Ascites relative enhancement during hepatobiliary phase after Gd-BOPTA administration: a new promising tool for characterising abdominal free fluid of unknown origin

  • Matteo BonattiEmail author
  • Riccardo Valletta
  • Giulia A. Zamboni
  • Fabio Lombardo
  • Maria Senoner
  • Mariachiara Simioni
  • Guenther Schifferle
  • Giampietro Bonatti
Magnetic Resonance



To correlate the degree of ascites enhancement during hepatobiliary phase after gadobenate dimeglumine (Gd-BOPTA) administration with ascites aetiology.


IRB-approved retrospective study, need for informed consent was waived. We included 74 consecutive ascitic patients who underwent Gd-BOPTA-enhanced liver MRI including hepatobiliary phase (HBP) images between January 2014 and December 2017. Ascites appearance on unenhanced and HBP images was classified as hypo-, iso- or hyperintense in comparison to paraspinal muscles. Ascites signal intensity on unenhanced and HBP images was measured using round ROIs and was normalised to paraspinal muscles (NSI). Normalised relative enhancement (NRE) between native phase and HBP was calculated. The results were related to ascites aetiology using Wilcoxon and Mann-Whitney tests.


On native images, ascites appeared hypointense in 95.9% of the cases and isointense in 4.1%, whereas on HBP images, it appeared hyperintense in 59.4% of the cases, isointense in 36.5% and hypointense in 4.1%. Mean ascites NSI was 0.52 on unenhanced images and 1.50 on HBP ones (p < 0.0001). Mean ascites NRE was 201 ± 133%. Ascites of non-malignant aetiology showed mean NRE of 210 ± 134%, whereas malignant ascites showed mean NRE of 92 ± 20% (p = 0.001). ROC analysis showed that a NRE < 112.5% correlates with malignant aetiology with 100% sensitivity and 83.4% specificity (LR = 5.667). NRE did not show any significant correlation with ascites thickness, eGFR and time interval between contrast administration and HBP acquisition (p > 0.05).


Ascites NRE in HBP after Gd-BOPTA administration is significantly lower in patients with ascites secondary to peritoneal carcinomatosis than in patients with non-malignant ascites.

Key Points

• Ascites enhancement in the hepatobiliary phase after Gd-BOPTA administration may determine false positive findings when looking for biliary leaks.

• Ascites enhancement in the hepatobiliary phase after Gd-BOPTA administration is lower in patients with peritoneal carcinomatosis than in patients with portal hypertension or congestive heart failure.

• None of the patients with peritoneal carcinomatosis showed an ascites enhancement of more than 112% as compared with unenhanced images.


Magnetic resonance imaging Ascites Gadobenate dimeglumine Peritoneal neoplasms Liver 

Abbreviations and acronyms


Hepatobiliary phase


Normalised relative enhancement


Normalised signal intensity



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Matteo Bonatti.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Dr. Fabio Lombardo) has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• multicenter study


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Matteo Bonatti
    • 1
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  • Riccardo Valletta
    • 1
    • 2
  • Giulia A. Zamboni
    • 2
  • Fabio Lombardo
    • 1
  • Maria Senoner
    • 1
  • Mariachiara Simioni
    • 1
    • 2
  • Guenther Schifferle
    • 1
  • Giampietro Bonatti
    • 1
  1. 1.Department of RadiologyBolzano Central HospitalBolzanoItaly
  2. 2.Department of RadiologyUniversity of VeronaVeronaItaly

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