Hepatobiliary MRI contrast agents: Properties, clinical applications and future directions

Hepatobiliary contrast agents (HBAs) are gadolinium-based contrast agent characterized by hepatocellular uptake and hepatobiliary excretion. The hepatobiliary phase has become an essential tool of modern magnetic resonance imaging (MRI) of the liver and refines the diagnostic capabilities of MRI. The specific characteristic of HBAs allows the combination of MRI dynamic vascular imaging with unique lesion characterization, biliary anatomy and liver functional assessment. The practical use of HBAs in the non-invasive diagnosis of benign hepatocellular lesions must be known, as imaging patterns are specific for focal nodular hyperplasia and hepatic adenomas, and may vary according to adenoma subtypes. HBAs for the non-invasive diagnosis of hepatocellular carcinomas are integrated into Western and Eastern guidelines and on specific criteria for use and interpretation. Metastatic liver disease also represents a major application. Emerging applications include advanced biliary imaging, functional assessment of the liver, and potential role in surveillance strategies. This review summarizes the properties of HBAs, including their pharmacokinetics, safety, and technical considerations for image acquisition. It also discusses their role in characterizing focal liver lesions, highlighting their strengths and limitations.