Top

Published in:

01-02-2009 | Gastrointestinal

Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions

Authors: Ahmed Ba-Ssalamah, Martin Uffmann, Sanjai Saini, Nina Bastati, Christian Herold, Wolfgang Schima

Published in: European Radiology | Issue 2/2009

Abstract

Screening of the liver for hepatic lesion detection and characterization is usually performed with either ultrasound or CT. However, both techniques are suboptimal for liver lesion characterization and magnetic resonance (MR) imaging has emerged as the preferred radiological investigation. In addition to unenhanced MR imaging techniques, contrast-enhanced MR imaging can demonstrate tissue-specific physiological information, thereby facilitating liver lesion characterization. Currently, the classes of contrast agents available for MR imaging of the liver include non-tissue-specific extracellular gadolinium chelates and tissue-specific hepatobiliary or reticuloendothelial agents. In this review, we describe the MR features of the more common focal hepatic lesions, as well as appropriate imaging protocols. A special emphasis is placed on the clinical use of non-specific and liver-specific contrast agents for differentiation of focal liver lesions. This may aid in the accurate diagnostic workup of patients in order to avoid invasive procedures, such as biopsy, for lesion characterization. A diagnostic strategy that considers the clinical situation is also presented.

Perilongo G, Shafford EA (1999) Liver tumours. Eur J Cancer 35(6):953–958 discussion 958–959PubMedCrossRef

Jones EC, Chezmar JL, Nelson RC, Bernardino ME (1992) The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. AJR Am J Roentgenol 158(3):535–539PubMed

Ba-Ssalamah A, Fakhrai N, Matzek WK, Herneth AM, Stadler A, Bastati N, Herold CJ, Schima W (2007) Magnetic resonance imaging of liver malignancies. Top Magn Reson Imaging 18(6):445–455PubMedCrossRef

Morana G, Salviato E, Guarise A (2007) Contrast agents for hepatic MRI. Cancer Imaging 7(Spec No A):S24–S27PubMedCrossRef

Ersoy H, Rybicki FJ (2007) Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis. J Magn Reson Imaging 26(5):1190–1197PubMedCrossRef

Niendorf HP, Alhassan A, Geens VR, Clauss W (1994) Safety review of gadopentetate dimeglumine. Extended clinical experience after more than five million applications. Invest Radiol 29(Suppl 2):S179–S182PubMedCrossRef

Semelka RC, Helmberger TK (2001) Contrast agents for MR imaging of the liver. Radiology 218(1):27–38PubMed

Reimer P, Schneider G, Schima W (2004) Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol 14(4):559–578PubMedCrossRef

Hammerstingl R, Zangos S, Schwarz W, Rosen T, Bechstein WO, Balzer T, Vogl TJ (2002) Contrast-enhanced MRI of focal liver tumors using a hepatobiliary MR contrast agent: detection and differential diagnosis using Gd-EOB-DTPA-enhanced versus Gd-DTPA-enhanced MRI in the same patient. Acad Radiol 9(Suppl 1):S119–S120PubMedCrossRef

10.

Schima W, Saini S, Petersein J, Weissleder R, Harisinghani M, Mayo-Smith W, Hahn PF (1999) MR imaging of the liver with Gd-BOPTA: quantitative analysis of T1-weighted images at two different doses. J Magn Reson Imaging 10(1):80–83PubMedCrossRef

11.

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(1):43–52PubMedCrossRef

12.

Halavaara J, Breuer J, Ayuso C, Balzer T, Bellin MF, Blomqvist L, Carter R, Grazioli L, Hammerstingl R, Huppertz A, Jung G, Krause D, Laghi A, Leen E, Lupatelli L, Marsili L, Martin J, Pretorius ES, Reinhold C, Stiskal M, Stolpen AH (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT-a multicenter trial. J Comput Assist Tomogr 30(3):345–354PubMedCrossRef

13.

Stroszczynski C, Gaffke G, Gnauck M, Streitparth F, Wieners G, Lopez-Haninnen E (2004) Current status of MRI diagnostics with liver-specific contrast agents. Gd-EOB-DTPA and Gd-BOPTA. Radiologe 44(12):1185–1191PubMedCrossRef

14.

Huppertz A, Haraida S, Kraus A, Zech CJ, Scheidler J, Breuer J, Helmberger TK, Reiser MF (2005) Enhancement of focal liver lesions at gadoxetic acid-enhanced MR imaging: correlation with histopathologic findings and spiral CT-initial observations. Radiology 234(2):468–478PubMedCrossRef

15.

Morana GGL, Schneider G et al (2002) Hypervascular hepatic lesions: dynamic late enhancement pattern with Gd-BOPTA. Acad Radiol 9(Suppl 2):S476–S479PubMedCrossRef

16.

Oudkerk M, Torres CG, Song B, Konig M, Grimm J, Fernandez-Cuadrado J, Op de Beeck B, Marquardt M, van Dijk P, de Groot JC (2002) Characterization of liver lesions with mangafodipir trisodium-enhanced MR imaging: multicenter study comparing MR and dual-phase spiral CT. Radiology 223(2):517–524PubMedCrossRef

17.

Scharitzer M, Schima W, Schober E, Reimer P, Helmberger TK, Holzknecht N, Stadler A, Ba-Ssalamah A, Weber M, Wrba F (2005) Characterization of hepatocellular tumors: value of mangafodipir-enhanced magnetic resonance imaging. J Comput Assist Tomogr 29(2):181–190PubMedCrossRef

18.

Helmberger TK, Laubenberger J, Rummeny E, Jung G, Sievers K, Dohring W, Meurer K, Reiser MF (2002) MRI characteristics in focal hepatic disease before and after administration of MnDPDP: discriminant analysis as a diagnostic tool. Eur Radiol 12(1):62–70PubMedCrossRef

19.

Wang C, Ahlstrom H, Eriksson B, Lonnemark M, McGill S, Hemmingsson A (1998) Uptake of mangafodipir trisodium in liver metastases from endocrine tumors. J Magn Reson Imaging 8(3):682–686PubMedCrossRef

20.

Bluemke DA, Weber TM, Rubin D, de Lange EE, Semelka R, Redvanly RD, Chezmar J, Outwater E, Carlos R, Saini S, Holland GA, Mammone JF, Brown JJ, Milestone B, Javitt MC, Jacobs P (2003) Hepatic MR imaging with ferumoxides: multicenter study of safety and effectiveness of direct injection protocol. Radiology 228(2):457–464PubMedCrossRef

21.

Saini S, Stark DD, Hahn PF, Wittenberg J, Brady TJ, Ferrucci JT Jr (1987) Ferrite particles: a superparamagnetic MR contrast agent for the reticuloendothelial system. Radiology 162(1 Pt 1):211–216PubMed

22.

Reimer P, Muller M, Marx C, Wiedermann D, Muller R, Rummeny EJ, Ebert W, Shamsi K, Peters PE (1998) T1 effects of a bolus-injectable superparamagnetic iron oxide, SH U 555 A: dependence on field strength and plasma concentration—preliminary clinical experience with dynamic T1-weighted MR imaging. Radiology 209(3):831–836PubMed

23.

Ba-Ssalamah A, Heinz-Peer G, Schima W, Schibany N, Schick S, Prokesch RW, Kaider A, Teleky B, Wrba F, Lechner G (2000) Detection of focal hepatic lesions: comparison of unenhanced and SHU 555 A-enhanced MR imaging versus biphasic helical CTAP. J Magn Reson Imaging 11(6):665–672PubMedCrossRef

24.

Montet X, Lazeyras F, Howarth N, Mentha G, Rubbia-Brandt L, Becker CD, Vallee JP, Terrier F (2004) Specificity of SPIO particles for characterization of liver hemangiomas using MRI. Abdom Imaging 29(1):60–70PubMedCrossRef

25.

Klatskin GCH (1993) Histopathology of the liver. Oxford University Press, New York

26.

Mortele KJ, Ros PR (2001) Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 21(4):895–910PubMed

27.

Reddy KR, Kligerman S, Levi J, Livingstone A, Molina E, Franceschi D, Badalamenti S, Jeffers L, Tzakis A, Schiff ER (2001) Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg 67(2):173–178PubMed

28.

Soyer P, Dufresne AC, Somveille E, Scherrer A (1997) Hepatic cavernous hemangioma: appearance on T2-weighted fast spin-echo MR imaging with and without fat suppression. AJR Am J Roentgenol 168(2):461–465PubMed

29.

Semelka RC, Brown ED, Ascher SM, Patt RH, Bagley AS, Li W, Edelman RR, Shoenut JP, Brown JJ (1994) Hepatic hemangiomas: a multi-institutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images. Radiology 192(2):401–406PubMed

30.

Marti-Bonmati L, Casillas C, Graells M, Masia L (1999) Atypical hepatic hemangiomas with intense arterial enhancement and early fading. Abdom Imaging 24(2):147–152PubMedCrossRef

31.

Danet IM, Semelka RC, Braga L, Armao D, Woosley JT (2003) Giant hemangioma of the liver: MR imaging characteristics in 24 patients. Magn Reson Imaging 21(2):95–101PubMedCrossRef

32.

Bennett GL, Petersein A, Mayo-Smith WW, Hahn PF, Schima W, Saini S (2000) Addition of gadolinium chelates to heavily T2-weighted MR imaging: limited role in differentiating hepatic hemangiomas from metastases. AJR Am J Roentgenol 174(2):477–485PubMed

33.

Ba-Ssalamah A, Happel B, Kettenbach J, Dirisamer A, Wrba F, Langle F, Schima W (2004) [MRT of the liver. Clinical significance of nonspecific and liver-specific MRT contrast agents]. Radiologe 44(12):1170–1184PubMedCrossRef

34.

Mitchell DG, Saini S, Weinreb J, De Lange EE, Runge VM, Kuhlman JE, Parisky Y, Johnson CD, Brown JJ, Schnall M et al (1994) Hepatic metastases and cavernous hemangiomas: distinction with standard- and triple-dose gadoteridol-enhanced MR imaging. Radiology 193(1):49–57PubMed

35.

Nguyen BN, Flejou JF, Terris B, Belghiti J, Degott C (1999) Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 23(12):1441–1454PubMedCrossRef

36.

Ba-Ssalamah A, Schima W, Schmook MT, Linnau KF, Schibany N, Helbich T, Reimer P, Laengle F, Wrba F, Kurtaran A, Ryan M, Mann FA (2002) Atypical focal nodular hyperplasia of the liver: imaging features of nonspecific and liver-specific MR contrast agents. AJR Am J Roentgenol 179(6):1447–1456PubMed

37.

Rummeny E, Weissleder R, Sironi S, Stark DD, Comptom CC, Hahn PF, Saini S, Wittenberg J, Ferrucci JT (1989) Central scars in primary liver tumors: MR features, specificity, and pathologic correlation. Radiology 171(2):323–326PubMed

38.

Grazioli L, Morana G, Kirchin MA, Schneider G (2005) Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: prospective study. Radiology 236(1):166–177PubMedCrossRef

39.

Grazioli L, Morana G, Federle MP, Brancatelli G, Testoni M, Kirchin MA, Menni K, Olivetti L, Nicoli N, Procacci C (2001) Focal nodular hyperplasia: morphologic and functional information from MR imaging with gadobenate dimeglumine. Radiology 221(3):731–739PubMedCrossRef

40.

Ricci P, Laghi A, Cantisani V, Paolantonio P, Pacella S, Pagliara E, Arduini F, Pasqualini V, Trippa F, Filpo M, Passariello R (2005) Contrast-enhanced sonography with SonoVue: enhancement patterns of benign focal liver lesions and correlation with dynamic gadobenate dimeglumine-enhanced MRI. AJR Am J Roentgenol 184(3):821–827PubMed

41.

Bluemke DA, Sahani D, Amendola M, Balzer T, Breuer J, Brown JJ, Casalino DD, Davis PL, Francis IR, Krinsky G, Lee FT Jr., Lu D, Paulson EK, Schwartz LH, Siegelman ES, Small WC, Weber TM, Welber A, Shamsi K (2005) Efficacy and safety of MR imaging with liver-specific contrast agent: U.S. multicenter phase III study. Radiology 237(1):89–98PubMedCrossRef

42.

Precetti-Morel S, Bellin MF, Ghebontni L, Zaim S, Opolon P, Poynard T, Mathurin P, Cluzel P (1999) Focal nodular hyperplasia of the liver on ferumoxides-enhanced MR imaging: features on conventional spin-echo, fast spin-echo and gradient-echo pulse sequences. Eur Radiol 9(8):1535–1542PubMedCrossRef

43.

Soe K (1992) Liver Pathology associated with the use of anabolic-androgenic steroids. Liver 12:73–79PubMed

44.

Meissner K (1998) Hemorrhage caused by ruptured liver cell adenoma following long-term oral contraceptives: a case report. Hepatogastroenterology 45(19):224–225PubMed

45.

Craig CPR, Edmonson HA (1989) Atlas of tumor pathology: tumors of the liver and intrahepatic bile ducts. Armed forces Institute of Pathology, Washington DC

46.

Paulson EK, McClellan JS, Washington K, Spritzer CE, Meyers WC, Baker ME (1994) Hepatic adenoma: MR characteristics and correlation with pathologic findings. AJR Am J Roentgenol 163(1):113–116PubMed

47.

Chung KY, Mayo-Smith WW, Saini S, Rahmouni A, Golli M, Mathieu D (1995) Hepatocellular adenoma: MR imaging features with pathologic correlation. AJR Am J Roentgenol 165(2):303–308PubMed

48.

Hussain SM, Zondervan PE, Ijzermans JN, Schalm SW, de Man RA, Krestin GP (2002) Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation. Radiographics 22(5):1023–1036 discussion 1037–1039PubMed

49.

Kim MJ, Kim JH, Lim JS, Oh YT, Chung JJ, Choi JS, Lee WJ, Kim KW (2004) Detection and characterization of focal hepatic lesions: mangafodipir vs. superparamagnetic iron oxide-enhanced magnetic resonance imaging. J Magn Reson Imaging 20(4):612–621PubMedCrossRef

50.

Sugarbaker PH, Kemeny N (1989) Management of metastatic cancer to the liver. Adv Surg 22:1–56PubMed

51.

Danet IM, Semelka RC, Leonardou P, Braga L, Vaidean G, Woosley JT, Kanematsu M (2003) Spectrum of MRI appearances of untreated metastases of the liver. AJR Am J Roentgenol 181(3):809–817PubMed

52.

Stern W, Schick F, Kopp AF, Reimer P, Shamsi K, Claussen CD, Laniado M (2000) Dynamic MR imaging of liver metastases with Gd-EOB-DTPA. Acta Radiol 41(3):255–262PubMedCrossRef

53.

Kim YK, Lee JM, Kim CS (2004) Gadobenate dimeglumine-enhanced liver MR imaging: value of dynamic and delayed imaging for the characterization and detection of focal liver lesions. Eur Radiol 14(1):5–13PubMedCrossRef

54.

King LJ, Burkill GJ, Scurr ED, Vlavianos P, Murray-Lyons I, Healy JC (2002) MnDPDP enhanced magnetic resonance imaging of focal liver lesions. Clin Radiol 57(12):1047–1057PubMedCrossRef

55.

Ros PR, Freeny PC, Harms SE, Seltzer SE, Davis PL, Chan TW, Stillman AE, Muroff LR, Runge VM, Nissenbaum MA et al (1995) Hepatic MR imaging with ferumoxides: a multicenter clinical trial of the safety and efficacy in the detection of focal hepatic lesions. Radiology 196(2):481–488PubMed

56.

Lai EC, Lau WY (2005) The continuing challenge of hepatic cancer in Asia. Surgeon 3(3):210–215PubMedCrossRef

57.

Mitchell DG (2000) MR imaging of cirrhosis and its complications. Abdom Imaging 25(5):455PubMedCrossRef

58.

Taouli B, Losada M, Holland A, Krinsky G (2004) Magnetic resonance imaging of hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S144–S152PubMedCrossRef

59.

Grazioli L, Olivetti L, Fugazzola C, Benetti A, Stanga C, Dettori E, Gallo C, Matricardi L, Giacobbe A, Chiesa A (1999) The pseudocapsule in hepatocellular carcinoma: correlation between dynamic MR imaging and pathology. Eur Radiol 9(1):62–67PubMedCrossRef

60.

Bartolozzi C, Crocetti L, Lencioni R, Cioni D, Della Pina C, Campani D (2007) Biliary and reticuloendothelial impairment in hepatocarcinogenesis: the diagnostic role of tissue-specific MR contrast media. Eur Radiol 17(10):2519–2530PubMedCrossRef

61.

Muramatsu Y, Nawano S, Takayasu K, Moriyama N, Yamada T, Yamasaki S, Hirohashi S (1991) Early hepatocellular carcinoma: MR imaging. Radiology 181(1):209–213PubMed

62.

Grazioli L, Morana G, Caudana R, Benetti A, Portolani N, Talamini G, Colombari R, Pirovano G, Kirchin MA, Spinazzi A (2000) Hepatocellular carcinoma: correlation between gadobenate dimeglumine-enhanced MRI and pathologic findings. Invest Radiol 35(1):25–34PubMedCrossRef

63.

Winter TC 3rd, Takayasu K, Muramatsu Y, Furukawa H, Wakao F, Koga H, Sakamoto M, Hirohashi S, Freeny PC (1994) Early advanced hepatocellular carcinoma: evaluation of CT and MR appearance with pathologic correlation. Radiology 192(2):379–387PubMed

64.

Pauleit D, Textor J, Bachmann R, Conrad R, Flacke S, Layer G, Kreft B, Schild H (2002) Hepatocellular carcinoma: detection with gadolinium- and ferumoxides-enhanced MR imaging of the liver. Radiology 222(1):73–80PubMedCrossRef

65.

Craig JR, Peters RL, Edmondson HA, Omata M (1980) Fibrolamellar carcinoma of the liver: a tumor of adolescents and young adults with distinctive clinico-pathologic features. Cancer 46(2):372–379PubMedCrossRef

66.

McLarney JK, Rucker PT, Bender GN, Goodman ZD, Kashitani N, Ros PR (1999) Fibrolamellar carcinoma of the liver: radiologic-pathologic correlation. Radiographics 19(2):453–471PubMed

67.

Corrigan K, Semelka RC (1995) Dynamic contrast-enhanced MR imaging of fibrolamellar hepatocellular carcinoma. Abdom Imaging 20(2):122–125PubMedCrossRef

68.

Worawattanakul S, Semelka RC, Noone TC, Calvo BF, Kelekis NL, Woosley JT (1998) Cholangiocarcinoma: spectrum of appearances on MR images using current techniques. Magn Reson Imaging 16(9):993–1003PubMedCrossRef

69.

Maetani Y, Itoh K, Watanabe C, Shibata T, Ametani F, Yamabe H, Konishi J (2001) MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. AJR Am J Roentgenol 176(6):1499–1507PubMed

70.

Zheng WW, Zhou KR, Chen ZW, Shen JZ, Chen CZ, Zhang SJ (2002) Characterization of focal hepatic lesions with SPIO-enhanced MRI. World J Gastroenterol 8(1):82–86PubMed

Title: Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions
Authors: Ahmed Ba-Ssalamah
Martin Uffmann
Sanjai Saini
Nina Bastati
Christian Herold
Wolfgang Schima
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 2/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1172-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2009

Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients

Effects of percutaneous transluminal angioplasty on muscle BOLD-MRI in patients with peripheral arterial occlusive disease: preliminary results

A rare cause of infertility (2009: 2a)

Intra-arterial haemodynamic changes during cerebral three-dimensional rotational angiography

MRI of respiratory dynamics with 2D steady-state free-precession and 2D gradient echo sequences at 1.5 and 3 Tesla: an observer preference study

Characterization of microcalcification: can digital monitor zooming replace magnification mammography in full-field digital mammography?