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Computed Tomography Cholangiography Using the Magnetic Resonance Contrast Agent Gadoxetate Disodium

A Phantom Study

Dilger, Samantha K.N. PhD; Nelson, Noelle; Venkatesh, Sudhakar K. MD; Ehman, Eric C. MD; Fidler, Jeff L. MD; Fletcher, Joel G. MD; McCollough, Cynthia H. PhD; Yu, Lifeng PhD

doi: 10.1097/RLI.0000000000000580
Original Articles
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Objective The purpose of this work is to determine whether low doses of gadoxetate disodium (Eovist; Bayer Healthcare LLC, Whippany, NJ), a gadolinium-based contrast agent used for magnetic resonance liver imaging, can be visualized for computed tomography (CT) cholangiography using a phantom setup.

Materials and Methods Vials containing 4 concentrations of gadoxetate disodium (1.9, 3.4, 4.8, and 9.6 mg Gd/mL) were placed in a 35 × 26-cm2 water phantom and imaged on 2 CT scanners: Siemens Somatom Flash and Force (Siemens Healthcare, Erlangen, Germany). These concentrations correspond to the estimated concentration in the bile duct for a 40-, 70-, or 100-kg patient, and twice the concentration of a 100-kg patient, respectively. Single-energy (SE) scans were acquired at 70, 80, 90, 100, 120, and 140 kVp, and dual-energy scans were acquired at 90/150Sn (Force) and 100/150 (Flash) for 2 dose levels (CTDIvol 13 and 23 mGy). Virtual monoenergetic images at 50 keV were created (Mono+; Siemens Healthcare, Erlangen, Germany). The mean intensity and standard deviation for each concentration of gadoxetate disodium and the water background were extracted from each image set and used to compute the contrast and contrast-to-noise ratio (CNR). To determine whether the signal provided by gadoxetate disodium was clinically sufficient, the measures were compared with those acquired from 12 clinical CT cholangiography examinations performed with iodine-containing iodipamide meglumine.

Results From the retrospective clinical cohort, mean contrast (± standard deviation) of 239 ± 107 HU and CNR of 12.8 ± 4.2 were found in the bile duct relative to the liver. Comparing these metrics to the gadoxetate disodium samples, the highest concentration (9.6 mg Gd/mL) surpassed these thresholds at all energy levels. The 4.8 mg Gd/mL had sufficient CNR in the Force, but not in the Flash. The 3.4 mg Gd/mL had clinically relevant CNR at low kV of SE (<100 kVp) and 50 keV of dual energy in the Force but was insufficient in the Flash. Images acquired by the Force had a lower noise level and greater CNR compared with the Flash. Similar trends were seen at both dose levels.

Conclusions Gadoxetate disodium shows promise as a viable contrast agent for CT cholangiography, with CNR similar to those seen clinically with an iodine-based contrast agent. Dual-energy CT or low kV SE-CT is helpful to enhance the signal.

From the Department of Radiology, Mayo Clinic, Rochester, MN.

Received for publication February 14, 2019; and accepted for publication, after revision, April 9, 2019.

Selected sections presented during oral presentation at the RSNA Annual Meeting in November 2018.

Conflicts of interest and sources of funding: Drs McCollough and Fletcher receive grant support given to our institution from Siemens Healthineers, the manufacturer for the computed tomography scanners used in this study. For the remaining authors, none were declared. No funding was provided for this work.

Correspondence to: Lifeng Yu, PhD, Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: yu.lifeng@mayo.edu.

Online date: July 1, 2019

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