Hepatocyte-specific contrast media: not so simple

Hepatocyte-specific contrast media are gadolinium chelates that are taken up by hepatocytes and partially cleared via the biliary tree. The absence of lesional uptake of the contrast media in the hepatobiliary phase is a marker of either the absence of hepatocytes or of poorly functioning, neoplastic hepatocytes. Uptake of the contrast media in the hepatobiliary phase, whether equal to or greater than background liver, reflects the presence of hepatocytes but does not equate to absence of neoplasia. Accurate diagnosis of liver lesions utilizing hepatocyte-specific contrast media requires an understanding of the mechanisms of uptake and clearance of the contrast media to avoid misdiagnosis. In this review we discuss the mechanisms of hepatocellular transport of hepatocyte-specific contrast media and utilize an understanding of those mechanisms to discuss the imaging appearance of a subset of hepatocellular lesions that can be seen in the pediatric and young adult liver. We pay particular attention to lesions that appear iso- to hyperintense in the hepatobiliary phase but have the potential for adverse clinical outcomes. We also discuss strategies for identifying these lesions.