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.

Contrast agents are chemical substances introduced to the anatomical or functional region being imaged, to increase the differences between different tissues or between normal and abnormal tissue, by altering the relaxation times. MRI contrast agents are classified by the different changes in relaxation times after their injection.
The design objectives for the next generation of MR contrast agents will likely focus on prolonging intravascular retention, improving tissue targeting, and accessing new contrast mechanisms. Macromolecular paramagnetic contrast agents are being tested worldwide. Preclinical data shows that these agents demonstrate great promise for improving the quality of MR angiography, and in quantificating capillary permeability and myocardial perfusion.
Ultrasmall superparamagnetic iron oxide (USPIO) particles have been evaluated in multicenter clinical trials for lymph node MR imaging and MR angiography, with the clinical impact under discussion. In addition, a wide variety of vector and carrier molecules, including antibodies, peptides, proteins, polysaccharides, liposomes, and cells have been developed to deliver magnetic labels to specific sites. Technical advances in MR imaging will further increase the efficacy and necessity of tissue-specific MRI contrast agents.

See also Adverse Reaction and Nephrogenic Systemic Fibrosis.

See also the related poll result: 'The development of contrast agents in MRI is'

(FLASH) A fast sequence producing signals called gradient echo with low flip angles. FLASH sequences are modifications, which incorporate or remove the effects of transverse coherence respectively.
FLASH uses a semi-random spoiler gradient after each echo to spoil the steady state (to destroy any remaining transverse magnetization) by causing a spatially dependent phase shift. The transverse steady state is spoiled but the longitudinal steady state depends on the T1 values and the flip angle. Extremely short TR times are possible, as a result the sequence provides a mechanism for gaining extremely high T1 contrast by imaging with TR times as brief as 20 to 30 msec while retaining reasonable signal levels. It is important to keep the TE as short as possible to suppress susceptibility artifacts.
The T1 contrast depends on the TR as well as on flip angle, with short TE.
Small flip angles and short TR results in proton density, and long TR in T2* weighting.
With large flip angles and short TR result T1 weighted images.

TR and flip angle adjustment:
TR 3000 ms, Flip Angle 90°
TR 1500 ms, Flip Angle 45°
TR 700 ms, Flip Angle 25°
TR 125 ms, Flip Angle 10°

The apparent ability to trade TR against flip angle for purposes of contrast and the variation in SNR as the scan time (TR) is reduced.

See also Gradient Echo Sequence.

(IR) The inversion recovery pulse sequence produces signals, which represent the longitudinal magnetization existing after the application of a 180° radio frequency pulse that rotates the magnetization Mz into the negative plane. After an inversion time (TI - time between the starting 180° pulse and the following 90° pulse), a further 90° RF pulse tilts some or all of the z-magnetization into the xy-plane, where the signal is usually rephased with a 180° pulse as in the spin echo sequence. During the initial time period, various tissues relax with their intrinsic T1 relaxation time.
In the pulse sequence timing diagram, the basic inversion recovery sequence is illustrated. The 180° inversion pulse is attached prior to the 90° excitation pulse of a spin echo acquisition. See also the Pulse Sequence Timing Diagram. There you will find a description of the components.
The inversion recovery sequence has the advantage, that it can provide very strong contrast between tissues having different T1 relaxation times or to suppress tissues like fluid or fat. But the disadvantage is, that the additional inversion radio frequency RF pulse makes this sequence less time efficient than the other pulse sequences.

Contrast values:
PD weighted: TE: 10-20 ms, TR: 2000 ms, TI: 1800 ms
T1 weighted: TE: 10-20 ms, TR: 2000 ms, TI: 400-800 ms
T2 weighted: TE: 70 ms, TR: 2000 ms, TI: 400-800 ms

See also Inversion Recovery, Short T1 Inversion Recovery, Fluid Attenuation Inversion Recovery, and Acronyms for 'Inversion Recovery Sequence' from different manufacturers.

(T1) The spin lattice relaxation time (also called longitudinal relaxation time and T1 Time) is a spin property, whereby the value changes between different tissues. By the spin lattice relaxation process, the longitudinal magnetization Mz achieve the equilibrium value Mz0. The T1 time constant is an exponential approach toward Mz0.
The equation for the magnetization at a time t will be (if at t=0 the longitudinal magnetization is Mz0):
Mz(t) = M0+(Mz (0) - Mz0) exp(t/T1)