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.

(Dy) The Dysprosium chelates are analogs of the extracellular gadolinium chelates, with substitution of the dysprosium ion for the gadolinium ion and offers advantages in application on first pass studies. The use of a dysprosium-based contrast agent (Dy-type) instead of a gadolinium-type (Gd-type) is an alternative in cases of a disrupted blood brain barrier. Because of its much smaller T1 enhancement, this contrast agent should give more accurate perfusion calculations in brain MRI.

An oral suspension of synthetic crystalline aqueous orange-flavored MRI contrast agent to enhance delineation of the bowel. Gadolite contains gadolinium, a lanthanide metal with paramagnetic characteristics. The toxic Gd is bound to become inert, along with water, inside a zeolite crystalline lattice structure. Gadolite gives a bright signal, and provides improved definition of the gastrointestinal tract from adjacent tissues.
Pharmacyclics receives an approvable letter from the FDA for Gadolite® Oral Suspension and in the United Kingdom an European marketing agreement signed with E-Z-Em, Ltd. in Dec. 1996.

Short name: Gd-DTPA, generic name: Gadopentetate dimeglumine, chemical compound: Gadolinium-diethylenetriaminepentaacetic acid
Gadopentetate dimeglumine was introduced in 1981, as the first paramagnetic MRI contrast agent (ionic). The Gd-induced dipole dipole interactions lead to shortening of T1, which results in contrast enhancement on T1 weighted images. The used metal ion Gd3+ (gadolinium) is toxic, and therefore bound in the renally excreted DTPA chelate, a very stable complex. The Gd-complex also induce susceptibility effects, as a result of the magnetic field gradient between the contrast agent in the blood vessels and the surrounding tissue, that lead to shortening of T2 or T2*.
Following intravenous administration, the compound is distributed rapidly in the extracellular space and is eliminated unchanged by glomerular filtration via the kidneys. Up to 6 hours, post injection an average of 83% of the dose is eliminated renal.

See also Magnevist®, Gadolinium and Contrast Agents.

Generic name: Liposomes, central moiety: different, contrast effect: paramagnetic, distribution: different
Liposomes are lipid containing nanoparticles, or fat molecules, surrounding a water core. Liposomes were the first type of nanoparticles created to be used as carriers for lipophilic MRI contrast agents with novel characteristics.
Liposomes loaded with gadolinium-containing chelates have potential as blood pool agents, caused by modifications of the surface (e.g., with polyethylene glycol) leading to longer blood retention times.
The incorporation of contrast agents into either the the bilayer membrane or the aqueous inner cavity is possible. These MRI contrast agents has been used to image the lymph nodes using liposomes containing Gd-DTPA as well as dextran coated iron oxide particles.
To image the liver or the hepatobiliary system, liposomes containing Gd-HPDO3A, or MnDPDP, have been tested.
Liposomes containing gadolinium were conjugated to antibodies and targeted to a specific organ system.
A method of targeting tumors with ultrasound that also uses MRI to watch the cell destroying, uses liposomes loaded with cytotoxic drugs and also with gadolinium to make them show up in MRI. As well as used as an imaging technique, ultrasound can also be used to destroy cancer cells. Once the drugs have been administered, focusing the ultrasound on the target area makes blood vessels permeable. The liposomes leak out of the blood vessel into the target area, watched by MRI, where the cytotoxic drug can then go to work.

See also Memosomes, Superparamagnetic Iron Oxide, Classifications, Characteristics, etc. and Mangafodipir Trisodium.