Gadoxetate Disodium–Enhanced MRI of the Liver on a patient with hemangioma.
Hemangiomas normally have a typical presentation at MRI with extracellular contrast and are not an indication for investigation with hepatobiliary contrast (Gadoxetate Disodium). At conventional MRI, hemangiomas present marked hypersignal on T2-weighted, hyposignal on T1-weighted sequences, discontinuous, nodular, peripheral contrast enhancement in the arterial phase, tending to centripetal fill-in by the contrast agent in the subsequent phases. However, considering that hemangiomas are common lesions, they will be frequently present on images acquired with hepatobiliary contrast for several reasons. Hemangiomas present the same imaging findings at dynamic studies with hepatobiliary contrast; however, in the transitional phases, as the hepatobiliary contrast medium is leaving the interstitium and entering into the functioning hepatocytes, the hemangioma fill-in might or might not occur in this phase, differing from its usual behavior with the use of extracellular gadolinium. Hemangiomas are formed by a clump of blood vessels and do not contain hepatocytes, therefore they do not present contrast enhancement during the hepatobiliary phase and appear hypointense in this phase. A potential confusion factor is the fact that some hemangiomas may present subtle central contrast uptake during the early hepatobiliary phase because of the tendency to persistent centripetal enhancement at dynamic study, like in those with extracellular gadolinium.