Primovist' disodium gadoxetate

Behaviour of Hepatic
Ch aracteristic. Signa[
Lesions in Liver MR!-Enhanced with Primovist@
T1-weighted
Dynamic imaging
Hepatocyte-
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Prim
disodium gadoxetate
st'

Ph armacokinetics
The special. pharmacokinetic profile and the duaI mode of
action of Primovist@ resutt in better imaging.s-l0

Primovist@ contains an ionic, highty water-sotubte Primovist@

Gd3* chelate comptex, whose paramagnetic properties

- 50o/o

resutt in effective contrast enhancement. This means

that Primovist@ has the properties of other extracet-
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[utar, gadotinium containing contrast media used to Primovist@ ijlfliil!r?;ind F

enhance dynamic imaging.

- 5Oo/o
ECCM
e-9. [,4aqnevist''
100%

However, the addition of the tipophitic EOB group

increases protein bonding in ptasma (about 10%
of the dose administered) and maximizes contrast Urine Feces

medium uptake by the hepatocytes (via OATP1B1

and OATP1P3 receptors). About 50% of Primovist@ Figure 2Contrary to other contrast media containing
is eliminated via the bite system and 50% via the gadolinium, in heatthy people about ha[f of the Primovist'
kidneys (figure 2). is etiminated via the bi[e (feces) and the other hatf via the
kidneys (urine).

Once injected, Primovist@ is taken up by functionat

hepatocytes, and therefore the contrast medium
accumutates in the ce[[s. After administration, the
signaI enhancement in heatthy [iver tissue is present
for at least two hours.
Since malignant tumours possess very few functional
hepatocytes, or none at att, they exhibit atmost no
Primovist@ uptake. This enhances the contrast kttveert
the matignanry (dark = hypointense) and the adjacent
heatthy [ivertissue (bright = hyperintense). Compared
with heatthy tissue, benign liver lesions may display ar
even more pronounced signaI enhancementu

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 Compared to Extrace[[utar Contrast
on and rapid
Media, Primovist@ Exhibits a Higher
m pa rtment
Retaxivity.'z
ln the btood vessets the recommended dose of liver-
These properties of Primovist@ permit accurate specific Primovist@ (0.025 mmot/kg body weight)
detection, [ocatisation, and characterisation of focaI coutd result in lower enhancement than with other
[iver lesions. extrace[tutar contrast media dosed at 0.1 mmot/kg
body weight.
Compared with extracettutar contrast media,
Primovist@ has a shorter hatf-tife (-60 minutes Compared with the extracettutar Magnevist@
versus 90 minutes) and is comptetely excreted (Gd-DTPA),14 it has been demonstrated that both
within 24 hours.s'12'71 contrast media disptay a comparable rise in signaI
strength during the arteriaI phase. One possibte
exp[anation could be the higher retaxivity of
Primovist@ (see tabte 2;.e"
WW
11 at 1.57 r1 at 3T
Prim ovisto 6.9 (6.s-7.3) 6.2 (5.e-6.s)

ftilagnevisto 4.1(3.9-+.3) 3.7(3.s-3.9)

Gadobenate dimegtumine 6.3 (5.0-6.6) 5.5 (5.2-5.8)

, ,,ril,r ,' TJ.-relaxivity (L/mmot-ts-t) for various contrast

media at 37 oC. This
tabte is based on the data by Rohrer
et aL., lnvest Radiot 2005.'/
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Primovist'
disodium gadoxetate
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Stand ard Workflow

The typicaI steps in an
lmaging before contrast enhancement
examination protocoI with
Iiver-s pecific Pri movist@ i,,r riirr.r
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i,, T1 |

in/opp ,
:
'Ti
T1:T2 T2 DWI
3D before: MRCP

c Approximate duration of study

39 minutes
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Unenhanced li r', r,, I :i,.r, ,',r- .l :.'ti tti, ;:l::it rt.:!.,,-..i,r1r.. a.,il.:...r.1

Modern dynamic MRI liver scans
usualty emptoy T1w-3D sequences.
This sequence is atready performed
before injection ofthe contrast
medium, which atlows a (quanti-
tative) comparison with the post-
contrast sequences or subtraction
of images before and after contrast
enhancement. The example in
this figure demonstrates a [arge,
almost isointense foca[ [esion in
the teft hepatic lobe (see arrow).
Here, the enhancement of the
aorta, the [arge abdominaI vessels,
and the branches ofthe hepatic
artery can be seen. Hyperintense
[esions, i.e., those with mostty ar-
teriaI vascutarisation such as the
focaI nodutar hyperptasia (FNH)
in this examp[e, atso exhibit
hyperintensity. The surrou nding
liver parenchyma receives onty
aboul 20Yo of its btood su ppty
from the arteriaI system.
During this phase the btood
comp[etes its first passage through
the intestinaI tract and enters
the [iver via the portatvein. Thus,
the poftalvein system and liver
parenchyma witt be enhanced,and
the beginning venous drainage
via the hepatic veins becomes
evident. At this time, hypervascu[ar
masses, such as FNH, often demon-
strate isointensity, white hypovas-
cutarised masses (e.9., metastases
of cotorectaI cancer) wou[d become
hypointense. The portaI vein detivers
80o/o of lhe hepatic blood suppty.

8 Primovistc Compendium
 Primovist@ injection

:.:

Dynamic imaging Hepatocyte-specific phase

Portovenous ,
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Tranliiranal
phase i
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After the injection of Primovist@, Primovist@ has teft the vessets atmost completety, which by now have
this phase differs from extra- become hypointense. Up to 50% of the contrast agent was tal<en up by
cettular contrast media. Vascutar the hepatocytes (or is atready being e[iminated by them via the bite).
enhancement decreases, and due The liver parenchyma is marl<edty hyperintense. Foca[ [esions not con-
to the beginning specific intra- taining hepatocytes, e.9., metastases, behave [il<e vessets and remain
celtutar uptal<e via the 0ATP1B1 hypointense and can be detineated from the surrounding parenchyma.
transport proteins in the apicat Since FNH inctudes functionaI hepatocytes, these lesions behave quite
ce[[ membrane, the signatof the differentty: Here, an uptal<e has tal<en p[ace which proves the hepa-
[iver parenchyma increases noti- tocettutar origin of the lesion - thereby providing vaIuabte additionaI
ceabty in the hepatocytes. information in differentia I diagnosis.

These images were provided courtesy oi

Prol Etmar M. Merkte, MD, PhD, Department of Radiotogy, Basel University [,ledicaI Center, Baset, Switzertand