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T2-weighted MR Imaging in the Assessment of Cirrhotic Liver¹

¹ From the Departments of Radiology (H.K.H., I.S., H.V.N., R.C.C., W.J.W., I.R.F.) and Biostatistics (T.D.J.), University of Michigan Hospitals, 1500 E Medical Center Dr, MRI B2B311, Ann Arbor, MI 48109-0030. From the 2001 RSNA scientific assembly. Received July 26, 2002; revision requested September 10; final revision received July 3, 2003; accepted July 31. Address correspondence to H.K.H. (e-mail: hhussain@umich.edu).

View larger version (15K): [in a new window]   Figure 1.  Power curve for correlated ROC analysis. Horizontal axis represents the difference in areas between the two ROC curves. Vertical axis is the power.

View larger version (110K): [in a new window]   Figure 2a.  MR images show a 4-cm HCC in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (170/4.2 with 70° flip angle). Tumor (arrow) is hyperintense compared with liver parenchyma and has a central area of hypointensity, probably a central scar. (b) Transverse T2-weighted fast SE image (4,000/94 with respiratory triggering and fat suppression). Reduced lesion conspicuity (arrow) on this image is predominantly caused by heterogeneity of surrounding liver parenchyma and isointensity of the lesion compared with surrounding heterogeneous parenchyma. Note the hyperintense central scar. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle) shows marked enhancement of the lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor. Central scar remains unenhanced.

View larger version (115K): [in a new window]   Figure 2b.  MR images show a 4-cm HCC in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (170/4.2 with 70° flip angle). Tumor (arrow) is hyperintense compared with liver parenchyma and has a central area of hypointensity, probably a central scar. (b) Transverse T2-weighted fast SE image (4,000/94 with respiratory triggering and fat suppression). Reduced lesion conspicuity (arrow) on this image is predominantly caused by heterogeneity of surrounding liver parenchyma and isointensity of the lesion compared with surrounding heterogeneous parenchyma. Note the hyperintense central scar. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle) shows marked enhancement of the lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor. Central scar remains unenhanced.

View larger version (129K): [in a new window]   Figure 2c.  MR images show a 4-cm HCC in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (170/4.2 with 70° flip angle). Tumor (arrow) is hyperintense compared with liver parenchyma and has a central area of hypointensity, probably a central scar. (b) Transverse T2-weighted fast SE image (4,000/94 with respiratory triggering and fat suppression). Reduced lesion conspicuity (arrow) on this image is predominantly caused by heterogeneity of surrounding liver parenchyma and isointensity of the lesion compared with surrounding heterogeneous parenchyma. Note the hyperintense central scar. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle) shows marked enhancement of the lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor. Central scar remains unenhanced.

View larger version (135K): [in a new window]   Figure 2d.  MR images show a 4-cm HCC in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (170/4.2 with 70° flip angle). Tumor (arrow) is hyperintense compared with liver parenchyma and has a central area of hypointensity, probably a central scar. (b) Transverse T2-weighted fast SE image (4,000/94 with respiratory triggering and fat suppression). Reduced lesion conspicuity (arrow) on this image is predominantly caused by heterogeneity of surrounding liver parenchyma and isointensity of the lesion compared with surrounding heterogeneous parenchyma. Note the hyperintense central scar. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle) shows marked enhancement of the lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6/1.8 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor. Central scar remains unenhanced.

View larger version (112K): [in a new window]   Figure 3a.  MR images show 5-cm HCC in the liver dome. (a) Transverse T1-weighted SPGR image (185/4.2 with 70° flip angle). Lesion is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,255/96 with respiratory triggering and fat suppression). No definite focal lesion is apparent. Reduced lesion conspicuity on this image is predominantly caused by isointensity of the lesion with heterogeneous liver parenchyma and artifact from ascites. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle) shows heterogeneous enhancement of the large dome lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor.

View larger version (96K): [in a new window]   Figure 3b.  MR images show 5-cm HCC in the liver dome. (a) Transverse T1-weighted SPGR image (185/4.2 with 70° flip angle). Lesion is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,255/96 with respiratory triggering and fat suppression). No definite focal lesion is apparent. Reduced lesion conspicuity on this image is predominantly caused by isointensity of the lesion with heterogeneous liver parenchyma and artifact from ascites. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle) shows heterogeneous enhancement of the large dome lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor.

View larger version (151K): [in a new window]   Figure 3c.  MR images show 5-cm HCC in the liver dome. (a) Transverse T1-weighted SPGR image (185/4.2 with 70° flip angle). Lesion is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,255/96 with respiratory triggering and fat suppression). No definite focal lesion is apparent. Reduced lesion conspicuity on this image is predominantly caused by isointensity of the lesion with heterogeneous liver parenchyma and artifact from ascites. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle) shows heterogeneous enhancement of the large dome lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor.

View larger version (150K): [in a new window]   Figure 3d.  MR images show 5-cm HCC in the liver dome. (a) Transverse T1-weighted SPGR image (185/4.2 with 70° flip angle). Lesion is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,255/96 with respiratory triggering and fat suppression). No definite focal lesion is apparent. Reduced lesion conspicuity on this image is predominantly caused by isointensity of the lesion with heterogeneous liver parenchyma and artifact from ascites. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle) shows heterogeneous enhancement of the large dome lesion (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (7/1.7 with 12° flip angle). Lesion becomes hypointense compared with liver parenchyma. Note enhancing thin pseudocapsule (arrow) around the tumor.

View larger version (116K): [in a new window]   Figure 4a.  MR images show 1.5-cm regenerating nodule in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (180/4.2 with 70° flip angle). No lesion is apparent. Nodule is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,750/94 with respiratory triggering and fat suppression). Lesion (arrow) is hyperintense compared with surrounding liver parenchyma. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion enhances homogeneously (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion is no longer apparent and has becomes isointense with liver parenchyma. This lesion disappeared in subsequent follow up MR studies at 3, 6, and 9 months.

View larger version (132K): [in a new window]   Figure 4b.  MR images show 1.5-cm regenerating nodule in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (180/4.2 with 70° flip angle). No lesion is apparent. Nodule is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,750/94 with respiratory triggering and fat suppression). Lesion (arrow) is hyperintense compared with surrounding liver parenchyma. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion enhances homogeneously (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion is no longer apparent and has becomes isointense with liver parenchyma. This lesion disappeared in subsequent follow up MR studies at 3, 6, and 9 months.

View larger version (145K): [in a new window]   Figure 4c.  MR images show 1.5-cm regenerating nodule in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (180/4.2 with 70° flip angle). No lesion is apparent. Nodule is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,750/94 with respiratory triggering and fat suppression). Lesion (arrow) is hyperintense compared with surrounding liver parenchyma. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion enhances homogeneously (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion is no longer apparent and has becomes isointense with liver parenchyma. This lesion disappeared in subsequent follow up MR studies at 3, 6, and 9 months.

View larger version (144K): [in a new window]   Figure 4d.  MR images show 1.5-cm regenerating nodule in the right lobe of the liver. (a) Transverse T1-weighted SPGR image (180/4.2 with 70° flip angle). No lesion is apparent. Nodule is isointense with liver parenchyma. (b) Transverse T2-weighted fast SE image (4,750/94 with respiratory triggering and fat suppression). Lesion (arrow) is hyperintense compared with surrounding liver parenchyma. (c) Transverse arterial dominant phase contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion enhances homogeneously (arrow). (d) Transverse 2-minute delayed contrast-enhanced fat-suppressed 3D SPGR image (6.4/1.8 with 12° flip angle). Lesion is no longer apparent and has becomes isointense with liver parenchyma. This lesion disappeared in subsequent follow up MR studies at 3, 6, and 9 months.