Eovist Abdomen

Pulse Sequences (applies to GE, Philips and Siemens MR Scanners)

· 3 Plane 2D SSFSE or BFFE survey

· Coronal single shot turbo spin echo or fast spin echo (i.e. SS-TSE or SS-FSE) (TE~200)

· Axial SS-TSE or SS-FSE (TE~200)

· Dual FFE

· Axial fat suppressed 3d gradient echo (3D GRE)

o Pre, double arterial

· Radial Slabs SS-TSE ##

o Obtain immediately after dynamic series. If there is a delay, bile ducts will not be visible.

· Axial (3D GRE) (late dynamic)

o Obtained 3 to 5 minutes post injection

· Balanced steady state free precession (i.e. FIESTA, BFFE, TRUE FISP)

· Axial moderately T2 weighted images (TE~80) with fat suppression

· Axial Diffusion (b = 0, 20, and 800). Please also send ADC map to PACS.

· Axial (3D GRE) 10 minute hepatobiliary

o Obtained 10 minutes post injection

§ Scanner modifications

o Philips 1.5T: THRIVE (flip = 30)

o GE: LAVA-flex or LAVA (flip=15)

o Philips 3T: m-Dixon (flip = 30)

· Coronal and axial (3D GRE) 20 minute hepatobiliary

o Obtained 20 minutes post injection

§ Scanner modifications (these sequences should fat suppressed, except for GE systems)

o Philips: THRIVE or m-Dixonwith (flip = 30)

o GE systems: 3D-FSPGR non-fatsat (flip = 30)

## Note: 3D MRCP must be obtained pre gadolinium or not at all

Caveats

1. The arterial and venous phases will show weaker enhancement than extracellular space contrast agents.

2. Interstitial enhancement (e.g. fibrosis, edema) will be minimal. Therefore, Eovist is suboptimal for suspected abscess or other inflammation, or for fibrosis.

3. Some patients with reduced hepatobiliary function have suboptimal Eovist enhancement. This is particularly likely if direct bilirubin > 2.18 mg/dL.

4. With prior treatment with ABLATIVE treatment such as RF or chemoembolization designed to infarct tumor, Gadavist and Multihance provide better contrast for distinguishing between infarcted vs. viable tumor. However, Eovist will provide greater sensitivity for detecting new foci of tumor.

5. If the clinical indication is to confirm a liver hemangioma, an extracellular contrast agent such as Gadavist is preferred.

6. Eovist should not be utilized for abdomen and pelvis combination studies. MultiHance should be used for these cases.

Rev: May 3, 2016