Use of gadoxetate disodium in patients with chronic liver disease and its implications for liver imaging reporting and data system (LI‐RADS)

Abstract

Use of gadoxetate disodium, a hepatobiliary gadolinium‐based agent, in patients with chronic parenchymal liver disease offers the advantage of improved sensitivity for detecting hepatocellular carcinoma (HCC). Imaging features of liver observations on gadoxetate‐enhanced MRI may also serve as biomarkers of recurrence‐free and overall survival following definitive treatment of HCC. A number of technical and interpretative pitfalls specific to gadoxetate exist, however, and needs to be recognized when protocoling and interpreting MRI exams with this agent. This article reviews the advantages and pitfalls of gadoxetate use in patients at risk for HCC, and the potential impact on Liver Imaging Reporting and Data System (LI‐RADS) imaging feature assessment and categorization. Level of Evidence: 5 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:1236–1252.

Interreader Reliability of Liver Imaging Reporting and Data System Treatment Response: A Systematic Review and Meta-Analysis

“…By contrast, iodized oil hardly masks viable HCC on MRI [26,27,31]. However, particularly with the use of gadoxetic acid as a contrast agent, the advantages of MRI can be offset by the weak arterial-phase hyperenhancement due to the relatively small contrast dose and strict washout criteria that are restricted to the portal venous phase according to the current LI-RADS [32].…”

User and system pitfalls in liver imaging with LI‐RADS

“…TP hypointensity is defined as an intensity in the TP that is unequivocally less, in whole or in part of an observation, as compared with the surrounding liver, and is only assessed on MRI with a hepatobiliary contrast agent such as gadoxetate disodium . This feature may be attributable to true washout, differences in extracellular distribution of contrast agent between liver and the observation, differences in hepatocellular uptake between liver and the observation, or a combination of all three factors . “Washout,” on the other hand, is supposed to be unrelated to differences in hepatocellular uptake and so should not be assessed during phases in which differences in hepatocellular uptake may be substantial.…”

“…“Washout,” on the other hand, is supposed to be unrelated to differences in hepatocellular uptake and so should not be assessed during phases in which differences in hepatocellular uptake may be substantial. For these reasons, LI‐RADS restricts assessment of “washout” to the PVP when utilizing gadoxetate disodium but allows assessment of “washout” in the PVP or delayed phase (DP) with extracellular contrast agents . If TP hypointensity is misinterpreted as "washout," it can potentially lead to erroneous categorization of LR‐5 (Fig.…”

“…2 This feature may be attributable to true washout, differences in extracellular distribution of contrast agent between liver and the observation, differences in hepatocellular uptake between liver and the observation, or a combination of all three factors. [24][25][26] "Washout," on the other hand, is supposed to be unrelated to differences in hepatocellular uptake and so should not be assessed during phases in which differences in hepatocellular uptake may be substantial. For these reasons, LI-RADS restricts assessment of "washout" to the PVP when utilizing gadoxetate disodium but allows assessment of "washout" in the PVP or delayed phase (DP) with extracellular contrast agents.…”

“…For these reasons, LI-RADS restricts assessment of "washout" to the PVP when utilizing gadoxetate disodium but allows assessment of "washout" in the PVP or delayed phase (DP) with extracellular contrast agents. 15,26 If TP hypointensity is misinterpreted as "washout," it can potentially lead to erroneous categorization of LR-5 ( Fig. 7).…”