Optimal Timing and Diagnostic Adequacy of Hepatocyte Phase Imaging with Gadoxetate-Enhanced Liver MRI

Rationale and Objectives

To evaluate clinical and imaging features associated with adequacy of the hepatocyte phase (HP) in gadoxetate disodium–enhanced liver magnetic resonance imaging (MRI) in patients without chronic liver disease (CLD).

Materials and Methods

This was a retrospective institutional review board–approved study of 97 patients who underwent liver MRI examinations with gadoxetate disodium and had no history of CLD. Available late dynamic and HP sequences (3–20 minutes postinjection) were independently analyzed by four radiologists for perceived image adequacy and level of biliary enhancement. Signal intensity ratios (SIRs) of liver/inferior vena cava (IVC), liver/spleen, and liver/muscle were measured. The Spearman ρ and receiver operating characteristic analyses were performed correlating various factors with HP adequacy. A rule for predicting HP adequacy was also derived and tested to determine whether overall examination time could be shortened.

Results

A visually adequate HP was observed in 12% of subjects by 10 minutes, 80% by 15 minutes, and 93% by 20 minutes. An SIR liver/IVC > 1.8 was the imaging feature that had the strongest correlation with an adequate HP (ρ = 0.813, P < .001), and was more predictive of adequacy of the HP than the time postinjection (ρ = 0.5, P < .001). The time at which an adequate HP was first observed did not correlate with any tested demographic or laboratory values. Stopping imaging when an SIR liver/IVC > 1.8 would have successfully reduced mean postcontrast time to 15:39 ± 4:02 from 20:00 ( P < .001), although maintaining HP adequacy.

Conclusions

Most patients without CLD undergoing gadoxetate-enhanced liver MRI achieve adequate HP at 20 minutes. However, a shorter postcontrast stopping time can be used in most patients.

Gadoxetate disodium is becoming a well-established contrast agent for contrast-enhanced magnetic resonance imaging (MRI) of the noncirrhotic liver for the detection of metastatic disease and the evaluation of focal lesions . In particular, hepatocyte phase (HP) imaging with this agent along with an optimized imaging protocol has been shown to provide high-resolution imaging with strong liver-to-lesion contrast and lesion conspicuity . At many centers, gadoxetate-enhanced MRI has become the study of choice for the detection of hepatic metastases from a variety of primary tumors.

Although most publications describe the performance of the HP performed at 20 minutes postinjection, there remains debate as to whether shorter imaging times can be used for the delayed phase without compromising image quality . In particular, the use of 10-minute postinjection HP image sets has been described, with excellent performance for the detection of focal lesions . Thus the ideal timing of the HP is unclear.

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Materials and methods

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Statistical Analysis

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Results

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Table 1

Descriptive Statistics for the Patient Cohort

Value Mean ± SD Range Number of Patients with Value Available within 4 weeks of MRI Age (years) 53.7 ± 14.0 28–85 Gender 31 M; 66 F Total bilirubin (mg/dL) 0.8 ± 0.3 0.3–1.7 N = 91 Albumin (g/dL) 3.5 ± 0.7 1.8–4.4 N = 91 Serum creatinine (mg/dL) 0.9 ± 0.3 0.5–2.3 N = 95 Estimated liver fat fraction (%) 6 ± 1 0–51 N = 97 Presence of liver lesions No lesions ( n = 25); hypointense lesion(s) ( n = 62); isointense lesion(s) ( n = 2); hyperintense lesion(s) ( n = 3); combination of lesion types ( n = 5)

MRI, magnetic resonance imaging; SD, standard deviation.

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Discussion

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Conclusions

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Optimal Timing and Diagnostic Adequacy of Hepatocyte Phase Imaging with Gadoxetate-Enhanced Liver MRI

Rationale and Objectives

Materials and Methods

Results

Conclusions

Materials and methods

Statistical Analysis

Results

Discussion

Conclusions

References

Further Reading

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