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.

(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.

In parallel MR imaging, a reduced data set in the phase encoding direction(s) of k-space is acquired to shorten acquisition time, combining the signal of several coil arrays. The spatial information related to the phased array coil elements is utilized for reducing the amount of conventional Fourier encoding.
First, low-resolution, fully Fourier-encoded reference images are required for sensitivity assessment. Parallel imaging reconstruction in the Cartesian case is efficiently performed by creating one aliased image for each array element using discrete Fourier transformation. The next step then is to create an full FOV image from the set of intermediate images. Parallel reconstruction techniques can be used to improve the image quality with increased signal to noise ratio, spatial resolution, reduced artifacts, and the temporal resolution in dynamic MRI scans.
Parallel imaging algorithms can be divided into 2 main groups:
Image reconstruction produced by each coil (reconstruction in the image domain, after Fourier transform): SENSE (Sensitivity Encoding), PILS (Partially Parallel Imaging with Localized Sensitivity), ASSET.
Reconstruction of the Fourier plane of images from the frequency signals of each coil (reconstruction in the frequency domain, before Fourier transform): GRAPPA.
Additional techniques include SMASH, SPEEDER™, IPAT (Integrated Parallel Acquisition Techniques - derived of GRAPPA a k-space based technique) and mSENSE (an image based enhanced version of SENSE).

The temporal order in which the phase encoding gradient pulses are applied. The order can be sequential, centric, reverse centric, random, etc.

The phased array coils operate typically as receive only coils. In that case, the in the MRI device implemented body coil act as the transmitter and sends the radio frequency energy to generate the excitation pulses. State-of-the-art array coil systems include the use of 4 (up to 32) coils with separate receivers. This method is often referred to as a phased array system, although the signals are not added such that the signal phase information is included. The use of phased array coils allows the decreasing of the number of signal averages, which shortens the scan time by high SNR and resolution.
High-sensitivity RF surface coils and digital processing algorithms have been developed that speed up image acquisition and reconstruction during the MRI scan.
Fast parallel imaging techniques, for example sensitivity encoding (SENSE), 'Partially Parallel Imaging with Localized Sensitivity' (PILS), Simultaneous Acquisition of Spatial Harmonics (SMASH) or Array Spatial Sensitivity Encoding Technique (ASSET) use phased array multichannel coils to further improve spatial and temporal resolution. The sensitivity profile of a phased array coil element is measured by a separate low resolution 3D acquisition over the entire field of view in the case of a SENSE acquisition. For an mSENSE measurement, a self-calibration acquires some of the missing lines in the center of the k-space.
Also called linear array coil or synergy surface coil.

See also the related poll result: '3rd party coils are better than the original manufacturer coils'