Hepatobiliary phase enhancement of liver metastases on gadoxetic acid MRI: assessment of frequency and patterns

Eur Radiol. 2021 Mar;31(3):1359-1366. doi: 10.1007/s00330-020-07228-3. Epub 2020 Sep 4.


Objectives: To assess for and characterize patterns of hepatobiliary phase (HBP) enhancement in hepatic metastases of various malignancies on gadoxetic acid-enhanced MRI.

Methods: Eighty gadoxetic acid-enhanced MRI studies performed between July 2012 and November 2019 in patients with hepatic metastases from 13 different primary malignancies were assessed. Most (n = 60) were from colorectal cancer (CRC), pancreatic ductal adenocarcinoma (PDAC), or neuroendocrine tumor (NET) primaries. Two radiologists quantitatively evaluated the dominant lesion on each MRI. A lesion was considered enhancing when HBP enhancement relative to muscle exceeded 20%. Lesions were classified by pattern of enhancement. Quantitative enhancement metrics and patterns of enhancement were compared between CRC, PDAC, and NET using non-parametric statistical tests.

Results: Most dominant metastatic lesions > 1 cm (77%, 54/70) demonstrated HBP enhancement. HBP enhancement was identified in hepatic metastases from 10 different primary malignancies, including CRC, PDAC, and NET. PDAC metastases demonstrated a lower degree of HBP enhancement (26%) than CRC (44%, padj = 0.04) and NET (51%, padj = 0.01) metastases. Three discrete enhancement patterns were identified: peripheral, central (target), and diffuse heterogeneous. Patterns of HBP enhancement varied between CRC, PDAC, and NET, with secondary analysis demonstrating that PDAC had the highest proportion of peripheral pattern (73%, padj < 0.001), CRC the highest proportion of diffuse heterogeneous pattern (32%, padj < 0.01), and NET the highest proportion of central pattern (89%, padj < 0.001).

Conclusion: Liver metastases from several primary malignancies, including PDAC, demonstrate mild HBP enhancement in variable patterns. Correlation with OATP1B3 expression and prognosis is required.

Key points: • Hepatobiliary phase (HBP) enhancement was identified in 77% of hepatic metastases in several different primary malignancies. • Discrete patterns of HBP enhancement exist (peripheral, central, diffuse heterogeneous) and varied between CRC, PDAC, and NET. CRC and PDAC metastases demonstrated mostly non-central patterns (diffuse and peripheral), and NET mostly a central pattern. • Relationship between HBP enhancement, enhancement pattern, OATP1B3 expression, and prognosis requires further dedicated exploration for each malignancy.

Keywords: Gadolinium ethoxybenzyl DTPA; Image enhancement; Liver neoplasms; Magnetic resonance imaging.

MeSH terms

  • Contrast Media*
  • Gadolinium DTPA
  • Humans
  • Liver
  • Liver Neoplasms* / diagnostic imaging
  • Magnetic Resonance Imaging
  • Retrospective Studies
  • Sensitivity and Specificity


  • Contrast Media
  • gadolinium ethoxybenzyl DTPA
  • Gadolinium DTPA