Effects of Gadolinium-ethoxybenzyl-diethylenetriamine Pentaacetic Acid on T2-weighted MRCP

Abstract

Purpose: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a recently developed liver-speciˆc contrast agent for magnetic resonance (MR) imaging that is excreted equally via the kidneys and the biliary system. To our knowledge, its eŠects on T 2 -weighted MR cholangiopancreatography (MRCP) images have not been explored. Acquisition of the hepatobiliary phase is recommended 20 min after administration of Gd-EOB-DTPA. Examination time cannot be extended if the contrast does not take eŠect on T 2 -weighted MRCP within 20 min after administration.We attempted to assess the change in signal of T 2 -weighted MRCP by excretion of Gd-EOB-DTPA.Methods: Between March and July 2008, 40 patients (15 women, 25 men; mean age 70.8 years) were examined with abdominal MR imaging. T 2 -weighted MRCP was performed before and 10 and 20 min after administration of Gd-EOB-DTPA. We analyzed signal intensity of the bile duct, gallbladder, cystic duct, and pancreatic duct on MRCP for changes in intensity.Results: T 2 -weighted MRCP 20 min after contrast administration showed loss of signal of the bile duct (intrahepatic bile duct in all cases, upper extrahepatic duct in 36 [90z], middle extrahepatic duct in 33 [85z], and lower extrahepatic duct in 26 [67z]), the gallbladder in 23 cases (72z), and the cystic duct in 25 (64z). This signal change increased with time. We observed no change in signal of the pancreatic duct.Conclusion: T 2 -weighted MRCP sequences should not be obtained after administration of Gd-EOB-DTPA because this contrast agent decreases signal intensity of the biliary structure on these images.

The T2-Shortening Effect of Gadolinium and the Optimal Conditions for Maximizing the CNR for Evaluating the Biliary System: a Phantom Study

“…However, they were higher on 1.5T with both Gd-DTPA and Gd-EOB-DTPA. Additionally, Gd-EOB-DTPA is not recommended for the T2-weighted MRCP sequence because of its properties of biliary excretion (1, 15). Our study also revealed a decreased CNR of the syringe tube (simulating a bile duct) with a higher gadolinium concentration.…”

Recommendations on the use of magnetic resonance imaging in PSC‐A position statement from the International PSC Study Group

“…This workup includes the use of MRI contrast media: MRCP, see recommendation for minimum standard above (A). If a hepatobiliary contrast agent is used, high‐resolution 3D MRCP sequences should be acquired before contrast injection . (1C) There are insufficient data to recommend one MRI contrast medium over another, so both options below could be followed: ○ for MRI with extracellular contrast, the following sequences should be applied: T1‐weighted image (T1wI) with Gd‐based extracellular contrast agent (precontrast, arterial, portal venous, parenchymal phase after 3‐5 minutes, fat suppressed).…”

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

“…[35][36][37][38][39] This is not true, though, for the bile duct, in which a much higher concentration of excreted gadoxetic acid than in the liver parenchyma leads to a signiˆcant decrease in bile duct signals and degradation of T 2 -weighted MR cholangiopancreatography (MRCP). 40,41 Kim and colleagues, however, reported that post-contrast MRCP is acceptable if obtained within a few minutes of gadoxetic acid injection 42 because excretion of the contrast agent into the bile duct does not start until approximately 5 to 10 min after injection. 43 DiŠusion-weighted images can also be obtained after gadoxetic acid administration.…”