Can a Multiphasic Contrast-Enhanced Three-Dimensional Fast Spoiled Gradient-Recalled Echo Sequence Be Sufficient for Liver MR Imaging?
Curtis H. Coulam1,2,
Frandics P. Chan1 and
King C. P. Li1,3
1
Department of Radiology, Stanford University School of Medicine, 300 Pasteur
Dr., Rm. H1307, Stanford, CA 94305
2
Present address: Department of Radiology, St. Alphonsus Regional Medical
Center, 1055 N. Curtis Rd., Boise, ID 837060.
3
Present address: Diagnostic Radiology, National Institutes of Health, Bldg.
10, Room 1C660, 10 Center Dr., MSC 1182, Bethesda, MD 20892-1182.
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Fig. 1. —Bar graph shows sensitivity of different pulse sequences in
focal hepatic lesion detection. [UNK] = all lesions (n = 114); 
= noncystic lesions (n = 60); T1 = T1-weighted sequence; T2 =
T2-weighted sequence; 3D = three-dimensional fast spoiled gradient-recalled
echo sequence.
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Fig. 2. —Bar graph shows specificity of different pulse sequence(s).
Specificity refers to probability that pulse sequence(s) will correctly
indicate no focal hepatic lesion(s) in liver in which none is present. Number
of livers examined = 23. T1 = T1-weighted sequence; T2 = T2-weighted sequence;
3D = three-dimensional fast spoiled gradient-recalled echo sequence.
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Fig. 3A. —12-month-old female infant with multiple congenital
abnormalities, including diaphragmatic hernia that had been repaired. Eight
small hypervascular liver masses were identified on dynamic contrast-enhanced
three-dimensional (3D) fast spoiled gradient-recalled echo MR Imaging. Only
five of eight were identified with T1- and T2-weighted sequence images. Nature
of these masses was indeterminate. Liver dome lesion (arrow, A
and B) is seen on both coronal portal venous phase 3D sequence
(A) and axial fat-suppressed (spatial-spectral) fast spin-echo
T2-weighted sequence (B) images.
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Fig. 3B. —12-month-old female infant with multiple congenital
abnormalities, including diaphragmatic hernia that had been repaired. Eight
small hypervascular liver masses were identified on dynamic contrast-enhanced
three-dimensional (3D) fast spoiled gradient-recalled echo MR Imaging. Only
five of eight were identified with T1- and T2-weighted sequence images. Nature
of these masses was indeterminate. Liver dome lesion (arrow, A
and B) is seen on both coronal portal venous phase 3D sequence
(A) and axial fat-suppressed (spatial-spectral) fast spin-echo
T2-weighted sequence (B) images.
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Fig. 3C. —12-month-old female infant with multiple congenital
abnormalities, including diaphragmatic hernia that had been repaired. Eight
small hypervascular liver masses were identified on dynamic contrast-enhanced
three-dimensional (3D) fast spoiled gradient-recalled echo MR Imaging. Only
five of eight were identified with T1- and T2-weighted sequence images. Nature
of these masses was indeterminate. Right lobe lesion (arrowhead,
C and D) located inferior to area in A and B is
well visualized on coronal 3D sequence image (C) but was seen only in
retrospect on T2-weighted sequence image (D).
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Fig. 3D. —12-month-old female infant with multiple congenital
abnormalities, including diaphragmatic hernia that had been repaired. Eight
small hypervascular liver masses were identified on dynamic contrast-enhanced
three-dimensional (3D) fast spoiled gradient-recalled echo MR Imaging. Only
five of eight were identified with T1- and T2-weighted sequence images. Nature
of these masses was indeterminate. Right lobe lesion (arrowhead,
C and D) located inferior to area in A and B is
well visualized on coronal 3D sequence image (C) but was seen only in
retrospect on T2-weighted sequence image (D).
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Fig. 4A. —76-year-old man with known cholangiocarcinoma (Klatskin's
tumor). MR images were obtained to evaluate extent of disease. Porta hepatis
mass (not shown) was causing biliary ductal obstruction. Mass measuring 3 cm
located in medial aspect of right hepatic lobe was well visualized only on
axial contrast-enhanced three-dimensional fast spoiled gradient-recalled echo
image.
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Fig. 4B. —76-year-old man with known cholangiocarcinoma (Klatskin's
tumor). MR images were obtained to evaluate extent of disease. Porta hepatis
mass (not shown) was causing biliary ductal obstruction. Prospectively, this
mass was not identified on axial spin-echo T1-weighted sequence image
(B) or axial fat-suppressed (spatial-spectral) fast spin-echo
T2-weighted sequence image (C) because of poor lesion-to-liver
contrast.
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Fig. 4C. —76-year-old man with known cholangiocarcinoma (Klatskin's
tumor). MR images were obtained to evaluate extent of disease. Porta hepatis
mass (not shown) was causing biliary ductal obstruction. Prospectively, this
mass was not identified on axial spin-echo T1-weighted sequence image
(B) or axial fat-suppressed (spatial-spectral) fast spin-echo
T2-weighted sequence image (C) because of poor lesion-to-liver
contrast.
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Fig. 5A. —71-year-old woman with right heart failure was found to have
right atrial mass on echocardiography. CT scan obtained at outside institution
showed right atrial and inferior vena cava mass but no definite evidence of
primary organ of origin. Note tumor thrombus within inferior vena cava
(straight arrows, A, B, and D) and right artery
(curved arrows, C and D). Liver dome lesion was missed
prospectively on axial spin-echo T1-weighted MR image because of lack of
lesion conspicuity.
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Fig. 5B. —71-year-old woman with right heart failure was found to have
right atrial mass on echocardiography. CT scan obtained at outside institution
showed right atrial and inferior vena cava mass but no definite evidence of
primary organ of origin. Note tumor thrombus within inferior vena cava
(straight arrows, A, B, and D) and right artery
(curved arrows, C and D). Lesion cannot be discerned on
axial fat-suppressed (spatial-spectral) fast spin-echo T2-weighted MR image
because of ghosting artifact from high-signal-intensity ascites.
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Fig. 5C. —71-year-old woman with right heart failure was found to have
right atrial mass on echocardiography. CT scan obtained at outside institution
showed right atrial and inferior vena cava mass but no definite evidence of
primary organ of origin. Note tumor thrombus within inferior vena cava
(straight arrows, A, B, and D) and right artery
(curved arrows, C and D). Hypervascular liver lesion
(arrowheads) is clearly depicted on arterial phase of coronal
contrast-enhanced three-dimensional fast spoiled gradient-recalled echo MR
image (C) and as hypointense mass (arrowheads) on portal
venous phase MR image (D).
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Fig. 5D. —71-year-old woman with right heart failure was found to have
right atrial mass on echocardiography. CT scan obtained at outside institution
showed right atrial and inferior vena cava mass but no definite evidence of
primary organ of origin. Note tumor thrombus within inferior vena cava
(straight arrows, A, B, and D) and right artery
(curved arrows, C and D). Hypervascular liver lesion
(arrowheads) is clearly depicted on arterial phase of coronal
contrast-enhanced three-dimensional fast spoiled gradient-recalled echo MR
image (C) and as hypointense mass (arrowheads) on portal
venous phase MR image (D).
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Fig. 6A. —Liver cysts in 50 -year-old woman with history of multiple
myeloma. Both unenhanced coronal three-dimensional (3D) fast spoiled
gradient-recalled echo MR image (A) and contrast-enhanced coronal
portal venous phase 3D gradient-recalled echo MR image (B) clearly
reveals 1-cm cyst (arrow) in liver dome. Image quality of 3D
sequences in this patient were rated as 3 on 5-point scale (sub-optimal)
because of moderate signal-to-noise ratio (body coil used for signal
reception) and motion artifact. These issues can be addressed with use of
surface coils and improved gradient performance.
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Fig. 6B. —Liver cysts in 50 -year-old woman with history of multiple
myeloma. Both unenhanced coronal three-dimensional (3D) fast spoiled
gradient-recalled echo MR image (A) and contrast-enhanced coronal
portal venous phase 3D gradient-recalled echo MR image (B) clearly
reveals 1-cm cyst (arrow) in liver dome. Image quality of 3D
sequences in this patient were rated as 3 on 5-point scale (sub-optimal)
because of moderate signal-to-noise ratio (body coil used for signal
reception) and motion artifact. These issues can be addressed with use of
surface coils and improved gradient performance.
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Fig. 6C. —Liver cysts in 50 -year-old woman with history of multiple
myeloma. Axial fat-suppressed (spatial-spectral) fast spin-echo T2-weighted MR
images. Cyst (arrow) visualized on A and B is also
visible on C. Additional tiny cysts (arrowheads, C and
D) seen on T2-weighted sequence images were not detected on 3D sequence
images. Better conspicuity of small cysts on T2-weighted imaging results from
excellent lesion-to-liver contrast.
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Fig. 6D. —Liver cysts in 50 -year-old woman with history of multiple
myeloma. Axial fat-suppressed (spatial-spectral) fast spin-echo T2-weighted MR
images. Cyst (arrow) visualized on A and B is also
visible on C. Additional tiny cysts (arrowheads, C and
D) seen on T2-weighted sequence images were not detected on 3D sequence
images. Better conspicuity of small cysts on T2-weighted imaging results from
excellent lesion-to-liver contrast.
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Copyright © 2002 by the American Roentgen Ray Society.
