Effect of 37°C Pre‐Warmed Versus Room Temperature Gadoxetic Acid Disodium Contrast Medium on Patient Comfort and Image Quality in Liver MRI : A Prospective, Double‐Blind, Self‐Controlled Before‐and‐After Study

BACKGROUND: Compromised patient comfort and suboptimal arterial phase (AP) image quality remain unresolved challenges in Gd-EOB-DTPA-enhanced liver MRI. OBJECTIVE: To evaluate the effects of pre-warmed (37°C) Gd-EOB-DTPA contrast medium on patient comfort and image quality in liver MRI. STUDY TYPE: Prospective, single-center, double-blind, self-controlled before-and-after study. SUBJECTS: One hundred and thirty-eight participants (113 males; mean age 56.33 ± 11.24 years) who underwent Gd-EOB-DTPA-enhanced liver MRI. FIELD STRENGTH/SEQUENCE: 3.0-T; AP and Hepatobiliary phase (HBP) were both T1WI 3D spoiled gradient-echo dynamic sequences. ASSESSMENT: The primary outcome of this self-controlled before-and-after study was to compare image quality of room temperature (25°C) and pre-warmed (37°C) contrast medium. A 4-point scale and an 11-Numeric Rating Scale were used to evaluate overall participant comfort, while a 4-point Likert scale was applied for image quality assessment. In vitro experiments were conducted to characterize the physicochemical properties of the contrast medium, and renal function parameters were measured to assess its nephrotoxicity. STATISTICAL TESTS: Paired t-test, Wilcoxon signed-rank test, and Stuart-Maxwell test; two-tailed p < 0.05 was significant. RESULTS: Significant differences were observed between 37°C and 25°C for participant comfort (comfortable or very comfortable rate: 97.1% vs. 82.6%), adverse sensations including dyspnea (incidence: 1.4% vs. 13.8%), and AP image quality (excellent rate: 50.0% vs. 0.7%). For the HBP, contrast-to-noise ratio (CNR) and liver-to-spleen contrast ratio (LSC) changes were not significant (p = 0.067, p = 0.079, respectively). In vitro, Gd-EOB-DTPA maintained stable chemical properties and its viscosity, shear stress, and torque decreased. Renal function showed no differences (urea p = 0.933, creatinine p = 0.249, endogenous clearance p = 0.206). CONCLUSION: Pre-warming Gd-EOB-DTPA to 37°C improves patient comfort, reduces adverse sensations, optimizes AP image quality, and maintains HBP image quality. EVIDENCE LEVEL: 2. TECHNICAL EFFICACY: Stage 3.