European Journal of Radiology 81 (2012) e625–e628 Contents lists available at SciVerse ScienceDirect European Journal of Radiology jo ur n al hom epage: www.elsevier.com/locate/ejrad Diffusion weighted MR imaging in patients with HCC and liver cirrhosis after administration of different gadolinium contrast agents: Is it still reliable? Sonja Kinner a,∗ , Lale Umutlu a , Sebastian Blex a , Stefan Maderwald a,b , Gerald Antoch a,c , Judith Ertle d , Guido Gerken d , Thomas C. Lauenstein a a Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany b Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany c Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Germany d Department of Gastroenterology and Hepatology, University Hospital Essen, Germany a r t i c l e i n f o Article history: Received 12 November 2011 Received in revised form 23 December 2011 Accepted 26 December 2011 Keywords: Diffusion weighted imaging Liver MRI HCC Contrast agents Gadolinium a b s t r a c t Purpose: Diffusion weighted imaging (DWI) is an emerging technique for abdominal MR and usually performed before intravenous contrast injection. Recent studies performed in patients with normal liver function have shown that DWI can be performed after gadolinium administration. Aim of this study was to compare DWI before and after administration of different gadolinium compounds in patients with HCC and liver cirrhosis. Materials and methods: 15 patients with known HCC and liver cirrhosis underwent liver MRI at 1.5 T (Magnetom Avanto, Siemens) including DWI on day 1 before and after administration of gadobutrol (Gadovist ® ) and on day 2 after administration of EOB-Gadolinium-DTPA (Primovist ® ). Signal to noise ratios (SNR) and contrast to noise ratios (CNR) of HCC lesions were determined for all DWI data sets. Furthermore, ADC values were compared using a Wilcoxon test. A p-value <0.05 indicated statistically significant differences. Results: There were no statistically significant differences regarding SNR pre-contrast (mean: 48.1), after gadobutrol (mean: 47.7) or after EOB-Gadolinium-DTPA (mean: 50.0; values for b = 50 s/mm 2 ). Similarly, no significant differences were found for CNR (average values:34.4 vs. 32.3 vs. 30.7; b = 50 s/mm 2 ) nor for ADC-values (mean: 1.5 vs. 1.4 vs. 1.5 × 10 -3 mm 2 /s) of HCC. Conclusion: There is no significant difference regarding DWI in patients with cirrhosis before and after contrast injection. Hence, it is reliable to run DWI after gadolinium either as an alternative for unsuccessful pre-contrast DWI or as a gap filler to spare time in EOB-Gadolinium-DTPA imaging. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Diffusion weighted imaging (DWI) is an emerging technique for abdominal MR imaging. DWI allows visualization of intravoxel incoherent motion of water molecules and has first been used in cerebral MRI, especially for stroke diagnosis [1–3]. In abdom- inal imaging DWI differences reflect tissue damage or texture change and help to differentiate between benign and malignant liver lesions [4–7]. Therefore, DWI data is nowadays routinely col- lected for abdominal imaging in many centers. DWI data is usually collected before intravenous contrast injec- tion. However, it may be necessary to acquire DWI data after gadolinium administration, for instance when intravenous contrast ∗ Corresponding author at: Department of Diagnostic and Interventional Radi- ology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany. Tel.: +49 201 723 84544; fax: +49 201 723 1526. E-mail address: Sonja.Kinner@uni-due.de (S. Kinner). has already been injected and pre-contrast DWI data turns out to be non-diagnostic due to motion artifacts. Furthermore, there is a large variety of different gadolinium compounds that is currently used for abdominal MRI. Particularly usage of liver specific gadolinium compounds such as Gd-EOB- DTPA or Gd-BOPTA may have an influence on DWI imaging as these agents show some degree of uptake by hepatocytes [8,9]. The enhancement of the liver parenchyma in a hepatocyte spe- cific phase (approximately 15 min after injection of Gd-EOB-DTPA) helps to increase sensitivity and specificity of MRI for the depiction and characterization of liver lesions. To use the time gap between the dynamic contrast-enhanced T1-weighted imaging and the liver specific phase imaging efficiently, it would be helpful to acquire T2-weighted, but also DWI data during this time frame. Influences of intravenous administration of contrast on DWI have already been examined in brain imaging [10]. Studies have also shown that DWI can be performed after administration of liver-specific contrast agents without any notable information loss [11,12]. These studies were performed in patients without liver 0720-048X/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2011.12.042