LIVER MRI Kyung Hee University Hospital Hyoung Jung Kim Department of Diagnostic Radiology, Kyung Hee University Hospital

MRI signal: Concept of Relaxation RF pulse T1 relaxation TR Tissue의 T1 value T2 relaxation TE Tissue의 T2 value

Routine Sequence of liver MRI in KMC Indications of Liver MRI Lesion characterization T2WI vs. heavily T2WI T1WI Dynamic enhanced image liver-specific contrast agent Lesion detection too small to characterize Limitations of liver MRI 3T MRI in hepatobiliary and GI tract

Routine Sequence of liver MRI in KMC

Pre Arterial Portal Delay

Indications of Liver MRI Lesion characterization T2WI vs. heavily T2WI

Ref) 1. Hayashi M, Matsui O, Ueda K, et al. Correlation between the blood supply and grade of malignancy of hepatocellular nodules associaed with liver cirrhosis: evaluation by during intraarterial injection of contrast medium. AJR 1999; 172:969-976. 2. Krinsky GA, Lee VS. MR imaging of cirrhotic nodules. Abdom Imaging 2000;25:471-482.

FU after 6 months

Indications of Liver MRI Lesion characterization T1WI Out of phase In phase

Indications of Liver MRI. Lesion characterization Indications of Liver MRI Lesion characterization Dynamic enhanced image

Indications of Liver MRI. Lesion characterization Indications of Liver MRI Lesion characterization Liver-specific contrast agent

- Liver MRI is helpful in the characterization of hepatic lesions. Take home message #1: - Liver MRI is helpful in the characterization of hepatic lesions. T2WI & Heavily T2WI: cyst, hemangioma vs. HCC, meta Dual echo T1WI: focal fatty infiltration or sparing, adenoma Liver specific contrast agent: FNH Take home message #2: - Liver MRI may show more prominent tumor enhancement than dynamic CT. Partial lipiodolized HCC

Indications of Liver MRI Lesion detection too small to characterize

Indications of Liver MRI. Lesion detection Indications of Liver MRI Lesion detection Liver-specific contrast agent Post 10 min T1

- Hepatic metastasis is a good candidate for liver MRI. Take home message #3: - Hepatic metastasis is a good candidate for liver MRI. ; candidate of tumorectomy for the known hepatic metastases ; increased tumor marker and no evidence recurrence on CT ; liver specific contrast agent may be helpful in the detection of small hepatic metastasis.

Limitations of Liver MRI - I

Focal eosinophilic necrosis_gross specimen

Limitations of Liver MRI - II 20060503 20060919 Post 10 min T2

20060503 20060919

3T MRI in hepatobiliary and GI tract - 3D THRIVE

Sagittal Coronal Axial - 3D VISTA(Volumetric ISotropic T2W Acquisition) VISTA Sagittal Coronal Axial

- DWI (diffusion weighted image)

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