title: Efficacy and safety of MR imaging with liver-specific contrast agent: U.S. multicenter phase III study.
abstract: OBJECTIVE
  To assess prospectively the efficacy and safety of postcontrast magnetic resonance (MR) imaging with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) compared with that of precontrast MR imaging in patients who are known to have or are suspected of having liver lesions and who are scheduled for hepatic surgery.
  
  
  METHODS
  Investigational review board approval and written informed consent were obtained. HIPAA went into effect after data collection. A total of 172 patients were enrolled. After precontrast MR imaging, 169 patients (94 men, 75 women; mean age, 61 years; age range, 19-84 years) received an intravenous bolus of 25 micromol/kg Gd-EOB-DTPA and underwent dynamic gradient-recalled-echo and delayed MR imaging 20 minutes after injection. Arterial and portal phase computed tomography (CT) were performed within 6 weeks of MR imaging. The standard of reference was surgery with intraoperative ultrasonography (US) and biopsy and/or pathologic evaluation of resected liver segments and/or 3-month follow-up of nonresected segments if intraoperative US was not available. Three blinded reviewers and unblinded site investigators identified liver lesions on segment maps. The Wilcoxon signed rank test was used to compare differences in per-patient sensitivity of precontrast and postcontrast MR images. Adverse events were recorded, and patient monitoring and laboratory assay were performed at time of injection and up to 24 hours after contrast material administration.
  
  
  RESULTS
  At MR imaging, 316 lesions were identified in 131 patients. In 77% (P = .012), 72% (P = .15), and 71% (P = .027) of patients for readers 1, 2, and 3, respectively, more lesions were seen at precontrast and postcontrast MR imaging combined than at precontrast MR imaging alone. Sensitivity values for blinded readings were significantly greater at postcontrast MR imaging than at precontrast MR imaging for two of three blinded readers. For all blinded readers, combined precontrast and postcontrast MR images showed no difference in sensitivity compared with helical CT scans. The use of MR imaging, however, yielded fewer patients with at least one false-positive lesion (37%, 31%, and 34% of patients for readers 1, 2, and 3, respectively) than did helical CT (45%, 36%, and 43% of patients for readers 1, 2, and 3, respectively).
  
  
  CONCLUSIONS
  Compared with precontrast MR imaging, postcontrast MR imaging with Gd-EOB-DTPA demonstrated improved sensitivity for lesion detection in the majority of blinded readers, with no substantial adverse events.
authors.affiliation: Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Dushyant
authors.initials: D
authors.lastname: Sahani
authors.forename: Marco
authors.initials: M
authors.lastname: Amendola
authors.forename: Thomas
authors.initials: T
authors.lastname: Balzer
authors.forename: Josy
authors.initials: J
authors.lastname: Breuer
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Brown
authors.forename: David D
authors.initials: DD
authors.lastname: Casalino
authors.forename: Peter L
authors.initials: PL
authors.lastname: Davis
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Francis
authors.forename: Glenn
authors.initials: G
authors.lastname: Krinsky
authors.forename: Fred T
authors.initials: FT
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Lu
authors.forename: Erik K
authors.initials: EK
authors.lastname: Paulson
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Schwartz
authors.forename: Evan S
authors.initials: ES
authors.lastname: Siegelman
authors.forename: William C
authors.initials: WC
authors.lastname: Small
authors.forename: Therese M
authors.initials: TM
authors.lastname: Weber
authors.forename: Adam
authors.initials: A
authors.lastname: Welber
authors.forename: Kohkan
authors.initials: K
authors.lastname: Shamsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017326:Clinical Trials, Phase III as Topic; D003287:Contrast Media; D005189:False Positive Reactions; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012449:Safety; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA