Magnetic resonance imaging of the liver: consensus statement from the 1st International Primovist User Meeting

Malone, Dermot E.; Zech, Christoph J.; Ayuso, Carmen; Bartolozzi, Carlo; Jonas, Eduard; Tanimoto, Akihiro

doi:10.1007/s10406-008-0010-1

Cited by 16 publications

(18 citation statements)

References 110 publications

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“…This infusion rate of 2 ml/s has been used extensively in clinical trials [14,16,19,20,24]. However, Zech (personal communication) has proposed that an infusion rate of 1 ml/s may be more appropriate [9], but may depend on the nature of the liver lesion. Data derived from a pig model suggest that Gd-EOB-DTPA injection at a rate of 1 ml/s is more effective [37].…”

Section: Optimization Of the Gd-eob-dtpa Imaging Protocolmentioning

confidence: 97%

“…A test bolus may then be administered, followed by a bolus injection of Gd-EOB-DTPA 0.1 ml/ kg body weight (dose 0.025 mmol/kg body weight) and T1-weighted three-dimensional gradient-echo (with fat saturation) imaging in breath-hold during the arterial (15-20 s post-injection), portal-venous (50-60 s) and 'equilibrium' (120 s) phases, and T1-weighted two-dimensional gradient-echo (with fat saturation and breath-hold) imaging in the hepatocyte-specific phase (20 min post-injection) [9]. This protocol is based on animal studies [10][11][12][13] and on clinical studies [4,[14][15][16][17][18][19][20][21][22][23][24][25][26].…”

Section: Optimization Of the Gd-eob-dtpa Imaging Protocolmentioning

confidence: 99%

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Consensus report of the 2nd International Forum for Liver MRI

et al. 2009

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Discussion at the 2nd Forum for Liver MRI: The International Primovist User Meeting on the use of the hepatocyte-specific contrast agent gadolinium-ethoxybenzyl-diethylene triamine penta-acetic acid (Gd-EOB-DTPA) is reported. Changes to the currently recommended Gd-EOB-DTPA imaging protocol were identified that can reduce the overall examination time. The potential benefits of 3-T MR imaging using Gd-EOB-DTPA have yet to be fully explored. Data show that Gd-EOB-DTPA-enhanced MRI allows identification of liver lesions and provides a differential diagnosis of hepatocellular nodules in the noncirrhotic and cirrhotic liver, based on vascularity, during the dynamic arterial, portal-venous and late phases, and during the hepatocytespecific phase. Current European, American and Japanese guidelines for the diagnosis of hepatocellular carcinoma need to take into account the recent rapid advances in liver imaging. Based on published clinical trials and the experience of the attendees in the use of Gd-EOB-DTPA in liver imaging, a new simplified, non-invasive diagnostic algorithm was proposed that would be applicable to both Eastern and Western clinical practice in the evaluation of hepatocarcinogenesis and hepatocellular carcinoma. Preliminary clinical experience suggests that Gd-EOB-DTPA may also provide an innovative and cost-effective one-stop approach for staging rectal cancer using wholebody imaging.

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Section: Optimization Of the Gd-eob-dtpa Imaging Protocolmentioning

confidence: 97%

Section: Optimization Of the Gd-eob-dtpa Imaging Protocolmentioning

confidence: 99%

Consensus report of the 2nd International Forum for Liver MRI

et al. 2009

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“…The early dynamic phase of Gd-EOB-DTPA was questioned due to the lower dosing of gadolinium; however, several reports documented that a sufficient arterial phase can be acquired and that hypervascular tumors can be depicted accurately [58,59] . However, due to the smaller injection volume it is recommended to use a bolus timing technique for Gd-EOB-DTPA-enhanced MRI, and there is data suggesting that a slower injection rate can lead to a more robust arterial phase with even increased arterial enhancement [60,61] . First emerging data from abstracts show promising results for Gd-EOB-DTPA in the detection of HCC [62,63] .…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Imaging of Hepatocellular Carcinoma by Computed Tomography and Magnetic Resonance Imaging: State of the Art

Zech

Reiser

Herrmann³

2009

Dig Dis

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Hepatocellular carcinoma (HCC) is a very frequent tumor worldwide. Its incidence is linked to the distribution of liver cirrhosis and viral hepatitis, which are the main risk factors for the development of HCC. For the evaluation of the cirrhotic liver and for the diagnosis of HCC, multidetector computed tomography (MDCT) proved to be a robust and reliable tool. In MDCT the diagnosis of HCC can be made based on neovascularization with increased arterial and decreased portal venous supply. With modern magnetic resonance imaging (MRI), spatial resolution and robustness increased dramatically. Beside the evaluation of neovascularization by means of gadolinium-enhanced early dynamic MRI, the main advantages of MRI are additional information on tissue composition and liver-specific function. With diffusion-weighted imaging or plain T₁- and T₂-weighted sequences, different tissue elements like fat, hemorrhage, glycogen, edema and cellular density can be evaluated. Liver-specific contrast agents give insight into the Kupffer cell density or the hepatocellular function. The integration of all these parts into the MR examination allows for a very high detection rate for overt HCC nowadays, although very small HCCs are still a challenge. Moreover, insight into the different stages of hepatocarcinogenesis can be possible with MRI. Despite its limited availability in some countries, it has to be rendered to be the modality of choice for the distinct evaluation of the cirrhotic liver.

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“…Among the pulse sequences commonly acquired for clinical liver MRI, T 2 weighted and diffusion weighted (DW) imaging are frequently performed using a respiratory-triggered method in order to improve image quality [10][11][12], thus a lengthy acquisition time is required. To shorten the examination time for gadoxetic acid-enhanced MRI, it has been proposed to perform respiratory-triggered T 2 weighted and DW imaging during the interval between dynamic T 1 weighted imaging and the hepatobiliary phase imaging [7,13,14]. However, this modification in the MRI protocol is only feasible if the administration of gadoxetic acid does not degrade the image quality and provides comparable image quality and accuracy to nonenhanced imaging.…”

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confidence: 99%

The effect of gadoxetic acid enhancement on lesion detection and characterisation usingT₂weighted imaging and diffusion weighted imaging of the liver

Ss²,

Ih³

et al. 2012

BJR

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Objectives: To evaluate the effect of gadoxetic acid enhancement on the detection and characterisation of focal hepatic lesions on T 2 weighted and diffusion weighted (DW) images. Methods: A total of 63 consecutive patients underwent T 2 weighted and DW imaging before and after gadoxetic acid enhancement. Two blinded readers independently identified all of the focal lesions using a five-point confidence scale and characterised each lesion using a three-point scale: 1, non-solid; 2, indeterminate; and 3, solid. For both T 2 weighted and DW imaging, the accuracies for detecting focal lesions were compared using the free-response receiver operating characteristic analysis; the accuracies for lesion characterisation were compared using the McNemar test between non-enhanced and gadoxetic acid-enhanced image sets. For hepatic lesions >1 cm, the lesion-to-liver contrast-to-noise ratio (CNR) and the apparent diffusion coefficient (ADC) were compared in the non-enhanced and enhanced image sets using the generalised estimating equations. Results: For both T 2 weighted and DW images, the accuracies for detecting focal lesions (p>0.52) and those for lesion characterisation (p>0.63) did not differ significantly between the non-enhanced and enhanced image sets. The lesion-to-liver CNR was significantly higher on enhanced DW images than on non-enhanced DW images (p50.02), although the difference was not significant for T 2 weighted imaging (p50.65). The mean ADC values of lesions did not differ significantly on enhanced and non-enhanced DW imaging (p50.75). Conclusion: The acquisition of T 2 weighted and DW images after administration of gadoxetic acid has no significant effect on the detection or characterisation of focal hepatic lesions, although it improves the lesion-to-liver CNR on DW images. Various contrast agents have been developed and utilised for MRI of the liver in order to facilitate the detection and characterisation of focal hepatic lesions. Gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, PrimovistH; Bayer Schering Pharma, Berlin, Germany) is a recently developed, liverspecific contrast agent. As it has combined extracellular and hepatocyte-specific properties, gadoxetic acid can provide functional information regarding the cellular composition of focal hepatic lesions on hepatobiliary phase imaging as well as haemodynamic information on dynamic MRI following bolus injection. These properties of gadoxetic acid have been reported to improve the accuracy of liver MRI for lesion detection and characterisation [1][2][3][4][5][6][7].By contrast, these advantages of gadoxetic acidenhanced liver MRI are obtained with increased examination time, as delayed scanning approximately 20 min after contrast administration is necessary for optimal hepatobiliary phase imaging [4,5,[7][8][9]. Among the pulse sequences commonly acquired for clinical liver MRI, T 2 weighted and diffusion weighted (DW) imaging are frequently performed using a respiratory-triggered method in order to improve image quality...

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Magnetic resonance imaging of the liver: consensus statement from the 1st International Primovist User Meeting

Abstract: The role of contrastenhanced liver MRI using the hepatocyte-specific agent gadoliniumethoxybenzyl-diethylene triamine penta-acetic acid (Gd-EOB-DTPA,

Cited by 16 publications

References 110 publications

Consensus report of the 2nd International Forum for Liver MRI

Consensus report of the 2nd International Forum for Liver MRI

Imaging of Hepatocellular Carcinoma by Computed Tomography and Magnetic Resonance Imaging: State of the Art

The effect of gadoxetic acid enhancement on lesion detection and characterisation usingT₂weighted imaging and diffusion weighted imaging of the liver

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Magnetic resonance imaging of the liver: consensus statement from the 1st International Primovist User Meeting

Abstract: The role of contrastenhanced liver MRI using the hepatocyte-specific agent gadoliniumethoxybenzyl-diethylene triamine penta-acetic acid (Gd-EOB-DTPA,

Cited by 16 publications

References 110 publications

Consensus report of the 2nd International Forum for Liver MRI

Consensus report of the 2nd International Forum for Liver MRI

Imaging of Hepatocellular Carcinoma by Computed Tomography and Magnetic Resonance Imaging: State of the Art

The effect of gadoxetic acid enhancement on lesion detection and characterisation usingT2weighted imaging and diffusion weighted imaging of the liver

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The effect of gadoxetic acid enhancement on lesion detection and characterisation usingT₂weighted imaging and diffusion weighted imaging of the liver