Diagnose und Differenzialdiagnose fokaler Leberläsionen unter Verwendung von Gd-EOB-DTPA (Primovist)

K. I. Ringe

doi:10.1055/s-0042-102037

Radiologie up2date, Table of Contents

Radiologie up2date 2016; 16(01): 15-32
DOI: 10.1055/s-0042-102037

Abdominelle und gastrointestinale Radiologie

Diagnose und Differenzialdiagnose fokaler Leberläsionen unter Verwendung von Gd-EOB-DTPA (Primovist)

Diagnosis und differential diagnosis of focal liver lesions using the hepatocyte-specific contrast agent Gd-EOB-DTPA

K. I. Ringe

Abstract

All articles of this category

Zusammenfassung

Der Einsatz von Kontrastmitteln in der MRT verbessert den Nachweis und die Charakterisierung fokaler Leberläsionen signifikant. Der vorliegende Beitrag fokussiert auf das hepatozytenspezifische Kontrastmittel Gd-EOB-DTPA, das seit 2004 in Deutschland für die Leberbildgebung verfügbar ist. Zunächst werden dabei die pharmakokinetischen und -dynamischen Eigenschaften dieses Kontrastmittels dargelegt und ein optimiertes Untersuchungsprotokoll für den Workflow im klinischen Alltag präsentiert. Dann wird das Erscheinungsbild der häufigsten fokalen Leberläsionen im Einzelnen dargestellt, wobei die Unterschiede zur Bildgebung mit einem extrazellulären Kontrastmittel berücksichtigt und die wichtigsten Differenzialdiagnosen diskutiert werden.

Abstract

The implementation of MR contrast agents significantly improves detection and characterization of focal liver lesions. This article is focusing on the hepatocyte-specific contrast agent Gd-EOB-DTPA, which has been available in Germany for liver MRI since 2004. In the introduction, the specific pharmacokinetic and -dynamic properties of this contrast agent are reviewed, and a workflow-optimized pulse sequence protocol for comprehensive hepatobiliary MRI in daily routine is presented. Afterwards, the appearance of the most common focal liver lesions is illustrated, including the differences to the use of extracellular contrast agents as well as a discussion of the most important differential diagnoses.

Keywords

Gd-EOB-DTPA - primovist - gadoxetate disodium - hepatocyte-specific - liver lesion - liver MRI

Full Text

References

Literatur
1 Ersoy H, Rybicki FJ. Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis. J Magn Reson Imaging 2007; 26: 1190-1197
2 Schuhmann-Giampieri G, Schmitt-Willich H, Press WR et al. Preclinical evaluation of Gd-EOB-DTPA as a contrast agent in MR imaging of the hepatobiliary system. Radiology 1992; 183: 59-64
3 Kirchin MA, Pirovano GP, Spinazzi A. Gadobenate dimeglumine (Gd-BOPTA). An overview. Invest Radiol 1998; 33: 798-809
4 van Montfoort JE, Stieger B, Meijer DK et al. Hepatic uptake of the magnetic resonance imaging contrast agent gadoxetate by the organic anion transporting polypeptide Oatp1. J Pharmacol Exp Ther 1999; 290: 153-157
5 Ringe KI, Hinrichs J, Merkle EM et al. Gadoxetate disodium in patients with primary sclerosing cholangitis: an analysis of hepatobiliary contrast excretion. J Magn Reson Imaging 2014; 40: 106-112
6 Zech CJ, Korpraphong P, Huppertz A et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Br J Surg 2014; 101: 613-621
7 Bartolozzi C, Battaglia V, Bargellini I et al. Contrast-enhanced magnetic resonance imaging of 102 nodules in cirrhosis: correlation with histological findings on explanted livers. Abdom Imaging 2013; 38: 290-296
8 Takagi H. Diagnosis and management of cavernous hemangioma of the liver. Semin Surg Oncol 1985; 1: 12-22
9 Doo KW, Lee CH, Choi JW et al. „Pseudo washout“ sign in high-flow hepatic hemangioma on gadoxetic acid contrast-enhanced MRI mimicking hypervascular tumor. AJR Am J Roentgenol 2009; 193: W490-496
10 Assy N, Nasser G, Djibre A et al. Characteristics of common solid liver lesions and recommendations for diagnostic workup. World J Gastroenterol 2009; 15: 3217-3227
11 Nguyen BN, Flejou JF, Terris B et al. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 1999; 23: 1441-1454
12 Ferlicot S, Kobeiter H, Tran Van Nhieu J et al. MRI of atypical focal nodular hyperplasia of the liver: radiology-pathology correlation. AJR Am J Roentgenol 2004; 182: 1227-1231
13 Flejou JF, Barge J, Menu Y et al. Liver adenomatosis. An entity distinct from liver adenoma?. Gastroenterology 1985; 89: 1132-1138
14 Deneve JL, Pawlik TM, Cunningham S et al. Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy. Ann Surg Oncol 2009; 16: 640-648
15 Grazioli L, Federle MP, Brancatelli G et al. Hepatic adenomas: imaging and pathologic findings. Radiographics 2001; 21: 877-892
16 Ba-Ssalamah A, Antunes C, Feier D et al. Morphologic and Molecular Features of Hepatocellular Adenoma with Gadoxetic Acid-enhanced MR Imaging. Radiology 2015; 277: 104-113
17 Kim J, Ahmad SA, Lowy AM et al. An algorithm for the accurate identification of benign liver lesions. Am J Surg 2004; 187: 274-279
18 Liu S, Chan KW, Wang B et al. Fibrolamellar hepatocellular carcinoma. Am J Gastroenterol 2009; 104: 2617-2624
19 Ringe KI, Husarik DB, Sirlin CB et al. Gadoxetate disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion appearance in the noncirrhotic liver. AJR Am J Roentgenol 2010; 195: 13-28
20 McLarney JK, Rucker PT, Bender GN et al. Fibrolamellar carcinoma of the liver: radiologic-pathologic correlation. Radiographics 1999; 19: 453-471
21 Jemal A, Murray T, Ward E et al. Cancer statistics 2005. CA Cancer J Clin 2005; 55: 10-30
22 Chong YS, Kim YK, Lee MW et al. Differentiating mass-forming intrahepatic cholangiocarcinoma from atypical hepatocellular carcinoma using gadoxetic acid-enhanced MRI. Clin Radiol 2012; 67: 766-773
23 Lewis KH, Chezmar JL. Hepatic metastases. Mag Reson Imaging Clin N Am 1997; 5: 319-330
24 Cruite I, Schroeder M, Merkle EM et al. Gadoxetate disodium-enhanced MRI of the liver: part 2, protocol optimization and lesion appearance in the cirrhotic liver. AJR Am J Roentgenol 2010; 195: 29-41
25 Brismar TB, Dahlstrom N, Edsborg N et al. Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA: a comparison in healthy volunteers. Acta Radiol 2009; 50: 709-715
26 Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014; 272: 635-654
27 Choi JY, Lee JM, Sirlin CB et al. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2014; 273: 30-50
28 McGlynn KA, London WT. Epidemiology and natural history of heptocellular carcinoma. Best Pract Res Clin Gastroenterol 2005; 19: 3-23
29 Taouli B, Losada M, Holland A et al. Magnetic resonance imaging of hepatocellular carcinoma. Gastroenterology 2004; 127: 144-152
30 Kim SH, Kim SH, Lee J et al. Gadoxetic acid-enhanced MRI versus triple-phase MDCT for the preoperative detection of hepatocellular carcinoma. AJR Am J Roentgenol 2009; 192: 1675-1681