Sequential use of gadolinium chelate and mangafodipir trisodium for the assessment of focal liver lesions:: Initial observations

The purpose of this study was to assess the feasibility of sequential administration of 2 different MR imaging contrast agents using a single visit protocol to image focal liver abnormalities. Twenty-one patients with known or suspected liver lesions were included in the study. All patients received a bolus intravenous injection of gadolinium chelate (Gd) and dynamically enhanced imaging performed. The patients then received an injection of mangafodipir trisodium (Mn) contrast and a second scan performed with an average delay of 62 min after the Gd bolus injection. The images were evaluated to determine the appearance of liver lesions after administration of each contrast agent, and for evidence of prior Gd administration adversely affecting evaluation of images acquired after Mn administration. Focal liver lesions were present in 19 patients, including 8 with liver metastases, 1 with liver lymphoma, 6 with hemangiomas, 3 with focal nodular hyperplasia (FNH), and 1 with hepatic abscess. In 2 other patients no liver lesions were identified in either the post-Gd or post-Gd-post-Mn scans. All malignant lesions identified on the post-Gd scan were also identified on post-Gd-post-Mn scans. Although the potential benefit for increasing detection sensitivity for hepatic metastases was not demonstrated, this is a preliminary series. This study does demonstrate the practicality for use a single visit sequential Gd-Mn protocol described here, with possible application of this technique for further assessment of the utility of combining Gd and Mn for detection of liver metastases.