Peritoneal and pleural fluids may appear hyperintense on hepatobiliary
phase using hepatobiliary MR contrast agents
Michele Di Martino
Received: 1 November 2017 /Revised: 6 December 2017 /Accepted: 20 December 2017 /Published online: 26 January 2018
European Society of Radiology 2018
Aim To describe the effect of hepatobiliary-specific MR imaging contrast agent (HBCA) administration on the signal intensity of
peritoneal and pleural fluid effusions on T1-weighted MR images.
Materials and methods From October 2015 to May 2016 139 patients (mean 60±10 years old, 69 % males) with peritoneal or
pleural effusions without biliary leakage who underwent HBCA-MRI (Gd-BOPTA or Gd-EOB-DTPA) at 1.5T and 3T were
included from two centres. The fluid signal intensity was classified as hypo/iso/hyperintense before/after HBCA administration.
The relative signal enhancement (RE) was calculated.
Results On hepatobiliary phase (HBP), peritoneal fluids appeared hyper/isointense in 88–100 % and pleural effusions in 100 %
of the patients following Gd-BOPTA administration. All fluids remained hypointense following Gd-EOB-DTPA. The signal
intensity of fluids increased with both HBCA but RE was significantly higher following Gd-BOPTA (p=0.002 to <0.001). RE
was correlated with HBP acquisition time-point (r=0.42, p<0.001 and r=0.50, p=0.033 for peritoneal and pleural fluids).
Conclusion The signal intensity of pleural and peritoneal fluids progressively increases following HBCA administration in the
absence of biliary leakage. Due to its later hepatobiliary phase, this is more pronounced after Gd-BOPTA injection, leading to
fluid hyperintensity that is not observed after Gd-EOB-DTPA injection.
• Fluids appear hyper/isointense on HBP in most patients after Gd-BOPTA injection.
• Fluids remain hypointense on HBP after Gd-EOB-DTPA injection.
• RE of fluids increases with time after liver-specific Gd injection.
• RE of fluids is higher in patients with chronic liver disease.
CT Computed tomography
HBCA Hepatobiliary contrast agent
HBP Hepatobiliary phase
HU Hounsfield unit
MRI Magnetic resonance images
Hepatobiliary contrast agents (HBCAs) are gadolinium che-
lates that are taken up by functional hepatocytes.
Internalization is mediated by organic anionic transporting
polypeptides (OATPs) expressed on the sinusoidal membrane
of these hepatocytes . Currently, there are two commercial-
ly available HBCAs: gadobenate dimeglumine or Gd-BOPTA
(Multihance, Bracco Imaging, Milan, Italy) and gadoxetate
disodium also known as gadoxetic acid or Gd-EOB-DTPA
(Primovist / Eovist, Bayer, Leverkusen, Germany). Around
50 % of the injected dose of the latter is rapidly transported
* Maxime Ronot
Department of Radiological Sciences, BSapienza^ University of
Rome, Policlinico Umberto I, Rome, Italy
Department of Radiology, University Hospitals Paris Nord Val de
Seine, Beaujon, 92118 Clichy, Hauts-de-Seine, France
University Paris Diderot, Sorbonne Paris Cité, Paris, France
INSERM U1149, Centre de recherche biomédicale Bichat-Beaujon,
CRB3, Paris, France
European Radiology (2018) 28:3020–3031