MRI of the Liver: A Practical Guide

by Robinson; Philip J.A.

• ISBN13: 9780824728717
• ISBN10: 0824728718
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-06-02
• Publisher: CRC Press

Summary

With 2300 radiological images dispersed throughout the text, this source provides an expansive armamentarium of case studies and examples showcasing both common and uncommon liver pathologies. Serving as an unparalleled how-to source for the investigation of liver disease by MRI, this guide demonstrates key MRI techniques currently utilized in clinical practice, as well as explaining the choice of acquisition sequences, specific parameters, and the use of contrast media for each application.

Author Biography

Philip J. A. Robinson is Professor of Clinical Radiology in the University of Leeds and Consultant Radiologist, St. James's University Hospital, Leeds, United Kingdom Janice Ward is a Consultant Radiographer in the MRI unit, Department of Clinical Radiology, St. James's University Hospital, Leeds, United Kingdom

Table of Contents

Preface	iii
Part A: Why, When, and How to Perform MRI of the Liver
An Introduction to the Role of MRI in Liver Disease	3	(6)
A Frame of Reference for Approaching Imaging in Liver Disease	4	(1)
Recent Developments in MR and Other Imaging Techniques	4	(1)
Current Choices for Imaging the Liver	4	(1)
Defining the Appropriate Clinical Applications of Liver MRI	5	(1)
References	6	(3)
Techniques for MRI of the Liver	9	(26)
Gradients, Sampling Frequency, Bandwith, and Echo Time (TE)	10	(1)
Parallel Acquisition Techniques	11	(1)
Reducing Breathing Artifact	11	(1)
Reducing Ghosting and Flow Artifacts	12	(1)
Susceptibility	12	(1)
Chemical Shift	12	(1)
Fat Suppression	13	(1)
T2-Weighted Imaging	13	(1)
Greater T2 Weighting	14	(1)
Single Shot FSE Sequences	14	(1)
STIR Sequences	15	(1)
Hybrid Sequences	15	(1)
True FISP/Balanced FFE Sequences	16	(1)
T2-Weighted GRE	16	(1)
T1-Weighted Imaging	16	(1)
Chemical Shift Imaging	16	(1)
Dynamic Gadolinium-Enhanced Imaging	17	(1)
Imaging the Non-Compliant Patient	17	(1)
Illustrative Figures	18	(1)
References	18	(17)
Contrast Agents for Liver MRI	35	(32)
Non-Specific Extra-Cellular (ECF) Gadolinium Agents	36	(2)
Tissue-Specific Contrast Agents	38	(1)
Hepatocyte Agents	38	(1)
Reticulo-Endothelial System (Kupffer Cell) Agents	39	(2)
Diagnostic Value of Contrast Agents	41	(1)
Dual Contrast MRI	42	(1)
Illustrative Figures	43	(1)
References	43	(24)
Normal and Variant Anatomy, and Imaging Artifacts	67	(24)
Hepatic Arterial Anatomy	68	(1)
Venous Anatomy	68	(1)
Segmental or Wedge-Shaped Signal Intensity Changes	69	(1)
Perfusion	69	(1)
Non-Portal Venous Inflow to the Liver	70	(2)
Lymphatic Drainage from the Liver	72	(1)
Post-Resection Anatomy	72	(1)
Artifacts from Clips, Stents, Coils, etc	72	(1)
Illustrative Figures	73	(1)
References	73	(18)
Part B: MRI for Characterizing Focal Lesions in the Non-Cirrhotic Liver
Cysts and Cyst-Like Lesions of the Liver	91	(20)
Simple Liver Cysts	92	(1)
Polycystic Disease	92	(1)
Other Developmental Cysts	92	(1)
Hydatid Cysts	93	(1)
Cystadenoma and Cystadenocarcinoma	93	(1)
Hamartoma and Biliary Adenoma	93	(1)
Differential Diagnosis of Cysts and Cyst-Like Lesions	94	(1)
Illustrative Figures	95	(1)
References	95	(16)
Solid Masses in the Non-Cirrhotic Liver	111	(64)
Focal Nodular Hyperplasia	112	(2)
Adenoma	114	(2)
Hemangioma	116	(3)
Angiomyolipoma	119	(1)
Peripheral Cholangiocarcinoma	119	(1)
Hepatocellular Carcinoma in the Non-Cirrhotic Liver	119	(1)
Fibrolamellar HCC	120	(1)
Inflammatory Pseudotumor	121	(1)
Hepatic Lymphoma	122	(1)
Miscellaneous Tumors	122	(1)
Illustrative Figures	123	(1)
References	123	(52)
Part C: MRI in Diffuse Liver Disease
Fat and the Liver	175	(18)
The Importance of Fat in Liver Disease	176	(1)
Causes of Fatty Liver	176	(1)
Imaging the Fatty Liver	176	(1)
Chemical Shift MRI	176	(1)
Geographic Distribution of Fatty Change	177	(1)
Tumors in the Fatty Liver	177	(1)
Fat in Liver Tumors	178	(1)
Illustrative Figures	178	(1)
References	178	(15)
Structural and Vascular Changes in Diffuse Liver Disease	193	(40)
Hepatitis and Liver Fibrosis	194	(1)
Iron and the Liver	195	(2)
Budd-Chiari Syndrome	197	(2)
Cirrhosis	199	(1)
Portal Hypertension and Portal Vein Thrombosis	200	(1)
Other Non-Cirrhotic Conditions Causing Disturbed Liver Architecture	201	(1)
Nodular Regenerative Hyperplasia	201	(1)
Peliosis	202	(1)
Hereditary Haemorrhagic Telangiectasia	202	(1)
Pseudo-Cirrhosis	203	(1)
Post-Necrotic Scarring	203	(1)
Illustrative Figures	203	(1)
References	203	(30)
Detecting Hepatocellular Carcinoma in the Cirrhotic Liver	233	(34)
Dysplastic Nodules	234	(1)
Dysplasia and HCC	234	(1)
Why Look for HCC in Cirrhosis?	235	(1)
Who Is at High Risk of HCC in Cirrhosis?	235	(1)
Hepatocellular Carcinoma	235	(2)
Non-Hepatocellular Focal Lesions in the Cirrhotic Liver	237	(1)
An Approach to the Differential Diagnosis of Cirrhotic Nodules	237	(3)
``Unidentified Bright Objects''	240	(1)
Illustrative Figures	241	(1)
References	241	(26)
Part D: MRI in Metastatic Disease of the Liver
Early Detection of Liver Metastases by MRI	267	(22)
The Role and Value of Imaging	268	(1)
Microscopic Metastases	268	(1)
The True Accuracy of Imaging	268	(1)
Optimizing MR Technique for Detecting Small Metastases	269	(2)
Recommendations	271	(1)
Illustrative Figures	271	(1)
References	272	(17)
Characterization of Liver Metastases	289	(38)
MR Appearances of Liver Metastases	290	(3)
Differential Diagnosis	293	(3)
Illustrative Figures	296	(1)
References	297	(30)
MRI of Liver Tumors After Treatment	327	(32)
Post-Operative Anatomy and Surgical Residues	328	(1)
Effects of Chemotherapy	329	(1)
Effects of Chemotherapy on Liver Parenchyma	329	(1)
Effects of Chemotherapy on Tumors	330	(1)
Thermal Ablation	331	(1)
Transarterial Chemo-Embolization	331	(1)
Differential Diagnosis	332	(1)
Recurrent Disease	333	(1)
Illustrative Figures	333	(1)
References	333	(26)
Part E: Liver MRI for Biliary Obstruction
Hilar Cholangiocarcinoma and Its Mimics	359	(28)
Associations	360	(1)
Anatomic Classification	360	(1)
Morphology and Modes of Spread	360	(1)
Clinical Presentation	360	(1)
Treatment	361	(1)
Objectives of Imaging	361	(1)
MRI Techniques	361	(1)
Appearances on MRI	362	(1)
Differential Diagnosis	363	(1)
Illustrative Figures	363	(1)
References	363	(24)
Some Unsolved Problems in Liver Imaging	387	(6)
Limitations in Detecting Small Volume Disease	388	(2)
Small Hypervascular Nodules in the Cirrhotic Liver	390	(1)
References	391	(2)
Index	393