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.
