Eovist - When to Use It,When Not to Use It

Eovist - When to Use It,When Not to Use It

Thomas Jefferson UniversityPhiladelphia, PA

Donald G. Mitchell, M.D.

•Trade-offs•Liver lesions•Liver lesion characterizion•When not to use Eovist•Off-label use

Eovist PropertiesGadoxetateGd-EOB-DTPAEovist®, Primovist®Linear; weak protein binding =double relaxivity. 1 mL = 1 mmol50% biliary elimination10 or 20 mL (0.025 – 0.05 mmol/kg; 25% - 50% dose)

STIR

Protocol Considerations

1. Shorter, smaller bolus2. 20 minute delayed image3. Timing is even more important4. MRCP < 5 min after injection5. STIR post contrast

Pre

Arterial

Venous

5-min

20-min

STIR

TJU Indications for Eovist1. FNH (focal nodular hyperplasia) or liver

adenoma characterization.2. Cirrhosis: HCC surveillance

Except short-term post ablation, or poor Eovist uptake

3. Hepatic metastasesExcept short-term post ablation

4. Post liver transplantUnless primary question is suspected vascular

complication or abscess.

5. Bile ducts improved delineation, bile leak or functional evaluation.

6. Suspected gallbladder obstruction.

Melanoma Metastases

STIR Hepatobiliary Phase

FNHPreArterial

Venous

5-minute 20-minute

HCC, Radiation injury

Hepatojejeunostomy

?Biliary leak

Nonobstructive Acute Cholecystitis

Trade-offs• What you gain:

» Liver lesion sensitivity, specificity, margins» Hepatobiliary phase

Parenchymal enhancement Biliary and bowel opacification

• What you give up:» Vascular phase optimization» Extracellular phase (becomes “late dynamic”)

• When not to use:» Vascular indications» Inflammatory disease» Short-term post-ablation, post-TACE» Probable hemangioma

1. The approved indication for Eovist is for detecting and diagnosing liver lesions.

2. Dynamic multiphasic imaging is possible with Eovist, but is less optimal unless it is given as double the recommended dose.

3. The extracellular phase, useful for depicting edema and fibrosis, is not obtained following Eovist administration.