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Impaired lesion detectability on gadoxetic acid-enhanced MR imaging in indocyanine green excretory defect: case series of three patients

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Abstract

Indocyanine green (ICG) excretory defect is characterized by an ICG retention rate of more than 50% at 15 min without any other abnormal liver functions. The incidence of ICG excretory defect is 0.007% in the Japanese population. Due to its rarity, the imaging characteristics associated with ICG excretory defect remain unclear. Herein, we present three cases of ICG excretory defect, which showed impaired lesion detectability on gadoxetic acid-enhanced MR imaging (EOB-MRI). In the hepatobiliary phase (HBP) of EOB-MRI, diminished enhancement of the liver parenchyma, prolonged intravascular enhancement, and attenuated gadoxetic acid excretion to the bile duct were observed. Our study also investigated the expression level of organic anion transporting polypeptide (OATP) 1B3 and OATP1B1/1B3, which is related to the uptake of ICG and gadoxetic acid into hepatocytes. All cases showed decreased expression of OATP1B3, which was assumed to be characteristic of ICG excretory defect. The present study indicates that, when patients with ICG excretory defect are evaluated using EOB-MRI, attention should be paid to the impaired lesion detectability in the HBP due to the attenuated gadoxetic acid uptake into the liver parenchyma.

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Acknowledgements

We are deeply grateful to both Osamu Matsui M.D. Ph.D. and Kazuto Kozaka M.D., Ph.D. (Kanazawa University Graduate School of Medical Sciences, Department of Radiology) for their valuable advice.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Tsukuba, Faculty of Medicine, 1-1-1, Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan

    Sota Masuoka, Katsuhiro Nasu, Masafumi Sakai, Toshitaka Ishiguro, Tsukasa Saida & Manabu Minami

  2. Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Katsuhiro Nasu

  3. Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Hiroaki Takahashi

  4. Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa, 920-8641, Japan

    Azusa Kitao

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  1. Sota Masuoka
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  2. Katsuhiro Nasu
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  3. Hiroaki Takahashi
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  4. Azusa Kitao
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  5. Masafumi Sakai
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  7. Tsukasa Saida
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  8. Manabu Minami
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Correspondence to Sota Masuoka.

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Masuoka, S., Nasu, K., Takahashi, H. et al. Impaired lesion detectability on gadoxetic acid-enhanced MR imaging in indocyanine green excretory defect: case series of three patients. Jpn J Radiol 38, 997–1003 (2020). https://doi.org/10.1007/s11604-020-00991-9

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  • DOI: https://doi.org/10.1007/s11604-020-00991-9

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