Setting a new standard of care for liver MRI contrast agents in patients with reduced kidney function

A ‘hot’ topic on the radar of radiologists in recent years has been the safety of the potentially toxic gadolinium-based contrast agents (GBCAs) used in magnetic resonance imaging (MRI). This is especially pertinent in the detection of focal liver lesions for patients with poor kidney function due to potentially fatal side effects of GBCAs. In this interview for European Pharmaceutical Review, Carl Bjartmar, Chief Medical Officer at Ascelia Pharma, explains how the company is working to resolve some of the key drawbacks of current imaging approaches and improve outcomes for these patients.

Why is non-invasive liver examination part of your R&D at Ascelia Pharma?

The liver is the second most common organ for metastases after the lymph nodes and is often both the first site of metastases and the cause of mortality in patients with many cancer types (including colorectal, breast and gastric cancers). Early detection and localisation of focal liver lesions is therefore critical for the optimal management of these patients.

Contrast enhanced MRI is the current gold standard for accurate detection and visualisation, planning of surgery or drug treatment, and post‑treatment surveillance of patients with focal liver lesions or primary liver cancer. In this procedure, patients are given contrast agents prior to the MRI to enhance the quality of the scans and make abnormalities like metastases appear more clearly. The magnetic properties of the contrast agent used – the active substance – increase the ability to visualise focal liver lesions through a stronger contrast between the normal and cancerous tissue and through clearer delineation of the lesion’s border, compared to MRI without a contrast agent (unenhanced). However, all currently available MRI contrast agents are based on gadolinium, the toxic heavy metal, which has some significant drawbacks for certain patients.