Hepatic MRI Using the Double-Echo Chemical Shift Phase-Selective Gradient-Echo Technique
Jeong-Sik Yu1,
Jun-Gyun Park1,
Eun-Kee Jeong1,2,
Mi-Suk Park1 and
Ki Whang Kim1
1 Department of Radiology and Research Institute of Radiological Science, Yonsei
University College of Medicine, YongDong Severance Hospital, 146-92
Dogok-Dong, Gangnam-Gu, Seoul 135-720, South Korea.
2 Present address: Department of Radiology, Utah Center for Advanced Imaging
Research, University of Utah, Salt Lake City, UT 84108.
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Fig. 1A —43-year-old man with diffuse and geographic hepatic
steatosis. Signal of hepatic parenchyma is homogeneous on transverse in-phase
spoiled gradient-echo MR image (TR/TE, 140/5.3; flip angle, 90°).
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Fig. 1C —43-year-old man with diffuse and geographic hepatic
steatosis. Subtracted image of out of phase (B) from in phase
(A) shows high signal intensities of fatty deposition that correspond
to the findings in A and B and that can be distinguished from
dark signal fat-spared areas (arrowheads).
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Fig. 2A —36-year-old woman with diffuse hepatic steatosis and
metastases from pancreatic cancer. Transverse in-phase spoiled gradient-echo
MR image (TR/TE, 140/5.3; flip angle, 90°) shows multifocal hypointense
lesions (arrows).
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Fig. 2B —36-year-old woman with diffuse hepatic steatosis and
metastases from pancreatic cancer. Out-of-phase image (TE, 2.7 msec) shows
perilesional hyperintense rims (arrowheads) distinguished from
decreased signal of background fatty liver.
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Fig. 2C —36-year-old woman with diffuse hepatic steatosis and
metastases from pancreatic cancer. Areas (arrowheads) of dark signal
on subtracted image of out of phase (B) from in phase (A)
imaging includes lesions and perilesional fat-spared areas. Decreased portal
venous perfusion around metastases prevented perilesional fat deposition.
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Fig. 3A —50-year-old man with cirrhosis from chronic hepatitis B virus
and dysplastic nodule containing intracellular fat. Transverse out-of-phase
image (TR/TE, 140/2.7) shows small hypointense nodule (arrow) in left
lobe of liver. Corresponding in-phase image (not shown) (TE, 5.3 msec) showed
relatively high-signal-intensity nodule at same site.
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Fig. 3B —50-year-old man with cirrhosis from chronic hepatitis B virus
and dysplastic nodule containing intracellular fat. Nodular hyperintensity
(arrow) on subtracted image of out of phase from in phase suggests
presence of fatty component within lesion.
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Fig. 4A —55-year-old woman with cirrhosis from chronic hepatitis B
virus and small hepatocellular carcinoma containing small amount of fat.
Transverse in-phase spoiled gradient-echo MR image (TR/TE, 140/5.3 msec; flip
angle, 90°) shows hypointense nodule (arrow). Out-of-phase image
(not shown) (TE, 2.7 msec) also showed hypointensity for same nodular
lesion.
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Fig. 4B —55-year-old woman with cirrhosis from chronic hepatitis B
virus and small hepatocellular carcinoma containing small amount of fat.
Hyperintense area (arrow) on subtracted image of out of phase from in
phase suggests intralesional fatty content, which was difficult to identify by
direct comparison of in-phase and out-of-phase images.
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Fig. 4C —55-year-old woman with cirrhosis from chronic hepatitis B
virus and small hepatocellular carcinoma containing small amount of fat.
Transverse in-phase dynamic MR image during arterial phase shows lesional
enhancement (arrow) of hypervascular tumor.
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Fig. 5A —50-year-old man with cirrhosis and hepatocellular carcinoma
treated by transarterial chemoembolization 3 months earlier. Transverse
in-phase spoiled gradient-echo MR image (TR/TE, 140/5.3; flip angle, 90°)
shows hyperintense nodule (arrow). Profound signal loss was observed
on out-of-phase images (not shown), and subtracted images (not shown) showed
hyperintensity for same lesion due to lipid content of intralesional iodized
oil mixed with necrotic tissue after chemoembolization.
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Fig. 5B —50-year-old man with cirrhosis and hepatocellular carcinoma
treated by transarterial chemoembolization 3 months earlier. During arterial
dominant phase of dynamic MRI, signal intensity of nodule (arrow,
B) is still higher than that of surrounding liver on in-phase image,
mimicking hypervascular lesion; however, opposed-phase image shows low signal
intensity corresponding to nonenhancement (arrow, C) of
necrotic tumor.
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Fig. 5C —50-year-old man with cirrhosis and hepatocellular carcinoma
treated by transarterial chemoembolization 3 months earlier. During arterial
dominant phase of dynamic MRI, signal intensity of nodule (arrow,
B) is still higher than that of surrounding liver on in-phase image,
mimicking hypervascular lesion; however, opposed-phase image shows low signal
intensity corresponding to nonenhancement (arrow, C) of
necrotic tumor.
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Fig. 6A —43-year-old woman with benign lipomatous tumor in fatty
liver. Transverse in-phase spoiled gradient-echo MR image (TR/TE, 140/5.3;
flip angle, 90°) shows lobulated hyperintense lesion (arrow) in
right lobe of liver.
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Fig. 6B —43-year-old woman with benign lipomatous tumor in fatty
liver. Out-of-phase image (TE, 2.7 msec) shows dark rind of intravoxel phase
cancellation at periphery of lesion and at interface between fatty mass and
surrounding hepatic parenchyma (arrow). Centrally preserved
hyperintensity originates from excessive proportion of fatty content, which is
comparable to subcutaneous fat. Geographically decreased signal on background
of hepatic parenchyma is due to hepatic steatosis.
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Fig. 6D —43-year-old woman with benign lipomatous tumor in fatty
liver. In-phase arterial phase dynamic MR image shows homogeneously high
signal intensity (arrow), suggesting diffuse contrast enhancement of
lesion.
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Fig. 6E —43-year-old woman with benign lipomatous tumor in fatty
liver. Homogeneously decreased signal of lesion (arrow) on
out-of-phase arterial phase image suggests paradoxical decrease in signal
intensity for enhancing lesions containing excessive fatty component.
Intralesional attenuation was approximately -50 H on CT scan (not shown), and
nonmalignant cellular fibrosis with abundant fat globules was verified by
percutaneous gun needle biopsy.
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Fig. 7A —38-year-old man with advanced cirrhosis containing
innumerable siderotic nodules. Transverse out-of-phase spoiled gradient-echo
MR image (TR/TE, 140/2.7; flip angle, 90°) shows contracted hepatic
parenchyma with surface nodularity (arrowheads) surrounded by massive
ascites (asterisk) and subcapsular slightly hyperintense lesion
(arrow).
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Fig. 7B —38-year-old man with advanced cirrhosis containing
innumerable siderotic nodules. In-phase image (TE, 5.3 msec) shows
high-signal-intensity lesion (arrow) well distinguished from
background parenchyma containing innumerable dark-signal-intensity nodules.
Darkened signal of siderotic nodules is due to T2* effect with
longer TE of in-phase imaging.
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Fig. 7C —38-year-old man with advanced cirrhosis containing
innumerable siderotic nodules. Subtracted image of out of phase from in phase
(B - A) shows "blackout" of hepatic parenchymal signal
(arrowheads) due to negative signal value after subtraction. In this
situation, presence of fatty component in lesion or background hepatic
parenchyma cannot be properly determined. Arrow = subcapsular focal lesion,
asterisk = ascites.
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Fig. 8A —62-year-old man with chronic hepatitis B virus and diffuse
hepatic steatosis complicated by small hepatocellular carcinoma. Transverse
in-phase spoiled gradient-echo MR image (TR/TE, 140/5.3; flip angle, 90°)
shows slightly hypointense nodule (arrow).
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Fig. 8B —62-year-old man with chronic hepatitis B virus and diffuse
hepatic steatosis complicated by small hepatocellular carcinoma. Lesion is not
well delineated on out-of-phase image (TE, 2.7 msec) because of signal loss
from background liver as result of diffuse fat infiltration and consequently
decreased lesion-to-liver contrast.
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Fig. 8C —62-year-old man with chronic hepatitis B virus and diffuse
hepatic steatosis complicated by small hepatocellular carcinoma. Transverse
in-phase (C) and out-of-phase (D) dynamic MR images during
arterial phase show iso- and mild hyperintensity of lesion, respectively
(arrows); these findings suggest hypervascular tumor when compared
with unenhanced images. Lesion-to-liver contrast is greater on D than
C due to signal loss from background hepatic parenchyma on
D.
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Fig. 8D —62-year-old man with chronic hepatitis B virus and diffuse
hepatic steatosis complicated by small hepatocellular carcinoma. Transverse
in-phase (C) and out-of-phase (D) dynamic MR images during
arterial phase show iso- and mild hyperintensity of lesion, respectively
(arrows); these findings suggest hypervascular tumor when compared
with unenhanced images. Lesion-to-liver contrast is greater on D than
C due to signal loss from background hepatic parenchyma on
D.
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Fig. 8E —62-year-old man with chronic hepatitis B virus and diffuse
hepatic steatosis complicated by small hepatocellular carcinoma. Transverse
in-phase (E) and out-of-phase (F) 5-minute delayed dynamic MR
images show decreased signal due to washout of contrast agent
(arrows) from lesion. Fibrotic pseudocapsule around lesion is better
delineated on F due to signal loss of background parenchyma.
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Fig. 8F —62-year-old man with chronic hepatitis B virus and diffuse
hepatic steatosis complicated by small hepatocellular carcinoma. Transverse
in-phase (E) and out-of-phase (F) 5-minute delayed dynamic MR
images show decreased signal due to washout of contrast agent
(arrows) from lesion. Fibrotic pseudocapsule around lesion is better
delineated on F due to signal loss of background parenchyma.
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Copyright © 2007 by the American Roentgen Ray Society.
