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1.5T Liver black-blood EPI - AZ St. Jan AV, Brugge

ExamCard
Dr. Coenegrachts, Kenneth Brugge, AZ St. Jan AV

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ExamCard purpose

This ExamCard is designed for detection of focal liver lesions and, in particular, provides good sensitivity for small (< 10 mm) lesions. The ExamCard was developed on Intera 1.5T with Explorer gradients, release 11.

 

The ExamCard is used for all MRI scans of the liver. The Black-Blood Single Shot Spin Echo Echo Planar Imaging (BB SS SE-EPI) sequence is useful for the detection of focal liver lesions and is nowadays routinely used as a roadmap sequence at the beginning of each MRI examination of the liver for the detection of all liver lesions with focus on small (<10mm) focal liver lesions. Especially in the setting of malignant disease the BB SS SE-EPI sequence is used for staging of metastatic disease.

ExamCard overview

Liver - Focal lesions
Scan 1Localizer
Scan 2Reference scan
Scan 3BB SS SE-EPI (TRA) [BB SS SE-EPI 4b]
Scan 4T2 TSE long TE (TRA) [s2T2w_PP SENSE]
Scan 5T2 TSE short TE SPAIR (TRA) [SPAIR_PP S2 SENSE]
Scan 6Dual FFE (TRA) [INOUT SEN CLEAR]
Scan 7THRIVE (TRA) before IV SPIO
Scan 8THRIVE (TRA) after IV SPIO (portal phase)
Scan 9THRIVE (TRA) after IV SPIO (2 minutes venous phase)
Scan 10T2 TSE short TE SPAIR (TRA) (10 minutes post-SPIO)

The BB SS SE-EPI is most sensitive for lesion detection.

 

For further characterization the T2 TSE long TE and T2 TSE short TE SPAIR are used.

 

Dual FFE is particularly useful to distinguish between focal lesions and steatosis.

 

THRIVE scans are done before IV SPIO, after IV SPIO in the portal phase and after 2 minutes venous phase for further lesions characterization and to visualize the patency of blood vessels.

 

10 minutes post-SPIO, a T2 TSE short TE SPAIR scan is performed, the "gold" standard for focal liver lesion visualization by MRI.

ExamCard images

Click on an image to enlarge it and improve visibility of arrow(s).

 

BB SS SE-EPI b=0 BB SS SE-EPI b=10 BB SS SE-EPI b=150
BB SS SE-EPI b=0
BB SS SE-EPI b=10
BB SS SE-EPI b=150
TSE long TE TSE short TE SPAIR
TSE long TE
TSE short TE SPAIR
Dual FFE in-phase Dual FFE out-of-phase
Dual FFE in-phase
Dual FFE out-of-phase
THRIVE before SPIO THRIVE 2 min. post SPIO T2 TSE short TE SPAIR <br>10 min. post SPIO
THRIVE before SPIO
THRIVE 2 min. post SPIO
T2 TSE short TE SPAIR
10 min. post SPIO

Patient preparation

Before the examination 500 ml of water is given to the patient to decrease the amount of bowel gasses around the liver parenchyma. This decreases the susceptibility artifacts when using BB SS SE-EPI.

Positioning

Position the patient supine, head first, arms overhead if able.

Connect IV to auto injector.

Use the 4-channel SENSE Torso coil.

Contrast agent / injection protocol

A Super Paramagnetic Iron Oxide (SPIO)-based contrast agent is used.

Post-processing / analysis

No postprocessing needed.

 

 

 

This ExamCard is used in the clinical case:



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ExamCard
Intera 1.5T
Release 11
Body, Liver
 

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