title: Multinodular focal fatty infiltration of the liver: atypical imaging findings on delayed T1-weighted Gd-BOPTA-enhanced liver-specific MR images.
abstract: We report a case of pathologically confirmed multinodular focal fatty infiltration. MRI was performed after bolus injection of gadobenate dimeglumine (Gd-BOPTA, MultiHance; Bracco, Milan, Italy), a liver-specific paramagnetic, gadolinium (Gd)-based MR contrast agent that concomitantly enables the acquisition of a standard dynamic phase with timing strategies similar to those used for other extracellular fluid contrast agents, followed by a delayed T1-weighted liver-specific phase (the so-called hepatobiliary phase). In the present case, multiple rounded areas of fatty infiltration, although confidently diagnosed using chemical shift sequences due to a significant signal intensity reduction on out-of-phase images, were unexpectedly hypointense during the delayed liver-specific phase of Gd-BOPTA. Reduced Gd-BOPTA concentration during the liver-specific phase is generally correlated with liver malignancy. Since such lesions can be prospectively mistaken for metastatic disease, we performed a hepatic biopsy to establish a definitive diagnosis. Our empirical observations suggest that Gd-BOPTA uptake may be impaired in fatty infiltrated liver tissue. Because at present there is no report evaluating the kinetics of Gd-BOPTA in fatty liver, further studies are needed to specifically investigate this issue.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marin
authors.forename: Riccardo
authors.initials: R
authors.lastname: Iannaccone
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000494:pharmacology; D005234:Fatty Liver / Q000175:diagnosis* / Q000473:pathology*; D006526:Hepatitis C / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007700:Kinetics; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives* / Q000494:pharmacology; D009942:Organometallic Compounds / Q000494:pharmacology*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine