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Hepatic Lesions: Morphologic and Functional Characterization with Multiphase Breath-hold 3D Gadolinium-enhanced MR Angiography—Initial Results

¹ Department of Radiological Diagnostics and Therapy, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany (H.H., S.O.S., M.V.K., M.E., G.v.K.)
² Department of Radiology, St Josefs Hospital, Heidelberg, Germany (P.M.).

View larger version (19K): [in a new window]   Figure 1. Graph of a representative signal intensity–time curve from data derived from the abdominal aorta adjacent to the root of the celiac trunk in one patient. Note the initial decay within the first 1–3 seconds to reach dynamic equilibrium, followed by the baseline signal intensity and a steep signal intensity increase caused by the arrival of the 1 mL of gadolinium-based contrast material injected as a test bolus. The length of the baseline signal depends on the individual circulation time and has to be determined for optimal imaging of the arterial phase in the liver to occur. The delay for the start of the 3D gadolinium-enhanced MR angiographic sequence was calculated in accordance with that in a previous report (8) as the time from the beginning of the contrast medium injection to 50% of peak enhancement. a.u. = arbitrary units.

View larger version (11K): [in a new window]   Figure 2. Diagram shows sequence timing.

View larger version (130K): [in a new window]   Figure 3a. Focal nodular hyperplasia in the right lower liver lobe that was missed on contrast-enhanced CT images obtained in a 38-year-old woman. (a) Axial T1-weighted precontrast FLASH MR image (166/5) shows that the lesion (arrow) is isointense in the periphery and mildly hypointense in the center as compared with normal liver parenchyma. (b) Axial T2-weighted image (4,200/120) shows that the lesion (arrow) is mildly hyperintense as compared with normal liver parenchyma. (c) Coronal breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase shows that the focal nodular hyperplasia (arrow) is characterized by strong and nearly homogeneous peripheral enhancement, with a central hypointense spoke-wheel pattern in the arterial phase. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the late venous phase shows that the lesion is obscured by the contrast enhancement of the surrounding liver parenchyma. In c and d, w = width and c = center.

View larger version (141K): [in a new window]   Figure 3b. Focal nodular hyperplasia in the right lower liver lobe that was missed on contrast-enhanced CT images obtained in a 38-year-old woman. (a) Axial T1-weighted precontrast FLASH MR image (166/5) shows that the lesion (arrow) is isointense in the periphery and mildly hypointense in the center as compared with normal liver parenchyma. (b) Axial T2-weighted image (4,200/120) shows that the lesion (arrow) is mildly hyperintense as compared with normal liver parenchyma. (c) Coronal breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase shows that the focal nodular hyperplasia (arrow) is characterized by strong and nearly homogeneous peripheral enhancement, with a central hypointense spoke-wheel pattern in the arterial phase. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the late venous phase shows that the lesion is obscured by the contrast enhancement of the surrounding liver parenchyma. In c and d, w = width and c = center.

View larger version (142K): [in a new window]   Figure 3c. Focal nodular hyperplasia in the right lower liver lobe that was missed on contrast-enhanced CT images obtained in a 38-year-old woman. (a) Axial T1-weighted precontrast FLASH MR image (166/5) shows that the lesion (arrow) is isointense in the periphery and mildly hypointense in the center as compared with normal liver parenchyma. (b) Axial T2-weighted image (4,200/120) shows that the lesion (arrow) is mildly hyperintense as compared with normal liver parenchyma. (c) Coronal breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase shows that the focal nodular hyperplasia (arrow) is characterized by strong and nearly homogeneous peripheral enhancement, with a central hypointense spoke-wheel pattern in the arterial phase. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the late venous phase shows that the lesion is obscured by the contrast enhancement of the surrounding liver parenchyma. In c and d, w = width and c = center.

View larger version (152K): [in a new window]   Figure 3d. Focal nodular hyperplasia in the right lower liver lobe that was missed on contrast-enhanced CT images obtained in a 38-year-old woman. (a) Axial T1-weighted precontrast FLASH MR image (166/5) shows that the lesion (arrow) is isointense in the periphery and mildly hypointense in the center as compared with normal liver parenchyma. (b) Axial T2-weighted image (4,200/120) shows that the lesion (arrow) is mildly hyperintense as compared with normal liver parenchyma. (c) Coronal breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase shows that the focal nodular hyperplasia (arrow) is characterized by strong and nearly homogeneous peripheral enhancement, with a central hypointense spoke-wheel pattern in the arterial phase. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the late venous phase shows that the lesion is obscured by the contrast enhancement of the surrounding liver parenchyma. In c and d, w = width and c = center.

View larger version (116K): [in a new window]   Figure 4a. Hemangioma in the right upper lobe of the liver in a 29-year-old woman. The spatial distribution and evolution of the contrast enhancement during the three phases are representative of the group of liver hemangiomas. (a, b) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic images (5/2) obtained in (a) the arterial phase and (b) the portal venous phase. Peripheral hyperintense nodules (arrow) had progressively become confluent by the time b was acquired. Appreciate the excellent delineation of the portal veins and the hepatic veins.

View larger version (141K): [in a new window]   Figure 4b. Hemangioma in the right upper lobe of the liver in a 29-year-old woman. The spatial distribution and evolution of the contrast enhancement during the three phases are representative of the group of liver hemangiomas. (a, b) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic images (5/2) obtained in (a) the arterial phase and (b) the portal venous phase. Peripheral hyperintense nodules (arrow) had progressively become confluent by the time b was acquired. Appreciate the excellent delineation of the portal veins and the hepatic veins.

View larger version (155K): [in a new window]   Figure 5a. Metastatic colorectal carcinoma. (a) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase shows characteristically strong and peripheral contrast enhancement of multiple suspected hepatic lesions (straight and curved arrows) with centripetal filling. (b) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the late venous phase shows peripheral washout (straight and curved arrows).

View larger version (165K): [in a new window]   Figure 5b. Metastatic colorectal carcinoma. (a) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase shows characteristically strong and peripheral contrast enhancement of multiple suspected hepatic lesions (straight and curved arrows) with centripetal filling. (b) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the late venous phase shows peripheral washout (straight and curved arrows).

View larger version (160K): [in a new window]   Figure 6a. Metastatic breast carcinoma in a woman. (a) Sagittal T2-weighted fast spin-echo MR image (4,200/120) of the liver shows no suspicious lesions. (b) Reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the early arterial phase shows two lesions (straight and curved arrows) that were histologically confirmed to be metastases from breast carcinoma. In a and b, a = anterior and h = height.

View larger version (130K): [in a new window]   Figure 6b. Metastatic breast carcinoma in a woman. (a) Sagittal T2-weighted fast spin-echo MR image (4,200/120) of the liver shows no suspicious lesions. (b) Reformatted 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the early arterial phase shows two lesions (straight and curved arrows) that were histologically confirmed to be metastases from breast carcinoma. In a and b, a = anterior and h = height.

View larger version (141K): [in a new window]   Figure 7a. Hepatocellular carcinoma in the right lower liver lobe in a 62-year-old man. (a) Axial T2-weighted fast spin-echo MR image (4,200/120) shows no suspicious lesion. (b) Sagittal T2-weighted fast spin-echo MR image (4,200/120) shows that the lower position of the right lobe of the liver (arrow) is enlarged; however, no definite suspicious lesion is seen. (c) Coronal breath-hold 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase. Due to the early and bright contrast enhancement, the suspected lesion (open arrow) becomes extremely well visible, which is characteristic of hepatocellular carcinoma. In addition, the feeding artery (solid straight arrow) can be detected. Note that the inferior vena cava has been marked with a curved arrow, as well. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) in the late venous phase shows that the lesion (open arrow) is nearly obscured by the contrast enhancement of the surrounding liver parenchyma. Note the venous drainage (solid straight arrow) into the inferior vena cava (curved arrow).

View larger version (139K): [in a new window]   Figure 7b. Hepatocellular carcinoma in the right lower liver lobe in a 62-year-old man. (a) Axial T2-weighted fast spin-echo MR image (4,200/120) shows no suspicious lesion. (b) Sagittal T2-weighted fast spin-echo MR image (4,200/120) shows that the lower position of the right lobe of the liver (arrow) is enlarged; however, no definite suspicious lesion is seen. (c) Coronal breath-hold 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase. Due to the early and bright contrast enhancement, the suspected lesion (open arrow) becomes extremely well visible, which is characteristic of hepatocellular carcinoma. In addition, the feeding artery (solid straight arrow) can be detected. Note that the inferior vena cava has been marked with a curved arrow, as well. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) in the late venous phase shows that the lesion (open arrow) is nearly obscured by the contrast enhancement of the surrounding liver parenchyma. Note the venous drainage (solid straight arrow) into the inferior vena cava (curved arrow).

View larger version (149K): [in a new window]   Figure 7c. Hepatocellular carcinoma in the right lower liver lobe in a 62-year-old man. (a) Axial T2-weighted fast spin-echo MR image (4,200/120) shows no suspicious lesion. (b) Sagittal T2-weighted fast spin-echo MR image (4,200/120) shows that the lower position of the right lobe of the liver (arrow) is enlarged; however, no definite suspicious lesion is seen. (c) Coronal breath-hold 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase. Due to the early and bright contrast enhancement, the suspected lesion (open arrow) becomes extremely well visible, which is characteristic of hepatocellular carcinoma. In addition, the feeding artery (solid straight arrow) can be detected. Note that the inferior vena cava has been marked with a curved arrow, as well. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) in the late venous phase shows that the lesion (open arrow) is nearly obscured by the contrast enhancement of the surrounding liver parenchyma. Note the venous drainage (solid straight arrow) into the inferior vena cava (curved arrow).

View larger version (167K): [in a new window]   Figure 7d. Hepatocellular carcinoma in the right lower liver lobe in a 62-year-old man. (a) Axial T2-weighted fast spin-echo MR image (4,200/120) shows no suspicious lesion. (b) Sagittal T2-weighted fast spin-echo MR image (4,200/120) shows that the lower position of the right lobe of the liver (arrow) is enlarged; however, no definite suspicious lesion is seen. (c) Coronal breath-hold 3D gadolinium-enhanced MR angiographic image (5/2) obtained in the arterial phase. Due to the early and bright contrast enhancement, the suspected lesion (open arrow) becomes extremely well visible, which is characteristic of hepatocellular carcinoma. In addition, the feeding artery (solid straight arrow) can be detected. Note that the inferior vena cava has been marked with a curved arrow, as well. (d) Breath-hold reformatted 3D gadolinium-enhanced MR angiographic image (5/2) in the late venous phase shows that the lesion (open arrow) is nearly obscured by the contrast enhancement of the surrounding liver parenchyma. Note the venous drainage (solid straight arrow) into the inferior vena cava (curved arrow).