Volume 51, Issue 1 pp. 62-69

Original Research

Predicting Patients With Insufficient Liver Enhancement in the Hepatobiliary Phase Before the Injection of Gadoxetic Acid: A Practical Approach Using the Bayesian Method

Yuki Mori MD,

Yuki Mori MD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Utaroh Motosugi MD, PhD,

Corresponding Author

Utaroh Motosugi MD, PhD

[email protected]

orcid.org/0000-0002-6743-9793

Department of Radiology, University of Yamanashi, Yamanashi, Japan

Address reprint requests to: U.M., Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan 409-3898. E-mail: [email protected]Search for more papers by this author

Tatsuya Shimizu MD,

Tatsuya Shimizu MD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Shintaro Ichikawa MD, PhD,

Shintaro Ichikawa MD, PhD

orcid.org/0000-0001-8043-8472

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Marie-Luise Kromrey MD,

Marie-Luise Kromrey MD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany

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Hiroshi Onishi MD, PhD,

Hiroshi Onishi MD, PhD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Yuki Mori MD,

Yuki Mori MD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Utaroh Motosugi MD, PhD,

Corresponding Author

Utaroh Motosugi MD, PhD

[email protected]

orcid.org/0000-0002-6743-9793

Department of Radiology, University of Yamanashi, Yamanashi, Japan

Tatsuya Shimizu MD,

Tatsuya Shimizu MD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Shintaro Ichikawa MD, PhD,

Shintaro Ichikawa MD, PhD

orcid.org/0000-0001-8043-8472

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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Marie-Luise Kromrey MD,

Marie-Luise Kromrey MD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany

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Hiroshi Onishi MD, PhD,

Hiroshi Onishi MD, PhD

Department of Radiology, University of Yamanashi, Yamanashi, Japan

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First published: 24 April 2019

https://doi.org/10.1002/jmri.26760

Citations: 3

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Abstract

Background

Gadoxetic acid-enhanced hepatobiliary phase (HBP) is useful in liver MRI, but sometimes shows insufficient liver enhancement. There is no established method to predict insufficient liver enhancement before the contrast injection.

Purpose

To reveal the utility of the Bayesian method for predicting patients with insufficient liver enhancement in the gadoxetic acid-enhanced HBP.

Study Type

Retrospective.

Subjects

In all, 576 patients with chronic liver disease.

Field Strength/Sequence

3T/3D gradient-echo T₁-weighted imaging and MR elastography (MRE).

Assessment

The patients were divided into two groups: insufficient and sufficient liver enhancement in HBP according to the liver-to-portal vein signal intensity ratio. Various parameters, including liver function tests and liver stiffness by MRE, were evaluated as predictors of insufficient liver enhancement.

Statistical Tests

We used Chi-square/Student's t-test/logistic regression analysis to determine independent associates, and Bayes' theorem to estimate the probability of insufficient (or sufficient) liver enhancement. The feasibility of Bayesian prediction of insufficient liver enhancement was tested by leave-one-out cross-validation to calculate sensitivity and specificity for single variables and combinations of some variables in all patients and in a subpopulation showing a confidence level of >80%.

Results

Independent associates of insufficient liver enhancement in HBP included: serum albumin (odds ratio [OR] = 4.82, P < 0.001), total bilirubin (OR = 0.30, P < 0.00), platelet count (OR = 1.54, P < 0.00), and liver stiffness by MRE (OR = 0.59, P < 0.00). The accuracy of Bayesian prediction of insufficient liver enhancement was 80.9% (466/576) for the single parameter of albumin and 79.0% (455/576) for total bilirubin, and was increased to 85.2% (487/576) for a combination of albumin, total bilirubin, and liver stiffness. In patients who showed a confidence level of >80%, the accuracy was 89.0% (439/493) for the above combination.

Data Conclusion

Bayesian prediction was useful to predict patients with insufficient enhancement by combining serum liver function tests and liver stiffness by MRE.

Level of Evidence: 3

Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:62–69.

Supporting Information

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Citing Literature

Volume51, Issue1

January 2020

Pages 62-69

Predicting Patients With Insufficient Liver Enhancement in the Hepatobiliary Phase Before the Injection of Gadoxetic Acid: A Practical Approach Using the Bayesian Method

Abstract

Background

Purpose

Study Type

Subjects

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Supporting Information

References

Citing Literature

References

Information

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Predicting Patients With Insufficient Liver Enhancement in the Hepatobiliary Phase Before the Injection of Gadoxetic Acid: A Practical Approach Using the Bayesian Method

Abstract

Background

Purpose

Study Type

Subjects

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Supporting Information

References

Citing Literature

References

Related

Information