Gadoxetic acid in China: a narrative review of the 15-year journey and the road ahead.
Authors
Affiliations (10)
Affiliations (10)
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China.
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou, China.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
- School of Mathematics and Statistics, University of New South Wales, New South Wales, Australia.
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Southern Medical University, Guangzhou, China.
Abstract
Since its pivotal introduction in 2011, gadoxetic acid has fundamentally revolutionized the landscape of hepatobiliary imaging in China, shifting the diagnostic paradigm from morphological assessment toward functional hepatocyte-level evaluation. This review comprehensively summarizes its 15-year clinical evolution within the Chinese healthcare system, exploring its pharmacological benefits, advanced applications, and future integration with data-driven frameworks. A systematic literature search was conducted across major electronic databases, including PubMed, Web of Science, and China National Knowledge Infrastructure, spanning from 2011 to 2026. The search targeted peer-reviewed articles, consensus statements, clinical guidelines, and high-impact reviews published in English and Chinese regarding gadoxetic acid-enhanced liver magnetic resonance imaging (MRI). Gadoxetic acid provides high sensitivity for early small hepatocellular carcinoma (sHCC) detection via specific OATP1B3 uptake. Beyond lesion detection, its quantitative mapping shows potential for estimating hepatic functional reserve (HFR) and risk stratification for post-hepatectomy liver failure. Crucially, the ongoing paradigm shift toward integrating radiomics and deep learning bridges macroscopic imaging and microscopic molecular biology, theoretically enabling a multi-dimensional profile of liver parenchyma and lesions within a single diagnostic session. However, a significant gap remains between retrospective predictive performance and clinical readiness, and these data-driven frameworks currently serve as supplementary investigational engines rather than standalone clinical decision-makers. Moving forward, integrating these high-dimensional signatures into constructs such as "digital twin" represents the next frontier. Furthermore, China's hepatitis B virus-dominant epidemiological cohorts, comprehensive multi-modal datasets, "Med-Engineering" fusion, and collaborative networks uniquely accelerate the development and preliminary validation of these models, offering valuable insights for global precision hepatology within China's healthcare system. Over the past 15 years, gadoxetic acid has evolved far beyond a conventional liver imaging tool in China. While clinical translation of advanced analytics requires rigorous, prospective multicenter validation to ensure safety, combining this functional imaging agent with data-driven frameworks represents a promising frontier to eventually optimize future radiology workflows and support personalized precision hepatology.