Hepatic metastases: dynamic MRI with hepatocyte-specific agent

Case contributed by Dr Ian Bickle

Presentation

Focal liver lesion on CT. Right upper lobe abnormality on CT. Biopsy negative for malignancy. Strong concern this is a false-negative biopsy. Liver metastasis?

Patient Data

Age: 60 years
Gender: Female

MRI LIVER - PRIMOVIST

4.2 cm segment 8/5 mass with an 8 mm adjacent same segment lesion. 2.3 cm segment 7 subcapsular mass and 5 mm segment 6 lesion. Several sub-3mm lesions in segment 6 which are apparent on the delayed (20 minutes) and DWI sequences.

All are devoid of contrast.

Gallstones.

Cortical scarring of both kidneys.

Right upper lobe mass/collapse and apical fluid on the scanogram.

 

Case Discussion

Primovist (gadoxetate disodium) may be used in the evaluation of hepatic metastases.  It is a hepatocyte -specific contrast agent. Therefore, metastases do not take up the contrast, as evidenced in this case, as they do not contain any hepatocytes.  

An ultrasound-guided biopsy was performed of the segment 8/5 lesion.

Histology: Adenocarcinoma of the lung

It is always worth scrutinising the localiser images as these have a wider field of view and may assist in the definitive diagnosis. In this case, a right upper lobe local collapse and central mass are apparent.

Disclosure: I, Ian Bickle, have no actual or potential ethical or financial conflict of interest in relation to this contrast agent. This case is not intended to be a personal endorsement or recommendation of this product.

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Case information

rID: 53536
Case created: 22nd May 2017
Last edited: 29th May 2017
Inclusion in quiz mode: Included

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