The use of hepatobiliary-specific contrast agents in liver MRI is a crucial diagnostic tool for evaluating liver disease, enabling the detection and characterisation of focal lesions and vascular alterations, as well as the assessment and grading of chronic hepatopathy. Paramagnetic hepatobiliary-specific contrast agents are gadolinium-based, partially taken up by hepatocytes, and excreted via both renal and biliary pathways. There are two linear ionic molecules that are currently commercially available: gadobenic acid (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA). Their main clinical indications include distinguishing and characterising focal liver lesions on healthy liver tissue, diagnosing and staging hepatocellular carcinoma in patients with chronic hepatopathy, and increasing reliability in the detection of hepatic metastases in oncology patients, especially prior to surgery. They are also useful in the evaluation of the biliary tract and in assessing complications of hepatic surgery such as bile leaks.
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