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| Potential of Gd-EOB-DTPA as an imaging biomarker for liver injury estimation after radiation therapy |
| Xiao-Li Sun a , Xue Jiang a , Yu Kuang b , Lei Xing c , Lu-Yi Bu a , Shuang-Hu Yuan d , Jin-Ming Yu d , Shu-Sen Zheng e , ∗ |
a Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
b Medical Physics Program, University of Nevada, Las Vegas, NV 89154, USA
c Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
d Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China
e Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
Part of this study was presented in American Society for Radiation Oncology (ASTRO) Annual Meeting on September 25–28, 2016 at Boston, USA.
∗ Corresponding author.
E-mail address: shusenzheng@zju.edu.cn (S.-S. Zheng). |
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Abstract Background: Hepatic radiation injury severely restricts irradiation treatment for liver carcinoma. The pur- pose of this study was to investigate the clinical application of gadolinium ethoxybenzyl diethylenetri- amine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI (EOB-MRI) in the assessment of liver function after external radiation therapy and to determine the relationship between focal liver reaction (FLR) and liver function.
Methods: A total of 47 patients with liver malignancies who underwent external beam radiation therapy were enrolled. EOB-MRI was performed on each patient at approximately one month post-radiotherapy. The hepatobiliary (HPB) phase images from EOB-MRI were fused with the planning CT images, and the isodose lines from the patients’ treatment plans were overlaid onto the fused images. The correlation of the EOB-MR image intensity distribution with the isodose lines was studied. We also compared liver function in patients between pre-treatment and post-treatment.
Results: Decreased uptake of Gd-EOB-DTPA, which was manifested by well-demarcated focal hypointensity of the liver parenchyma or FLR to high-dose radiation, was observed in the irradiated areas of 38 patients. The radiotherapy isodose line of decreased uptake area of Gd-EOB-DTPA was 30–46 Gy. The median corresponding dose curve of FLR was 34.4 Gy. Nine patients showed the absence of decreased uptake area of Gd-EOB-DTPA in the irradiated areas. Compared to the 38 patients with the presence of decreased uptake area of Gd-EOB-DTPA, 9 patients with the absence of decreased uptake area of Gd-EOB-DTPA showed significant higher levels of total bile acid, total bilirubin, direct bilirubin and alpha-fetoprotein (P < 0.05). There were no significant differences in alanine transaminase, aspartate aminotransferase, gamma-glutamyl transpeptidase or albumin levels between the two groups (P > 0.05).
Conclusions: Visible uptake of Gd-EOB-DTPA by the liver parenchyma was significantly associated with liver function parameters. EOB-MRI can be a valuable imaging biomarker for the assessment of liver parenchyma function outside of radiation area.
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2019, Vol. 18 
