(GRE - sequence) A gradient echo is generated by using a pair of bipolar gradient pulses. In the pulse sequence timing diagram, the basic gradient echo sequence is illustrated. There is no refocusing 180° pulse and the data are sampled during a gradient echo, which is achieved by dephasing the spins with a negatively pulsed gradient before they are rephased by an opposite gradient with opposite polarity to generate the echo.
See also the Pulse Sequence Timing Diagram. There you will find a description of the components.
The excitation pulse is termed the alpha pulse α. It tilts the magnetization by a flip angle α, which is typically between 0° and 90°. With a small flip angle there is a reduction in the value of transverse magnetization that will affect subsequent RF pulses. The flip angle can also be slowly increased during data acquisition (variable flip angle: tilt optimized nonsaturation excitation). The data are not acquired in a steady state, where z-magnetization recovery and destruction by ad-pulses are balanced. However, the z-magnetization is used up by tilting a little more of the remaining z-magnetization into the xy-plane for each acquired imaging line.
Gradient echo imaging is typically accomplished by examining the FID, whereas the read gradient is turned on for localization of the signal in the readout direction. T2* is the characteristic decay time constant associated with the FID. The contrast and signal generated by a gradient echo depend on the size of the longitudinal magnetization and the flip angle. When α = 90° the sequence is identical to the so-called partial saturation or saturation recovery pulse sequence. In standard GRE imaging, this basic pulse sequence is repeated as many times as image lines have to be acquired. Additional gradients or radio frequency pulses are introduced with the aim to spoil to refocus the xy-magnetization at the moment when the spin system is subject to the next α pulse.
As a result of the short repetition time, the z-magnetization cannot fully recover and after a few initial α pulses there is an equilibrium established between z-magnetization recovery and z-magnetization reduction due to the α pulses.
Gradient echoes have a lower SAR, are more sensitive to field inhomogeneities and have a reduced crosstalk, so that a small or no slice gap can be used. In or out of phase imaging depending on the selected TE (and field strength of the magnet) is possible. As the flip angle is decreased, T1 weighting can be maintained by reducing the TR. T2* weighting can be minimized by keeping the TE as short as possible, but pure T2 weighting is not possible. By using a reduced flip angle, some of the magnetization value remains longitudinal (less time needed to achieve full recovery) and for a certain T1 and TR, there exist one flip angle that will give the most signal, known as the "Ernst angle".
Contrast values:
PD weighted: Small flip angle (no T1), long TR (no T1) and short TE (no T2*)
T1 weighted: Large flip angle (70°), short TR (less than 50ms) and short TE
T2* weighted: Small flip angle, some longer TR (100 ms) and long TE (20 ms)

Classification of GRE sequences can be made into four categories:

• T1 weighted or incoherent/(RF or gradient) spoiled GRE sequences
• T1/T2* weighted or coherent/refocused GRE sequences
• T2 weighted contrast enhanced GRE sequences
• ultrafast GRE sequences

See also Gradient Recalled Echo Sequence, Spoiled Gradient Echo Sequence, Refocused Gradient Echo Sequence, Ultrafast Gradient Echo Sequence.

The incoherent gradient echo (gradient spoiled) type of sequence uses a continuous shifting of the RF pulse to spoil the remaining transverse magnetization. The transverse magnetization is destroyed by a magnetic field gradient. This results in a T1 weighted image. Spoiling can be accomplished by RF or a gradient.
Gradient spoiling occurs after each echo by using strong gradients in the slice-select direction after the frequency encoding and before the next RF pulse. Because spins in different locations in the magnet thereby experience a variety of magnetic field strengths, they will precess at differing frequencies; as a consequence they will quickly become dephased. Magnetic field gradients are not very efficient at spoiling the transverse steady state. To be effective, the spins must be forced to precess far enough to become phased randomly with respect to the RF excitation pulse. In clinical MRI machines, the field gradients are set up in such a way that they increase and decrease relative to the center of the magnet; the magnetic field at the magnet 'isocenter' does not change.
The T1 weighting increases with the flip angle and the T2* weighting increases with echo time (TE). Typical repetition time (TR) are 30-500 ms and TE less than 15 ms.

See also Ernst Angle.

(T) Times between successive RF pulses used in pulse sequences. Particularly important are the inversion time (TI) in inversion recovery, and the time between 90° pulse and the subsequent 180° pulse to produce a spin echo, which will be approximately one half the spin echo time(TE). The time between repetitions of pulse sequences is the repetition time(TR).

(IR) Inversion recovery is an MRI technique, which can be incorporated into MR imaging, wherein the nuclear magnetization is inverted at a time on the order of T1 before the regular imaging pulse-gradient sequences. The resulting partial relaxation of the spins in the different structures being imaged can be used to produce an image that depends strongly on T1. This may bring out differences in the appearance of structures with different T1 relaxation times. Note that this does not directly produce an image of T1. T1 in a given region can be calculated from the change in the MR signal from the region due to the inversion pulse compared to the signal with no inversion pulse or an inversion pulse with a different inversion time. This sequence involves successive 180° and 90° pulses. The inversion recovery sequence is specified in terms of three parameters, inversion time (TI), repetition time (TR) and echo time (TE).

See also Inversion Recovery Sequence and FLAIR.

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.