Dynamic MR Imaging of the Biliary System Using Hepatocyte-Specific Contrast Agents

Abstract

Because of their dual route of excretion through the kidneys and the liver, gadolinium-based, hepatocyte-specific MR contrast agents can be used to evaluate the biliary tract as an off-label use. Images are obtained during the hepatocyte phase, which usually occurs within 20-40 minutes after injection depending on the specific contrast agent selected. Potential uses include showing variant biliary anatomy and choledocholithiasis. Evaluation for acute cholecystitis is possible by assessing for reflux of contrast material across the cystic duct. Additionally, these agents have value in both presurgical and postsurgical imaging for showing anatomy and complications. Finally, these agents are useful in the evaluation of choledochal cysts.

Liver MRI in the hepatocyte phase with gadolinium‐EOB‐DTPA: Does increasing the flip angle improve conspicuity and detection rate of hypointense lesions?

“…This is in contrast to the recommendations of the consensus report of the Second International Forum for Liver MRI published in 2009 (23). The use of faster, higher spatial resolution 3D pulse sequences is well supported by more recent work from around the world (20,(24)(25)(26)(27)(28). We also noted that although this technique was useful at both 3T and 1.5T, the increased projected energy deposition at 3T (SAR) caused the MR scanner console to reduce the FA of the pulse sequence in four of seven cases performed at 3T in our initial review, a phenomenon that has been previously described (20).…”

Functional evaluation of cystic duct patency with Gd-EOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis?

“…Specific sequence design should include pre-contrast and dynamic postcontrast imaging to evaluate the gallbladder as well as to search for other causes of abdominal pain. T2-weighted MRCP sequences should be utilized to assess for biliary dilation and choledocholithiasis and can be combined with T1-weighted MRC during the hepatocyte phase to increase the sensitivity of detection of biliary tract abnormalities [7].…”

“…All delayed phase images were assessed qualitatively for the presence of the contrast agent in the gallbladder or cystic duct. Gd-EOB-DTPA characteristically layers in the nongravity dependent aspect of the gallbladder secondary to differing densities between bile and the contrast material [7] (Figs. 1 and 2).…”

“…The increased commercial availability of hepatobiliary specific gadolinium-based MR contrast agents, with their properties of dual excretion through the hepatic and renal systems, has allowed for dynamic MR evaluation of the biliary system as an off-label indication [7,8]. Gadobenate dimeglumine (Gd-BOPTA, MultiHance, Bracco Diagnostics) and gadoxetate disodium/gadoxetic acid (Gd-EOB-DTPA, Eovist/Primovist, Bayer Pharmaceuticals) are the main gadolinium-based hepatobiliary agents that combine the imaging properties of extracellular agents during the arterial and portal venous phases with the imaging properties of hepatobiliary agents in the delayed phases [9][10][11][12][13].…”

Evaluation of the gallbladder and cystic duct patency with gadoxetate disodium enhanced MR cholangiography: prospective comparison of patients with normal gallbladder function and acute cholecystitis

“…With the recent availability of hepatocyte-specific MRI contrast agents such as gadoxetate disodium, in addition to anatomic information, MRI can also provide functional information regarding the patency of the cystic duct similar to hepatobiliary scintigraphy (3,10,11). Obtaining both anatomic and functional information with one test may lead to better understanding of the pathophysiology of acute cholecystitis and also potentially may have an impact on management decisions.…”