Respiratory-triggered Three-dimensional T2-weighted MR Cholangiography after Injection of Gadoxetate Disodium: Is It Still Reliable?

Ringe, Kristina; Gupta, Rajan T.; Brady, Christopher M.; Massey, Christopher M; Hahn, Andreas; Galanski, Michael; Merkle, Elmar M.; Lotz, Joachim

doi:10.1148/radiol.10091130

Cited by 22 publications

(10 citation statements)

References 26 publications

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“…T2-weighted sequences can be acquired during the accumulation phase, however, once Gd-EOB-DTPA is excreted in the bile, the signal in the bile ducts will be lowered hampering assessment of the biliary tree during the hepatobiliary phase [8, 14, 15]. Nonetheless, if acquired immediately after the dynamic series, before biliary enhancement occurs, image quality is not impaired [14].…”

Section: Discussionmentioning

confidence: 99%

MR liver imaging with Gd-EOB-DTPA: a delay time of 10 minutes is sufficient for lesion characterisation

et al. 2012

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ObjectivesTo assess whether, in patients with normal liver function, a hepatobiliary delay time of 10 min after Gd-EOB-DTPA injection is sufficient for lesion characterisation.MethodsIn 42 consecutive patients with suspected focal liver lesions, dynamic MRI was performed after intravenous Gd-EOB-DTPA, followed by hepatobiliary phases at 5, 10 and 20 min. The following items were assessed at each hepatobiliary phase: parenchymal enhancement, contrast agent excretion in bile ducts, lesion enhancement characteristics (hypo-, iso-, or hyperintensity, rim enhancement, central non-enhancement), and contrast- and signal-to-noise ratios, separately for hypo- and hyperintense lesions.ResultsFollowing enhancement, parenchymal signal intensity increased significantly up to 10 min (86.3%, P < 0.001), and subsequently stabilised (86.5% after 20 min, P = 0.223). Biliary contrast agent excretion was first observed in 2, 32 and 5 patients after 5, 10 and 20 min respectively. Hepatobiliary lesion enhancement characteristics observed after 5 min persisted during later hepatobiliary phases. CNR and SNR ratios increased significantly (P < 0.05) up to 10 min after enhancement without further increase at 20 min, in hypo- and hyperintense lesions.ConclusionsIf lesion characterisation is the primary reason for performing MRI, a hepatobiliary delay time of 10 min after Gd-EOB-DTPA injection is sufficient in patients with normal liver function.Key Points• Magnetic resonance imaging is now a first line of investigation of the liver.• Optimal CNR and SNR are achieved 10 min after Gd-EOB-DTPA injection.• Typical enhancement characteristics are observed early and do not change.• Ten-minute hepatobiliary delay is sufficient for characterisation of focal liver lesions.

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Section: Discussionmentioning

confidence: 99%

MR liver imaging with Gd-EOB-DTPA: a delay time of 10 minutes is sufficient for lesion characterisation

et al. 2012

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“…However, the visualization of the bile ducts may be poor or even absent at GD-EOB-DTPA-enhanced cholangiography in patients with advanced diffuse parenchymal disease or bile duct obstruction [68]. T2-weighted MR cholangiography should be performed before Gd-EOB-DTPA administration due to the T2 shortening effect of enhanced bile which renders the biliary system invisible [69].…”

Section: Bile Duct Diseasesmentioning

confidence: 99%

Primovist, Eovist: What to expect?

Beers

Pastor²,

Hussain

2012

Journal of Hepatology

360

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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“…If imaging is performed with gadoxetic acid, T2w MRCP based on breathing gated 3D single shot fast spin echo sequence is most reliably performed before the injection, although recent data suggests that effective T2W MRCP can be achieved afterwards (21). Gadoxetic acid in the bile, even in very low concentrations shortens the T2 sufficiently to have a detrimental impact on the heavily T2-weighted MRCP images (22). However, conventional T2w imaging of the liver is largely unaffected because the concentration of gadolinium in the liver is relatively low and has minimal impact on image quality (22).…”

Section: Clinical Applicationmentioning

confidence: 99%

“…Gadoxetic acid in the bile, even in very low concentrations shortens the T2 sufficiently to have a detrimental impact on the heavily T2-weighted MRCP images (22). However, conventional T2w imaging of the liver is largely unaffected because the concentration of gadolinium in the liver is relatively low and has minimal impact on image quality (22). In fact, performing T2w imaging in the interval between dynamic phase T1w imaging and the hepatobiliary phase is a useful strategy to reduce total protocol time (23).…”

Section: Clinical Applicationmentioning

confidence: 99%

Hepatobiliary MR imaging with gadolinium‐based contrast agents

Frydrychowicz

Lubner

Brown

et al. 2012

Magnetic Resonance Imaging

Self Cite

126

113

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The advent of gadolinium-based “hepatobiliary” contrast agents offers new opportunities for diagnostic MRI and has triggered a great interest for innovative imaging approaches to the liver and bile ducts. In this review article we will discuss the imaging properties of the two gadolinium-based hepatobiliary contrast agents currently available in the USA, gadobenate dimeglumine and gadoxetic acid, as well as important pharmacokinetic differences that affect their diagnostic performance. We will review potential applications, protocol optimization strategies, as well as diagnostic pitfalls. A variety of illustrative case examples will be used to demonstrate the role of these agents in detection and characterization of liver lesions as well as for imaging the biliary system. Changes in MR protocols geared towards optimizing workflow and imaging quality will also be discussed. It is our aim that the information provided in this article will facilitate the optimal utilization of these agents, and will stimulate the reader‘s pursuit of new applications for future benefit.

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Respiratory-triggered Three-dimensional T2-weighted MR Cholangiography after Injection of Gadoxetate Disodium: Is It Still Reliable?

Abstract: Gadoxetate disodium adversely affects respiratory-triggered 3D MR cholangiography, both qualitatively and quantitatively. We recommend that such a sequence be performed before injection of gadoxetate disodium.

Cited by 22 publications

References 26 publications

MR liver imaging with Gd-EOB-DTPA: a delay time of 10 minutes is sufficient for lesion characterisation

MR liver imaging with Gd-EOB-DTPA: a delay time of 10 minutes is sufficient for lesion characterisation

Primovist, Eovist: What to expect?

Hepatobiliary MR imaging with gadolinium‐based contrast agents

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