1. with slides borrowed from
Portal MR Venography
with slides borrowed from
Tom Grist, MD
Jorg Debatin, MD
Qian Dong, MD
Ruth Carlos, MD
David Stafford-Johnson, MD
Mohammed Neimatallah, MD
Brian Hamilton, MD
Jochen Gaa, MD

2. Arterial phase
Portal venous phase 1

3. Coronal 3D Gd MRA of Portal Vein
Coronal Plane
Field of view = width of patient (28-32 cm)
Thick slices: 3-5 mm
Zero padding
Fast enough for breath holding
TR < 10 msec
TE < 3 msec
Partial Fourier imaging (0.5 NEX)
Adjust phase encoding steps ( )
Three phases
Arterial
Portal venous
Equilibrium

4. Mesenteric Portal Protocol
Sequence Time
Sag SSFSE 0:56
Axial T1 5:32
Axial T2 & fat sat 6:04
MRCP (optional)
Coronal 3D Gd (3 phases) 0:30 x 3
Axial 2D TOF (optional)
Total imaging time ~15-25 minutes

5. Arterial Phase
Venous Phase

6. Hepatoma
Venous Phase

7. Fig Hepatoma.
Clinical Scenario: 54-year-old female with abdominal pain and elevated AFP.
Technique: Coronal Acquisition, TR/TE/Flip = 8.1/2.1/45°, Field-of-View = 320 x 320 x 96 mm, Matrix 256 x 160 x 32, Centric Ordering of k-space, Acquisition Time = 29 s, 40 ml gadolinium contrast infused at 2 ml/s, and timed empirically.
Interpretation: A coronal MIP from the portal venous-phase of the contrast bolus shows an enhancing mass in the dome of the liver with heterogenously enhancing tumor invading the right portal vein and extending down to the confluence of right and left portal veins. The main and left portal veins are widely patent.
Diagnosis: Hepatoma with invasion of right portal vein.
Submitted by Martin R. Prince, M.D., Ph.D., Ann Arbor, MI. 7

8. Sub-Volume MIP MIP of Entire 3D Volume Axial Reformation
Main Portal Vein
SMV
Main Portal Vein
Axial Reformation

9. Sub-Volume MIP MIP of Entire 3D Volume Axial Reformation
Right Hepatic vein
Right Hepatic vein
Axial Reformation

10. Portal hypertension with varices

11. Coronal 3D Gd MRA MIP during venous phase
55 year old female prior to TIPS
Coronal 3D Gd MRA MIP during venous phase

12. Varices
Thick MIP
Thin MIP

13. Portal hypertension

14. Spleno-renal shunt
Anterior MIP
Posterior MIP

15. 3 Fig. 7.3. MRA of Portocaval Shunt.
Clinical Scenario: 42-year-old male, status post-portocaval shunt with worsening ascites.
Technique: Coronal Acquisition, TR/TE/Flip = 7.2/1.2/45°, Field-of-View = 300 x 300, Matrix = 256 x 128, Centric Ordering of k-space, Acquisition Time = 32 s, 1 NEX, 40 ml of gadolinium infused at 2 ml/s, and timed empirically.
Interpretation: Coronal subvolume MIP (a) and magnification view (b) shows a widely patent portocaval shunt (arrows). Note also gastric varices (arrowheads). During this equilibrium phase image, there is comparable enhancement of the portal vein, IVC, and aorta.
Diagnosis: Patent portocaval shunt.
Submitted by David Stafford-Johnson, M.D., Ann Arbor, MI.
Reprinted with permission from Investigative Radiology Sept. Oct 3

16. 56 year old female with abdominal pain
Minimun intensity projections
Maximum intensity projection

17. Portal and hepatic vein thrombosus
Minimun intensity projections
Maximum intensity projection

18. Acute thrombosis of portal vein (arrows) with perithrombus enhancement (arrowheads)
Maximum Intensity Projection 6

19. Cavernous Transformation8

20. 32-year-old female with abdominal pain

21. Budd Chiari

22. Fig Liver Transplant.
Clinical Scenario: Status post liver transplant with increased liver function tests.
Technique: Coronal Acquisition, TR/TE/Flip = 7/2.1/45°, Field-of-View = 320 x 320 x 84 mm, Matrix = 256 x 128 x 28, Sequential Ordering of k-space, Acquisition Time = 27 s, 40 ml gadolinium contrast infused at 2 ml/ s, and timed empirically.
Interpretation: Coronal oblique subvolume MIP shows a widely patent splenic and portal veins. There is minor narrowing (arrows) at the site of anastomosis between the native and donor portal veins.
Diagnosis: Widely patent transplant portal vein.
Submitted by Martin R. Prince, M.D., Ph.D., Ann Arbor, MI. v 4

23. IVC anastomotic narrowing

24. 13 year old female post liver and kidney transplant
Arterial Phase
Portal-venous Phase

25. Post Liver Transplant

26. Post Liver Transplant with
abcess narrowing portal vein

27. Pancreatic mass encasing celiac and spleno-portal confluence

28. Summary Normal flow: Gd not necessary Slow flow: Gd essential
Coronal 3D: thick slices & breathholding
Useful for evaluating
Varices
Shunts
Tumor encasement
Tumor invasion
Thrombosis
Cavernous transformation
Budd Chiari
Liver transplant