Gadoxetate disodium

Gadoxetate disodium (also known by the tradenames Primovist in Europe and Australia/New Zealand and Eovist in the United States) is a hepatospecific paramagnetic gadolinium-based contrast agent, used exclusively in MRI liver imaging. Its primary use is in hepatic lesion characterization, i.e. assessing focal liver lesions identified on other imaging studies.

Chemistry

Gadoxetate disodium distributes into the vascular and extravascular spaces during the arterial, portal venous, and late dynamic phases, and then progressively into the hepatocytes and bile ducts during the hepatobiliary phase ¹. This last phase allows an opportunity to acquire a contrast MRI cholangiogram.

The pharmacological properties of gadoxetate disodium are:

• linear, ionic molecule 

• 50% hepatic excretion, 50% renal excretion

• T1 relaxivity at 1.5 T: 6.5-7.3 (slightly higher than extracellular contrast agents)

• concentration: 0.25 mmol/ml

• recommended dosage: 0.025 mmol/kg

Approximately 50% of an injected dose of gadoxetate disodium is taken up by the liver. The next strongest hepatobiliary agent is gadobenate dimeglumine (MultiHance), with only 5% of the injected dose taken up by the liver ². 

Protocol

• a shorter, tighter bolus profile is preferred

• MRCP should be obtained within 5 minutes of injection

• the hepatobiliary phase is obtained 20 minutes after contrast injection

• STIR sequence is obtained post-contrast

Indications

• evaluating focal nodular hyperplasia (FNH) vs adenoma

  • hepatobiliary phase (20 minutes after contrast injection)

    • focal nodular hyperplasia appears iso- to hyperintense

    • adenoma appears hypointense

• evaluation of hepatic metastases

  • does not take up the contrast 

  • gadoxetate disodium uptake in a lesion indicates that it contains hepatocytes (or is a vascular malformation), and effectively excludes a metastasis from outside the liver

• post-liver transplant (except if hepatic artery suspected or if suspecting abscess)

• hepatocellular carcinoma (HCC) surveillance

• contrast enhanced cholangiogram

  • bile leak

  • suspected gallbladder obstruction

  • hepatojejunostomy evaluation

Disadvantages

• can cause severe respiratory motion artifact in the arterial phase (also referred to as transient arterial phase respiratory motion-related artifact) ³

  • this may limit the evaluation of a lesion's potential hypervascularity and potentially limits evaluation of hepatocellular carcinoma

• should not be used in the short-term after hepatic ablation

• not best study for hemangioma evaluation or evaluation of inflammatory disease

As with all gadolinium-based contrast agents, it should be used with caution in those with renal impairment, due to the risk of nephrogenic systemic fibrosis.

See also

• hepatobiliary contrast agents and LI-RADS