Gadoteric acid 10mmol/20ml solution for injection pre-filled syringes

Stereotactic body radiotherapy (SBRT) is an established locoregional treatment option for hepatocellular carcinoma (HCC). However, post-treatment imaging remains challenging because tumor response and focal liver reaction (FLR), defined as radiation-related alterations of the adjacent liver parenchyma, may both evolve gradually and mimic viable or recurrent tumor. We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, Embase, and manual reference screening were used to identify studies published between January 2012 and February 2025 that evaluated MRI findings after SBRT for HCC. Studies were eligible if they reported MRI-based post-treatment outcomes after stereotactic, image-guided, highly conformal external-beam radiotherapy delivered in a limited number of fractions with ablative intent. Studies evaluating non-SBRT regimens, non-MRI imaging modalities, theoretical modeling approaches, reviews, and case reports were excluded. Eight studies met the inclusion criteria. Overall, MRI findings after SBRT demonstrated a delayed and time-dependent pattern rather than immediate tumor regression. In responding lesions, arterial phase hyperenhancement (APHE) and washout commonly decreased over time or evolved toward delayed enhancement or non-enhancement. T2-weighted and diffusion-weighted imaging (DWI) signal intensity tended to decline, whereas apparent diffusion coefficient (ADC) values increased. FLR was frequently observed and included perilesional enhancement, hepatobiliary phase hypointensity, capsular retraction, and dose-related parenchymal changes on gadoxetic acid-enhanced MRI. Response assessment after SBRT should therefore rely on serial multiparametric MRI rather than early arterial enhancement alone. Persistent enhancement shortly after treatment should not automatically be interpreted as treatment failure, and FLR remains an important source of diagnostic uncertainty. Prospective studies are needed to standardize MRI protocols, follow-up intervals, and response assessment criteria in this setting.

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Abstract Background & Aims: Posthepatectomy liver failure (PHLF) is a major cause of morbidity and mortality following liver resection. Accurate preoperative prediction of posthepatectomy liver failure (PHLF) remains a clinical challenge. Gadoxetic acid-enhanced MRI (Gd-EOB-MRI) enables quantitative assessment of liver function. This systematic review and meta-analysis aims to determine the diagnostic accuracy of Gd-EOB-MRI quantitative parameters for predicting PHLF and to explore sources of heterogeneity. Methods: A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted from January 2011 to June 2025 for studies evaluating Gd-EOB-MRI parameters for PHLF prediction in adults undergoing hepatectomy. The bivariate random-effects model was used to calculate the pooled area under the curve (AUC). Heterogeneity was assessed using the I² statistic. Subgroup, threshold effect, and publication bias analyses were performed. Results: Nineteen studies involving 3,658 patients were included. Future liver remnant (FLR)-based parameters (14 studies) demonstrated high diagnostic accuracy with a pooled AUC of 0.85 (95% CI: 0.82–0.89) and moderate heterogeneity (I² = 27.9%). Whole liver-based parameters (7 studies) also showed good performance (pooled AUC = 0.80, 95% CI: 0.76–0.84). Subgroup analyses revealed no significant differences based on MRI parameters， study design, region, sample size, or PHLF definition. However, studies using 3.0T MRI scanners showed a significantly higher pooled AUC than those using 1.5T (0.859 vs. 0.763, p=0.018). A significant threshold effect was observed for FLR parameters (Spearman's ρ = 0.744, p=0.006) but not for whole liver parameters. No significant publication bias was detected. Conclusions: FLR-based Gd-EOB-MRI parameters provide excellent diagnostic performance for predicting PHLF, outperforming to whole liver-based assessment. This supports the integration of functional FLR assessment into preoperative risk stratification. However, the presence of a threshold effect underscores the need for standardized protocols and validated diagnostic cut-offs in future prospective multicenter studies. Prospective multicenter studies with standardized protocols and predefined diagnostic thresholds are needed to validate these findings and facilitate clinical translation.

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BackgroundRespiratory motion artifacts impair diagnostic accuracy in gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced liver MRI. Conventional verbal pre-scan breathing training often yields inconsistent patient cooperation and image quality, creating an urgent clinical need for optimized training methods.PurposeTo evaluate the impact of a visualized respiratory training method integrated into clinical workflow on patient cooperation, image quality, and examination efficiency for Gd-EOB-DTPA-enhanced liver MRI.Study typeProspective, single-center, randomized controlled trial.PopulationOne hundred and eighty-four patients (135 males; mean age 53.5 ± 13.3 years) scheduled for first-time Gd-EOB-DTPA-enhanced liver MRI.Field strength/sequence3 T; Dynamic contrast-enhanced imaging was performed with a 3D fast spoiled gradient-echo sequence, covering pre-contrast, arterial, portal venous, transitional, and hepatobiliary phases.AssessmentPrimary outcome was patient cooperation rate assessed by blinded MRI technologists. Secondary outcomes included motion artifact scores (rated by three blinded radiologists), Signal-to-Noise Ratio (SNR), Contrast-to-Noise Ratio (CNR), transient severe motion (TSM) incidence, and examination duration.Statistical testsStudent's t-test, Mann-Whitney U test, Chi-square test, and Gamma correlation; two-tailed p ResultsThe experimental group (85 patients) had a significantly higher full cooperation rate (56.5% [48/85] vs. 27.3% [27/99], OR = 3.46, 95% CI: 1.87, 6.40, γ = 0.406), significantly lower motion artifact scores in arterial/portal venous/transitional phases, and significantly higher arterial and transitional phase SNR/CNR. The experimental group also showed significantly shorter preparation time (14.40 ± 2.36 vs. 16.16 ± 2.20 min; mean difference: -1.76 min; 95% CI: -2.42, -1.101). Scanning time did not differ significantly between groups (24.60 ± 1.60 vs. 24.89 ± 2.21 min; p = 0.329). TSM incidence did not differ significantly between groups (1.18% vs. 5.05%, p = 0.219).Data conclusionVisualized respiratory training significantly improves patient cooperation, image quality, and workflow efficiency in Gd-EOB-DTPA-enhanced liver MRI, with no additional resource requirements supporting its routine clinical adoption.Evidence level2.Technical efficacyStage 1.

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