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Rectal cancer with liver and bone metastases

Case Study
Kownacki, Lukasz, M.D., Ph.D. - European Centre of Health Otwock • Poland

Patient History

53-year-old male with lower gastrointestinal tract bleeding symptoms. Colonoscopy revealed rectal carcinoma. Two focal liver lesions were diagnosed by ultrasonography.
The patient was initially referred for a CT, but because of iodine allergy, he was forwarded for an abdomen-pelvis MR exam on Achieva 3.0T TX at European Centre of Health Otwock, Poland.

MR examination

The patient consumed 3-4 liters of pineapple juice within 24 hours prior to examination. The high concentration of (paramagnetic) manganese in pineapple juice helps to obtain a good delineation of intestines on 3D T1-weighted images (e.g. mDIXON), as well as suppressing unwanted “shining” of intestinal fluid content on T2-weighted images.
The 16-channel SENSE XL Torso coil was carefully positioned to cover abdomen and pelvis.
Oxygen was given with a flow rate of 4l/min. during the entire examination to help make breath holding easier for the patient.
All sequences use a two-station (pelvis and abdomen) approach using GeoLink. The examination was performed with two stations.

The following sequences were performed:

MR Images and interpretation

Pelvis T2-SPAIR
Pelvis T2-SPAIR
Coronal T2-SPAIR shows a suspicious lesion with infiltration of the  rectal wall on the right side, with surrounding edema and fat tissue infiltration. Suspicious lesions are also seen in the lymph nodes and bones.

Pelvis, ADC map Pelvis, Post contrast mDIXON
Pelvis, ADC map
Pelvis, Post contrast mDIXON
The ADC map derived from 6 b-values in (0, 50, 100, 500, 750, 1000 [s/mm2]) in DWI SE images demonstrates restricted diffusion in the rectal wall and surrounding infiltration, markedly larger on the right side.
Gd-enhanced 3D T1 FFE mDIXON image
Abdomen, ADC map Abdomen, post contrast mDIXON
Abdomen, ADC map
Abdomen, post contrast mDIXON
The ADC map derived from 6 b-values DWI SE, demonstrates restricted diffusion in the lesion and necrotic core without diffusion restriction.
Gd-enhanced 3D T1 FFE mDIXON (water only)
MPR reconstruction
MPR reconstruction
These MPR reconstructions are derived from two merged abdomen and pelvis 3D T1 FFE mDIXON (water only) datasets of axial images. The suspicious lesions are seen in the liver, as well as in the rectum and surrounding fatty tissue.

MPR reconstruction
MPR reconstruction
This MPR reconstruction of the abdomen and spine region was derived from first phase of 3 dynamic 3D T1 FFE mDIXON (water only) axial image datasets. Numerous suspicious lesions are seen in the vertebral bodies.


Rectal cancer with local infiltration and numerous metastases were demonstrated by histology and other suspicious lesions in liver were seen.

Impact of Achieva 3.0T TX mDIXON imaging:

Post-gadolinium 3D T1-FFE mDIXON allows an ultra-high resolution in abdominal and pelvis imaging with exceptional SNR and CNR, and with large coverage. In the author’s opinion its quality is superb and he prefers to use this method instead of any other fast 3D T1 approach and it resembles the CT scanning.
In the described case all the lesions could be very precisely imaged with mDIXON imaging only. Additionally, very small hepatic suspicious lesions could be spotted.

Thus Achieva 3.0T TX with only mDIXON could theoretically be almost as fast as a CT but with superb image contrast and high in-plane resolution.

MR can be a better option than CT for patients with iodine allergy.

An Achieva 3.0T TX mDIXON only exam approach avoids a long scan time – one of the drawbacks of MRI - and may thus be a promising alternative for follow-up of oncologic patients, who often receive high doses of radiation due to repetitive CT examinations with iodine-based contrast media.

The 16-channel SENSE XL Torso coil provides a large patient coverage and high SNR. MultiTransmit provides high quality images, not disturbed by dielectric shading. MultiTransmit also has a high impact on imaging time. It allows performing high resolution imaging in reasonable scan times in single shot TSE and DWI SE. Imaging times were compared by turning MultiTransmit on and off.

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Feb 5, 2013

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Case Study
Achieva 3.0T TX
Release 3
Quasar Dual
Abdomen, ADC, Body, Bone, DWIBS, Liver, mDIXON, MultiTransmit, Pelvis, Rectum, SENSE XL Torso coil

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