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Multinodular focal fatty infiltration of the liver: Atypical imaging findings on delayed T1‐weighted Gd‐BOPTA‐enhanced liver‐specific MR images
Author(s) -
Marin Daniele,
Iannaccone Riccardo,
Catalano Carlo,
Passariello Roberto
Publication year - 2006
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.20660
Subject(s) - medicine , fatty liver , magnetic resonance imaging , infiltration (hvac) , biopsy , hepatocellular carcinoma , radiology , gadolinium , gadoxetic acid , nuclear medicine , pathology , gadolinium dtpa , disease , chemistry , physics , thermodynamics , organic chemistry
We report a case of pathologically confirmed multinodular focal fatty infiltration. MRI was performed after bolus injection of gadobenate dimeglumine (Gd‐BOPTA, MultiHance®; Bracco, Milan, Italy), a liver‐specific paramagnetic, gadolinium (Gd)‐based MR contrast agent that concomitantly enables the acquisition of a standard dynamic phase with timing strategies similar to those used for other extracellular fluid contrast agents, followed by a delayed T1‐weighted liver‐specific phase (the so‐called hepatobiliary phase). In the present case, multiple rounded areas of fatty infiltration, although confidently diagnosed using chemical shift sequences due to a significant signal intensity reduction on out‐of‐phase images, were unexpectedly hypointense during the delayed liver‐specific phase of Gd‐BOPTA. Reduced Gd‐BOPTA concentration during the liver‐specific phase is generally correlated with liver malignancy. Since such lesions can be prospectively mistaken for metastatic disease, we performed a hepatic biopsy to establish a definitive diagnosis. Our empirical observations suggest that Gd‐BOPTA uptake may be impaired in fatty infiltrated liver tissue. Because at present there is no report evaluating the kinetics of Gd‐BOPTA in fatty liver, further studies are needed to specifically investigate this issue. J. Magn. Reson. Imaging 2006. © 2006 Wiley‐Liss, Inc.