Gadolinium-enhanced imaging to identify metastatic lesions

Both of these cases demonstrate the use of MRI to detect, characterize, and monitor response to treatment of patients who at first may not have been considered surgical candidates. In the presurgical setting, the use of extracellular contrast agents in combination with T2-weighted images, DWI, and noncontrast T1-weighted images permitted the detection and characterization of hypervascular lesions (in the setting of HCC) or hypovascular solid lesions (in the setting of metastatic disease). As presented here, there are multiple therapeutic options for the treatment of liver malignancies. These include liver resection, transplantation, chemoembolization, radiofrequency ablation, and systemic chemotherapy. Both of these cases demonstrate the ability of MRI to detect the response to treatment of both liver-directed and systemic therapy of primary and metastatic liver lesions. In contrast to CT, MRI with gadolinium has higher sensitivity and does not suffer from some of the limitations of iodine-enhanced CT. Finally, in the setting of systemic chemotherapy, where lesion size has been considered the standard for assessment of response to treatment, we suggest that the lack of enhancement proved useful for the characterization of response to treatment.