Learning objectives
The aim of this presentation is to review the main imaging features of benign or malignant liver nodules, including incidentalomas, based on the MultiHance (Gd-BOPTA) pharmacological mechanism through a series of sample cases from our institution’s archive. The use of this hepatobiliary contrast agent allows a comprehensive non-invasive imaging assessment of the liver parenchyma, intrahepatic lesions, hepatic vessels, and the biliary tree in one examination.
Background
MRI is at the moment the most sensible and specific non-invasive diagnostic tool for liver nodules that remain undetermined after the use of an extracellular contrast agent, hepatobilliary contrast agents increase diagnostic accuracy and reduce the necessity of liver biopsies, the use of complementary diagnostic techniques and an unnecessary follow up (5-7].
Primovist and MultiHance are the two main hepatobiliary contrast agents being used today in liver imaging. Contrary to the well known Primovist, fewer studies have been reported concerning the use of MultiHance.
Its...
Findings and procedure details
Gd-BOPTA offers both imaging properties of conventional extracellular MR agents as well as an uptake by hepatocytes with a biliary excretion of 5%. Due to this pharmacodynamic, the MRI protocole includes an arterial phase (30-35 sec), a portal phase (60-70 sec), a delayed phase (2-3 min) and a hepatobiliary phase (90-120 min).
It is used to characterise lesions that contain bile ducts (dysplastic nodules in cirrhotic patients and focal nodular hyperplasia in non-cirrhotic patients) from lesions like hepatocellular carcinoma (HCC), adenoma and metastasis. In addition,...
Conclusion
Multihance is a specific hepatobiliary contrast agent with dual properties (extracellular and with an affinity for hepatocytes). It is mainly used in the non-invasive diagnostic of a wide range of benign and malignant liver lesions, serving as well as a mean of imaging the biliary tree. Because MultiHance is the main alternative to Primovist, it is important for radiologists to be familiar with its pharmacological and imaging features, advantages, along with its clinical applications.
Personal information and conflict of interest
S. Bivol; Paris/FR - nothing to disclose A. T. Radu; Paris/FR - nothing to disclose M.-R. Pogana; Strasbourg/FR - nothing to disclose I. Turcanu; Bucharest/RO - nothing to disclose A. Elmaleh; Villejuif/FR - nothing to disclose M. Lewin-Zeitoun; Villejuif Cedex/FR - nothing to disclose
References
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