Contrast is the relative difference of signal intensities in two adjacent regions of an image.
Due to the T1 and T2 relaxation properties in magnetic resonance imaging, differentiation between various tissues in the body is possible. Tissue contrast is affected by not only the T1 and T2 values of specific tissues, but also the differences in the magnetic field strength, temperature changes, and many other factors. Good tissue contrast relies on optimal selection of appropriate pulse sequences (spin echo, inversion recovery, gradient echo, turbo sequences and slice profile).
Important pulse sequence parameters are TR (repetition time), TE (time to echo or echo time), TI (time for inversion or inversion time) and flip angle. They are associated with such parameters as proton density and T1 or T2 relaxation times. The values of these parameters are influenced differently by different tissues and by healthy and diseased sections of the same tissue.
For the T1 weighting it is important to select a correct TR or TI. T2 weighted images depend on a correct choice of the TE. Tissues vary in their T1 and T2 times, which are manipulated in MRI by selection of TR, TI, and TE, respectively. Flip angles mainly affect the strength of the signal measured, but also affect the TR/TI/TE parameters.
Conditions necessary to produce different weighted images:
T1 Weighted Image: TR value equal or less than the tissue specific T1 time - TE value less than the tissue specific T2 time.
T2 Weighted Image: TR value much greater than the tissue specific T1 time - TE value greater or equal than the tissue specific T2 time.
Proton Density Weighted Image: TR value much greater than the tissue specific T1 time - TE value less than the tissue specific T2 time.

See also Image Contrast Characteristics, Contrast Reversal, Contrast Resolution, and Contrast to Noise Ratio.

(FLARE) Fast Low Angle Recalled Echoes is a gradient echo sequence, typically with low flip angles and refocused gradient echo.

See also Refocused Gradient Echo Sequence and Flip Angle.

(IR-FSPGR) This sequence uses an inversion pulse followed by a spoiled low flip angle and short TR gradient echo train to collect all partition data. The 3D-IR-FSPGR uses centric ordering of Gz. The selected TI is also the effective TI. The centric reordering strategy can lead to image blurring if a steady state is not achieved quickly with low flip angles (less than 20°).

(GEMS) This pulse sequence uses a changeable flip angle instead of a 90° pulse and a gradient instead of a RF pulse to rephase the FID.
T2*, T1 weighted and proton density images can be acquired. The flip angle in combination with the TR determines the T1 weighting and the TE controls the amount of dephasing. To minimize T2* the echo time should be short.

See also Gradient Echo Sequence.

Liver imaging can be performed with sonography, computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound is, caused by the easy access, still the first-line imaging method of choice; CT and MRI are applied whenever ultrasound imaging yields vague results. Indications are the characterization of metastases and primary liver tumors e.g., benign lesions such as focal nodular hyperplasia (FNH), adenoma, hemangioma and malignant lesions (cancer) such as hepatocellular carcinomas (HCC). The decision, which medical imaging modality is more suitable, MRI or CT, is dependent on the different factors. CT is less costly and more widely available; modern multislice scanners provide high spatial resolution and short scan times but has the disadvantage of radiation exposure.
With the introduction of high performance MR systems and advanced sequences the image quality of MRI for the liver has gained substantially. Fast spin echo or single shot techniques, often combined with fat suppression, are the most common T2 weighted sequences used in liver MRI procedures. Spoiled gradient echo sequences are used as ideal T1 weighted sequences for evaluating of the liver. The repetition time (TR) can be sufficiently long to acquire enough sections covering the entire liver in one pass, and to provide good signal to noise. The TE should be the shortest in phase echo time (TE), which provides strong T1 weighting, minimizes magnetic susceptibility effects, and permits acquisition within one breath hold to cover the whole liver. A flip angle of 80° provides good T1 weighting and less of power deposition and tissue saturation than a larger flip angle that would provide comparable T1 weighting.
Liver MRI is very dependent on the administration of contrast agents, especially when detection and characterization of focal lesions are the issues. Liver MRI combined with MRCP is useful to evaluate patients with hepatic and biliary disease.
Gadolinium chelates are typical non-specific extracellular agents diffusing rapidly to the extravascular space of tissues being cleared by glomerular filtration at the kidney. These characteristics are somewhat problematic when a large organ with a huge interstitial space like the liver is imaged. These agents provide a small temporal imaging window (seconds), after which they begin to diffuse to the interstitial space not only of healthy liver cells but also of lesions, reducing the contrast gradient necessary for easy lesion detection. Dynamic MRI with multiple phases after i.v. contrast media (Gd chelates), with arterial, portal and late phase images (similar to CT) provides additional information.
An additional advantage of MRI is the availability of liver-specific contrast agents (see also Hepatobiliary Contrast Agents). Gd-EOB-DTPA (gadoxetate disodium, Gadolinium ethoxybenzyl dimeglumine, EOVIST Injection, brand name in other countries is Primovist) is a gadolinium-based MRI contrast agent approved by the FDA for the detection and characterization of known or suspected focal liver lesions.
Gd-EOB-DTPA provides dynamic phases after intravenous injection, similarly to non-specific gadolinium chelates, and distributes into the hepatocytes and bile ducts during the hepatobiliary phase. It has up to 50% hepatobiliary excretion in the normal liver.
Since ferumoxides are not eliminated by the kidney, they possess long plasmatic half-lives, allowing circulation for several minutes in the vascular space. The uptake process is dependent on the total size of the particle being quicker for larger particles with a size of the range of 150 nm (called superparamagnetic iron oxide). The smaller ones, possessing a total particle size in the order of 30 nm, are called ultrasmall superparamagnetic iron oxide particles and they suffer a slower uptake by RES cells. Intracellular contrast agents used in liver MRI are primarily targeted to the normal liver parenchyma and not to pathological cells. Currently, iron oxide based MRI contrast agents are not marketed.
Beyond contrast enhanced MRI, the detection of fatty liver disease and iron overload has clinical significance due to the potential for evolution into cirrhosis and hepatocellular carcinoma. Imaging-based liver fat quantification (see also Dixon) provides noninvasively information about fat metabolism; chemical shift imaging or T2*-weighted imaging allow the quantification of hepatic iron concentration.

See also Abdominal Imaging, Primovistâ„¢, Liver Acquisition with Volume Acquisition (LAVA), T1W High Resolution Isotropic Volume Examination (THRIVE) and Bolus Injection.

For Ultrasound Imaging (USI) see Liver Sonography at Medical-Ultrasound-Imaging.com.