Transcript MR Venography and Pulmonary MRA

Portal MR Venography
with slides borrowed from
Tom Grist, MD
Jorg Debatin, MD
Qian Dong, MD
Ruth Carlos, MD
David Stafford-Johnson, MD
Mohammed Neimatallah, MD
Brian Hamilton, MD
Jochen Gaa, MD
Arterial phase
Portal venous phase
Coronal 3D Gd MRA of Portal Vein
• Coronal Plane
• Field of view = width of patient (28-32 cm)
• Thick slices: 3-5 mm
• Zero padding
• Fast enough for breath holding
• TR < 10 msec
• TE < 3 msec
• Partial Fourier imaging (0.5 NEX)
• Adjust phase encoding steps (128-224)
• Three phases
• Arterial
• Portal venous
• Equilibrium
Mesenteric Portal Protocol
Sequence
Time
• Sag SSFSE
0:56
•Axial T1
5:32
• Axial T2 & fat sat
6:04
• MRCP (optional)
• Coronal 3D Gd (3 phases)
0:30 x 3
• Axial 2D TOF (optional)
Total imaging time
~15-25 minutes
Arterial
Phase
Venous
Phase
Hepatoma
Venous
Phase
Fig. 7.7. Hepatoma.
Clinical Scenario: 54-year-old female
with abdominal pain and elevated AFP.
Technique: Coronal Acquisition,
TR/TE/Flip = 8.1/2.1/45°, Field-ofView = 320 x 320 x 96 mm, Matrix 256
x 160 x 32, Centric Ordering of kspace, Acquisition Time = 29 s, 40 ml
gadolinium contrast infused at 2 ml/s,
and timed empirically.
Interpretation: A coronal MIP from
the portal venous-phase of the contrast
bolus shows an enhancing mass in the
dome of the liver with heterogenously
enhancing tumor invading the right
portal vein and extending down to the
confluence of right and left portal veins.
The main and left portal veins are
widely patent.
Diagnosis: Hepatoma with invasion of
right portal vein.
Submitted by Martin R. Prince, M.D.,
Ph.D., Ann Arbor, MI.
MIP of Entire 3D Volume
Sub-Volume MIP
Main Portal Vein
SMV
Main Portal Vein
Axial Reformation
MIP of Entire 3D Volume
Sub-Volume MIP
Right Hepatic vein
Right Hepatic vein
Axial Reformation
Portal hypertension
with varices
55 year old female
prior to TIPS
Coronal 3D Gd MRA MIP during
venous phase
Varices
Thick MIP
Thin MIP
Portal hypertension
Spleno-renal shunt
Anterior MIP
Posterior MIP
Fig. 7.3. MRA of Portocaval Shunt.
Clinical Scenario: 42-year-old male,
status post-portocaval shunt with
worsening ascites.
Technique: Coronal Acquisition,
TR/TE/Flip = 7.2/1.2/45°, Field-ofView = 300 x 300, Matrix = 256 x 128,
Centric Ordering of k-space,
Acquisition Time = 32 s, 1 NEX, 40 ml
of gadolinium infused at 2 ml/s, and
timed empirically.
Interpretation: Coronal subvolume
MIP (a) and magnification view (b)
shows a widely patent portocaval shunt
(arrows). Note also gastric varices
(arrowheads). During this equilibrium
phase image, there is comparable
enhancement of the portal vein, IVC,
and aorta.
Diagnosis: Patent portocaval shunt.
Submitted by David Stafford-Johnson,
M.D., Ann Arbor, MI.
Reprinted with permission from
Investigative Radiology Sept. Oct.
1998.
56 year old female with abdominal
pain
Minimun
intensity
projections
Maximum intensity projection
Portal and hepatic vein thrombosus
Minimun
intensity
projections
Maximum intensity projection
Acute thrombosis of portal vein (arrows) with
perithrombus enhancement (arrowheads)
Maximum Intensity Projection
Cavernous Transformation
32-year-old female
with abdominal pain
Budd Chiari
Fig. 7.4. Liver Transplant.
Clinical Scenario: Status post liver
transplant with increased liver function
tests.
Technique: Coronal Acquisition,
TR/TE/Flip = 7/2.1/45°, Field-of-View =
320 x 320 x 84 mm, Matrix = 256 x 128 x
28, Sequential Ordering of k-space,
Acquisition Time = 27 s, 40 ml gadolinium
contrast infused at 2 ml/ s, and timed
empirically.
Interpretation: Coronal oblique subvolume
MIP shows a widely patent splenic and
portal veins. There is minor narrowing
(arrows) at the site of anastomosis between
the native and donor portal veins.
Diagnosis: Widely patent transplant portal
vein.
Submitted by Martin R. Prince, M.D.,
Ph.D., Ann Arbor, MI. v
IVC anastomotic narrowing
13 year old female post liver
and kidney transplant
Arterial Phase
Portal-venous Phase
Post Liver Transplant
Post Liver Transplant with
abcess narrowing portal vein
Pancreatic mass encasing
celiac and spleno-portal
confluence
Summary
• Normal flow: Gd not necessary
• Slow flow: Gd essential
• Coronal 3D: thick slices & breathholding
• Useful for evaluating
• Varices
• Shunts
• Tumor encasement
• Tumor invasion
• Thrombosis
• Cavernous transformation
• Budd Chiari
• Liver transplant