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MRI of the Liver

Laurie Fisher¹, Richard Semelka², Kathy Wilber²

¹Siemens Uptime Service Center, Cary, North Carolina
²University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A15.1

DOI:

10.1002/0471142719.mia1501s00

Online Posting Date:

May, 2001

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Abstract

MRI provides comprehensive information on the full range of liver diseases, including congenital abnormalities, benign and malignant focal liver lesions, and diffuse liver disease. This unit presents a protocol that incorporates various types of T1-and T2-weighted sequences, including transverse and coronal data acquisition, and the routine use of intravenous gadolinium.

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Unit Introduction
Basic Protocol: Liver Imaging
Commentary
Bibliography
Figures
Tables

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Materials

Basic Protocol: Liver Imaging

Materials

Normal saline (0.9% NaCl), sterile, 40 ml minimum
Extravascular contrast agent (e.g., Magnevist, Omniscan, or Prohance), volume by patient weight

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Figures

Figure A15.1.1

Coronal breath-hold image used to plan transverse breath-hold sequences.

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Figure A15.1.2

Unenhanced transverse spoiled gradient echo image.

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Figure A15.1.3

Immediate post-gadolinium spoiled gradient echo image (arterial phase) demonstrates the absence of gadolinium in hepatic veins and the presence of gadolinium in the hepatic arteries and portal veins.

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Figure A15.1.4

1-min post-gadolinium spoiled gradient echo transverse image (portal-phase) demonstrates maximal hepatic enhancement.

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Figure A15.1.5

2-min post-gadolinium fat-suppressed spoiled gradient echo transverse image (equilibrium-phase) demonstrates delayed contrast enhancement.

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Literature Cited

Literature Cited
	Larson, R.E., Semelka, R.C., Bagley, A.S., Molina, P.L., Brown, E.D., and Lee, J.K. 1994. Hypervascular malignant liver lesions; comparison of various MR imaging pulse sequences and dynamic CT. Radiology 192:393-399.
	Low, R.N., Francis, I.R., Sigeti, J.S., and Foo, T.K. 1993. Abdominal MR imaging: Comparison of T₂ -weighted fast conventional spin-echo and contrast-enhanced fast multiplanar spoiled gradient-recalled imaging. Radiology 186:803-811.
	Low, R.N., Semelka, R.C., Worawattankul, S., Alzate, G.D., and Sigeti, J.S. 1999. Extra hepatic abdominal imaging in patients with malignancy: Comparison of MR imaging and helical CT with subsequent surgical correlation. Radiology 210:625-632.
	Oi, H., Murakami, T., Kim, T., Matsushita, M., Kishimoto, H., and Nakamura, H. 1996. Dynamic MR imaging and early-phase helical CT for detection small intrahepatic metastases of hepatocellular carcinoma. AJR Am. J. Roentgenol. 366:36-374.
	Rofsky, N.M., Lee, V.S., Laub, G., Pollack, M.A., Krinsky, G.A., Thomasson, D., Ambrosino, M.M., and Weinreb, J.C. 1999. Abdominal MR imaging with a volumetric interpolated breath-hold examination. Radiology 212:876-884.
	Semelka, R.C. and Kelekis, N.L. 1997. Liver. In MRI of the Abdomen and Pelvis. A Text-Atlas. (R.C. Semelka, S.M. Ascher, C. Reinhold eds.) pp. 19-135. Wiley-Liss, New York.
	Semelka, R.C., Shoenut, J.P., Kroeker, M.A., Greenberg, H.M., Simm, F.C., Minuk, G.Y., Kroeker, R.M., and Micflikier, A.B. 1992. Focal liver disease:Comparison of dynamic contrast-enhanced CT and T₂-weighted fat suppressed, FLASH and dynamic gadolinium-enhanced MR imaging at 1.5T. Radiology 184:687-694.
	Semelka, R.C., Cumming, M.J., Shoenut, J.P., Magro, C.M., Yaffe, C.S., Kroeker, M.A., and Greenberg, H.M. 1993. Islet cell tumors: Comparison of dynamic contrast-enhanced CT and MR imaging with dynamic gadolinium enhancement and fat suppression. Radiology 186:799-802.
	Semelka, R.C., Willms, A.B., Brown, M.A., Brown, E.D., and Finn, J.P. 1994. Comparison of breath-hold T₁ -weighted MR sequences for imaging of the liver. J. Magn. Reson. Imaging 4:759-765.
	Semelka, R.C., Worawattanakul, S., Kelekis, N.L., John, G., Woosley, J.T., Graham, M., and Cance, W.G. 1997. Liver lesion detection, characterization, and effect on patient management; comparison of single-phase spiral CT and current MR techniques. J. Magn. Reson. Imaging 7:1040-1047.
	Semelka, R.C., Balci, N.C., Op de Beeck, B., and Reinhold, C. 1999. Evaluation of a 10-minute comprehensive MR imaging examination of the upper abdomen. Radiology 211:189-195.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Whitney, W.S., Herfkens, R.J., Jeffrey, R.B., McDonnell, C.H., Li, K.C., Van Dalsem, W.J., Low, R.N., Francis, I.R., Dabatin, J.F., and Glazer, G.M. 1993. Dynamic breath-hold multiplanar spoiled gradient-recalled MR imaging with gadolinium enhancement for differentiating hepatic hemangiomas from malignancies at 1.5T. Radiology 189:863-870.
	Yamashita, Y., Mitsuzaki, K., Yi, T., Ogata, I., Nishiharu, T., Urata, J., and Takahashi, M. 1996. Small hepatocellular carcinoma in patients with chronic liver damage: Prospective comparison of detection with dynamic MR imaging and helical CT of the whole liver. Radiology 200:79-84.
Key References
	Shellock 1996. See above.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.