Double-Dose Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients With Chronic Liver Disease

Motosugi, Utaroh; Ichikawa, Tomoaki; Sano, Katsuhiro; Sou, Hironobu; Onohara, Kojiro; Muhi, Ali; Kitamura, Takatoshi; Amemiya, Fumitake; Enomoto, Nobuyuki; Matsuda, Masanori; Asakawa, Masami; Fujii, Hideki; Araki, Tsutomu

doi:10.1097/rli.0b013e3181f9c487

Cited by 78 publications

(54 citation statements)

References 21 publications

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“…It is possible that the previous study could not demonstrate a difference in lesion-to-liver CNRs between 0.025-and 0.05-mmol/kg doses because we used a suboptimal flip angle (12°). 21 Further, the difference in results between the previous and current studies can be explained by the homogeneity of the study subjects; in this study, we assessed volunteers and not patients with cirrhosis and muscle rather than liver lesions as the object.…”

Section: Discussionmentioning

confidence: 78%

“…17 A recent intraindividual comparison of 0.025 and 0.05 mmol/kg in patients with cirrhosis suggested significant improvement of liver-to-lesion (hepatocellular carcinoma) contrast in patients with decreased hepatic function (Child-Pugh class B disease) but not in patients with preserved hepatic function (Child-Pugh class A disease). 21 A study performed in the early stages of gadoxetic acid development also showed that liver-to-lesion contrast during the hepatobiliary phase was not necessarily higher using 0.05 compared with 0.025 mmol/kg, although the degree of enhancement compared to precontrast images was consistently higher using 0.05 mmol/kg. 16 Our estimates of gadoxetic acid concentration in the liver during the hepatobiliary phase (Fig.…”

Section: Discussionmentioning

confidence: 94%

“…Moreover, a recent study demonstrated improved clinical performance of gadoxetic acid at a dose of 0.05 mmol/kg compared to 0.025 mmol/kg for both dynamic-and hepatobiliary-phase imaging in patients with cirrhosis. 21 The purpose of this crossover study was to perform a systematic and objective comparison of doses of 0.025 mmol/kg and 0.05 mmol/kg of gadoxetic acid in healthy volunteers. We compared the doses in both the dynamic and hepatobiliary phases using state-of-the-art pulse sequences and included measurements of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).…”

Section: Introductionmentioning

confidence: 99%

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Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Bannas

Hernando

Rahimi

et al. 2016

MRMS

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Purpose: We performed a quantitative intraindividual comparison of the performance of 0.025-and 0.05-mmol/kg doses for gadoxetic acid-enhanced liver magnetic resonance (MR) imaging.Materials and Methods: Eleven healthy volunteers underwent liver MR imaging twice, once with a 0.025-and once with a 0.05-mmol/kg dose of gadoxetic acid. MR spectroscopy and 3-dimensional gradient-echo T 1 -weighted images (3D-GRE) were obtained before and 3, 10, and 20 min after injection of the contrast medium to measure T 1 and T 2 values and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) performance. During the dynamic phase, highly time-resolved 3D-GRE was used to estimate the relative CNR (CNR rel ) of the hepatic artery and portal vein (PV) to the liver. We used paired t-tests to compare the results of different doses.Results: During the hepatobiliary phase, we observed shorter T 1 values and higher SNRs of the liver (P < 0.001) and higher liver-to-PV and liver-to-muscle CNRs (P < 0.002) using 0.05 mmol/kg compared to 0.025 mmol/kg. Increasing the dose to 0.05 mmol/kg yielded a greater T 1 -shortening effect at 10 min delay even compared with 0.025 mmol/kg at 20 min (P < 0.001). During the dynamic phase, the peak CNR rel for the hepatic artery and portal vein were higher using 0.05 mmol/kg (P = 0.007 to 0.035).Conclusion: Use of gadoxetic acid at a dose of 0.05 mmol/kg leads to significantly higher SNR and CNR performance than with 0.025 mmol/kg. Quantitatively, a 10-min delay may be feasible for hepatobiliary-phase imaging when using 0.05 mmol/kg of gadoxetic acid.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Bannas

Hernando

Rahimi

et al. 2016

MRMS

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“…Doubling the dose of Gd-EOB-DTPA has also been suggested. In a study of patients with cirrhosis and hepatocellular carcinomas (HCC), it has been shown that doubling the dose improves the tumor-to-liver contrast during the arterial phase in all patients and during the hepatobiliary phase in Child B patients [12].The clinical impact of this policy in terms of lesion detection remains unknown.…”

Section: Characteristics Of Gd-eob-dtpamentioning

confidence: 99%

Primovist, Eovist: What to expect?

Beers

Pastor²,

Hussain

2012

Journal of Hepatology

359

338

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Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA, Primovist in Europe and Eovist in the USA) is a liver-specific magnetic resonance imaging contrast agent that has up to 50% hepatobiliary excretion in the normal liver. After intravenous injection, Gd-EOB-DTPA distributes into the vascular and extravascular spaces during the arterial, portal venous and late dynamic phases, and progressively into the hepatocytes and bile ducts during the hepatobiliary phase. The hepatocyte uptake of Gd-EOB-DTPA mainly occurs via the organic anion transporter polypeptides OATP1B1 and B3 located at the sinusoidal membrane and biliary excretion via the multidrug resistance-associated proteins MRP2 at the canalicular membrane. Because of these characteristics, Gd-EOB-DTPA behaves similarly to non-specific gadolinium chelates during the dynamic phases, and adds substantial information during the hepatobiliary phase, improving the detection and characterization of focal liver lesions and diffuse liver disease. This information is particularly relevant for the detection of metastases, and for the detection and characterization of nodular lesions in liver cirrhosis, including early hepatocellular carcinomas. Finally, GD-EOB-DTPA-enhanced magnetic resonance imaging may provide quantitative assessment regarding liver perfusion and hepatocyte function in diffuse liver diseases. The full potential of GD-EOB-DTPA-enhanced magnetic resonance imaging has to be established further. It is already clear that GD-EOB-DTPA-enhanced magnetic resonance imaging provides anatomic and functional information in the setting of focal and diffuse liver disease that is unattainable with magnetic resonance imaging enhanced with non-specific contrast agents.

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“…13,17 However, there is little information on the optimal time delay after the arrival of the contrast agent to the aorta. Researchers have used delay times ranging from 7 to 15 s. 17,[20][21][22] If bolus timing cannot be manipulated as described above, timing may instead be adjusted via the test-injection method, in which a small amount (e.g., 0.5 mL) of contrast agent is injected before dynamic study to measure the length of time for the agent to reach the aorta.…”

Section: Acquiring Images During the Optimal Arterial Phase Time Windowmentioning

confidence: 99%

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

Ichikawa

Araki

2013

magn reson med sci

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Since its launch onto the world medical market, gadoxetic acid has received a great deal of attention from a diverse group of researchers, including gastroenterologists, hepatologists, and abdominal radiologists. Gadoxetic acid in liver magnetic resonance (MR) imaging might be considered to have excellent utility. However, several issues remain that radiologists should keep in mind when utilizing this product. We compiled this review to introduce gadoxetic acid, describe how it should be used, highlight the situations in which it is most and least reliable, and suggest potential avenues for future research.

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Double-Dose Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients With Chronic Liver Disease

Abstract: administration of double dose of Gd-EOB-DTPA provided better arterial enhancement of hepatocellular carcinomas in patients with chronic liver disease, and also improved the lesion-liver contrast in hepatocyte-phase images in patients with Child-Pugh class B disease.

Cited by 78 publications

References 21 publications

Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Primovist, Eovist: What to expect?

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

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