What is the comparison between Clariscan (gadolinium-based contrast agent) and Eovist (gadoxetate disodium) for detecting liver lesions by Magnetic Resonance Imaging (MRI)?

From the Guidelines

Eovist (gadoxetate disodium) is generally superior to Clariscan (gadoterate meglumine) for detecting and characterizing liver lesions due to its dual mechanism of dynamic perfusion imaging and hepatobiliary phase imaging. This is because Eovist offers both dynamic perfusion imaging and hepatobiliary phase imaging, as approximately 50% of the contrast is taken up by functioning hepatocytes and excreted into the bile, allowing for better lesion detection, particularly for small metastases and hepatocellular carcinoma 1. Some key points to consider when choosing between Clariscan and Eovist include:

• The standard dose for Eovist is lower (0.025 mmol/kg) compared to Clariscan (0.1 mmol/kg) 1
• Hepatobiliary phase imaging with Eovist typically occurs 10-20 minutes after injection, providing additional diagnostic information not available with Clariscan 1
• Eovist is more expensive and may not be necessary for all patients, but its ability to detect early HCCs is one of its strengths compared to conventional extracellular contrast agents (ECAs) in the diagnosis of HCC 1
• For patients with severely impaired liver function, Clariscan may be preferred as Eovist's hepatobiliary phase may be limited in these cases 1
• Both agents have similar safety profiles regarding nephrogenic systemic fibrosis risk in patients with impaired renal function 1. It's also worth noting that the accuracy of Eovist for diagnosis of hemangioma, FNH, and HCC in patients with incidentally discovered liver lesions is high, with accuracy of 95% to 99% for diagnosis of hemangioma, accuracy of 88% to 99% for the diagnosis of FNH, and accuracy of 97% for diagnosis of HCC 1.

From the FDA Drug Label

The combination of non-contrasted and EOVIST-contrasted MR images had improved sensitivity for the detection and characterization of liver lesions, compared to pre-contrasted MR images The improved sensitivity in detection of lesions was predominantly related to the detection of additional lesions among patients with multiple lesions on the pre-contrast MR images.

There is no direct comparison between Clariscan and Eovist for detecting liver lesions by Magnetic Resonance Imaging (MRI) in the provided drug labels. The labels only discuss the efficacy of Eovist in detecting and characterizing liver lesions. Key points:

• Eovist improves sensitivity for liver lesion detection and characterization when combined with non-contrasted MR images.
• No direct comparison with Clariscan is provided in the drug labels 2, 2, 2.

From the Research

Comparison of Clariscan and Eovist for Liver Lesions

• Clariscan (gadolinium-based contrast agent) and Eovist (gadoxetate disodium) are both used for detecting liver lesions by Magnetic Resonance Imaging (MRI) 3, 4.
• A study comparing gadobenate dimeglumine (similar to Clariscan) and gadoxetate disodium (Eovist) found that gadobenate dimeglumine had higher sensitivity and specificity for malignant/benign differentiation of focal liver lesions (FLLs) 3.
• The study also found that gadobenate dimeglumine had better diagnostic performance and greater confidence in the characterization of FLLs, which could improve patient management decisions and outcomes 3.
• Another study found that gadoxetate disodium (Eovist) had a significantly higher increase in sensitivity for patients with hepatocellular carcinoma (HCC) and HCC + cirrhosis compared to gadobenate dimeglumine 5.
• However, gadoxetate disodium (Eovist) provides less satisfactory dynamic phase images compared to extracellular contrast agents (ECAs) like Clariscan, particularly during the arterial phase 6.
• The choice of contrast agent for liver MRI depends on the clinical situation and question to be answered, with ECAs like Clariscan providing excellent dynamic phase information and hepatobiliary agents (HBAs) like Eovist providing useful information for characterizing lesions with functioning hepatocytes 6.

Key Differences

• Sensitivity and specificity: Gadobenate dimeglumine (similar to Clariscan) had higher sensitivity and specificity for malignant/benign differentiation of FLLs compared to gadoxetate disodium (Eovist) 3.
• Dynamic phase imaging: Gadoxetate disodium (Eovist) provides less satisfactory dynamic phase images compared to ECAs like Clariscan 6.
• Patient populations: Gadoxetate disodium (Eovist) had a significantly higher increase in sensitivity for patients with HCC and HCC + cirrhosis compared to gadobenate dimeglumine 5.

Clinical Implications

• The choice of contrast agent for liver MRI should be based on the clinical situation and question to be answered 6.
• Gadobenate dimeglumine (similar to Clariscan) may be preferred for characterizing FLLs due to its higher sensitivity and specificity 3.
• Gadoxetate disodium (Eovist) may be preferred for patients with HCC and HCC + cirrhosis due to its higher increase in sensitivity 5.