Optimization of hepatobiliary phase imaging in gadoxetic acid-enhanced magnetic resonance imaging: a narrative review

Abstract

Background and Objective: Gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) is widely used in clinical practice. Its unique hepatobiliary phase (HBP) has been used to improve the detection and identification of hepatic lesions and has also been used to evaluate hepatic function and fibrosis. At the early stage of its clinical practice, the HBP was typically collected empirically with a delay of 20 minutes after intravenous administration to image the liver with sufficient enhancement for diagnosis. However, numerous methods and consensus statements for optimizing HBP acquisition have been proposed. This review details the methods and consensus statements on optimizing HBP collection.Methods: The electronic literature search was performed using the databases PubMed, MEDLINE, Cochrane, and Embase without limit on publication period to identify published reports on optimizing HBP imaging in Gd-EOB-DTPA-enhanced MRI. Articles with low relevance to the topics were excluded.Key Content and Findings: Recently, an increasing number of investigations suggest that collecting HBP after 20 min is too drawn-out for patients with normal liver function but is too short for patients with cirrhosis. Previous studies demonstrated that liver enhancement is closely related to liver function in Gd-EOB-DTPA-enhanced MRI. Therefore several reports have proposed various HBP delay times at different liver function levels. These delay times could be evaluated by laboratory indicators, such as prothrombin (PT) activity, total bilirubin, direct bilirubin, and the model for end-stage liver disease. Other investigations have found that the initial visualization time of the intrahepatic bile duct (IHD) in Gd-EOB-DTPA-enhanced MRI to also be related to liver enhancement and function. Therefore, initial visualization of the IHD is considered necessary for adequate HBP and has been employed in HBP acquisition in recent reports. Conclusions:Optimizing HBP acquisition according to individual hepatic function is a good strategy and was followed in most of the investigations included in our review. Obtaining adequate HBP in the shortest possible time is the target condition in Gd-EOB-DTPA-enhanced MRI. However, a more concise and efficient HBP acquisition strategy is still expected to be developed in the future.

Imaging findings in malignant hepatic infiltration from neuroendocrine tumor presenting with acute liver failure and mimicking cirrhosis: a case description

“…In our patient, the radiological findings that leaned more toward the diagnosis of liver metastasis than cirrhosis were the presence of a suspected primary pulmonary lesion with associated mediastinal lymphadenopathy and bone lesions, the absence of signs of portal hypertension and hypervascular lesions with typical features of hepatocellular carcinoma, and the widespread liver restriction of proton diffusivity in MRI diffusion-weighted images. Our case highlights also the concept that in patients with severe liver function impairment, the use of Gd-EOB-DTPA as MRI hepatobiliary contrast agent does not help in the detection of diffuse malignant infiltration, even after acquiring images well beyond 20 minutes (the typical delay time of hepatobiliary phase) after intravenous administration ( 18 ).…”

Liver metastases: The role of magnetic resonance imaging

“…Thus, these two contrast media need different acquisition times to obtain diagnostic HBP images, which are acquired about 1.5-3 h after Gd-BOPTA injection and about 15-20 min after Gd-EOB-DTPA administration in non-cirrhotic livers. Consequently, the HBP can be acquired at the end of the liver MRI protocol in the case of Gd-EOB-DTPA, while in a second step in the case of Gd-BOPTA[ 26 , 27 ]. Figure 1 summarizes MRI protocols by using ECAs and HBAs.…”