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Gadoxetic acid-enhanced magnetic resonance imaging has become a useful tool for quantitative evaluation of liver capacity. We report on the importance of intrahepatic fat on gadoxetic acid-supported T1 mapping for estimation of liver maximum capacity, assessed by the realtime 13 C-methacetin breathing test ( 13 C-MBT). For T1 relaxometry, we used a respective T1-weighted sequence with two-point Dixon water-fat separation and various flip angles. Both T1 maps of the in-phase component without fat separation (T1&#95;in) and T1 maps merely based on the water component (T1&#95;W) were generated, and respective reduction rates of the T1 relaxation time (rrT1) were evaluated. A steady considerable decline in rrT1 with progressive reduction of liver function could be observed for both T1&#95;in and T1&#95;W (p < 0.001). When patients were subdivided into 3 different categories of 13 C-MBT readouts, the groups could be significantly differentiated by their rrT1&#95;in and rrT1&#95;W values (p < 0.005). In a simple correlation model of 13 C-MBT values with T1&#95;inpost (r = 0.556; p < 0.001), T1&#95;Wpost (r = 0.557; p < 0.001), rrT1&#95;in (r = 0.711; p < 0.001) and rrT1&#95;W (r = 0.751; p < 0.001), a log-linear correlation has been shown. Liver maximum capacity measured with 13 C-MBT can be determined more precisely from gadoxetic acid-supported T1 mapping when intrahepatic fat is taken into account. Here, T1&#95;W maps are shown to be significantly superior to T1&#95;in maps without separation of fat.

Gadoxetic acid (Gd-EOB-DTPA) is a paramagnetic MRI contrast agent with raising popularity and has been used for evaluation of imaging-based liver function in recent years. In order to verify whether liver function as determined by real-time breath analysis using the intravenous administration of 13 C-methacetin can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using signal intensity (SI) values. 110 patients underwent Gd-EOB-DTPA-enhanced 3-T MRI and, for the evaluation of liver function, a 13 C-methacetin breath test ( 13 C-MBT). SI values from before (SI pre ) and 20 min after (SI post ) contrast media injection were acquired by T1-weighted volume-interpolated breath-hold examination (VIBE) sequences with fat suppression. The relative enhancement (RE) between the plain and contrast-enhanced SI values was calculated and evaluated in a correlation analysis of 13 C-MBT values to SI post and RE to obtain a SI-based estimation of 13 C-MBT values. The simple regression model showed a log-linear correlation of 13 C-MBT values with SI post and RE (p < 0.001). Stratified by 3 different categories of 13 C-MBT readouts, there was a constant significant decrease in both SI post (p ≤ 0.002) and RE (p ≤ 0.033) with increasing liver disease progression as assessed by the 13 C-MBT. Liver function as determined using real-time 13 C-methacetin breath analysis can be estimated quantitatively from Gd-EOB-DTPA-enhanced MRI using SI-based indices.