European Radiology

, Volume 28, Issue 10, pp 4215–4224 | Cite as

Can functional parameters from hepatobiliary phase of gadoxetate MRI predict clinical outcomes in patients with cirrhosis?

  • Kumar SandrasegaranEmail author
  • Enming Cui
  • Reem Elkady
  • Pauley Gasparis
  • Gitasree Borthakur
  • Mark Tann
  • Suthat Liangpunsakul



To determine the value of quantitative parameters of gadoxetate-enhanced magnetic resonance imaging (MRI) in predicting prognosis in patients with cirrhosis.


A cohort of 63 cirrhotic patients who had gadoxetate MRI and 2-year clinical follow-up was enrolled. Enhancement ratio (ER), contrast enhancement index (CEI) and contrast enhancement spleen index (CES) were calculated. The usefulness of these parameters and clinical scores, such as Child-Pugh score (CPS) and model for end stage liver disease (MELD), in predicting adverse outcomes, such as variceal bleeding (VB), hepatic encephalopathy (HE) and mortality at 2 years were evaluated.


Fifteen, 31 and 27 patients, respectively, had VB, HE and mortality within 2 years. The ER at 15 min (ER 15) and CES at 20 min (CES 20) were found to be the best MRI predictors. Areas under the receiver operating characteristic curve (AUC) for predicting VB were 0.785, 0.729, 0.673, 0.714, respectively, for ER 15, CES 20, CPS and MELD scores. ER 15 of less than 48 had sensitivity of 96% and specificity of 84% for predicting onset of HE within 2 years.


In patients with cirrhosis, ER 15 or CES 20 were equivalent or better predictors of major morbidity and mortality compared with commonly used clinical scores.

Key Points

• Gadoxetate parameters may identify cirrhotic patients at risk of adverse events.

• Gadoxetate parameters usually show superior predictive values compared to clinical scores.

• CES 20 score is associated with risk of mortality within 2 years.


Liver cirrhosis Patient outcome assessment Magnetic resonance imaging Gadolinium Hepatic encephalopathy 



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

Compliance with ethical standards


The scientific guarantor of this publication is Kumar Sandrasegaran, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Kumar Sandrasegaran is a consultant for Guerbet Pharmaceuticals.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Case-control study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Department of RadiologyJiangmen Central HospitalJiangmenChina
  3. 3.Department of RadiologyAssiut UniversityAssiutEgypt
  4. 4.Department of RadiologyTaibah UniversityMedinaSaudi Arabia
  5. 5.Department of Medicine (Division of Hepatology)Indiana University School of MedicineIndianapolisUSA
  6. 6.Department of MedicineRobert Roudebush VA Medical CenterIndianapolisUSA

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