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.

Magnetic resonance imaging (MRI) of the spine is a noninvasive procedure to evaluate different types of tissue, including the spinal cord, vertebral disks and spaces between the vertebrae through which the nerves travel, as well as distinguish healthy tissue from diseased tissue.
The cervical, thoracic and lumbar spine MRI should be scanned in individual sections. The scan protocol parameter like e.g. the field of view (FOV), slice thickness and matrix are usually different for cervical, thoracic and lumbar spine MRI, but the method is similar. The standard views in the basic spinal MRI scan to create detailed slices (cross sections) are sagittal T1 weighted and T2 weighted images over the whole body part, and transverse (e.g. multi angle oblique) over the region of interest with different pulse sequences according to the result of the sagittal slices. Additional views or different types of pulse sequences like fat suppression, fluid attenuation inversion recovery (FLAIR) or diffusion weighted imaging are created dependent on the indication.

Indications:

Contrast enhanced MRI techniques delineate infections vs. malignancies, show a syrinx cavity and support to differentiate the postoperative conditions. After surgery for disk disease, significant fibrosis can occur in the spine. This scarring can mimic residual disk herniation. Magnetic resonance myelography evaluates spinal stenosis and various intervertebral discs can be imaged with multi angle oblique techniques. Cine series can be used to show true range of motion studies of parts of the spine. Advanced open MRI devices are developed to perform positional scans in the position of pain or symptom (e.g. Uprightâ„¢ MRI formerly Stand-Up MRI).

MRI of the lumbar spine, with its multiplanar 3 dimensional imaging capability, is currently the preferred modality for establishing a diagnosis. MRI scans and magnetic resonance myelography have many advantages compared with computed tomography and/or X-ray myelography in evaluating the lumbar spine. MR imaging scans large areas of the spine without ionizing radiation, is noninvasive, not affected by bone artifacts, provides vascular imaging capability, and makes use of safer contrast agents (gadolinium chelate).
Due to the high level of tissue contrast resolution, nerves and discs are clearly visible. MRI is excellent for detecting degenerative disease in the spine. Lumbar spine MRI accurately shows disc disease (prolapsed disc or slipped disc), the level at which disc disease occurs, and if a disc is compressing spinal nerves. Lumbar spine MRI depicts soft tissues, including the cauda equina, spinal cord, ligaments, epidural fat, subarachnoid space, and intervertebral discs. Loss of epidural fat on T1 weighted images, loss of cerebrospinal fluid signal around the dural sac on T2 weighted images and degenerative disc disease are common features of lumbar stenosis.

Common indications for MRI of the lumbar spine:
Lumbar spine imaging requires a special spine coil. often used whole spine array coils have the advantage that patients do not need other positioning if also upper parts of the spine should be scanned. Sagittal T1 and T2 weighted FSE sequences are the standard views. With multi angle oblique techniques individually oriented transverse images of each intervertebral disc at different angles can be obtained.

See also the related poll result: 'MRI will have replaced 50% of x-ray exams by'

Quantification relies on inflow effects or on spin phase effects and therefore on quantifying the phase shifts of moving tissues relative to stationary tissues.
With properly designed pulse sequences (see phase contrast sequence) the pixel by pixel phase represents a map of the velocities measured in the imaging plane. Spin phase effect-based flow quantification schemes use pulse sequences specifically designed so that the phase angle in a pixel obtained upon measuring the signal is proportional to the velocity. As the relation of the phase angle to the velocity is defined by the gradient amplitudes and the gradient switch-on times, which are known, velocity can be determined quantitatively on a pixel-by-pixel basis. Once, this velocity is known, the flow in a vessel can be determined by multiplying the pixel area with the pixel velocity. Summing this quantity for all pixels inside a vessel results in a flow volume, which is measured, e.g. in ml/sec.
Flow related enhancement-based flow quantification techniques (entry phenomena) work because spins in a section perpendicular to the vessel of interest are labeled with some radio frequency RF pulse. Positional readout of the tagged spins some time T later will show the distance D they have traveled.
For constant flow, the velocity v is obtained by dividing the distance D by the time T : v = D/T. Variations of this basic principle have been proposed to measure flow, but the standard methods to measure velocity and flow use the spin phase effect.
Cardiac MRI sequences are used to encode images with velocity information. These pulse sequences permit quantification of flow-related physiologic data, such as blood flow in the aorta or pulmonary arteries and the peak velocity across stenotic valves.

Quick Overview

The slice overlap artifact is another name for crosstalk artifact. If slices of multislice acquisitions are overlapping, the spinning nuclei belonging to more than one slice getting multiple times saturated, which leads to signal loss in this areas.

This problem occurs often in cervical or lumbar spine MRI, when scanning each disc with multi angle oblique technique. If prevention of overlapping is not possible, try to position the saturated region posterior to the spinal canal, outside the region of interest.

See also Crosstalk (Crosstalk), and Multiple Slice Imaging.