Clin Mol Hepatol.  2019 Sep;25(3):223-233. 10.3350/cmh.2018.0107.

Gadoxetic acid-enhanced magnetic resonance imaging: Hepatocellular carcinoma and mimickers

  • 1Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 2Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Radiology, King Faisal University College of Medicine, Al-Ahsa, Saudi Arabia.


Gadoxetic acid, a hepatocyte-specific magnetic resonance imaging (MRI) contrast agent, has emerged as an important tool for hepatocellular carcinoma (HCC) diagnosis. Gadoxetic acid-enhanced MRI is useful for the evaluation of early-stage HCC, diagnosis of HCC precursor lesions, and highly sensitive diagnosis of HCC. Furthermore, functional information provided by gadoxetic acid-enhanced MRI can aid in the characterization of focal liver lesions. For example, whereas lesions lack functioning hepatocytes appear hypointense in the hepatobiliary phase, preserved or enhanced expression of organic anion transporting polypeptides in some HCCs as well as focal nodular hyperplasia lead to hyperintensity in the hepatobiliary phase; and a targetoid appearance on transitional phase or hepatobiliary phase imaging can be helpful for identifying the histopathological composition of tumors. While gadoxetic acid-enhanced MRI may improve the sensitivity of HCC diagnosis and provide new insights into the characterization of focal liver lesions, there are many challenges associated with its use. This article reviews the pros and cons of HCC diagnosis with gadoxetic acid-enhanced MRI and discuss some clues in the radiological differentiation of HCC from HCC mimickers.


Diagnosis; Liver neoplasm; Hepatocellular carcinoma; Magnetic resonance imaging; Gadoxetic acid

MeSH Terms

Carcinoma, Hepatocellular*
Focal Nodular Hyperplasia
Liver Neoplasms
Magnetic Resonance Imaging*
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