(TSE) A pulse sequence characterized by a series of rapidly applied 180° rephasing pulses and multiple echoes.

See Fast spin echo.

Diffusion weighted imaging can be performed similar to the phase contrast angiography sequence. The gradients must be increased in amplitude to depict the much slower motions of molecular diffusion in the body.
While a T1 weighted MRI pulse sequence is diffusion sensitive, a quantitative diffusion pulse sequence was introduced by Steijskal and Tanner. Its characteristic features are two strong symmetrical gradient lobes placed on either side of the 180° refocusing pulse in a spin echo sequence. These symmetrical gradient lobes have the sole purpose of enhancing dephasing of spins, thereby accelerating intravoxel incoherent motion (IVIM) signal loss.
Dephasing is proportional to the square of the time (diffusion time) during which the gradients are switched on and the strength of the applied gradient field. Therefore, the use of high field gradient systems with faster and more sensitive sequences, make diffusion weighting more feasible.
Areas in which the protons diffuse rapidly (swollen cells in early stroke, less restriction to diffusion) will show an increased signal when the echo is measured relative to areas in which diffusion is restricted. For increased accuracy of diffusion measurement and image enhancement, useful motion correction techniques such as navigator echo and other methods should be used. In addition to this, applying the b-value calculated by the strength and duration of motion probing gradients with a high rate of accuracy is very important.

See also Apparent Diffusion Coefficient, ADC Map, Lattice Index Map.

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.

Many MR imaging techniques using Motion Probing Gradients (MPG's) such as Spin Echo (SE), Stimulated Echo (STE), Rapid Acquisition with Relaxation Enhancement (RARE), Turbo-SE, and SE-EPI (Echo Planar Imaging for Spin echo acquisition), Spiral imaging, and Projection reconstruction including PROPELLER are applicable to DWI. In diffusion weighted imaging, 2 MPG's are required. The MPG's are put symmetrically into both sides of a 180° or 90° RF pulse to change the direction of the magnetized spin in the X-Y plane for spin echo or stimulated echo acquisition.

Quick Overview

Artifacts either by distorting the k-space trajectory (i.e. due to imperfect shimming) or as a consequence of the reduced bandwidth in the phase encode direction, commonly with EPI sequences.
While a standard spin warp-based sequence has an infinitely large bandwidth in the phase encode direction (about 1 or 2 kH), the bandwidth in EPI is related to the time between the gradient echoes (about a millisecond).
Hence even small frequency offsets can result in significant shifts of the signal in the phase encoding direction. Segmentation can introduce ghosting if there are significant difference in the amplitude and phase of the signal. This can be a particular problem when trying to acquire the segments in rapid succession.

Suitable choices of excitation schemes and/or subsequent correction can help to reduce this artifact. The signal from fat can easily be offset by a large fraction of the FOV, and must be suppressed. The effect of frequency offsets can be reduced by collecting data with more than one excitation, which effectively increases the bandwidth in the phase encoding direction.