This family of sequences uses a balanced gradient waveform. This waveform will act on any stationary spin on resonance between 2 consecutive RF pulses and return it to the same phase it had before the gradients were applied. A balanced sequence starts out with a RF pulse of 90° or less and the spins in the steady state. Prior to the next TR in the slice encoding, the phase encoding and the frequency encoding direction, gradients are balanced so their net value is zero. Now the spins are prepared to accept the next RF pulse, and their corresponding signal can become part of the new transverse magnetization. If the balanced gradients maintain the longitudinal and transverse magnetization, the result is that both T1 and T2 contrast are represented in the image.
This pulse sequence produces images with increased signal from fluid (like T2 weighted sequences), along with retaining T1 weighted tissue contrast. Balanced sequences are particularly useful in cardiac MRI. Because this form of sequence is extremely dependent on field homogeneity, it is essential to run a shimming prior the acquisition.
Usually the gray and white matter contrast is poor, making this type of sequence unsuited for brain MRI. Modifications like ramping up and down the flip angles can increase signal to noise ratio and contrast of brain tissues (suggested under the name COSMIC - Coherent Oscillatory State acquisition for the Manipulation of Image Contrast).
These sequences include e.g. Balanced Fast Field Echo (bFFE), Balanced Turbo Field Echo (bTFE), Fast Imaging with Steady Precession (TrueFISP, sometimes short TRUFI), Completely Balanced Steady State (CBASS) and Balanced SARGE (BASG).

Coherent gradient echo sequences can measure the free induction decay (FID), generated just after each excitation pulse or the echo formed prior to the next pulse. Coherent gradient echo sequences are very sensitive to magnetic field inhomogeneity. An alternative to spoiling is to incorporate residual transverse magnetization directly into the longitudinal steady state. These GRE sequences use a refocusing gradient in the phase encoding direction during the end module to maximize remaining transverse (xy) magnetization at the time when the next excitation is due, while the other two gradients are, in any case, balanced.
When the next excitation pulse is sent into the system with an opposed phase, it tilts the magnetization in the -a direction. As a result the z-magnetization is again partly tilted into the xy-plane, while the remaining xy-magnetization is tilted partly into the z-direction.
A fully refocused sequence with a properly selected and uniform f would yield higher signal, especially for tissues with long T2 relaxation times (high water content) so it is used in angiographic, myelographic or arthrographic examinations and is used for T2* weighting. The repetition time for this sequence has to be short. With short TR, coherent GE is also useable for breath hold and 3D technique. If the repetition time is about 200 msec there's no difference between spoiled or unspoiled GE. T1 weighting is better with spoiled techniques.
The common types include GRASS, FISP, FAST, and FFE.
The T2* component decreases with long TR and short TE. The T1 time is controlled by flip angle. The common TR is less than 50 ms and the common TE less than 15 ms
Other types have stronger T2 dependence but lower SNR. They include SSFP, CE-FAST, PSIF, and CE-FFE-T2.
Examples of fully refocused FID sequences are TrueFISP, bFFE and bTFE.

Fat suppression is the process of utilizing specific MRI parameters to remove the deleterious effects of fat from the resulting images , e.g. with STIR, FAT SAT sequences, water selective (PROSET WATS - water only selection, also FATS - fat only selection possible) excitation techniques, or pulse sequences based on the Dixon method.
Spin magnetization can be modulated by using special RF pulses. CHESS or its variations like SPIR, SPAIR (Spectral Selection Attenuated Inversion Recovery) and FAT SAT use frequency selective excitation pulses, which produce fat saturation.
Fat suppression techniques are nearly used in all body parts and belong to every standard MRI protocol of joints like knee, shoulder, hips, etc. Imaging of, e.g. the foot can induce bad fat suppression with SPIR/FAT SAT due to the asymmetric volume of this body part. The volume of the foot alters the magnetic field to a different degree than the smaller volume of the lower leg affecting the protons there. There is only a small band of tissue where the fat protons are precessing at the frequency expected, resulting in frequency selective fat saturation working only in that area. This can be corrected by volume shimming or creating a more symmetrical volume being imaged with water bags.
Even with their longer scan time and motion sensitivity, STIR (short T1/tau inversion recovery) sequences are often the better choice to suppress fat. STIR images are also preferred because of the decreased sensitivity to field inhomogeneities, permitting larger fields of views when compared to fat suppressed images and the ability to image away from the isocenter.
See also Knee MRI.
Sequences based on Dixon turbo spin echo (fast spin echo) can deliver a significant better fat suppression than conventional TSE/FSE imaging.

Quantification relies on inflow effects or on spin phase effects and therefore on quantifying the phase shifts of moving tissues relative to stationary tissues.
With properly designed pulse sequences (see phase contrast sequence) the pixel by pixel phase represents a map of the velocities measured in the imaging plane. Spin phase effect-based flow quantification schemes use pulse sequences specifically designed so that the phase angle in a pixel obtained upon measuring the signal is proportional to the velocity. As the relation of the phase angle to the velocity is defined by the gradient amplitudes and the gradient switch-on times, which are known, velocity can be determined quantitatively on a pixel-by-pixel basis. Once, this velocity is known, the flow in a vessel can be determined by multiplying the pixel area with the pixel velocity. Summing this quantity for all pixels inside a vessel results in a flow volume, which is measured, e.g. in ml/sec.
Flow related enhancement-based flow quantification techniques (entry phenomena) work because spins in a section perpendicular to the vessel of interest are labeled with some radio frequency RF pulse. Positional readout of the tagged spins some time T later will show the distance D they have traveled.
For constant flow, the velocity v is obtained by dividing the distance D by the time T : v = D/T. Variations of this basic principle have been proposed to measure flow, but the standard methods to measure velocity and flow use the spin phase effect.
Cardiac MRI sequences are used to encode images with velocity information. These pulse sequences permit quantification of flow-related physiologic data, such as blood flow in the aorta or pulmonary arteries and the peak velocity across stenotic valves.

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.