Assessing regional hepatic function changes after hypertrophy induction by radioembolisation: comparison of gadoxetic acid-enhanced MRI and 99mTc-mebrofenin hepatobiliary scintigraphy

Eur Radiol Exp. 2024 Jan 29;8(1):15. doi: 10.1186/s41747-023-00409-x.

Abstract

Background: To compare Gd-ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and 99mTc-labelled mebrofenin hepatobiliary scintigraphy (HBS) as imaging-based liver function tests after unilateral radioembolisation (RE) in patients with primary or secondary liver malignancies.

Methods: Twenty-three patients with primary or secondary liver malignancies who underwent Gd-EOB-DTPA-enhanced MRI within a prospective study (REVoluTion) were evaluated. REVoluTion was a prospective open-label, non-randomised, therapy-optimising study of patients undergoing right-sided or sequential RE for contralateral liver hypertrophy at a single centre in Germany. MRI and hepatobiliary scintigraphy were performed before RE (baseline) and 6 weeks after (follow-up). This exploratory subanalysis compared liver enhancement on hepatobiliary phase MRI normalised to the spleen (liver-to-spleen ratio (LSR)) and the muscle (liver-to-muscle ratio (LMR)) with mebrofenin uptake on HBS for the total liver (TL) and separately for the right (RLL) and left liver lobe (LLL).

Results: Mebrofenin uptake at baseline and follow-up each correlated significantly with LSR and LMR on MRI for TL (≤ 0.013) and RLL (≤ 0.049). Regarding the LLL, mebrofenin uptake correlated significantly with LMR (baseline, p = 0.013; follow-up, p = 0.004), whereas with LSR, a borderline significant correlation was only seen at follow-up (p = 0.051; p = 0.046).

Conclusion: LSRs and LMR correlate with mebrofenin uptake in HBS. This study indicates that Gd-EOB-DTPA-enhanced MRI and 99mTc-labelled mebrofenin HBS may equally be used to assess an increase in contralateral liver lobe function after right-sided RE.

Relevance statement: MRI may be a convenient and reliable method for assessing the future liver remnant facilitating treatment planning and monitoring of patients after RE-induced hypertrophy induction.

Key points: • Both MRI and HBS can assess liver function after RE. • Liver enhancement on MRI correlates with mebrofenin uptake on HBS. • MRI might be a convenient alternative for estimating future liver remnants after hypertrophy induction.

Keywords: Gadolinium ethoxybenzyl DTPA; Liver; Magnetic resonance imaging; Radioembolisation; Technetium Tc 99 m mebrofenin.

MeSH terms

  • Aniline Compounds*
  • Gadolinium DTPA*
  • Glycine*
  • Humans
  • Hypertrophy
  • Liver Neoplasms* / diagnostic imaging
  • Liver Neoplasms* / radiotherapy
  • Magnetic Resonance Imaging / methods
  • Pentetic Acid
  • Prospective Studies
  • Radionuclide Imaging
  • Radiopharmaceuticals*

Substances

  • gadolinium ethoxybenzyl DTPA
  • mebrofenin
  • Radiopharmaceuticals
  • Pentetic Acid
  • Aniline Compounds
  • Glycine
  • Gadolinium DTPA