Differentiating focal eosinophilic liver disease from hepatic metastases using unenhanced and gadoxetic acid-enhanced MRI

To examine the differential features of focal eosinophilic liver disease (FELD) from liver metastases on gadoxetic acid-enhanced MRI. Twenty patients with 41 FELD and 20 patients with 55 metastases were enrolled in this study. Liver MRI consisted of precontrast 2D T1-weighted image (T1WI) and gadoxetic acid-enhanced 3D T1WI (arterial, portal, 20 min hepatocyte-selective phases), and a postcontrast T2WI. Images were analyzed for the margin and shape of the lesions; lesion conspicuity on T1- and T2WI; signal intensity of the lesions on 3D T1WI; presence of rim enhancement and misty signs; and presence of significant smaller lesions on the unenhanced T1WI (< 50%) compared to hepatocyte phase image. Univariate analysis revealed the following significant parameters to favor FELD: a fuzzy margin, irregular shape, subtle signal intensity changes on T1- and T2WI, absence of target signs on the hepatocyte phase image, presence of misty signs, and size discrepancies on T1WI and hepatocyte phase images. Multivariate analysis revealed only a significantly smaller lesion size on T1WI compared to hepatocyte phase images to be predictive of FELD. A significantly smaller lesion size on T1WI relative to hepatocyte phase image is the best predictor for identifying FELD on gadoxetic acid-enhanced MRI.