Dynamic Contrast-Enhanced MR Imaging of the Liver: Current Status and Future Directions

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Dynamic contrast-enhanced magnetic resonance imaging (DCE-MR imaging) is emerging as a tool that can quantify changes in liver perfusion that occur in both diffuse and focal liver diseases. Recent data show promise for DCE-MR imaging of the liver in diagnosing fibrosis and cirrhosis before morphologic changes can be detected. It may also be valuable in the assessment of hepatocellular carcinoma and liver metastases. Acquisition parameters, postprocessing methods, applications, and recent results of DCE-MR imaging of the liver are also described. Finally, it reviews the limitations and future directions of DCE-MR imaging for liver applications.

Section snippets

Dynamic contrast-enhanced MR imaging

Regional perfusion can be assessed by following the uptake and washout of contrast agent with either MR imaging or CT. MR imaging has several advantages over CT, including the lack of ionizing radiation. Therefore, it has the ability to image whole organs repeatedly and dynamically with high temporal resolution, and the possibility of repeating the study multiple times after treatment. In addition, intravenous gadolinium contrast for MR imaging is also generally preferable to iodinated CT

Dynamic contrast-enhanced MR imaging applications in the liver

DCE-MR imaging is potentially useful for the diagnosis of advanced liver fibrosis and cirrhosis, and for the characterization of the angiogenic activity of HCC and liver metastases, and for monitoring antiangiogenic treatment response.

Dynamic contrast-enhanced MR imaging limitations

In DCE-MR imaging, the selection of imaging parameters is important to optimize the competing demands of spatial resolution, anatomic coverage, and temporal resolution. This flexibility in parameter selection leads to institutional differences based on available MR imaging equipment and pulse sequence technology. Together with different pharmacokinetic models, the variability in methodology limits the comparison of DCE-MR imaging results from study to study. In addition, the intensive

Future directions

With improved hardware, parallel acquisition, and higher field magnets, DCE-MR imaging techniques will continue to improve in image quality, spatial resolution, and temporal resolution. DCE-MR imaging will likely be an important tool for drug trials assessing new antiangiogenic treatments, monitoring treatment response to antiangiogenic drugs, and may improve our sensitivity and specificity in the initial diagnosis of HCC and metastatic liver lesions. Differentiation between benign cirrhotic

Summary

DCE-MR imaging of the liver is an emerging tool for diagnosing focal and diffuse liver disease, with a potential role for staging of liver fibrosis and early detection of cirrhosis, before morphologic changes can be detected. DCE-MR imaging may also be useful for assessment of angiogenesis in HCC and liver metastases. A consensus on acquisition and processing methods will be needed.

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    Financial support: RSNA Scholarship Grant # 0710, Bracco Diagnostics Research Grant.

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