Inter- and intra-reader agreement for gadoxetic acid-enhanced MRI parameter readings in patients with chronic liver diseases.

Abstract

OBJECTIVES:

To examine inter- and intra-observer agreement for four simple hepatobiliary phase (HBP)-based scores on gadoxetic acid (GA)-enhanced MRI and their correlation with liver function in patients with mixed chronic liver disease (CLD).

METHODS:

This single-center, retrospective study included 287 patients (62% male, 38% female, mean age 53.5 ± 13.7 years) with mixed CLD (20.9% hepatitis C, 19.2% alcoholic liver disease, 8% hepatitis B) who underwent GA-enhanced MRI of the liver for clinical care between 2010 and 2015. Relative liver enhancement (RLE), contrast uptake index (CUI), hepatic uptake index (HUI), and liver-to-spleen contrast index (LSI) were calculated by two radiologists independently using unenhanced and GA-enhanced HPB (obtained 20 min after GA administration) images; 50 patients selected at random were reviewed twice by one reader to assess intra-observer reliability. Agreement was assessed by intraclass correlation coefficient (ICC). The albumin-bilirubin (ALBI) score, the model of end-stage liver disease (MELD), and the Child-Turcotte-Pugh (CTP) score were calculated as standards of reference for hepatic function.

RESULTS:

Intra-observer ICCs ranged from 0.814 (0.668-0.896) for CUI to 0.969 (0.945-0.983) for RLE. Inter-observer ICCs ranged from 0.777 (0.605-0.874) for HUI to 0.979 (0.963-0.988) for RLE. All HBP-based scores correlated significantly (all p < 0.001) with the ALBI, MELD, and CTP scores and were able to discriminate patients with a MELD score ≥ 15 versus ≤ 14, with area under the curve values ranging from 0.760 for RLE to 0.782 for HUI.

CONCLUSION:

GA-enhanced, MRI-derived, HBP-based parameters showed excellent inter- and intra-observer agreement. All HBP-based parameters correlated with clinical and laboratory scores of hepatic dysfunction, with no significant differences between each other.

KEY POINTS:

• Radiological parameters that quantify the hepatic uptake of gadoxetic acid are highly reproducible. • These parameters can be used interchangeably because they correlate with each other and with scores of hepatic dysfunction. • Assessment of these parameters may be helpful in monitoring disease progression.

• Authors: Lucian Beer, Mattias Mandorfer, Nina Bastati, Sarah Poetter-Lang, Dietmar Tamandl, Dilyana Plamenova Stoyanova, Michael Christoph Elmer, Georg Semmler, Benedikt Simbrunner, Jacqueline C Hodge, Claude B Sirlin, Thomas Reiberger, Ahmed Ba-Ssalamah
• Journal: European radiology (Eur Radiol) Vol. 29 Issue 12 Pg. 6600-6610 (Dec 2019) ISSN: 1432-1084 [Electronic] Germany
• PMID: 31001679 (Publication Type: Journal Article)

Chemical References

• Contrast Media
• gadolinium ethoxybenzyl DTPA
• Gadolinium DTPA

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Chronic Disease
• Contrast Media (pharmacology)
• Female
• Gadolinium DTPA (pharmacology)
• Humans
• Liver Diseases (diagnosis)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• ROC Curve
• Reproducibility of Results
• Retrospective Studies
• Young Adult