Gadoxetate disodium is a liver specific contrast agent, which shows an uptake by hepatocytes and subsequent biliary excretion of approximately 50% in patients with normal liver and renal function¹. The significance lies especially in the improved detection and characterization of focal lesions in the non-cirrhotic as well as in the cirrhotic liver. Only recently, an association has been described between the intravenous injection of gadoxetate disodium and motion artifacts in the arterial phase of the contrast dynamic, which has been termed acute transient severe motion (TSM). This typically self-limiting dyspnea lasts for only 10-20 seconds, but may have destructive effects on arterial phase MRI^2,3. The purpose of our present study was to evaluate the incidence of TSM at gadoxetate disodium-enhanced MRI using different contrast application protocols.200 patients (129m/71f; mean age 51 years) who were referred for gadoxetate disodium-enhanced MRI were included in this retrospective IRB approved study. All patients underwent a clinical routine liver protocol between 10/2012 and 02/2015. Due to departmental changes over time, contrast applications protocols (n=4) differed with regards to injection rate (1ml/s or 2ml/s), contrast dose (0.1ml/ kg body weight or fixed dose of 10ml independent of weight) and a possible nasal oxygen application (2l/ minute; no or yes). For quantitative analysis, SNR measurements were performed by one reader in the aorta and portal vein in the arterial phase. Qualitatively, two different readers separately assessed motion artifacts in each phase of the contrast dynamic (on a 5-point-scale) and the quality of the arterial phase (on a 4-point scale), using a grading system which has been suggested previously³. SNR measurements, motion score and arterial phase image quality between different protocols were compared (Kruskal-Wallis Test, Dunn’s multiple comparison Test). The incidence of TSM was calculated for different protocols. In addition, the frequency of TSM using different contrast application parameters was evaluated by means of univariate analysis.SNR in the aorta and portal vein were significantly higher in protocols using an injection rate of 1ml/s as compared to 2ml/s (mean arterial SNR 422 and 254, mean portal vein SNR 159 and 223, respectively; p<0.05). Arterial phase image quality was comparable between different protocols (mean 2.69 for both readers). The overall incidence of TSM in our study group was 11.5%. Regarding the occurrence of TSM, there was no significant between different contrast application protocols. At univariate analysis, injection rate, contrast dose and oxygen application had no significant influence on the rate of TSM (p>0.05).TSM is an only recently addressed phenomenon at gadoxetate disodium-enhanced MRI, which is known to cause significant degradation of arterial phase image quality. The reported incidence is in the range from 2.4-18%^2,4, which is in line with our present results. The cause and pathophysiology of TSM is still unknown, even though patient-specific factors are likely involved but have not yet been evaluated. In the present study we sought to address the influence of different contrast application parameters on the rate of TSM, however neither the variation of contrast dose, injection rate nor the supporting nasal application of oxygen seem to significantly reduce the incidence of TSM in clinical routine.TSM is a known adverse effect at gadoxetate disodium-enhanced MRI. Technique specific factors regarding the mode of contrast application do not seem to significantly reduce the incidence of TSM. However, these specific factors should be elucidated in larger prospective studies.