MRI of the Liver: A Practical Guide

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.

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

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

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

FREE SHIPPING

Amazon no longer offers textbook rentals. We do!

MRI of the Liver: A Practical Guide

Summary

Author Biography

Table of Contents

Supplemental Materials