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.

The paramagnetic water-soluble metallofullerenes (Gd-fullerenols), which have strong T1 shortening effect, can be used as a novel core material of MRI contrast agents. Gadolinium endohedral metallofullerenes have been synthesized as polyhydroxyl forms (Gd@C82(OH)n, Gd-fullerenes) with the evaluation of their paramagnetic properties. The modification to the water-soluble forms is essential for the biomedical application of the metallofullerenes. The in vitro water proton relaxivity, R1 (the effect on 1/T1), of Gd-fullerenes is significantly higher (20-folds) than that of commercial MRI contrast agents - e.g. Gd-DTPA.

(McAb) Monoclonal antibodies are used for tumor detection and localization in nuclear medicine. In MRI, monoclonal antibodies labeled with paramagnetic or superparamagnetic particles are being studied for targeting tumors, for example contrast agent containing gadolinium attached to a targeting antibody. The antibody would bind to a specific target (e.g., a metastatic melanoma cell) while the gadolinium would increase the MRI signal. Further developments are MRI contrast agents that specifically target glucose receptors on tumor cells; coupled with the high spatial resolution of high field MRI devices, these agents have potentials to detect small tumor foci.
The monoclonal antibody manufacturers produce a wide variety of ligands, which can be directed against a multiplicity of pathologic molecular targets. MRI enhanced with targeted contrast agents can be used for molecular imaging.

Nanoparticles may be utilize as a new class of uniform, biodegradable and non-toxic superparamagnetic contrast agents (Fe3O4). The preparation process of these particles is simple, does not involve any toxic material and the yield is close to 100%. The particles are usually of varying sizes from several to several hundred nanometer. They are irregular in shape and highly light-absorbing. They have no magnetic hysteresis at ambient temperatures, which is characteristic of superparamagnetic materials. Each magnetic nanoparticle is composed of a very thin organic nucleus (5-10%) and a thick shell of magnetite.
Different techniques were established for coating these magnetite nanoparticles with several functional and biocompatible polymers. Both the coating and the magnetite production processes are controllable, so that it is possible to prepare particles with a specific size of each particle component as well as particles coated with protein ligands for tissue specific imaging applications.

Nitroxide radicals (or nitroxyl spin labels) are stable organic compounds with theoretical potential for use as a paramagnetic MRI contrast agent. Similar to gadolinium they have an unpaired electron, a property that provides enhancement in T1 based MRI, and a comparable pharmacokinetic. Depending on their structure and chemical bonding, different nitroxides formula may have the potential for use as cardiovascular imaging agents, to enhance the MR imaging on joints (e.g., dendrimer-linked nitroxides have a strong affinity for cartilage), to evaluate brain tumors and infarction, and as a contrast enhancement agent of body/abdominal NMR imaging. Nitroxides are rapidly enzymatically reduced in tissues to products that do not enhance the NMR signal, which can be a problem for MR imaging. In animal experiments with EPRI (electron paramagnetic resonance imaging), tissue redox studies show differences between tumors and normal tissues, which reflect their respective redox status consistent with the reduction/clearance of nitroxides.