MRI Liver With and Without IV Contrast (Eovist or Multihance) — Dictation, Appropriateness, and Dose for Residents

1. The High-Stakes Liver MRI: Getting to LI-RADS 5 Confidently

It’s a Tuesday afternoon. You pick up the outpatient multiphase liver MRI on a patient with cirrhosis and a new 1.8 cm observation in segment 8. It’s showing arterial phase hyperenhancement (APHE). Now what? Your attending expects a definitive Liver Imaging Reporting and Data System (LI-RADS) classification on every observation, and fumbling through the major feature criteria mid-read isn’t the look you’re going for. Is that a capsule? Is there washout? Is that enough for LR-5? This is one of the highest-stakes reads in body imaging, where your report directly guides decisions on transplantation, ablation, or resection.

When I was a fellow, the pressure to nail every LI-RADS feature was intense. You have to be systematic. This guide breaks down the essential MRI liver protocol with a hepatobiliary agent, providing a structured template you can build on. For more tools like this, check out our free residents and fellows resource hub with calculators and other high-yield references.

2. What an MRI Liver With Hepatobiliary Agent Covers and What Attendings Look For

The multiphase MRI of the liver with a hepatobiliary agent like Eovist (gadoxetate disodium) is the most sensitive non-invasive exam for characterizing liver lesions, especially for detecting or ruling out Hepatocellular Carcinoma (HCC). It leverages dynamic contrast enhancement patterns and the unique properties of agents that are taken up by functional hepatocytes and excreted into the biliary system. This dual-functionality gives us both vascular and functional information.

Your attending is looking for a report that systematically answers these key clinical questions:

• Lesion Characterization: Is the observation benign, malignant, or indeterminate? For patients with cirrhosis, what is its LI-RADS classification (LR-1 through LR-5, LR-M, LR-TIV)?
• Major Features for HCC: Is there arterial phase hyperenhancement? Nonperipheral “washout”? An enhancing “capsule”? Threshold growth?
• Hepatobiliary Phase Behavior: Does the lesion retain contrast (suggesting functional hepatocytes, as in Focal Nodular Hyperplasia (FNH) or some adenomas) or is it hypointense (suggesting non-hepatocyte origin, like HCC or metastases)?
• Vascular Invasion: Is there evidence of tumor in vein (LR-TIV)?
• Biliary Anatomy: What does the biliary tree look like on the 20-minute delayed images? Is there evidence of a leak or obstruction?

This study is the first-line choice for HCC screening and surveillance, characterizing indeterminate liver lesions found on other imaging, and for pre-procedural planning before transplant, resection, or locoregional therapy.

3. Radiology Report Template for MRI Liver With and Without Contrast (Hepatobiliary Agent)

This template provides a solid foundation. Dictate your specific findings, and use the structure to ensure you cover all the key elements your attending and the clinical team need to see.

Technique

Multiplanar, multisequence MRI of the liver was performed with and without intravenous contrast. Pre-contrast sequences include T1-weighted in-and-out-of-phase, T2-weighted, and diffusion-weighted imaging. Post-contrast imaging was performed following the administration of [volume] mL of [Eovist (gadoxetate disodium) OR Multihance (gadobenate dimeglumine)] with dynamic T1-weighted 3D fat-suppressed acquisitions in the late arterial, portal venous, transitional, and hepatobiliary phases.

Findings

LIVER: The liver contour is [smooth/nodular], consistent with [no chronic liver disease/cirrhosis]. No diffuse signal abnormality. Background parenchymal enhancement is [homogeneous/heterogeneous].

LIVER OBSERVATIONS (LI-RADS):
Observation 1: Located in segment [number]. Measures [size] cm.
– T2 signal: [hyperintense/isointense/hypointense]
– DWI: [shows/does not show] restricted diffusion.
– Pre-contrast T1: [hyperintense/isointense/hypointense]
– Arterial phase: [shows/does not show] non-rim arterial phase hyperenhancement.
– Portal venous/Transitional phase: [shows/does not show] nonperipheral “washout.” [Shows/does not show] an enhancing “capsule.”
– Hepatobiliary phase: [hypointense/isointense/hyperintense] relative to background liver parenchyma.
– Size change: [stable/threshold growth] compared to prior exam from [date].

(Repeat for each observation)

PORTAL AND HEPATIC VEINS: The main portal vein and its branches are patent. The hepatic veins are patent.

BILIARY SYSTEM: The common bile duct measures [diameter] mm. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is [present/surgically absent]. [No gallstones or wall thickening].

SPLEEN: [Normal in size/Enlarged, measuring X cm]. No focal lesions.

PANCREAS: Unremarkable.

ADRENAL GLANDS: Unremarkable.

KIDNEYS: Unremarkable.

OTHER FINDINGS: [Note ascites, varices, or other relevant findings].

Impression

1. Evidence of cirrhosis.

2. Liver Observations:
– Observation 1: [Size] cm observation in segment [number] demonstrating [list major features like APHE, washout, capsule]. These findings are diagnostic of hepatocellular carcinoma. LI-RADS 5.
– Observation 2: [Size] cm T2-hyperintense observation in segment [number] demonstrating peripheral nodular enhancement, consistent with a hemangioma. LI-RADS 1.
– Observation 3: [Size] cm observation in segment [number] with arterial enhancement and hepatobiliary phase retention, consistent with focal nodular hyperplasia (FNH). LI-RADS benign.

3. Patent portal and hepatic veins.

4. Where to Find More Free Radiology Report Templates

Building your own template library is a rite of passage. But you don’t have to start from scratch. Beyond what you find here, two great free repositories exist that are curated by and for radiologists. They are excellent sources for building out your personal macros.

• RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed, structured reporting templates covering nearly every modality and subspecialty.
• Radiology Templates (AU): An excellent, physician-led resource from Australia with clean, practical templates that are easy to adapt for your own use.

5. The Next-Level Move: From Free-Form Dictation to Structured Report

The biggest time sink on call isn’t the dictation itself—it’s the cleanup. It’s going back to add the LI-RADS category, the measurements, and the structured language the referring hepatologist expects. This is where AI-assisted reporting tools can streamline your workflow.

Instead of manually structuring your report, you can dictate the positive findings in free form—”1.8 cm lesion in segment 8 with APHE and washout”—and let the software handle the rest. Tools like GigHz Precision AI are designed to parse that clinical language and generate a clean, structured report based on pre-loaded ACR and SIR templates. It helps ensure that all necessary elements, like LI-RADS classifications, are included in the final impression without you having to stop and type. This approach supports a more natural dictation flow while producing a high-quality, attending-ready report.

6. When Should You Order an MRI Liver With a Hepatobiliary Agent? ACR Appropriateness Criteria

The American College of Radiology (ACR) provides evidence-based guidelines to help clinicians choose the right test for the right reason. For liver lesions, multiphase MRI with a hepatobiliary agent is frequently the top choice.

Per the ACR Appropriateness Criteria on Liver Lesion-Initial Characterization and Staging and Follow-up of Primary Liver Cancer, this exam is Usually Appropriate for most key scenarios. For an indeterminate liver lesion greater than 1 cm found on ultrasound or a non-contrast/single-phase CT, a multiphase contrast-enhanced MRI is the recommended next step, whether in a patient with a normal liver, known chronic liver disease, or a history of extrahepatic malignancy. Similarly, for both initial staging and post-treatment monitoring of HCC, this study is rated as Usually Appropriate.

In the post-liver transplant setting, MRI is also Usually Appropriate for evaluating suspected vascular or biliary complications, as well as for routine surveillance. When MRI is contraindicated (e.g., incompatible hardware, severe claustrophobia), a triphasic liver protocol CT is the primary alternative. Contrast-enhanced ultrasound (CEUS) and biopsy are also valuable tools for select lesions or when imaging remains non-diagnostic.

7. MRI Liver With Hepatobiliary Agent Protocol — Phases, Contrast, and Key Parameters

A successful liver MRI hinges on a well-timed, technically sound protocol. The key is capturing the distinct vascular phases and the all-important functional hepatobiliary phase. The slow injection rate for Eovist is a critical detail to minimize the risk of transient dyspnea, a known side effect.

Below is a standard protocol. Note that specific timing and sequences may vary slightly by institution.

Common protocol pitfalls:

• Injection Rate: For Eovist (gadoxetate), a slow injection rate of 1-2 mL/sec is critical. A faster rate increases the risk of transient severe dyspnea. This is less of a concern with Multihance (gadobenate).
• Arterial Phase Timing: Nailing the late arterial phase is everything for identifying APHE. Using a bolus tracking technique with a 10-15 second delay after contrast arrival in the aorta is standard.
• Contrast Choice: Eovist offers a convenient 20-minute hepatobiliary phase but has a higher incidence of transient dyspnea. Multihance requires a longer wait (1-3 hours) for the hepatobiliary phase and has lower biliary excretion, but is often better tolerated.

8. The Offer: 3+ Months Free for Radiology Residents and Fellows

Look like a rockstar on your reports. We’re offering trainees a free, extended trial of GigHz Precision AI. You can dictate your positive findings in free form, and the AI generates a structured report using ACR and SIR templates, firing the appropriate clinical decision support automatically.

All we ask in return is your feedback so we can keep improving the product for trainees. The signup is simple—no credit card, no long forms. To get started, just reply to the application with three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or fellowship specialty)
3. Your training program / hospital name

Ready to give it a try? Apply for the residents free-access program here.

9. Frequently Asked Questions

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. No patient-identifying information (PII) is required to use the tool for generating structured report language from your findings.

Do I need my hospital’s IT department to set this up?

No. GigHz Precision AI is browser-based and requires no local software installation. It works on any modern computer, including the call-room PC or your personal laptop or iPad.

Does this replace PowerScribe or other dictation systems?

No, it works alongside them. You still dictate into your hospital’s system. You use Precision AI to quickly generate the structured impression or findings section, which you can then copy and paste into your final report. It’s a workflow accelerator, not a replacement.

Can I use this on my phone or iPad?

Yes, the tool is fully responsive and designed to work on mobile browsers, making it easy to use on an iPad during rounds or on your phone when you need a quick reference.

Can I customize the templates?

Yes. While the system comes pre-loaded with standard ACR and society-based templates, you can create, modify, and save your own templates to match your personal style or your institution’s specific requirements.

What happens after I finish residency or fellowship?

Trainee accounts transition to a standard plan after graduation. We offer discounts for early-career radiologists who wish to continue using the platform in their practice.