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.

Lumirem® belongs to the negative oral contrast agents (same as GastroMARK®, another brand name for ferumoxsil). Lumirem® is used to distinguish the loops of the bowel from other abdominal structures and physiology. When Lumirem® is ingested, it flows through and darkens the stomach and the small intestine in 30 to 45 minutes. By more clearly identifying the intestinal loops, Lumirem® improves visualization of adjacent abdominal tissues such as the pancreas.
Additionally, in Europe Lumirem® is approved for rectal administration to delineate the lower intestinal system.

Lung imaging is furthermore a challenge in MRI because of the predominance of air within the lungs and associated susceptibility issues as well as low signal to noise of the inflated lung parenchyma. Cardiac and respiratory triggered or breath hold sequences allow diagnostic imaging, however a comparable image quality with computed tomography is still difficult to achieve.
Assumptions for lung MRI:
The current trends in MRI are the use of new imaging technologies and increasingly powerful magnetic fields. Among these technologies are parallel imaging techniques as well as ventilation agents like hyperpolarized helium for the use as an inert inhalational contrast agent to study lung ventilation properties. With hyperpolarized gases clear images of the lungs can be obtained without using a large magnetic field (see also back projection imaging). Single shot sequences (e.g. TSE or Half Fourier Acquisition Single Shot Turbo Spin Echo HASTE) used in lung MR imaging benefits from parallel imaging techniques due to reduced relaxation time effects during the echo train and therefore reduced image blurring as well as reduced motion artifacts.
In the future, more effective contrast agents may provide an alternative solution to the need for high field MRI. Dynamic contrast enhanced MRI perfusion has demonstrated a potential in the diagnosis of pulmonary embolism or to characterize lung cancer and mediastinal tumors. 3D contrast enhanced magnetic resonance angiography of the thoracic vessel.

See also the related poll result: 'MRI will have replaced 50% of x-ray exams by'

(MTC) This MRI method increases the contrast by removing a portion of the total signal in tissue. An off resonance radio frequency (RF) pulse saturates macromolecular protons to make them invisible (caused by their ultra-short T2* relaxation times). The MRI signal from semi-solid tissue like brain parenchyma is reduced, and the signal from a more fluid component like blood is retained.
E.g., saturation of broad spectral lines may produce decreases in intensity of lines not directly saturated, through exchange of magnetization between the corresponding states; more closely coupled states will show a greater resulting intensity change. Magnetization transfer techniques make demyelinated brain or spine lesions (as seen e.g. in multiple sclerosis) better visible on T2 weighted images as well as on gadolinium contrast enhanced T1 weighted images.
Off resonance makes use of a selection gradient during an off resonance MTC pulse. The gradient has a negative offset frequency on the arterial side of the imaging volume (caudally more off resonant and cranially less off resonant). The net effect of this type of pulse is that the arterial blood outside the imaging volume will retain more of its longitudinal magnetization, with more vascular signal when it enters the imaging volume. Off resonance MTC saturates the venous blood, leaving the arterial blood untouched.
On resonance has no effect on the free water pool but will saturate the bound water pool and is the difference in T2 between the pools. Special binomial pulses are transmitted causing the magnetization of the free protons to remain unchanged. The z-magnetization returns to its original value. The spins of the bound pool with a short T2 experience decay, resulting in a destroyed magnetization after the on resonance pulse.

See also Magnetization Transfer.

(PRESTO) PRESTO is a 3 dimensional ultrafast gradient echo sequence that combines the whole brain coverage with T2* weighted imaging. PRESTO is useful for BOLD and perfusion imaging studies. In combination with parallel imaging techniques, PRESTO provides higher temporal resolution and more coverage compared to traditional multi slice imaging. In addition, the sensitivity to susceptibility artifacts and flow phenomena is reduced, compared with EPI techniques, enabling MRI scans throughout the brain including the skull base.

See also T2 Star.