Atypical Enhancement of Gd-BOPTA on the Hepatobiliary Phase in Hepatic Metastasis from Carcinoid Tumor – Case Report
Unknown ethiology, Mistake in diagnosis
Patryk Pozowski, Paula Misiak, Kinga Szymańska, Rafał Mazur, Małgorzata Sierpowska, Jurand Silicki, Milena Celmer, Mateusz Łasecki, Aleksander Pawluś, Urszula Zaleska-Dorobisz
Department of General and Pediatric Radiology, Wrocław Medical University, Wrocław, Poland
Am J Case Rep 2020; 21:e924280
Available online: 2020-07-27
Carcinoid tumor is the most frequent neuroendocrine tumor (NET) that causes liver metastases. One of the best methods to assess this type of pathology is magnetic resonance imaging with hepatocyte-specific contrast media with low molecular weight gadolinium chelate Gd-BOPTA. As these lesions do not contain hepatocytes, they present as hypointense on MRI in comparison with liver tissue which enhances this type of contrast.
CASE REPORT: In this article, we present a case of a 65-year-old female patient who was admitted to the Emergency Department with abdominal pain. Computed tomography revealed a single focal lesion in her liver. The patient underwent further evaluation using magnetic resonance imaging (MRI). The hepatobiliary phase MRI showed an unspecific homogenous enhancement of the hepatobiliary agent Gd-BOPTA. Since the lesion was interpreted as a non-characteristic lesion, the patient was discharged from the hospital with a recommendation for early follow-up. The follow-up MRI 6 months after discharge disclosed multiple liver metastases.
CONCLUSIONS: Liver metastases generally demonstrate enhancement of hepatobiliary contrast agents in the T1-weighted hepatocellular phase. Metastasis from a carcinoid tumor may also demonstrate this enhancement.
Keywords: Carcinoid Tumor, Contrast Media, Magnetic Resonance Imaging, Neoplasm Metastasis