(UTSE) The ultrashort turbo spin echo (TSE / FSE) sequence is a technique with extremely short echo spacing, resulting in shorter scan times. This is an advantage in areas where motion is a problem, for example dynamic or abdominal imaging. The shorter scan time and echo spacing are achieved by using a higher TSE factor and an increased data sampling rate.
Disadvantages are the decrease in SNR (caused through the increase of the bandwidth) and artifacts if minimum echo spacing is used (incomplete dephasing of the 180° pulse FID).

See also Fast Spin Echo.

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.

The activation of the brain is mirrored in the local changes in metabolism and hemodynamics (brit. haemodynamics). By using heavily T2 weighted scans activated brain areas show an increase in signal intensity as oxyhaemoglobin (brit. oxyhaemoglobin) is diamagnetic and deoxyhemoglobin (brit. deoxyhaemoglobin) is paramagnetic. Oxygen mapping will benefit from high field strength.

See also Blood Oxygenation Level Dependent Contrast, Haemoglobin, Perfusion Imaging, Diamagnetism, Paramagnetism.

The subacute risks and side effects of magnetic and RF fields (for patients and staff) have been intensively examined for a long time, but there have been no long-term studies following persons who have been exposed to the static magnetic fields used in MRI. However, no permanent hazardous effects of a static magnetic field exposure upon human beings have yet been demonstrated.
Temporary possible side effects of high magnetic and RF fields:
The results of some animal and cellular studies suggest the possibility that electromagnetic fields may act as co-carcinogens or tumor promoters, but the data are inconclusive. Up to 45 tesla, no important effects on enzyme systems have been observed. Neither changes in enzyme kinetics, nor orientation changes in macromolecules have been conclusively demonstrated.
There are some publications associating an increase in the incidence of leukemia with the location of buildings close to high-current power lines with extremely low-frequency (ELF) electromagnetic radiation of 50-60 Hz, and industrial exposure to electric and magnetic fields but a transposition of such effects to MRI or MRS seems unlikely.
Under consideration of the MRI safety guidelines, real dangers or risks of an exposure with common MRI field strengths up to 3 tesla as well as the RF exposure during the MRI scan, are not to be expected.

For more MRI safety information see also Nerve Conductivity, Contraindications, Pregnancy and Specific Absorption Rate.

See also the related poll result: 'In 2010 your scanner will probably work with a field strength of'