European Radiology. 32:7555–7565. https://doi.org/10.1007/s00330-022-08852-x

Methodology

• Retrospective

• Observational study

• Performed at one institution

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Nakazawa, Y., Okada, M., Hyodo, T. et al. Comparison between CT volumetry, technetium99m galactosyl-serum-albumin scintigraphy, and gadoxetic-acid-enhanced MRI to estimate the liver fibrosis stage in preoperative patients. Eur Radiol 34, 2212–2222 (2024). https://doi.org/10.1007/s00330-023-10219-9

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