title: Combined gadoxetic acid and gadofosveset enhanced liver MRI for detection and characterization of liver metastases.
abstract: OBJECTIVE
  To compare gadoxetic acid alone and combined gadoxetic acid/gadofosveset trisodium-enhanced liver MRI for detection of metastases and differentiation of metastases from haemangiomas.
  
  
  METHODS
  Ninety-one patients underwent gadoxetic acid-enhanced liver MRI before and after additional injection of gadofosveset. First, two readers retrospectively identified metastases on gadoxetic acid alone enhanced delayed hepatobiliary phase T1-weighted images together with all other MR images (dynamic images, T2-weighted images, diffusion-weighted images). Second, readers assessed additional T1-weighted images obtained after administration of gadofosveset trisodium. For both interpretations, readers rated lesion conspicuity and confidence in differentiating metastases from haemangiomas. Results were compared using alternative free-response receiver-operating characteristic (AFROC) and conventional ROC methods. Histology and follow-up served as reference standard.
  
  
  RESULTS
  There were 145 metastases and 16 haemangiomas. Both readers detected more metastases using combined gadoxetic acid/gadofosveset (reader 1 = 130; reader 2 = 124) compared to gadoxetic acid alone (reader 1 = 104; reader 2 = 103). Sensitivity of combined gadoxetic acid/gadofosveset (reader 1 = 90 %; reader 2 = 86 %) was higher than that of gadoxetic acid alone (reader 1 = 72 %; reader 2 = 71 %, both P < 0.01). AFROC-AUC was higher for the combined technique (0.92 vs. 0.86, P < 0.001). Sensitivity for correct differentiation of metastases from haemangiomas was higher for the combined technique (reader 1 = 98 %; reader 2 = 99 % vs. reader 1 = 86 %; reader 2 = 91 %, both P < 0.01). ROC-AUC was significantly higher for the combined technique (reader 1 = 1.00; reader 2 = 1.00 vs. reader 1 = 0.87; reader 2 = 0.92, both P < 0.01).
  
  
  CONCLUSIONS
  Combined gadoxetic acid/gadofosveset-enhanced MRI improves detection and characterization of liver metastases compared to gadoxetic acid alone.
  
  
  CONCLUSIONS
  • Combined gadoxetic acid and gadofosveset-enhanced liver MRI significantly improves detection of metastases. • The combined enhancement technique improves the accuracy to differentiate metastases from haemangiomas. • Prospective studies need to determine the clinical impact of the combined technique.
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA. p.bannas@uke.de.|Department of Radiology, University Hospital, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. p.bannas@uke.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Bannas
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Candice A
authors.initials: CA
authors.lastname: Bookwalter
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Ziemlewicz
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.|Department of Radiology, University of Yamanashi, Yamanashi, Japan.
authors.forename: Utaroh
authors.initials: U
authors.lastname: Motosugi
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Munoz Del Rio
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Theodora A
authors.initials: TA
authors.lastname: Potretzke
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.|Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.|Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Nagle
authors.affiliation: Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.|Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.|Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.|Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.|Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Reeder
mesh_terms: D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D005682:Gadolinium / Q000494:pharmacology*; D019786:Gadolinium DTPA / Q000494:pharmacology*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000494:pharmacology*; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C073590:gadolinium ethoxybenzyl DTPA; D005682:Gadolinium; D019786:Gadolinium DTPA; C109932:gadofosveset trisodium
keywords: Gadofosveset trisodium; Gadoxetic acid; Liver; Magnetic resonance imaging; Metastases