The current liver imaging landscape in Canada: from CT to Primovist®-enhanced MRI
With the constantly evolving field of diagnostic imaging of the liver, growing incidence of liver disease1-3, and changes to clinical practice related to the pandemic, Bayer has sought out ways to best support liver imaging practices and optimize patient outcomes. For that reason, we recently conducted a survey across Canada to gain a better understanding of the current liver imaging landscape directly from clinics and healthcare professionals – such as yourself.
A total of 102 responses were received with representation from all geographical regions, academic and community sites, and cancer centers. Survey respondents included technologists, radiologists, MR supervisors and coordinators, and health administrators. Approximately 85% of respondents currently use Primovist in their practice, while 15% do not use Primovist - with most indicating they would be interested in learning more and trying Primovist.
The “Central” region encompasses Ontario. “East” includes Quebec, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador. “West” includes Manitoba, Saskatchewan, Alberta, and British Columbia.
Currently, CT remains the most frequently used modality for imaging of the liver compared to non-specific contrast enhanced MRIs and Primovist-enhanced MRIs. When Primovist is chosen, respondents indicated that their top reasons for using Primovist include its better characterization of lesions, better diagnostic clarification, and ability to detect small lesions. Indeed, Primovist has shown superior detection of liver lesions and treatment-decision making compared to CT and other MRI contrast agents for several indications and clinical situations.4-8
Some respondents indicated they were not aware that Primovist could be used for indications other than focal nodular hyperplasia (FNH) versus hepatocellular adenoma (HCA) differentiation. In fact, Primovist is indicated for the detection and characterization of all focal liver lesions – which includes its use in lesions such as hepatocellular carcinoma (HCC), cholangiocarcinoma (CCC), liver metastases, and for differentiating FNH and HCA. 9, 10
Sites were asked about the indications they currently use Primovist for, and indications they would like to use Primovist for if there were no constraints/barriers. Academic sites indicated FNH vs HCA differentiation and searching for metastatic disease as their most used and desired indications. Community sites indicated FNH vs HCA differentiation, searching for metastatic disease, and HCC/CCC screening as their most used and desired indications. Overall, survey responses demonstrated that sites are interested in expanding their use of Primovist within the focal liver lesion indication in their clinical practice, and Bayer looks forward to supporting sites during this process.
The survey also explored potential factors that may impact the use of Primovist, such as cost, workflow, reimbursement, perception of Primovist’s advantage over multi-purpose contrast media, lack of clinical experience/training, knowledge of referring physicians, and safety. Respondents were given the option to select “extremely limiting,” “somewhat limiting”, or “not at all limiting”, and none of these factors were indicated as “extremely limiting” to the use of Primovist by the majority of sites and respondents. This may suggest that the use of Primovist is not severely limited by factors such as cost and workflow, and health care professionals are willing to use it when the value of Primovist’s advantage over other agents is clear.
Lastly, the survey revealed that outside of radiologists, the top 3 referring physicians for Primovist are oncologists, surgeons and hepatologists. This presents potential opportunities for multidisciplinary collaboration between radiologists and referring physicians to optimize the patient journey, liver imaging process, and health outcomes.
Overall, the survey revealed general trends in liver imaging across Canada and highlighted differences in clinical practice between sites as well. Bayer will continue to use these responses to act as a partner in liver imaging, tailor support to each clinic and find ways to best improve the health of Canadians.
If you are interested to learn more about the role of Primovist-enhanced MRI and how you can further incorporate it into your liver imaging practice, then please let us know by filling in this form.
1. Moon, A. M., Singal, A. G., & Tapper, E. B. (2020). Contemporary epidemiology of chronic liver disease and cirrhosis. Clinical Gastroenterology and Hepatology, 18(12), 2650-2666.
2. Liver Cancer and Tumors. (2022). Canadian Liver Foundation. Accessed through https://www.liver.ca/patients-caregivers/liver-diseases/liver-cancer/
3. Liver cancer incidence rates have increase in Ontario. (Dec 2018). CancerCareOntario. https://www.cancercareontario.ca/en/cancer-facts/liver-cancer-incidence-rates-have-increased-ontario
4. Zech, C. J., Korpraphong, P., Huppertz, A., Denecke, T., Kim, M. J., Tanomkiat, W., ... & Ba-Ssalamah, A. (2014). Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Journal of British Surgery, 101(6), 613-621.
5. Morin, C., Drolet, S., Daigle, C., Deshaies, I., Ouellet, J. F., Ball, C. G., ... & Ouellet, J. F. B. (2020). Additional value of gadoxetic acid-enhanced MRI to conventional extracellular gadolinium-enhanced MRI for the surgical management of colorectal and neuroendocrine liver metastases. HPB, 22(5), 710-715.
6. Lee, Y. J., Lee, J. M., Lee, J. S., Lee, H. Y., Park, B. H., Kim, Y. H., ... & Choi, B. I. (2015). Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging—a systematic review and meta-analysis. Radiology, 275(1), 97-109.
7. Ricke, J., Steffen, I. G., Bargellini, I., Berg, T., Jaureguizar, J. I. B., Gebauer, B., ... & Seidensticker, M. (2020). Gadoxetic acid-based hepatobiliary MRI in hepatocellular carcinoma. Jhep Reports, 2(6), 100173. (SORAMIC TRIAL)
8. Vanhooymissen, I. J., Thomeer, M. G., Braun, L. M., Gest, B., van Koeverden, S., Willemssen, F. E., ... & Dwarkasing, R. S. (2019). Intrapatient comparison of the hepatobiliary phase of Gd‐BOPTA and Gd‐EOB‐DTPA in the differentiation of hepatocellular adenoma from focal nodular hyperplasia. Journal of Magnetic Resonance Imaging, 49(3), 700-710.
9. Primovist Monograph. (2017). Drug Product Database. Accessed through https://health-products.canada.ca/dpd-bdpp/index-eng.jsp
10. Scali, E. P., Walshe, T., Tiwari, H. A., Harris, A. C., & Chang, S. D. (2017). A pictorial review of hepatobiliary magnetic resonance imaging with hepatocyte-specific contrast agents: Uses, findings, and pitfalls of gadoxetate disodium and gadobenate dimeglumine. Canadian Association of Radiologists' Journal, 68(3), 293-307.
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