Hepatobiliary phase in cirrhotic patients with different Model for End-stage Liver Disease score: comparison of the performance of gadoxetic acid to gadobenate dimeglumine

  • Claudia Khouri Chalouhi
  • Federica VernuccioEmail author
  • Francesca Rini
  • Piergiorgio Duca
  • Bruno Tuscano
  • Giuseppe Brancatelli
  • Angelo Vanzulli



The purpose of this study was to compare the performance of gadobenate dimeglumine–enhanced MRI and gadoxetic acid–enhanced MRI in the hepatobiliary phase (HBP) in cirrhotic patients with different degrees of liver dysfunction.


In this retrospective cross-sectional study, we analyzed the unenhanced phase and the HBP of 131 gadobenate dimeglumine–enhanced MRI examinations (gadobenate dimeglumine group) and 127 gadoxetic acid–enhanced MRI examinations (gadoxetic acid group) performed in 249 cirrhotic patients (181 men and 68 women; mean age, 64.8 years) from August 2011 to April 2017. For each MRI, the contrast enhancement index of the liver parenchyma was calculated and correlated to the Model For End-Stage Liver Disease (MELD) score (multiple linear regression analysis). A qualitative analysis of the adequacy of the HBP, adjusted for the MELD score (logistic regression analysis), was performed.


The contrast enhancement index was inversely related (r = − 0.013) with MELD score in both gadoxetic acid and gadobenate dimeglumine group. At the same MELD score, the contrast enhancement index in the gadoxetic acid group was increased by a factor of 0.23 compared to the gadobenate dimeglumine group (p < 0.001), and the mean odds ratio to have an adequate HBP with gadoxetic acid compared to gadobenate dimeglumine was 3.64 (p < 0.001). The adequacy of the HBP in the gadoxetic acid group compared to the gadobenate dimeglumine group increased with the increase of the MELD score (exp(b)interaction = 1.233; p = 0.011).


In cirrhotic patients, the hepatobiliary phase obtained with gadoxetic acid–enhanced MRI is of better quality in comparison to gadobenate dimeglumine–enhanced MRI, mainly in patients with high MELD score.

Key Points

• In cirrhotic patients, the adequacy of the hepatobiliary phase with gadoxetic acid–enhanced MRI is better compared to gadobenate dimeglumine–enhanced MRI.

• Gadoxetic acid–enhanced MRI should be preferred to gadobenate dimeglumine–enhanced MRI in cirrhotic patients with MELD score > 10, if the hepatobiliary phase is clinically indicated.

• In patients with high MELD score (> 15), the administration of the hepatobiliary agent could be useless; even though, if it is clinically indicated, we recommend to use gadoxetic acid given the higher probability of obtaining clinically relevant information.


Liver cirrhosis Gadolinium ethoxybenzyl DTPA Gadobenic acid Magnetic resonance imaging 



Contrast enhancement index


Hepatobiliary phase


Model for end-stage liver disease


Magnetic resonance imaging


Signal intensity ratio



This work has been presented as an oral presentation titled “Comparison of two liver specific contrast agents in patients with different degrees of liver cirrhosis” at the European Congress of Radiology that was held in Vienna in March 2018.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Angelo Vanzulli.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Giuseppe Brancatelli: Speaker for Bayer and Guerbet; Guerbet advisory Board.

Angelo Vanzulli: Invited lecture with fee at the European Congress of Radiology 2017, funded by Bracco Spa.

The remaining authors declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise: Piergiorgio Duca.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• cross-sectional study

• multicenter study


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.ASST Grande Ospedale Metropolitano NiguardaMilanItaly
  2. 2.Biomedical Department of Internal Medicine and Medical Specialties (Di.Bi.M.I.S)University of PalermoPalermoItaly
  3. 3.‘L. Sacco’ Department of Biomedical and Clinical SciencesUniversity of MilanMilanItaly
  4. 4.Postgraduation School of RadiodiagnosticsUniversity of MilanMilanItaly
  5. 5.Biomedicina, Neuroscienze e Diagnostica avanzata (BIND)University of PalermoPalermoItaly
  6. 6.Department of Oncology and Hemato-oncologyUniversity of MilanMilanItaly

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