AIM: To establish cut-off levels of the clinical parameters, which would predict 
suboptimal 30 minutes delayed hepatobiliary phase (HBP) with high specificity.
MATERIALS AND METHODS: This retrospective study included patients with chronic 
liver disease who underwent hepatocellular carcinoma screening with 
Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) between 1 January 2011 and 
30 November 2014. For each case, HBP was graded as adequate or suboptimal, based 
on Liver Image Reporting and Data System (LI-RADS) criteria. The following 
laboratory data obtained within 3 months of the MRI date was extracted: total 
bilirubin (TB), direct bilirubin (DB), serum glutamic oxaloacetic transaminase 
(SGOT), serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALP), 
albumin, activated partial thromboplastin time (aPTT), and International 
normalised ratio (INR). Model For End-Stage Liver Disease (MELD) scores were 
calculated as 3.78×ln[TB] + 11.2×ln[INR] + 9.57×ln[creatinine] + 6.43. Receiver 
operating characteristic (ROC) curve analysis was used to establish cut-off 
values for predicting suboptimal HBP.
RESULTS: Of 284 patients, 242 (85.2%) patients (91; 57.6% male) had an adequate 
HBP and 42 (14.8%) patients (13; 61.9% male) had suboptimal HBP, with mean ages 
of 58.5±9.7 years and 55±12.7 years, respectively (p=0.096). Areas under the ROC 
curve for predicting suboptimal HBP were 0.85 (95%CI 0.79-0.91) for the MELD 
score, 0.88 (95%CI 0.82-0.93) for TB, and 0.91 (95%CI 0.86-0.95) for DB. 
Accuracy, positive likelihood ratios and cut-off values for predicting 
suboptimal HBP were, respectively: 86.7% and 11.2 for the MELD score ≥16.7, 
88.2% and 28.7 for TB ≥4.3 mg/dl, and 91.1% and 36.4 for DB ≥1.3 mg/dl. SGOT, 
SGPT, and ALP were not statistically significantly different between the groups.
CONCLUSION: Cut-off levels of MELD score, DB, and TB can predict an suboptimal 
HBP with high accuracy. Prospective identification of patients with a high 
likelihood of an suboptimal HBP can help to avoid administering a more costly 
agent to patients who would not benefit from its unique properties.