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Technologic Advances in Abdominal MR Imaging

¹ From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02215 (M.T.K.); and the Department of Radiology, Evanston Northwestern Healthcare, Ill (R.R.E.). Received October 4, 1999; revision requested November 16; final revision received August 8, 2000; accepted August 31. Address correspondence to M.T.K. (e-mail: mkeogan@caregroup.harvard.edu).

View larger version (134K): [in a new window]   Figure 1. Coronal 3D contrast-enhanced MR angiogram (repetition time [TR] msec/echo time [TE] msec, 5/2; 40° flip angle; 40 mL gadopentetate dimeglumine) demonstrates a thrombus occluding the main portal vein (short straight arrow), with a patent superior mesenteric vein (long straight arrow) and multiple collateral vessels (curved arrow) arising from the coronary vein and communicating with the esophageal and gastric veins.

View larger version (147K): [in a new window]   Figure 2. Coronal 3D contrast-enhanced MR angiogram (5/2, 40° flip angle, 40 mL gadopentetate dimeglumine) obtained in a patient with an arteriovenous fistula (presumed congenital) demonstrates the abdominal aorta (thick arrow), superimposed tortuous splenic artery and vein (thin arrows), and early appearance of signal intensity in the portal vein (arrowhead).

View larger version (135K): [in a new window]   Figure 3a. Transverse breath-hold T1-weighted MR images (131/4.1, 80° flip angle) obtained in a patient with focal nodular hyperplasia in the left lobe of the liver. (a) Before contrast enhancement. Note the almost isointense lesion (arrowheads) with a hypointense scar (arrow). (b) Arterial phase image (approximately 25 seconds after contrast material injection). Note the early marked enhancement of the lesion with a nonenhancing central scar (arrow). (c) Portal venous phase image (approximately 60 seconds after injection). Note that the lesion is almost isointense to the liver, and note the delayed enhancement of the central scar (arrow).

View larger version (133K): [in a new window]   Figure 3b. Transverse breath-hold T1-weighted MR images (131/4.1, 80° flip angle) obtained in a patient with focal nodular hyperplasia in the left lobe of the liver. (a) Before contrast enhancement. Note the almost isointense lesion (arrowheads) with a hypointense scar (arrow). (b) Arterial phase image (approximately 25 seconds after contrast material injection). Note the early marked enhancement of the lesion with a nonenhancing central scar (arrow). (c) Portal venous phase image (approximately 60 seconds after injection). Note that the lesion is almost isointense to the liver, and note the delayed enhancement of the central scar (arrow).

View larger version (138K): [in a new window]   Figure 3c. Transverse breath-hold T1-weighted MR images (131/4.1, 80° flip angle) obtained in a patient with focal nodular hyperplasia in the left lobe of the liver. (a) Before contrast enhancement. Note the almost isointense lesion (arrowheads) with a hypointense scar (arrow). (b) Arterial phase image (approximately 25 seconds after contrast material injection). Note the early marked enhancement of the lesion with a nonenhancing central scar (arrow). (c) Portal venous phase image (approximately 60 seconds after injection). Note that the lesion is almost isointense to the liver, and note the delayed enhancement of the central scar (arrow).

View larger version (139K): [in a new window]   Figure 4. Three-dimensional T1-weighted spoiled gradient-echo MR images (4/1.6, 12° flip angle) obtained in the arterial phase after gadolinium enhancement. Top: Transverse fat-saturated breath-hold image (1-mm section thickness) demonstrates the sharp edge definition of the normal pancreas (P). Note the excellent demonstration of the celiac axis (short arrow) and common hepatic artery (long arrow). Bottom: Curved multiplanar reconstruction provides a different perspective of the pancreas and clearly shows its relationship to the normal superior mesenteric artery (arrow).

View larger version (172K): [in a new window]   Figure 5a. (a-c) Transverse 3D T1-weighted spoiled gradient-echo MR images (4/1.6, 12° flip angle) obtained in a patient with hepatocellular carcinoma. (a) Nonenhanced fat-saturated image shows excellent contrast between tumor (arrowheads) and normal liver. Note the high signal intensity (arrow) in the left-sided collecting system, which appeared after a timing bolus was administered. (b) Gadolinium-enhanced arterial phase image shows a heterogeneously enhancing tumor (arrow). (c) Portal-phase gadolinium-enhanced image shows diffuse tumor enhancement (arrow). (d) Transverse 90-second-delayed gradient-echo image (130/4.6, no fat saturation) shows delayed enhancement of the tumor capsule (arrows). (e) Maximum intensity projection reconstructed in an oblique transverse plane (1.5-cm slab) shows the arterial supply to the tumor (arrow) from the right hepatic artery (arrowheads).

View larger version (154K): [in a new window]   Figure 5b. (a-c) Transverse 3D T1-weighted spoiled gradient-echo MR images (4/1.6, 12° flip angle) obtained in a patient with hepatocellular carcinoma. (a) Nonenhanced fat-saturated image shows excellent contrast between tumor (arrowheads) and normal liver. Note the high signal intensity (arrow) in the left-sided collecting system, which appeared after a timing bolus was administered. (b) Gadolinium-enhanced arterial phase image shows a heterogeneously enhancing tumor (arrow). (c) Portal-phase gadolinium-enhanced image shows diffuse tumor enhancement (arrow). (d) Transverse 90-second-delayed gradient-echo image (130/4.6, no fat saturation) shows delayed enhancement of the tumor capsule (arrows). (e) Maximum intensity projection reconstructed in an oblique transverse plane (1.5-cm slab) shows the arterial supply to the tumor (arrow) from the right hepatic artery (arrowheads).

View larger version (154K): [in a new window]   Figure 5c. (a-c) Transverse 3D T1-weighted spoiled gradient-echo MR images (4/1.6, 12° flip angle) obtained in a patient with hepatocellular carcinoma. (a) Nonenhanced fat-saturated image shows excellent contrast between tumor (arrowheads) and normal liver. Note the high signal intensity (arrow) in the left-sided collecting system, which appeared after a timing bolus was administered. (b) Gadolinium-enhanced arterial phase image shows a heterogeneously enhancing tumor (arrow). (c) Portal-phase gadolinium-enhanced image shows diffuse tumor enhancement (arrow). (d) Transverse 90-second-delayed gradient-echo image (130/4.6, no fat saturation) shows delayed enhancement of the tumor capsule (arrows). (e) Maximum intensity projection reconstructed in an oblique transverse plane (1.5-cm slab) shows the arterial supply to the tumor (arrow) from the right hepatic artery (arrowheads).

View larger version (150K): [in a new window]   Figure 5d. (a-c) Transverse 3D T1-weighted spoiled gradient-echo MR images (4/1.6, 12° flip angle) obtained in a patient with hepatocellular carcinoma. (a) Nonenhanced fat-saturated image shows excellent contrast between tumor (arrowheads) and normal liver. Note the high signal intensity (arrow) in the left-sided collecting system, which appeared after a timing bolus was administered. (b) Gadolinium-enhanced arterial phase image shows a heterogeneously enhancing tumor (arrow). (c) Portal-phase gadolinium-enhanced image shows diffuse tumor enhancement (arrow). (d) Transverse 90-second-delayed gradient-echo image (130/4.6, no fat saturation) shows delayed enhancement of the tumor capsule (arrows). (e) Maximum intensity projection reconstructed in an oblique transverse plane (1.5-cm slab) shows the arterial supply to the tumor (arrow) from the right hepatic artery (arrowheads).

View larger version (160K): [in a new window]   Figure 5e. (a-c) Transverse 3D T1-weighted spoiled gradient-echo MR images (4/1.6, 12° flip angle) obtained in a patient with hepatocellular carcinoma. (a) Nonenhanced fat-saturated image shows excellent contrast between tumor (arrowheads) and normal liver. Note the high signal intensity (arrow) in the left-sided collecting system, which appeared after a timing bolus was administered. (b) Gadolinium-enhanced arterial phase image shows a heterogeneously enhancing tumor (arrow). (c) Portal-phase gadolinium-enhanced image shows diffuse tumor enhancement (arrow). (d) Transverse 90-second-delayed gradient-echo image (130/4.6, no fat saturation) shows delayed enhancement of the tumor capsule (arrows). (e) Maximum intensity projection reconstructed in an oblique transverse plane (1.5-cm slab) shows the arterial supply to the tumor (arrow) from the right hepatic artery (arrowheads).

View larger version (161K): [in a new window]   Figure 6. Coronal half-Fourier RARE MR image (4.4/64) obtained in an immunocompromised patient with right-sided colitis (secondary to cytomegalovirus infection) demonstrates mural thickening and intramural high signal intensity (arrow) in the ascending colon; this finding is consistent with diffuse edema. High-signal-intensity pericolonic and perihepatic fluid secondary to ascites (arrowheads) is noted.

View larger version (199K): [in a new window]   Figure 7a. (a, b) Coronal true FISP MR images (6/3, 70° flip angle) obtained in a patient with right-sided renal carcinoma. (a) Note the large tumor (thick straight solid arrow) with mixed signal intensity, area of abnormally low signal intensity that represents a thrombus in the vena cava (thin straight solid arrow), and peritumoral collateral vessels (curved arrow). Note also the normal high signal intensity in the portal vein (open arrows) and normal jejunal loops (arrowheads). (b) Anterior image demonstrates the pancreatic body (short straight arrow), high-signal-intensity normal pancreatic duct (long straight arrow), superior mesenteric vein (arrowhead), and multiple low-signal-intensity gallstones (curved arrow). (c) Transverse contrast-enhanced T1-weighted MR image (131/4.1, 80° flip angle) demonstrates the large tumor (thick arrow) and low-signal-intensity thrombus within the inferior vena cava (thin arrow).

View larger version (201K): [in a new window]   Figure 7b. (a, b) Coronal true FISP MR images (6/3, 70° flip angle) obtained in a patient with right-sided renal carcinoma. (a) Note the large tumor (thick straight solid arrow) with mixed signal intensity, area of abnormally low signal intensity that represents a thrombus in the vena cava (thin straight solid arrow), and peritumoral collateral vessels (curved arrow). Note also the normal high signal intensity in the portal vein (open arrows) and normal jejunal loops (arrowheads). (b) Anterior image demonstrates the pancreatic body (short straight arrow), high-signal-intensity normal pancreatic duct (long straight arrow), superior mesenteric vein (arrowhead), and multiple low-signal-intensity gallstones (curved arrow). (c) Transverse contrast-enhanced T1-weighted MR image (131/4.1, 80° flip angle) demonstrates the large tumor (thick arrow) and low-signal-intensity thrombus within the inferior vena cava (thin arrow).

View larger version (144K): [in a new window]   Figure 7c. (a, b) Coronal true FISP MR images (6/3, 70° flip angle) obtained in a patient with right-sided renal carcinoma. (a) Note the large tumor (thick straight solid arrow) with mixed signal intensity, area of abnormally low signal intensity that represents a thrombus in the vena cava (thin straight solid arrow), and peritumoral collateral vessels (curved arrow). Note also the normal high signal intensity in the portal vein (open arrows) and normal jejunal loops (arrowheads). (b) Anterior image demonstrates the pancreatic body (short straight arrow), high-signal-intensity normal pancreatic duct (long straight arrow), superior mesenteric vein (arrowhead), and multiple low-signal-intensity gallstones (curved arrow). (c) Transverse contrast-enhanced T1-weighted MR image (131/4.1, 80° flip angle) demonstrates the large tumor (thick arrow) and low-signal-intensity thrombus within the inferior vena cava (thin arrow).

View larger version (161K): [in a new window]   Figure 8a. Coronal RARE MR images (2,800/1,100, 20-mm section thickness). (a) Image obtained before the administration of secretin shows high signal intensity within the gallbladder (GB), stomach (S), and duodenum (D). The common bile duct (short arrow) is seen, but the main pancreatic duct is seen only in the pancreatic head (long arrow) on this thick section. The accessory duct (arrowhead) is barely seen. (b) Two minutes after the intravenous injection of secretin, the pancreatic duct (short arrows) is distended and well depicted in the pancreatic body; it inserts into the major papilla (long arrow). The accessory duct is now seen in the pancreatic head (arrowhead). Note increased fluid in the jejunum (J).

View larger version (167K): [in a new window]   Figure 8b. Coronal RARE MR images (2,800/1,100, 20-mm section thickness). (a) Image obtained before the administration of secretin shows high signal intensity within the gallbladder (GB), stomach (S), and duodenum (D). The common bile duct (short arrow) is seen, but the main pancreatic duct is seen only in the pancreatic head (long arrow) on this thick section. The accessory duct (arrowhead) is barely seen. (b) Two minutes after the intravenous injection of secretin, the pancreatic duct (short arrows) is distended and well depicted in the pancreatic body; it inserts into the major papilla (long arrow). The accessory duct is now seen in the pancreatic head (arrowhead). Note increased fluid in the jejunum (J).

View larger version (167K): [in a new window]   Figure 9. Coronal T1-weighted 3D gradient-echo MR colonogram (5/2, 40° flip angle) obtained in a patient with cecal carcinoma. Abdominal image obtained after instillation of dilute gadolinium-based contrast material reveals a low-signal-intensity mass in the cecum (arrow); cecal adenocarcinoma was confirmed at resection. Note an out-of-phase effect secondary to the short TE, which resulted in reduced conspicuity of fat. (Image courtesy of Martina M. Morrin, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.)