Magnetic resonance imaging of the cirrhotic liver in the era of gadoxetic acid

Figure 2 Intraindividual differences in hepatic enhancement in cirrhotic liver between extra-cellular contrast agent (top row) and gadoxetic acid (bottom row) in a 69-year-old woman with hepatitis C virus-related cirrhosis. On contrast-enhanced magnetic resonance (MR) images obtained with an extra-cellular agent liver enhancement peaks on portal venous phase and then slightly decreases. On contrast-enhanced MR images obtained with gadoxetic acid, liver enhancement shows a stepwise increase from the hepatic arterial phase to the 20 min phase. Vascular enhancement is more prolonged with extra-cellular agent than with gadoxetic acid, indicating a slower vascular elimination. On 10 min, the intrahepatic vessels (black arrow) show slight hypointensity to the liver, and the bile ducts are not opacified. These findings indicate hepatic dysfunction and a prolonged transitional phase. Also, note a wedge shaped enhancing area in the hepatic arterial phase (white arrow), with lack of washout on portal venous phase and isointensity on hepatobiliary phase, due to arterioportal shunt. PRE: Precontrast; HAP: Late hepatic arterial phase; PVP: Portal venous phase.