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DOI: 10.1055/a-2192-9921
Application of liver-specific contrast agents for evaluation of focal liver lesions – Expert recommendations from the Gastrointestinal and Abdominal Imaging Workgroup of the German Roentgen Society
Article in several languages: English | deutschAbstract
Purpose
Contrast-enhanced MRI is the imaging modality of choice for the detection and differential diagnosis of focal liver lesions. Liver-specific contrast agents (CAs) are now well established in addition to extracellular contrast agents. However, there is a lack of explicit recommendations reflecting the pros and cons of each specific contrast agent in the daily routine.
Materials and Methods
Development of recommendations for the clinical application of liver-specific CAs by members of the Gastrointestinal and Abdominal Imaging Workgroup within the Germany Radiological Society, using methodology comparable to that of an S1 guideline with informal consensus. The diagnostic criteria for the evaluation of liver lesions are intentionally outside the scope of this article, as there are already plenty of excellent publications available.
Results and Conclusion
The application of liver-specific CAs in the daily routine is associated with advantages and disadvantages due to the specific pharmacokinetic and pharmacodynamic properties and necessitates adjustment of the imaging technique as well consideration during image interpretation. Recommendations for the application of liver-specific CAs are presented based on different clinical scenarios, taking into account current evidence and guidelines.
Key points
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Both liver-specific and extracellular contrast agents are established
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Liver-specific contrast agents make it possible to draw conclusions about the hepatocellular function of a lesion
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Recommendations for the use of liver-specific contrast agents in the daily routine are presented
Citation Format
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Ringe KI, Fischbach F, Grenacher L et al. Einsatz leberspezifischer Kontrastmittel in der MRT zur Beurteilung von Leberläsionen – Expertenempfehlungen der AG Gastrointestinal- und Abdominaldiagnostik der Deutschen Röntgengesellschaft. Fortschr Röntgenstr 2024; 196: 690 – 698
Publication History
Received: 30 June 2023
Accepted: 27 September 2023
Article published online:
19 December 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 AWMF. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik und Therapie des Hepatozellulären Karzinoms und biliärer Karzinome Langversion 3.0, 2022, AWMF-Registernummer: 032/053OL. Accessed June 23, 2023 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/hcc-und-biliare-karzinome/
- 2 Röntgengesellschaft. D. Hintergrund medizinische Leitlinien. Accessed June 23, 2023 at: https://www.drg.de/de-DE/48/leitlinien/
- 3 Schuhmann-Giampieri G, Schmitt-Willich H, Press WR. et al. Preclinical evaluation of Gd-EOB-DTPA as a contrast agent in MR imaging of the hepatobiliary system. Radiology 1992; 183: 59-64
- 4 Kirchin MA, Pirovano GP, Spinazzi A. Gadobenate dimeglumine (Gd-BOPTA). An overview. Invest Radiol 1998; 33: 798-809
- 5 Ba-Ssalamah A, Uffmann M, Saini S. et al. Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions. Eur Radiol 2009; 19: 342-357
- 6 Zech CJ, Grazioli L, Jonas E. et al. Health-economic evaluation of three imaging strategies in patients with suspected colorectal liver metastases: Gd-EOB-DTPA-enhanced MRI vs. extracellular contrast media-enhanced MRI and 3-phase MDCT in Germany, Italy and Sweden. Eur Radiol 2009; 19 (Suppl. 03) S753-S763
- 7 Zech CJ, Ba-Ssalamah A, Berg T. et al. Consensus report from the 8th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 2020; 30: 370-382
- 8 Zech CJ, Vos B, Nordell A. et al. Vascular enhancement in early dynamic liver MR imaging in an animal model: comparison of two injection regimen and two different doses Gd-EOB-DTPA (gadoxetic acid) with standard Gd-DTPA. Invest Radiol 2009; 44: 305-310
- 9 Ringe KI, von Falck C, Raatschen HJ. et al. Evaluation of transient respiratory motion artifact at gadoxetate disodium-enhanced MRI-Influence of different contrast agent application protocols. PLoS One 2018; 13: e0200887
- 10 Kukuk GM, Ringe KI, Maurer M. et al. Schwere transiente Atemartefakte in der Leber-MRT mit Gadoxetat Dinatrium (Primovist): Ergebnisse einer multizentrischen Studie. Fortsch Röntgenstr 2019; 191
- 11 Davenport MS, Caoili EM, Kaza RK. et al. Matched within-patient cohort study of transient arterial phase respiratory motion-related artifact in MR imaging of the liver: gadoxetate disodium versus gadobenate dimeglumine. Radiology 2014; 272: 123-131
- 12 Luetkens JA, Kupczyk PA, Doerner J. et al. Respiratory motion artefacts in dynamic liver MRI: a comparison using gadoxetate disodium and gadobutrol. Eur Radiol 2015; 25: 3207-3213
- 13 Zech CJ, Justo N, Lang A. et al. Cost evaluation of gadoxetic acid-enhanced magnetic resonance imaging in the diagnosis of colorectal-cancer metastasis in the liver: Results from the VALUE Trial. Eur Radiol 2016; 26: 4121-4130
- 14 Seitz K, Greis C, Schuler A. et al. Frequency of tumor entities among liver tumors of unclear etiology initially detected by sonography in the noncirrhotic or cirrhotic livers of 1349 patients. Results of the DEGUM multicenter study. Ultraschall Med 2011; 32: 598-603
- 15 Schreyer AG, Grenacher L, Wessling J. et al. [Incidental and “leave me alone” findings of abdominal organs-part 1: Liver, gall ducts and pancreas]. Radiologe 2022; 62: 351-364
- 16 Berland LL, Silverman SG, Gore RM. et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010; 7: 754-773
- 17 Neri E, Bali MA, Ba-Ssalamah A. et al. ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 2016; 284: 921-931
- 18 Doo KW, Lee CH, Choi JW. et al. “Pseudo washout” sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. Am J Roentgenol 2009; 193: W490-W496
- 19 Vernuccio F, Bruno A, Costanzo V. et al. Comparison of the Enhancement Pattern of Hepatic Hemangioma on Magnetic Resonance Imaging Performed With Gd-EOB-DTPA Versus Gd-BOPTA. Curr Probl Diagn Radiol 2020; 49: 398-403
- 20 Schaible J, Schreyer AG, Mehrabi A. et al. Subtyping of hepatocellular adenomas using Gd-EOB-DTPA: a qualitative and quantitative analysis. Acta Radiol 2023; 64: 2253-2260
- 21 Grazioli L, Bondioni MP, Haradome H. et al. Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 2012; 262: 520-529
- 22 McInnes MD, Hibbert RM, Inacio JR. et al. Focal Nodular Hyperplasia and Hepatocellular Adenoma: Accuracy of Gadoxetic Acid-enhanced MR Imaging-A Systematic Review. Radiology 2015; 277: 927
- 23 Spangenber HC, Thimme R, Blum HE. Der Leberrundherd. Dtsch Arztebl Int 2009; 1: 34
- 24 Motosugi U, Bannas P, Sano K. et al. Hepatobiliary MR contrast agents in hypovascular hepatocellular carcinoma. J Magn Reson Imaging 2015; 41: 251-265
- 25 Choi JW, Lee JM, Kim SJ. et al. Hepatocellular carcinoma: imaging patterns on gadoxetic acid-enhanced MR Images and their value as an imaging biomarker. Radiology 2013; 267: 776-786
- 26 Renzulli M, Biselli M, Brocchi S. et al. New hallmark of hepatocellular carcinoma, early hepatocellular carcinoma and high-grade dysplastic nodules on Gd-EOB-DTPA MRI in patients with cirrhosis: a new diagnostic algorithm. Gut 2018; 67: 1674-1682
- 27 Ricke J, Steffen IG, Bargellini I. et al. Gadoxetic acid-based hepatobiliary MRI in hepatocellular carcinoma. JHEP Rep 2020; 2: 100173
- 28 Bundesaerztekammer. Richtlinien zur Organtransplantation gem. §16 TPG. 2023 Accessed June 23, 2023 at: https://www.bundesaerztekammer.de/fileadmin/user_upload/BAEK/Ueber_uns/Richtlinien_Leitlinien_Empfehlungen/RiliOrgaWIOvLeberTx20230912.pdf
- 29 OPTN. Guidance to Liver Transplant Programs and National Liver Review Board for: Adult MELD exceptions for hepatocellular carcinoma (HCC). 2020 Accessed June 23, 2023 at: https://optn.transplant.hrsa.gov/media/2846/liver_guidance_hcc_201706.pdf
- 30 Kasper HU, Drebber U, Dries V. et al. [Liver metastases: incidence and histogenesis]. Z Gastroenterol 2005; 43: 1149-1157
- 31 AWMF. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 2.1, 2019, AWMF Registernummer: 021/007OL. Accessed June 23, 2023 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom
- 32 AWMF. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Exokrines Pankreaskarzinom, Langversion 2., 2021, AWMF Registernummer: 032/010OLL. Accessed June 23, 2023 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom
- 33 Zech CJ, Korpraphong P, Huppertz A. et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Br J Surg 2014; 101: 613-621