(FSE) In the pulse sequence timing diagram, a fast spin echo sequence with an echo train length of 3 is illustrated. This sequence is characterized by a series of rapidly applied 180° rephasing pulses and multiple echoes, changing the phase encoding gradient for each echo.
The echo time TE may vary from echo to echo in the echo train. The echoes in the center of the K-space (in the case of linear k-space acquisition) mainly produce the type of image contrast, whereas the periphery of K-space determines the spatial resolution. For example, in the middle of K-space the late echoes of T2 weighted images are encoded. T1 or PD contrast is produced from the early echoes.
The benefit of this technique is that the scan duration with, e.g. a turbo spin echo turbo factor / echo train length of 9, is one ninth of the time. In T1 weighted and proton density weighted sequences, there is a limit to how large the ETL can be (e.g. a usual ETL for T1 weighted images is between 3 and 7). The use of large echo train lengths with short TE results in blurring and loss of contrast. For this reason, T2 weighted imaging profits most from this technique.
In T2 weighted FSE images, both water and fat are hyperintense. This is because the succession of 180° RF pulses reduces the spin spin interactions in fat and increases its T2 decay time. Fast spin echo (FSE) sequences have replaced conventional T2 weighted spin echo sequences for most clinical applications. Fast spin echo allows reduced acquisition times and enables T2 weighted breath hold imaging, e.g. for applications in the upper abdomen.
In case of the acquisition of 2 echoes this type of a sequence is named double fast spin echo / dual echo sequence, the first echo is usually density and the second echo is T2 weighted image. Fast spin echo images are more T2 weighted, which makes it difficult to obtain true proton density weighted images. For dual echo imaging with density weighting, the TR should be kept between 2000 - 2400 msec with a short ETL (e.g., 4).
Other terms for this technique are:
Turbo Spin Echo
Rapid Imaging Spin Echo,
Rapid Spin Echo,
Rapid Acquisition Spin Echo,
Rapid Acquisition with Refocused Echoes

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.

Many MR imaging techniques using Motion Probing Gradients (MPG's) such as Spin Echo (SE), Stimulated Echo (STE), Rapid Acquisition with Relaxation Enhancement (RARE), Turbo-SE, and SE-EPI (Echo Planar Imaging for Spin echo acquisition), Spiral imaging, and Projection reconstruction including PROPELLER are applicable to DWI. In diffusion weighted imaging, 2 MPG's are required. The MPG's are put symmetrically into both sides of a 180° or 90° RF pulse to change the direction of the magnetized spin in the X-Y plane for spin echo or stimulated echo acquisition.