Biliary Imaging with Gd-EOB-DTPA: Is a 20-minute Delay Sufficient?

doi:10.1016/S1076-6332(03)80565-2

Academic Radiology

Volume 9, Issue 11, November 2002, Pages 1322-1325

https://doi.org/10.1016/S1076-6332(03)80565-2 Get rights and content

Abstract

Rationale and Objectives

The authors performed this study to quantitate the change in intrabiliary signal intensity 20 minutes after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) injection and to correlate the degree of biliary visualization with changes in biliary signal intensity.

Materials and Methods

Sixteen patients with known hepatic masses (without known biliary disease) who were candidates for resection were enrolled in an open-label protocol of Gd-EOB-DTPA. Three-dimensional spoiled gradient-echo magnetic resonance (MR) images obtained in the coronal plane with breath holding before and 20 minutes after Gd-EOB-DTPA made up the biliary MR cholangiogram study. Manually defined regions of interest were used to measure signal intensity in the bile ducts before and after contrast material administration. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated. Biliary visualization was qualitatively assessed by using a five-point scale.

Results

The SNR and CNR significantly increased (P < .0002) after the administration of contrast material. Average biliary visualization ratings were excellent, with moderate to excellent interobserver agreement. There was no correlation between measured SNR or CNR and visualization ratings.

Conclusion

A 20-minute delay after Gd-EOB-DTPA administration appears to be sufficient for adequate biliary enhancement. Residual hepatic enhancement does not appear to interfere with biliary visualization.

Section snippets

Materials and Methods

Sixteen patients (six men, 10 women; mean age, 63.5 years; range, 42–84 years) with known hepatic masses who were candidates for surgical resection were prospectively enrolled in an open-label study of Gd-EOB-DTPA (Eovist; Berlex, Montville, NJ) between November 1998 and January 2001. None of the patients had or were suspected of having biliary abnormalities. Informed consent was obtained from all participants by using a protocol approved by the Institutional Review Board.

Results

Contrast was identified within the biliary tree in all patients after contrast material administration on images obtained after a 20–minute delay (Figure 1, Figure 2).

The mean intrabiliary signal intensity (± standard deviation) before contrast material administration was 8 ± 7 in the common bile duct, 8 ± 8 in the right hepatic duct, and 7 ± 5 in the left hepatic duct. Twenty minutes after contrast material administration, the mean signal intensity (± standard deviation) was 92 ± 70 in the

Discussion

Previous studies performed in humans to evaluate hepatobiliary enhancement and excretion of Gd–EOB–DTPA showed rapid early enhancement of the liver, with enhancement peaking 20 minutes after injection (1). Hepatic signal intensity plateaus and then begins to decrease 90 minutes after injection. In rhesus monkeys, hepatic enhancement peaked 4 minutes after injection and then slowly declined (2). In both studies, the authors recommended a minimum delay of 20 minutes before liver imaging (1, 2).

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Relaxivity of Gd-EOB-DTPA in the normal and biliary obstructed guinea pig
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Gadolinium-ethoxybenzyl-DTPA, a new liver-specific magnetic resonance contrast agent: kinetic and enhancement patterns in normal and cholestatic rats
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Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment
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Cited by (48)

Balanced MR cholangiopancreatography with motion-sensitised driven-equilibrium (MSDE) preparation: feasibility of Gd-EOB-DTPA-enhanced biliary examination
2016, Clinical Radiology
To evaluate the effectiveness of motion-sensitised driven-equilibrium (MSDE)-prepared balanced magnetic resonance cholangiopancreatography (MRCP) in a gadolinium ethoxybenzyl diethylene triamine pentaacetic acid (Gd-EOB-DTPA)-enhanced study compared to conventional T2-weighted MRCP.
Fifteen patients (seven male and eight female patients) prospectively underwent conventional three-dimensional turbo spin-echo T2-weighted MRCP and MSDE-balanced MRCP using a 1.5 T MRI system after hepatobiliary phase image acquisition. For quantitative evaluation, the contrast-to-noise ratio (CNR) of the common hepatic duct to liver tissue was calculated. For qualitative analysis, two radiologists evaluated the depiction of the biliary system and main pancreatic duct (MPD) using a scoring system. Signal suppression of the portal vein (PV) and hepatic vein (HV) on MSDE-balanced MRCP was also scored.
MSDE-balanced MRCP showed significantly higher CNR than T2-weighted MRCP. For all biliary structures, the mean depiction scores of MSDE-balanced MRCP were significantly higher than those of T2-weighted MRCP, whereas the mean depiction score of MPD with MSDE-balanced MRCP was significantly lower than that of T2-weighted MRCP. Signal suppression of the PV and HV was thought to be clinically sufficient.
MSDE-balanced MRCP more clearly depicted biliary structures compared with T2-weighted MRCP in a Gd-EOB-DTPA-enhanced study. This sequence may be utilised for routine MRCP on Gd-EOB-DTPA-enhanced MRI.
Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers
2016, European Journal of Radiology
Citation Excerpt :
Second, in our study, HBP images were obtained at 15–18 min after an intravenous administration of gadoxetic acid. The biliary tract enhancement at 10–20 min after the administration of gadoxetic acid was enough in patients with normal liver function [26], on the other hand, the time to peak was longer than 30 min in patients with hepatic dysfunction. However, the differences between the signal intensities at 15 and 30 min were relatively small.
To evaluate the association between gadoxetic-acid-enhanced magnetic resonance (MR) imaging measurements and laboratory and clinical biomarkers of liver function and fibrosis.
One hundred thirty nine consecutive patients with suspected liver disease or liver tumor underwent gadoxetic-acid-enhanced MR imaging. MR imaging measurements during the hepatobiliary phase included biliary tract structure-to-muscle signal intensity ratio (SIR). These measurements were compared with Child-Pugh classification, end-stage liver disease (MELD) score, and aspartate aminotransferase-to-platelet ratio index (APRI).
The SIRs of cystic duct and common bile duct were significantly correlated with Child-Pugh classification (P = 0.012 for cystic duct and P < 0.0001 for common bile duct), MELD score (P = 0.0016 and P = 0.0033), and APRI (P = 0.0022 and P = 0.0015). The sensitivity, specificity, and area under the receiver-operating-characteristic curve were: (74%, 88%, 0.86) with the SIR of common bile duct for the detection of patients with Child-Pugh class B or C; (100%, 87%, 0.94) with the SIR of cystic duct for MELD score (>10); (65%, 76%, 0.70) with the SIR of common bile duct for APRI (>1.5).
Gadoxetic-acid contrast enhancement of cystic duct and common bile duct could be used as biomarkers to assess liver function.
Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose, double dose or half-dose contrast enhanced imaging
2014, European Journal of Radiology
Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC).
30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated.
All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference.
Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR.
Diagnosis of biliary stone disease: T1-weighted magnetic resonance cholangiography with Gd-EOB-DTPA versus T2-weighted magnetic resonance cholangiography
2014, Clinical Imaging
Citation Excerpt :
Therefore, there is limitation in use of hepatocyte-specific contrast agent in hyperbilirubinemic patients [33]. Many studies demonstrated that the hepatobiliary phase images can be obtained 10 min after intravenous injection of Gd-EOB-DTPA in healthy patients and 20 min after in liver cirrhosis patients [16,20,34]. However, more delayed time is required to obtain optimal hepatobiliary phase images and Gd-EOB-DTPA-enhanced MRC in patients with decreased liver function [35,36].
We aimed to compare diagnostic performance of gadoxetic-acid-enhanced-T1-weighted-MR cholangiography (MRC) with that of conventional T2-weighted-MRC in diagnosing biliary stone disease.
Ninety patients who underwent MRC for evaluation of biliary disease were included. Presence of stones in extrahepatic duct, gallbladder and intrahepatic duct, and presence of acute cholecystitis were evaluated. Sensitivity, specificity, and accuracy of biliary stone disease diagnosis in each biliary duct location according to each image sets were measured.
There was no significant difference in diagnostic performance between two sets of MRC in diagnosing biliary stone disease.
Diagnostic performance of T1-MRC with gadoxetic-acid in diagnosing biliary stone disease is comparable to that of T2-MRC.
Feasibility of gadoxetate disodium-enhanced MR cholangiography in chronic cholestatic biliary disease
2014, Clinical Radiology
To investigate the feasibility of gadoxetate disodium-enhanced magnetic resonance (MR) cholangiography in chronic obstructive cholestatic biliary disease in the clinical setting.
Twenty-three patients with dilated bile duct trees and ten volunteers underwent gadoxetate disodium-enhanced liver MR cholangiography and were enrolled in the present retrospective study. Gadoxetate disodium was given in a standardized manner as a bolus injection at a dose of 0.25 mmol/kg of body weight (0.1 ml/kg). Region of interest-based measurement of mean enhancement of the dilated bile ducts was performed in series before gadoxetate disodium administration and during hepatobiliary phases.
Direct comparison of mean bile duct enhancement during hepatobiliary phases in the clinical imaging window between healthy volunteers [4.7 ± 2.2 arbitrary units (au)] and patients with dilated bile ducts (0.1 ± 0.3 au) revealed significantly lower or absent enhancement in dilated bile ducts (p = 0.001).
Standard clinical gadoxetate disodium-enhanced MR cholangiography is not a reliable technique for the evaluation of the biliary trees, because of altered biliary gadoxetate disodium elimination in patients with chronic obstructive biliary diseases.
Pediatric hepatobiliary magnetic resonance imaging
2013, Radiologic Clinics of North America
Citation Excerpt :
Gadofosveset trisodium, a Food and Drug Administration–approved blood-pool gadolinium contrast agent for the assessment of aortoiliac disease in adults, may also be useful in pediatric vascular assessment (see Fig. 5). Finally, gadoxetate disodium (Gd-EOB-DTPA) is advantageous as an off-label use for biliary evaluation33–37 given the 50% hepatobiliary excretion in the setting of normal renal and hepatic function. Gd-EOB-DTPA provides a functional and anatomic MRCP examination (see Figs.4–6).

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^☆: Supported by a grant from Berlex.

¹: R.C.C. supported in part by the GE-AUR Radiology Research Academic Fellowship.

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Technical ReportBiliary Imaging with Gd-EOB-DTPA: Is a 20-minute Delay Sufficient?☆

Abstract

Rationale and Objectives

Materials and Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging

Radiology

A comparison of two MR hepatobiliary gadolinium chelates: Gd-BOPTA and Gd-EOB-DTPA

J Comput Assist Tomogr

Relaxivity of Gd-EOB-DTPA in the normal and biliary obstructed guinea pig

J Magn Reson Imaging

Gadolinium-ethoxybenzyl-DTPA, a new liver-specific magnetic resonance contrast agent: kinetic and enhancement patterns in normal and cholestatic rats

Invest Radiol

Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid as an intrabiliary contrast agent: preliminary assessment

AJR Am J Roentgenol

Technical Report
Biliary Imaging with Gd-EOB-DTPA: Is a 20-minute Delay Sufficient?☆