Combined gadoxetic acid and gadobenate dimeglumine enhanced liver MRI: a parameter optimization study
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To demonstrate the feasibility of combined delayed-phase gadoxetic acid (GA) and gadobenate dimeglumine (GD) enhanced liver MRI for improved detection of liver metastases, and to optimize contrast agent dose, timing, and flip angle (FA).
Fourteen healthy volunteers underwent liver MRI at 3.0T at two visits during which they received two consecutive injections: 1. GA (Visit 1 = 0.025 mmol/kg; Visit 2 = 0.05 mmol/kg) and 2. GD (both visits = 0.1 mmol/kg) 20 min after GA administration. Two sub-studies were performed: Experiment-1 Eight subjects underwent multi-phase breath-held 3D-fat-saturated T1-weighted spoiled gradient echo (SGRE) imaging to determine the optimal imaging window for the combined GA + GD protocol to create a homogeneously hyperintense liver and vasculature (“plain-white-liver”) with maximum contrast to muscle which served as a surrogate for metastatic lesions in both experiments. Experiment-2 Six subjects underwent breath-held 3D-fat-saturated T1-weighted SGRE imaging at three different FA to determine the optimal FA for best image contrast. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated.
Experiment-1 The combined GA + GD protocol created a homogeneously hyperintense liver and vasculature with maximum CNR liver/muscle at approximately 60–120 s after automatic GD-bolus detection. Experiment-2 Flip angles between 25° and 35° at a dose of 0.025 mmol/kg GA provided the best combination that minimized liver/vasculature CNR, while maximizing liver/muscle CNR. CNR performance to achieve a “plain-white-liver” was superior with 0.025 mmol/kg GA compared to 0.05 mmol/kg.
Combined GA + GD enhanced T1-weighted MRI is feasible to achieve a homogeneously “plain-white-liver”. Future studies need to confirm that this protocol can improve sensitivity of liver lesion detection in patients with metastatic liver disease.
KeywordsGadolinium ethoxybenzyl DTPA Gadobenic acid Contrast media Magnetic resonance imaging Liver diseases
The authors thank Jenelle Fuller, Kelli Hellenbrand, and Sara John for their assistance in the recruitment and imaging of the volunteers. The authors gratefully acknowledge support from the NIH (K24 DK102595) and the Departments of Radiology and Medical Physics at the University of Wisconsin. We also wish to acknowledge GE Healthcare and Bracco Diagnostics who provided research support to the University of Wisconsin. Further, Dr. Reeder is a Romnes Faculty Fellow, and has received an award provided by the University of Wisconsin-Madison Office of the Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation.
Compliance with ethical standards
Scott Reeder is a shareholder of Reveal Pharmaceuticals. No authors have any other potential conflicts of interest.
- 1.FDA. EOVIST (Gadoxetate Disodium) Labeling-Package Insert 2008. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=022090. Accessed 2018.
- 2.Theilig D, Elkilany A, Schmelzle M, Muller T, Hamm B, Denecke T. Consistency of hepatocellular gadoxetic acid uptake in serial MRI examinations for evaluation of liver function. 2019.Google Scholar
- 4.Ba-Ssalamah A, Qayyum A, Bastati N, Fakhrai N, Herold CJ, Caseiro Alves F. P4 radiology of hepatobiliary diseases with gadoxetic acid-enhanced MRI as a biomarker. Expert review of gastroenterology & hepatology. 2014;8(2):147-60.Google Scholar
- 12.Muhi A, Ichikawa T, Motosugi U, et al. Diagnosis of colorectal hepatic metastases: comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. Journal of magnetic resonance imaging : JMRI. 2011;34(2):326-35.PubMedGoogle Scholar
- 13.Kim JH, Lee SJ, Moon SH, et al. Incremental value of cell block preparations over conventional smears alone in the evaluation of EUS-FNA for pancreatic masses. Hepato-gastroenterology. 2014;61(135):2117-22.Google Scholar
- 16.Heiken JP. Distinguishing benign from malignant liver tumours. Cancer imaging : the official publication of the International Cancer Imaging Society. 2007;7 Spec No A:S1-14.Google Scholar
- 19.Well L, Rausch VH, Adam G, Henes FO, Bannas P. Transient Severe Motion Artifact Related to Gadoxetate Disodium-Enhanced Liver MRI: Frequency and Risk Evaluation at a German Institution. Rofo. 2017;189(7):651-60.Google Scholar
- 25.FDA. ABLAVAR (gadofosveset trisodium) Labeling-Package Insert 2013; vol 2018, no Jan 28, 2018. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=021711.
- 26.FDA. Gadavist (gadobutrol) Labeling-Package Insert 2011; vol 2018, no Jan 28, 2018. Available at: https://google2.fda.gov/search?q=gadavist&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&requiredfields=-archive%3AYes&output=xml_no_dtd&getfields=*.
- 27.FDA. MultiHance (gadobenate dimeglumine) Labeling-Package Insert 2018; vol 2018, no Jan 28, 2018. Available at: https://google2.fda.gov/search?q=multihance&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&requiredfields=-archive%3AYes&output=xml_no_dtd&getfields=*.
- 28.FDA. DOTAREM® (gadoterate meglumine) Labeling-Package Insert 2017; vol 2018, no Jan 28,2018. Available at: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&applno=204781.
- 31.Frydrychowicz A, Nagle SK, D’Souza SL, Vigen KK, Reeder SB. Optimized high-resolution contrast-enhanced hepatobiliary imaging at 3 tesla: a cross-over comparison of gadobenate dimeglumine and gadoxetic acid. Journal of magnetic resonance imaging : JMRI. 2011;34(3):585-94.PubMedPubMedCentralGoogle Scholar
- 40.Motosugi U, Bannas P, Hernando D, Salmani Rahimi M, Holmes JH, Reeder SB. Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers. Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine. 2016;15(1):60-72.PubMedGoogle Scholar
- 41.EMA. Gadolinium-containing contrast agents2017; vol 2018, no Jan 30, 2018. Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Gadolinium-containing_contrast_agents/human_referral_prac_000056.jsp&mid=WC0b01ac05805c516f.
- 42.FDA. FDA Drug Safety Communication: FDA warns that gadolinium-based contrast agents (GBCAs) are retained in the body; requires new class warnings2017; vol 2018, no Jan 30, 2018. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm589213.htm.