(LAVA) The MRI technique LAVA is based on a 3 dimensional spoiled gradient echo pulse sequence. The optimized inversion pulse and a new fat suppression technique (called segmented special) provides enhanced image contrast and uniform fat suppression. Array spatial sensitivity encoding technique (ASSET) with partial data filling and shorter TR/TE enables to use short breath holds for dynamic liver imaging with multiple phases.

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.

Volumetric imaging is a 3D technique where all the MRI signals are collected from the entire tissue sample and imaged as a whole entity, therefore providing a high signal to noise ratio. The acquisition of isotropic voxels or thin slices with high spatial resolution allows to create multiplanar reconstructions in all planes; a compensation for the usually longer scan time. The acquisition time can be reduced by parallel imaging technique.
New T2 weighted variants of 3D sequences (FSE-XETA, T2-SPACE, VISTA) have been introduced that differ from conventional FSE sequences. An echo train containing up to 200 echoes obtained at a minimum echo spacing allows very fast acquisition. A flip angle modulation (flip angle sweep - FAS) during the FSE readout carries magnetization as long as possible to avoid blurring and provide optimal signal at the effective echo time. This type of imaging is well suited for brain and spine MRI procedures.
Newer T1 weighted variants include Liver Acquisition with Volume Acquisition (LAVA) and T1W High Resolution Isotropic Volume Examination (THRIVE), which have advantages for dynamic breath hold imaging in liver and abdominal examinations.

See also Volume Imaging, 3 Dimensional Imaging.

(MRCP) This MR imaging technique takes advantage of the high signal intensity of body fluids and acquires heavy T2 weighted images of the gall bladder, the pancreas and parts of the liver. Due to the T2 weighting, the liver and other solid parenchyma are signal suppressed and only fluid-filled structures in addition to the gall bladder, the bile and pancreatic ducts retain important signal intensity. Hepatobiliary contrast agents (e.g. Gadoxetic Acid, CMC 001) can be useful for enhancement of the bile ducts and better imaging of the biliary tract.
A 2D cholangiogram, often only one thick slice (a volume with a thickness of 4 - 8 cm, mostly coronal planned) or 5 - 6 radial placed slices, shows a view like single slices. If a 3D acquisition is used, the postprocessing function maximum intensity projection (MIP) can show reconstructions from multiple sides.