Consensus Report of the Third International Forum for Liver Magnetic Resonance Imaging

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Abstract
This consensus report arises from the discussions at the Third International Forum for Liver Magnetic Resonance Imaging, at which attendees evaluated the use of the hepatocyte-specific contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA, Primovist, Bayer Schering Pharma, Berlin, Germany; Eovist, Bayer HealthCare Pharmaceuticals Inc., Wayne, NJ; EOB-Primovist, Bayer Schering Pharma, Osaka, Japan). The impact of Gd-EOB-DTPA uptake by hepatocytes on the enhancement pattern, compared with dynamic imaging with extracellular contrast media, and its value in diagnostic confidence were discussed. Although the dynamic-phase images of typical cavernous hemangiomas are comparable using Gd-EOB-DTPA and gadolinium-based extracellular contrast media, such lesions appear hypointense during the hepatobiliary phase with Gd-EOB-DTPA. The rapid uptake of Gd-EOB-DTPA by hepatocytes results in lesions of hepatocellular origin already appearing hyperintense during the late-dynamic-phase imaging. Focal nodular hyperplasia can be detected with confidence using Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, information on the appearance of the Gd-EOB-DTPA-enhanced images of hepatic adenomas in the hepatobiliary phase is limited. Published data support the use of Gd-EOB-DTPA-enhanced MRI for diagnosis of liver metastases. However, some diagnostic algorithms do not address recent advances in imaging technology and fail to recognize the role of Gd-EOB-DTPA in the detection of hepatocellular carcinoma and its ability to distinguish between benign and malignant lesions. Beyond its approved use for the detection and characterization of liver lesions in adults with known or suspected focal liver disease, Gd-EOB-DTPA has the potential to be used in the assessment of liver function and the examination of the biliary system.

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