Review of hepatobiliary contrast agents: Current applications and challenges

Abstract

The group of hepatobiliary contrast agents comprises two gadolinium-based contrast agents (GBCAs) that show a specific amount of hepatocellular uptake and biliary excretion. Gadobenate dimeglumine (Gd-BOPTA; Bracco Diagnostics) and gadoxetic acid (Gd-EOB-DTPA; Bayer Healthcare) are US Food and Drug Administration (FDA)-approved agents for magnetic resonance imaging (MRI) and for detection and characterization of liver lesions, respectively. A third agent with hepatobiliary properties, gadofosveset trisodium, has recently been discontinued.The success of these so-called hepatobiliary contrast agents (hbGBCAs) is essentially related to satisfying the fundamental motive in MRI-that is, the pursuit to structurally characterize tissues or lesions. Specifically, MRI's high intrinsic soft tissue contrast with its ability to enhance specific tissue characteristics is further amended by the ability of hbGBCAs to detect hepatocytes and biliary canaliculi. In combination, the use of hbGBCAs in MRI is a powerful diagnostic instrument.hbGBCAs carry the dual properties of acting like ''conventional'' GBCAs during the first pass and early phases of contrast enhancement, and by revealing the characteristic delayed or hepatobiliary enhancement. In the initial phases after injection, their contrast enhancement is dominated by the distribution in vessels and the extracellular space like in conventional GBCAs. However, unlike other GBCAs, hbGBCAs are then taken up by functional hepatocytes. As a result, there is a persistent enhancement in hepatocytes that allows for identifying lesions of Abbreviations: EMA, European Medicines Agency; FDA, US Food and Drug Administration; FNH, focal nodular hyperplasia; GBCA, gadolinium-based contrast agent; HA, hepatic adenoma; hbGBCA, hepatobiliary GBCA; MRC, magnetic resonance cholangiography; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; NSF, nephrogenic systemic fibrosis.From the *University of L€ ubeck, Campus L€ ubeck, and

Magnetic Resonance Imaging Role in Metastatic Liver Disease

“…Despite that, gadobenate dimeglumine has a cost comparable to extracellular gadolinium contrast agents, while gadoxetate disodium has a significantly higher cost. 11 Gadolinium-based contrast agents are related to fewer allergic adverse event occurrences in comparison to iodinated contrasts. Systemic nephrogenic fibrosis is an uncommon complication that is usually related to an underlying deficit in renal function.…”

Liver Anatomy and Cross-Sectional Imaging Techniques: A Practical Approach

“…In addition, biliary excretion of this contrast allows for both identifying lesions that contain biliary canaliculi and enhancing the biliary excretion system. 24 Lesion de-enhancement described in the hepatobiliary phase of MRI is one of the ancillary features, favoring malignancy in LI-RADS documentation. 2 Gadobenate dimeglumine and gadoxetate disodium are the commercially available hepatobiliary contrast agents.…”

New boundaries of liver imaging: from morphology to function

“…Hepatobiliary-specific agents have been developed during the past three decades, and the ones currently in use for clinical purposes are gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA) [23]. These contrast agents have a different pharmacokinetic behavior: initially distributed in the extracellular fluid compartment, similarly to ECA, are subsequently taken up by organic anion transporters in the normal hepatocyte sinusoidal membrane and excreted into the bile 60 or 20 min after injection, respectively (depending on the agent).…”

“…Another application is the assessment of liver function by quantifying the degree of hepatic signal intensity enhancement in the hepatobiliary phase and the presence of contrast media in the bile ducts. This has potential applications for the noninvasive prediction of residual liver function for patients proposed to major partial hepatectomy or to diagnose early liver failure after an orthotopic liver transplant graft [17,23].…”