Gadoxetate Disodium–Enhanced MRI of the Liver: Part 1, Protocol Optimization and Lesion Appearance in the Noncirrhotic Liver

Cruite, Irene; Schroeder, Michael E.; Merkle, Elmar M.; Sirlin, Claude B.

doi:10.2214/ajr.10.4392

Cited by 313 publications

(219 citation statements)

References 76 publications

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“…18,44 -46 Therefore, some radiologists prefer to use an undiluted fixed dose of 10 mL of gadoxetic acid independent of the patient's weight and thereby often exceed the recommended package insert dose. 47 As expected, we observed significantly greater arterial and portal enhancement in the early dynamic phase using a higher dose, which may support the use of doses exceeding 0.025 mmol/kg in clinical practice.…”

Section: Discussionsupporting

confidence: 86%

Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Bannas

Hernando

Rahimi

et al. 2016

MRMS

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Purpose: We performed a quantitative intraindividual comparison of the performance of 0.025-and 0.05-mmol/kg doses for gadoxetic acid-enhanced liver magnetic resonance (MR) imaging.Materials and Methods: Eleven healthy volunteers underwent liver MR imaging twice, once with a 0.025-and once with a 0.05-mmol/kg dose of gadoxetic acid. MR spectroscopy and 3-dimensional gradient-echo T 1 -weighted images (3D-GRE) were obtained before and 3, 10, and 20 min after injection of the contrast medium to measure T 1 and T 2 values and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) performance. During the dynamic phase, highly time-resolved 3D-GRE was used to estimate the relative CNR (CNR rel ) of the hepatic artery and portal vein (PV) to the liver. We used paired t-tests to compare the results of different doses.Results: During the hepatobiliary phase, we observed shorter T 1 values and higher SNRs of the liver (P < 0.001) and higher liver-to-PV and liver-to-muscle CNRs (P < 0.002) using 0.05 mmol/kg compared to 0.025 mmol/kg. Increasing the dose to 0.05 mmol/kg yielded a greater T 1 -shortening effect at 10 min delay even compared with 0.025 mmol/kg at 20 min (P < 0.001). During the dynamic phase, the peak CNR rel for the hepatic artery and portal vein were higher using 0.05 mmol/kg (P = 0.007 to 0.035).Conclusion: Use of gadoxetic acid at a dose of 0.05 mmol/kg leads to significantly higher SNR and CNR performance than with 0.025 mmol/kg. Quantitatively, a 10-min delay may be feasible for hepatobiliary-phase imaging when using 0.05 mmol/kg of gadoxetic acid.

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Section: Discussionsupporting

confidence: 86%

Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Bannas

Hernando

Rahimi

et al. 2016

MRMS

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“…Based on our results, we currently use a scan delay of %15 minutes to allow the acquisition of T2-weighted, heavily T2-weighted, and diffusion-weighted images between the dynamic and hepatobiliary phase imaging (36,37). With this scan delay, the interval between dynamic imaging and acquisition of hepatobiliary phase image could be effectively utilized to shorten the total scan time without lowering the image quality (38,39). In our study the sensitivity for the dynamic set (MR set 1) was relatively lower in the chemotherapy group (77.9%) than in the nonchemotherapy group (82.6%).…”

Section: Discussionmentioning

confidence: 99%

Detection of liver metastases using gadoxetic‐enhanced dynamic and 10‐ and 20‐minute delayed phase MR imaging

Jeong

Kim

Park

et al. 2011

Magnetic Resonance Imaging

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Purpose: To assess the incremental value of hepatobiliary phase images in gadoxetate disodium-enhanced magnetic resonance imaging (MRI), and to compare diagnostic accuracy and lesion conspicuity on 10-and 20-minute delayed images for preoperative detection of hepatic metastases with subgroup analysis according to size and history of chemotherapy. Materials and Methods:Forty-six patients with 107 metastases who underwent surgery after gadoxetate disodium-enhanced MRI were evaluated. Four observers independently interpreted three sets: dynamic set comprising precontrast T1-, T2-weighted, and dynamic images; 10-minute set comprising dynamic set and 10-minute delayed; 20-minute set comprising 10-minute set and 20-minute delayed. Diagnostic accuracy was compared with subgroup analysis. Liver-to-lesion signal ratio (SR) was calculated using the region of interest method and compared.Results: Mean A z and sensitivities were significantly higher for 10-(A z ¼ 0.894, sensitivity ¼ 95.6%) and 20-minute (0.910, 97.2%) than dynamic set (0.813, 79.9%) (P < 0.001), with no significant difference between 10-and 20-minute sets (P ¼ 0.140). In patients with small ( 1 cm) metastases and a history of chemotherapy, sensitivities were significantly higher with 10-(88.2%) and 20-minute (91.6%) sets than dynamic set (48.6%) (P < 0.001). SR was significantly higher for 10-and 20-minute delayed than precontrast and dynamic, with significantly higher SR on 20-than 10-minute delayed. Conclusion:Regardless of size or prior chemotherapy, detection of hepatic metastases was significantly improved by adding hepatobiliary phase images without significant differences between 10-and 20-minute delayed.

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“…The smaller volume shortens the duration of arterial enhancement and reduces signal intensity [21]. Therefore, some institutions use higher doses of 0.05 mmol/kg [18,22,23]. Other institutions use a fixed dose of 10 ml equaling the package size, resulting in varying concentrations of gadoxetate disodium, depending on the patient's body weight [6, 8 -10, 12, 14].…”

Section: Influence Of Contrast Dosementioning

confidence: 99%

Transient Severe Respiratory Motion Artifacts After Application of Gadoxetate Disodium: What We Currently Know

Well

Weinrich

Adam

et al. 2017

Fortschr Röntgenstr

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Background Gadoxetate disodium is an intracellular contrast agent for magnetic resonance imaging (MRI) of the liver. Recent publications revealed that injection of gadoxetate disodium can lead to imaging artifacts due to transient severe motion (TSM) in the arterial phase of contrast-enhanced liver MRI. In this review we present and discuss published frequencies of TSM, contrast injection and image acquisition protocols, potential risk factors, and proposed strategies to avoid or minimize the effects of TSM. Method Two reviewers independently searched the PubMed search engine for “transient severe motion artifact” and related terms. Reference lists of retrieved articles were also searched. The two reviewers selected in consensus nine studies that reported both frequencies of TSM and potential risk factors. Study data were extracted by both reviewers, and disagreement was resolved by consensus. Results and Conclusion TSM is caused by impaired breath-hold ability after gadoxetate disodium injection and occurs in 5 – 22 % of patients. The dose of applied contrast agent, repeated exposure to gadoxetate disodium, high BMI and pulmonary disease have been described as potential risk factors for TSM. However, there are only few concordant results on this topic and the pathophysiology of TSM has not been identified. Proposed strategies for the prevention of TSM are slow injection rates and low doses of diluted gadoxetate disodium. Accelerated and free-breathing MRI sequence protocols and breath-hold training may minimize the effects of TSM. Further prospective studies are needed to confirm these strategies and to identify the underlying mechanism of TSM. Key Points Citation Format

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Gadoxetate Disodium–Enhanced MRI of the Liver: Part 1, Protocol Optimization and Lesion Appearance in the Noncirrhotic Liver

Cited by 313 publications

References 76 publications

Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers

Detection of liver metastases using gadoxetic‐enhanced dynamic and 10‐ and 20‐minute delayed phase MR imaging

Transient Severe Respiratory Motion Artifacts After Application of Gadoxetate Disodium: What We Currently Know

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