[Contrast agents for liver MRI]

Iron oxide-, manganese-, and gadolinium-based contrast agents (CAs) have been developed for liver magnetic resonance imaging (MRI). Gadolinium-based agents dominate clinical practice and comprise extracellular and hepatobiliary (liver-specific) compounds.

To characterize the available CA classes and define criteria for choosing between extracellular and hepatobiliary agents.

Narrative review based on the current literature, guidelines, approval status, and the author's clinical experience.

Extracellular CAs provide robust dynamic imaging, unrestricted washout assessment, and shorter examination times; they are preferred for incidental lesions and prior to liver transplantation. Hepatobiliary CAs add information derived from hepatocyte uptake, particularly for differentiating focal nodular hyperplasia from hepatocellular adenoma, detecting metastases before resection, and demonstrating bile leaks. Pitfalls such as pseudo-washout, steatosis, iron overload, and impaired liver function reduce diagnostic performance and must be considered in protocol selection and interpretation.

Extracellular and hepatobiliary CAs are complementary. The choice depends on the clinical question, liver function, and individual circumstances; selecting the appropriate agent upfront avoids additional and follow-up examinations.