Evaluation of hepatic disease is one of the most common requests for patients referred for abdominal imaging. Infectious, inflammatory, and neoplastic diseases of the liver may affect patients referred from many clinical specialties. Recent advances in MR software and hardware have moved MRI to the forefront of abdominal and liver imaging, with much faster exams, routine breath-hold imaging that eliminates respiratory artifacts, and special liver specific IV contrast agents that improve liver lesion detection and characterization. In addition the versatility of MRI allows the combination of anatomic liver imaging with Magnetic Resonance Cholangiopancreatography (MRCP) or Magnetic Resonance Angiography (MRA) to yield the most information to the referring physician.
Radiological Evaluation of the Liver
♦ CT versus MRI
Accurate liver imaging requires depiction and characterization…
♦ Hardware and Software Advances in MRI
The architecture of MR imagers has moved towards short-bore scanners in which the tunnel or bore of the magnet is dramatically shortened to accommodate larger and claustrophobic patients without..
♦ MR Liver Imaging
Several types of MR images are routinely obtained during a liver MR exam. Each type of MR image, such as T1-, T2-, diffusion-weighted, and dynamic contrast-enhanced imaging, provides a slightly different view of the liver to allow for the most accurate depiction and characterization of focal and diffuse…
Clinical Applications for Hepatic MRI
♦ Colorectal Cancer Staging and Monitoring Liver Metastases
Colorectal cancer is the third most commonly diagnosed malignancy in the United States and the third leading cause of cancer related death, with over 150,000 newly diagnosed cases each year, resulting in 50,000 deaths.1
The presence of coincidental benign hepatic lesions in the patient with colorectal cancer, such as simple cysts, hemangiomas, or focal nodular hyperplasia, necessitates accurate…
Figure 1. Patient with elevated liver function tests.
A: CT shows slightly heterogeneous liver without focal abnormalities.
B: FSE T2-weighted MRI shows diffuse multifocal hepatocellular cancer replacing all of the liver parenchyma. The intrinsic superior contrast resolution of MRI allows depiction of liver tumors.
♦ Liver Metastases from Other Primary Malignancies
The liver is a common site for metastatic spread from numerous primary malignancies making metastases the most common malignant tumors of the liver. The goal of cross-sectional abdominal imaging in the patient with a known primary malignancy…
♦ Hepatocellular Cancer
Hepatocellular carcinomas are the most…
♦ Cholangiocarcinoma and Gallbladder Carcinoma
Combining the information from MRI and MR Cholangiopancreatography provides…
♦ Benign Liver Lesions
It is equally important that benign liver lesions are accurately characterized and not mistaken for primary…
- Benign cavernous hemangiomas of the liver are also….
- Focal nodular hyperplasia is a benign hepatocellular tumor that shows…
- Liver abscesses are depicted on MR images as irregular…
- Areas of focal fat deposition or focal sparing from fatty infiltration…
Recent Advances in Abdominal MRI Techniques
♦ Magnetic Resonance Cholangiopancreatography
MRI is unique in its ability to noninvasively depict the biliary tree. 2D and 3D views of the biliary tree can be created without the injection of contrast material. Using very fast imaging that is sensitive to…
♦ MR Angiography
MR angiograms depict the arterial anatomy of the abdomen by rapidly scanning during IV bolus injection of contrast. Thin 3D sections are obtained that show the abdominal…
♦ 3D Imaging and 3D Display of MR Images
Three-D MRI allows one to obtain very thin anatomic sections of the abdomen and liver. These images are typically…
Conclusion
This article is edited from Recent Advances in Hepatic Images by the same author. The unabridged version, with all its images and references, is available at the Apple iBooks Store. For similar articles click here.
REFERENCES
- American Cancer Society. Colorectal Cancer Facts & Figures 2014-2016. Atlanta:American Cancer Society, 2016.
- Vilarinho S, Taddei T. Therapeutic strategies for hepatocellular carcinoma: new advances and challenges. Curr Treat Options Gastroenterol. 2015 Jun;13(2):219-34.