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Introduction to liver disease management

2. Primovist
®
-enhanced MRI

2.1 Context

  • Primovist® belongs to the group of intracellular gadolinium-based contrast agents (GBCAs). Primovist® is indicated for use in MRI of the liver to detect and characterize lesions in patients with known or suspected focal liver disease. Primovist® has a favorable benefit-risk profile in the approved indication.
  • Primovist®—like multipurpose gadolinium-based extracellular contrast media (ECCM)—distributes in the vasculature and interstitial space and can provide dynamic-phase imaging (i.e., arterial and portal-venous phases) before excretion in the kidneys.
  • Primovist®—unlike multipurpose ECCM—also shows highly selective intracellular uptake by functioning hepatocytes, with 50% of the dose later excreted into bile.
  • The uptake of Primovist® into functioning hepatocytes during the hepatobiliary phase (HBP) creates high liver-to-lesion contrast, which facilitates especially the detection of small focal liver lesions and supports accurate lesion detection and characterization.
  • Optimized MRI protocols can begin as early as 10 minutes after Primovist® injection in patients with normal liver function, providing both time and cost savings relative to conventional protocols.
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    • 1
      Bayer PLC. Primovist 0.25 mmol/ml, solution for injection, prefilled syringe. Summary of Product Characteristics. Updated May 22, 2024. Available from: https://www.radiology.bayer.ca/en/primovist. Accessed May 2024.
    • 2
      Frydrychowicz A, Lubner MG, Brown JJ, et al. Hepatobiliary MR imaging with gadolinium-based contrast agents. J Magn Reson Imaging. 2012;35(3):492-511.
    • 3
      Hammerstingl R, Huppertz A, Breuer J, et al. Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol. 2008;18(3):457-467.
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      Filippone A, Blakeborough A, Breuer J, et al. Enhancement of liver parenchyma after injection of hepatocyte-specific MRI contrast media: a comparison of gadoxetic acid and gadobenate dimeglumine. J Magn Reson Imaging. 2010;31(2):356-364.
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      Ringe KI, Husarik DB, Sirlin CB, Merkle EM. Gadoxetate disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion appearance in the noncirrhotic liver. AJR Am J Roentgenol. 2010;195(1):13-28.
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      Zech CJ, Ba-Ssalamah A, Berg T, et al. Consensus report from the 8th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol. 2020;30(1):370-382.