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Hepatic MR Imaging with a Dynamic Contrast-enhanced Isotropic Volumetric Interpolated Breath-hold Examination: Feasibility, Reproducibility, and Technical Quality¹

¹ From the Department of Radiology, New York University Medical Center, 530 First Ave, HCC Basement-MRI, New York, NY 10016 (V.S.L., M.T.L., N.M.R., G.A.K., J.C.W.); and Siemens Medical Systems, Erlangen, Germany (G.L., D.M.T.). Received April 12, 1999; revision requested June 10; final revision received September 3; accepted September 15. Address correspondence to V.S.L. (e-mail: lee@mri.med.nyu.edu).

View larger version (99K): [in a new window]   Figure 1a. Metastatic carcinoid tumor in a 55-year-old woman. Transverse (a) nonenhanced, (b) arterial phase, and (c) portal venous phase volumetric interpolated breath-hold images (4.2/1.8, 12° flip angle) with pixel size of 2 mm or less in all dimensions demonstrate innumerable hypervascular masses (arrows in b) that are best seen on the arterial phase image. (d) Coronal maximum intensity projection image of arterial phase volumetric interpolated breath-hold acquisition (same data set as in a) shows the numerous hypervascular metastases, including a lesion (arrow) in the thoracic spine.

View larger version (95K): [in a new window]   Figure 1b. Metastatic carcinoid tumor in a 55-year-old woman. Transverse (a) nonenhanced, (b) arterial phase, and (c) portal venous phase volumetric interpolated breath-hold images (4.2/1.8, 12° flip angle) with pixel size of 2 mm or less in all dimensions demonstrate innumerable hypervascular masses (arrows in b) that are best seen on the arterial phase image. (d) Coronal maximum intensity projection image of arterial phase volumetric interpolated breath-hold acquisition (same data set as in a) shows the numerous hypervascular metastases, including a lesion (arrow) in the thoracic spine.

View larger version (102K): [in a new window]   Figure 1c. Metastatic carcinoid tumor in a 55-year-old woman. Transverse (a) nonenhanced, (b) arterial phase, and (c) portal venous phase volumetric interpolated breath-hold images (4.2/1.8, 12° flip angle) with pixel size of 2 mm or less in all dimensions demonstrate innumerable hypervascular masses (arrows in b) that are best seen on the arterial phase image. (d) Coronal maximum intensity projection image of arterial phase volumetric interpolated breath-hold acquisition (same data set as in a) shows the numerous hypervascular metastases, including a lesion (arrow) in the thoracic spine.

View larger version (117K): [in a new window]   Figure 1d. Metastatic carcinoid tumor in a 55-year-old woman. Transverse (a) nonenhanced, (b) arterial phase, and (c) portal venous phase volumetric interpolated breath-hold images (4.2/1.8, 12° flip angle) with pixel size of 2 mm or less in all dimensions demonstrate innumerable hypervascular masses (arrows in b) that are best seen on the arterial phase image. (d) Coronal maximum intensity projection image of arterial phase volumetric interpolated breath-hold acquisition (same data set as in a) shows the numerous hypervascular metastases, including a lesion (arrow) in the thoracic spine.

View larger version (23K): [in a new window]   Figure 2. Graph shows mean SI measurements (n = 50) for nonenhanced and dynamic contrast-enhanced volumetric interpolated breath-hold (VIBE) studies; error bars indicate 1 SD. The significantly higher SI of the aorta and hepatic artery (the latter is not shown) compared with hepatic parenchymal and venous enhancement during the first contrast-enhanced acquisition (Arterial Phase) illustrates the preferential arterial enhancement attained when volumetric interpolated breath-hold acquisition is timed by using a test bolus of contrast material.  = aorta,  = liver, • = portal vein,  = hepatic vein.

View larger version (130K): [in a new window]   Figure 3. Coronal projection image of a volume-rendered angiographic image obtained from an arterial phase breath-hold volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) demonstrates a Michels class VIII hepatic arterial variant—an accessory left hepatic artery (open arrows) arising from a prominent left gastric artery (black arrow) and a replaced right hepatic artery (white solid straight arrow) arising from the superior mesenteric artery (curved arrow).

View larger version (109K): [in a new window]   Figure 4a. (a) Coronal and (b) sagittal projection images of a volume-rendered angiographic image obtained from an arterial phase volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) show the right hepatic artery (black straight arrow on a and b) arising directly from the aorta, between the celiac artery (curved arrow in b) and superior mesenteric artery (white arrow in b). Mild narrowing at the origin of the right hepatic artery was also seen on source images.

View larger version (112K): [in a new window]   Figure 4b. (a) Coronal and (b) sagittal projection images of a volume-rendered angiographic image obtained from an arterial phase volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) show the right hepatic artery (black straight arrow on a and b) arising directly from the aorta, between the celiac artery (curved arrow in b) and superior mesenteric artery (white arrow in b). Mild narrowing at the origin of the right hepatic artery was also seen on source images.

View larger version (87K): [in a new window]   Figure 5. Oblique transverse reconstruction image of a volume-rendered portal venous phase volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) demonstrates a portal venous variant. The main portal vein trifurcates into the right posterior (thin arrow), right anterior (wide arrow), and left main (curved arrow) portal veins.

View larger version (114K): [in a new window]   Figure 6a. (a) Transverse image from an arterial phase volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) depicts a 1-cm mass (curved arrow) with a central nodule of enhancement (straight arrow) that was visible on transverse images and that persisted on equilibrium phase studies. This lesion was considered indeterminate at contrast-enhanced CT imaging. There is marked enhancement of the aorta (A) without visible enhancement of the hepatic veins (V), as expected for an arterial phase study in which timing of acquisition was based on a test dose of contrast material. (b) When the volumetric interpolated breath-hold examination data (same data set as a) were reformatted in the coronal plane, a distinct peripheral nodular pattern of enhancement in the lesion was seen (arrows), and hemangioma was diagnosed. The lesion was uniformly hyperintense on T2-weighted images (not shown). (c) Coronal volume-rendered angiographic image from the arterial phase 3D data set (same as in a and b) demonstrates the versatility of the volumetric interpolated breath-hold examination. When reconstructed to exclude the aorta partly, an accessory left hepatic artery (curved arrows) arising from the left gastric artery (straight arrow) is visible (Michels class V).

View larger version (118K): [in a new window]   Figure 6b. (a) Transverse image from an arterial phase volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) depicts a 1-cm mass (curved arrow) with a central nodule of enhancement (straight arrow) that was visible on transverse images and that persisted on equilibrium phase studies. This lesion was considered indeterminate at contrast-enhanced CT imaging. There is marked enhancement of the aorta (A) without visible enhancement of the hepatic veins (V), as expected for an arterial phase study in which timing of acquisition was based on a test dose of contrast material. (b) When the volumetric interpolated breath-hold examination data (same data set as a) were reformatted in the coronal plane, a distinct peripheral nodular pattern of enhancement in the lesion was seen (arrows), and hemangioma was diagnosed. The lesion was uniformly hyperintense on T2-weighted images (not shown). (c) Coronal volume-rendered angiographic image from the arterial phase 3D data set (same as in a and b) demonstrates the versatility of the volumetric interpolated breath-hold examination. When reconstructed to exclude the aorta partly, an accessory left hepatic artery (curved arrows) arising from the left gastric artery (straight arrow) is visible (Michels class V).

View larger version (122K): [in a new window]   Figure 6c. (a) Transverse image from an arterial phase volumetric interpolated breath-hold acquisition (4.2/1.8, 12° flip angle) depicts a 1-cm mass (curved arrow) with a central nodule of enhancement (straight arrow) that was visible on transverse images and that persisted on equilibrium phase studies. This lesion was considered indeterminate at contrast-enhanced CT imaging. There is marked enhancement of the aorta (A) without visible enhancement of the hepatic veins (V), as expected for an arterial phase study in which timing of acquisition was based on a test dose of contrast material. (b) When the volumetric interpolated breath-hold examination data (same data set as a) were reformatted in the coronal plane, a distinct peripheral nodular pattern of enhancement in the lesion was seen (arrows), and hemangioma was diagnosed. The lesion was uniformly hyperintense on T2-weighted images (not shown). (c) Coronal volume-rendered angiographic image from the arterial phase 3D data set (same as in a and b) demonstrates the versatility of the volumetric interpolated breath-hold examination. When reconstructed to exclude the aorta partly, an accessory left hepatic artery (curved arrows) arising from the left gastric artery (straight arrow) is visible (Michels class V).