Characterization and Prediction of Signal Intensity Changes in Normal Liver Parenchyma on Gadoxetic Acid–enhanced MRI Scans after Liver-directed Radiation Therapy

Purpose: To better characterize and understand the significance of focal liver reaction (FLR) development in a large cohort of patients who underwent gadoxetic acid–enhanced MRI after being treated with radiation therapy (RT) for hepatobiliary tumors. Materials and Methods: This retrospective study evaluated 100 patients (median age, 65 years [first and third quartiles, 60–69 years]; 80 men) who underwent RT for hepatocellular carcinoma, bile duct tumors, or liver metastases at Mount Sinai Hospital between March 1, 2018, and February 29, 2020. CT simulation scans were fused to MRI scans obtained 1–6 months and 6–12 months after RT, using the hepatobiliary phase of the MRI. To define FLR volume, two radiation oncologists independently delineated the borders of the hypointensity observed on MRI scans in the liver region where RT was delivered. Biologically effective dose (BED) thresholds for the formation of FLRs were calculated, along with albumin-bilirubin (ALBI) scores and grades, and overall survival. Results: Most patients developed FLRs, which decreased in volume over time. Median BED threshold values for FLR development were 63.6 Gy at 1–6 months and 88.7 Gy at 6–12 months. While higher baseline ALBI scores were associated with a lower rate of FLRs, there was a significant association between FLR volume and increase in ALBI score at 1–6 months (P = .048). Twelve-and 24-month survival estimates for the cohort were 81% and 48%, respectively. Histopathologic analysis of seven explanted liver speci-mens demonstrated findings consistent with radiation-induced liver disease. Conclusion: FLRs were a clear measure of liver damage after RT and were associated with the development of liver dysfunction and focal radiation-induced liver disease.