Gadoxetic acid disodium-enhanced hepatocyte phase MRI: can increasing the flip angle improve focal liver lesion detection?

J Magn Reson Imaging. 2012 Jan;35(1):132-9. doi: 10.1002/jmri.22805. Epub 2011 Sep 29.


Purpose: To determine whether hepatocyte phase gadoxetic acid disodium (EOB)-enhanced MRI using a high flip angle (FA) improves focal liver lesion (FLL) detection compared with using a standard low FA.

Materials and methods: Sixty-two consecutive patients with 159 FLLs underwent EOB-enhanced MRI during the hepatocyte phase at 5, 10, 15, and 20 min, with both low (10°) and high (30°) FAs. Two blinded radiologists independently and randomly reviewed the two image sets using a four-point rating scale. Sensitivities and specificities were calculated and lesion-to-liver contrast ratio (LLC) on all hepatocyte phase images was measured.

Results: The sensitivities with high FA for small (≤10 mm) malignant FLLs were significantly higher than those with low FA, at all time points, for both readers (P ≤ 0.05). Meanwhile, the specificities of the two protocols for the detection of all FLLs at all time points during the hepatocyte phase were high and same (98.2%) for both readers, without any significant differences (P = 1.00). LLCs with high FA were significantly higher than those with low FA at all time points (P ≤ 0.001).

Conclusion: Hepatocyte phase EOB-enhanced MRI with increasing FA can significantly increase LLC and improve the detection of FLLs, particularly small malignant lesions.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Contrast Media / pharmacology
  • Female
  • Gadolinium DTPA / pharmacology*
  • Hepatocytes / cytology
  • Hepatocytes / pathology*
  • Humans
  • Image Processing, Computer-Assisted
  • Liver Neoplasms / diagnosis
  • Liver Neoplasms / pathology*
  • Magnetic Resonance Imaging / instrumentation
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Observer Variation
  • Radiology / methods
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Time Factors


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA