To acknowledge the facts of gadoxetate disodium-related events in Japan and to achieve better MR practice by analyzing large cohort data with various MR parameters.
Materials and methods
This prospective multi-institutional study included 1993 patients (1201 men, mean age 66.4 ± 12.8 years), who received dynamic MRI with gadoxetate disodium (gadoxetate group, n = 1646) or extracellular gadolinium-based contrast agents (other-GBCAs group, n = 347) between January and November 2016. Recorded data covered adverse reactions including dyspnea, breath-hold failure during acquisition, respiratory artifacts rated with a four-point scale, and MR parameters. We compared data between the two groups in whole cohort and age-, gender-, and institution-matched subcohort using χ2 test (n = 640). Logistic regression model was used to reveal independent associates of substantial artifacts in arterial phase imaging.
Transient dyspnea rarely occurred in gadoxetate or other-GBCAs group (both < 1%). Gadoxetate group (vs other-GBCAs group) showed higher rates of breath-hold failure (whole cohort, 18.2% vs 7.7%, p < 0.001; subcohort, 17.6% vs 6.3%, p < 0.001) and substantial artifacts in arterial phase (7.2% vs 2.2%, p = 0.001; 7.4% vs 1.7%, p = 0.001). With single arterial phase protocol, substantial artifacts under gadoxetate were independently associated with age (odds ratio [OR] = 1.04, p < 0.001), hearing difficulty (OR = 2.92, p = 0.008), breath-hold practice required (OR = 1.61, p = 0.039), and short acquisition time (OR = 0.43, p = 0.005). Multiple arterial phase acquisition did not reduce the incident rate of substantial artifacts.
Gadoxetate disodium was associated with breath-hold failure and substantial artifacts in arterial phase imaging, but not with dyspnea in Japan. Shorter acquisition time should be used to sustain image quality in gadoxetate disodium-enhanced arterial phase imaging.
• Gadoxetate disodium administration leads to breath-hold failure and substantial imaging artifacts in arterial phase MRI in Japan.
• Contrast agent-induced dyspnea in arterial phase and adverse reactions are rare in Japan, without showing differences between gadoxetate disodium or other extracellular gadolinium-based contrast agents.
• Shorter acquisition time significantly reduces gadoxetate-induced imaging artifacts in the arterial phase.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Body mass index
Chronic obstructive pulmonary disease
Gadolinium-based contrast agent
Magnetic resonance imaging
Portal venous phase
Transient severe motion
Chung YE, Kim MJ, Kim YE, Park MS, Choi JY, Kim KW (2013) Characterization of incidental liver lesions: comparison of multidetector CT versus Gd-EOB-DTPA-enhanced MR imaging. PLoS One 8:e66141
Mohajer K, Frydrychowicz A, Robbins JB, Loeffler AG, Reed TD, Reeder SB (2012) Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid. J Magn Reson Imaging 36:686–696
Chen L, Zhang J, Zhang L et al (2012) Meta-analysis of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the detection of liver metastases. PLoS One 7:e48681
Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6:43–52
Frydrychowicz A, Lubner MG, Brown JJ et al (2012) Hepatobiliary MR imaging with gadolinium-based contrast agents. J Magn Reson Imaging 35:492–511
Davenport MS, Viglianti BL, Al-Hawary MM et al (2013) Comparison of acute transient dyspnea after intravenous administration of gadoxetate disodium and gadobenate dimeglumine: effect on arterial phase image quality. Radiology 266:452–461
Pietryga JA, Burke LM, Marin D, Jaffe TA, Bashir MR (2014) Respiratory motion artifact affecting hepatic arterial phase imaging with gadoxetate disodium: examination recovery with a multiple arterial phase acquisition. Radiology 271:426–434
Motosugi U, Bannas P, Bookwalter CA, Sano K, Reeder SB (2016) An investigation of transient severe motion related to gadoxetic acid-enhanced MR imaging. Radiology 279:93–102
Gutzeit A, Matoori S, Froehlich JM et al (2016) Reduction in respiratory motion artefacts on gadoxetate-enhanced MRI after training technicians to apply a simple and more patient-adapted breathing command. Eur Radiol 26:2714–2722
Kim SY, Park SH, Wu EH et al (2015) Transient respiratory motion artifact during arterial phase MRI with gadoxetate disodium: risk factor analyses. AJR Am J Roentgenol 204:1220–1227
McClellan TR, Motosugi U, Middleton MS et al (2017) Intravenous gadoxetate disodium administration reduces breath-holding capacity in the hepatic arterial phase: a multi-center randomized placebo-controlled trial. Radiology 282:361–368
Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022
Motosugi U, Ichikawa T, Araki T (2013) Rules, roles, and room for discussion in gadoxetic acid-enhanced magnetic resonance liver imaging: current knowledge and future challenges. Magn Reson Med Sci 12:161–175
Hayashi T, Saitoh S, Tsuji Y et al (2015) Influence of gadoxetate disodium on oxygen saturation and heart rate during dynamic contrast-enhanced MR imaging. Radiology 276:756–765
Namimoto T, Shimizu K, Nakagawa M et al (2018) Reducing artifacts of gadoxetate disodium-enhanced MRI with oxygen inhalation in patients with prior episode of arterial phase motion: intra-individual comparison. Clin Imaging 52:11–15
Polanec SH, Bickel H, Baltzer PAT et al (2017) Respiratory motion artifacts during arterial phase imaging with gadoxetic acid: can the injection protocol minimize this drawback? J Magn Reson Imaging 46:1107–1114
Song JS, Choi EJ, Park EH, Lee JH (2018) Comparison of transient severe motion in gadoxetate disodium and gadopentetate dimeglumine-enhanced MRI: effect of modified breath-holding method. Eur Radiol 28:1132–1139
Gutzeit A, Matoori S, Froehlich J, Koh D (2016) Reduction in respiratory motion artifacts on gadoxetate acid-enhanced MR images after training technicians. Radiology 279:981–982
Weiss J, Notohamiprodjo M, Taron J et al (2018) Continuous hepatic arterial multiphase magnetic resonance imaging during free-breathing. Invest Radiol 53:596–601
Kaltenbach B, Bucher AM, Wichmann JL et al (2017) Dynamic liver magnetic resonance imaging in free-breathing: feasibility of a Cartesian T1-weighted acquisition technique with compressed sensing and additional self-navigation signal for hard-gated and motion-resolved reconstruction. Invest Radiol 52:708–714
Yoon JH, Yu MH, Chang W et al (2017) Clinical feasibility of free-breathing dynamic T1-weighted imaging with Gadoxetic acid-enhanced liver magnetic resonance imaging using a combination of variable density sampling and compressed sensing. Invest Radiol 52:596–604
Chandarana H, Feng L, Ream J et al (2015) Respiratory motion-resolved compressed sensing reconstruction of free-breathing radial acquisition for dynamic liver magnetic resonance imaging. Invest Radiol 50:749–756
Min JH, Kim YK, Kang TW et al (2018) Artifacts during the arterial phase of gadoxetate disodium-enhanced MRI: multiple arterial phases using view-sharing from two different vendors versus single arterial phase imaging. Eur Radiol 28:3335–3346
Li H, Xiao Y, Wang S et al (2017) TWIST-VIBE five-arterial-phase technology decreases transient severe motion after bolus injection of Gd-EOB-DTPA. Clin Radiol 72:800 e801–800 e806
Park YS, Lee CH, Yoo JL et al (2016) Hepatic arterial phase in gadoxetic acid-enhanced liver magnetic resonance imaging: analysis of respiratory patterns and their effect on image quality. Invest Radiol 51:127–133
Davenport MS, Bashir MR, Pietryga JA, Weber JT, Khalatbari S, Hussain HK (2014) Dose-toxicity relationship of gadoxetate disodium and transient severe respiratory motion artifact. AJR Am J Roentgenol 203:796–802
Morisaka H, Motosugi U, Ichikawa S, Onishi H (2018) Dose-dependence of transient respiratory motion artifacts on gadoxetic acid-enhanced arterial phase MR images. J Magn Reson Imaging 47:433–438
Davenport MS, Malyarenko DI, Pang Y, Hussain HK, Chenevert TL (2017) Effect of Gadoxetate disodium on arterial phase respiratory waveforms using a quantitative fast Fourier transformation-based analysis. AJR Am J Roentgenol 208:328–336
Kim YK, Lin WC, Sung K et al (2017) Reducing artifacts during arterial phase of gadoxetate disodium-enhanced MR imaging: dilution method versus reduced injection rate. Radiology 283:429–437
Grazioli L, Faletti R, Frittoli B et al (2018) Evaluation of incidence of acute transient dyspnea and related artifacts after administration of gadoxetate disodium: a prospective observational study. Radiol Med 123:910–917
Gruber L, Rainer V, Plaikner M, Kremser C, Jaschke W, Henninger B (2018) CAIPIRINHA-Dixon-TWIST (CDT)-VIBE MR imaging of the liver at 3.0T with gadoxetate disodium: a solution for transient arterial-phase respiratory motion-related artifacts? Eur Radiol 28:2013–2021
Bashir MR, Gupta RT, Davenport MS et al (2013) Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis? J Magn Reson Imaging 37:398–406
Bashir MR, Castelli P, Davenport MS et al (2015) Respiratory motion artifact affecting hepatic arterial phase MR imaging with gadoxetate disodium is more common in patients with a prior episode of arterial phase motion associated with gadoxetate disodium. Radiology 274:141–148
Haradome H, Grazioli L, Tsunoo M et al (2010) Can MR fluoroscopic triggering technique and slow rate injection provide appropriate arterial phase images with reducing artifacts on gadoxetic acid-DTPA (Gd-EOB-DTPA)-enhanced hepatic MR imaging? J Magn Reson Imaging 32:334–340
The authors state that this work has not received any funding.
The scientific guarantor of this publication is Utaroh Motosugi, MD PhD.
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 has significant statistical expertise.
Written informed consent was not required for this study because of the retrospective study design.
Institutional Review Board approval was obtained.
• performed at one institution
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Kromrey, ML., Hori, M., Goshima, S. et al. Gadoxetate disodium-related event during image acquisition: a prospective multi-institutional study for better MR practice. Eur Radiol 30, 281–290 (2020). https://doi.org/10.1007/s00330-019-06358-7
- Magnetic resonance imaging
- Gadoxetate disodium