Consensus report from the 6th International forum for liver MRI using gadoxetic acid

Abstract

As the utility of liver-specific magnetic resonance imaging (MRI) increases, it is pertinent to optimize and expand protocols to improve accuracy and foster evolution of techniques; in turn, positive impacts should be seen in patient management. This article reports on the latest expert thinking and current evidence in the field of liver-specific MRI, as discussed at the 6(th) International Forum for Liver MRI, which was held in Vancouver, Canada in September 2012. Topics discussed at this forum described the use of gadoxetic acid-enhanced MRI for the assessment of liver function at the segmental level; to increase accuracy in the diagnosis of liver metastases; to overcome current challenges in patients with cirrhosis, including management of arterial hypo-/isovascular, hepatobiliary phase hypointense nodules; and the data which would be required in order to recommend the use of this modality in hepatocellular carcinoma management guidelines. Growing evidence suggests that gadoxetic acid-enhanced MRI can help to improve the management of patients with a number of different liver disorders; however, more data are needed in some areas, and there may be a case for developing an interpretation guideline for gadoxetic acid-enhanced MRI findings to aid standardization.

An Investigation of Transient Severe Motion Related to Gadoxetic Acid–enhanced MR Imaging

“…Gadoxetic acid is a useful liver-specific magnetic resonance (MR) imaging contrast agent (1–3) for liver metastasis (4–6), hepatocellular carcinoma (7,8), and other diseases (9). For the diagnosis of hypervascular lesions with gadoxetic acid (10,11), the arterial phase is essential (12–14).…”

Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment – Part 2

“…Gadoxetic acid-enhanced MRI has numerous advantages in imaging the cirrhotic liver including: i) higher sensitivity for the diagnosis of HCC, especially for lesions ≤ 20 mm (Figure 6) (28,35,38,39) ; ii) improved characterization of arterially enhancing lesions without definite washout on subsequent imaging (Figure 6) (33,35) ; iii) distinguishing arterially enhancing pseudo-lesions from HCC (33) ; and iv) detection of lesions that are isointense to the background hepatic parenchyma on all sequences, apart from the hepatobiliary phase, that are at high risk of transforming to hypervascular HCC (40,41) . Nodules that show hypointensity on the hepatobiliary phase, but lacking diagnostic features of HCC on the earlier post-contrast phases may represent high-grade dysplastic nodules or early HCC (6,7,42) , and are at increased risk of progression to invasive hypervascular HCC.…”

The role of imaging in the surveillance and diagnosis of hepatocellular cancer

“…It is usual practice to acquire images in the arterial, portal venous, and delayed post‐contrast phases. In recent years agents have become available for MRI that exhibit a delayed hepatobiliary phase . Two recent systematic reviews and meta‐analyses have been published examining the performance of available modaliites for diagnosis of HCC with the following findings from these studies and others:…”