Liver Protocol
Liver MR imaging may be helpful in detecting and diagnosing lesions especially when other radiological studies are inconclusive. Small tumors and hepatic masses in a diffusely fatty liver may not be easily discerned on CT or US. In such cases, MR imaging may be the modality of choice. Indications include but are not limited to evaluation of parenchymal disease such as cirrhosis and hemosiderosis, characterization of a suspected benign lesions such as hemangioma, FNH, and adenoma, and demonstration of dysplastic nodules or HCC in the cirrhotic liver. Donor liver volume and vascular anatomy prior to liver transplantation can be reliably demonstrated with 3D MR Angiography an optimally timed contrast-enhanced dynamic 3D gradient echo study (see reimbursable ICD9 codes).
Scheduling Guidelines
· First Ask:
1. Why is the liver MRI being
requested?..................
2. What prior liver imaging (CT, US) has been done?
…………..If prior imaging was performed in another imaging
center, please ask for a copy of report and ask patient to bring in films if
possible.
3. Have you had prior liver or gallbladder surgery? ………..…….. What operation? ………………
4. Have you ever had cancer? ……….. What type of cancer? ………….…… When was the cancer diagnosed? ……………….
5. Have you ever been diagnosed any liver disease, such as hepatitis or cirrhosis? .............................
6. What is the alpha fetoprotein level?
……LDH: ……SGPT: ….. SGOT: …… Alkaline
Phosphatase: ……Total Bilirubin: ……
Patient Preparation
· Start intravenous line (20 or 22 gauge IV). If iv caliber is small (i.e. 22 gauge) then warm the Gd contrast up to body temperature to reduce its viscosity.
· Valium (5-10mg po) or Xanax (1-2 mg po) if patient is claustrophobic
· Ear plugs
Coil: 8 channel body coil
Patient positioning: Supine, feet first. The arms are positioned comfortably next to abdomen. Patient must have comfortable pillow for head and a cushion under the knees to relieve back pressure.
Landmark: Three fingers below the xyphoid at rib cage margin.
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Portal Vein PC |
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Coil |
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Full FOV |
Full FOV |
Full FOV |
Upper |
Upper |
Upper |
Upper |
Full FOV |
Upper |
Upper |
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IMAGING
PARAMETERS |
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Plane |
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3-Plane |
Axial |
Coronal |
Axial |
Axial |
Axial |
Axial |
Coronal |
Axial |
Oblique |
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Mode |
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2D |
2D |
2D |
2D |
2D |
3D |
3D |
2D |
2D |
2D |
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Pulse Sequence |
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Localizer |
Fast GRE |
SSFSE |
SSFSE |
Fast SPGR |
Fast SPGR |
Fast SPGR |
Fast SPGR |
Fast TOF SPGR |
Fast 2D PC |
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Imaging Options
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NPW |
Calib,Fast |
Asset,SS,Fast |
Asset,SS,Fast |
Asset,Fast |
MPh,ZIP2, ZIP512,Fast |
MPh,ZIP2,Fluoro,ZIP512,Fast |
Asset,VBwFast |
FC,Seq,ZIP512,Fast |
FC,Gat,Seq, Fast |
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SCAN
TIMING |
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# of Echoes |
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1 |
1 |
1 |
1 |
2 |
1 |
1 |
1 |
1 |
1 |
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TE |
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180 |
180 |
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Minimum |
Minimum |
Minimum |
Minimum |
Min Full |
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TR |
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Minimum |
Minimum |
225 |
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150 |
Minimum |
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Flip Angle |
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65 |
25 |
? |
45 |
60 |
25 |
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Bandwidth |
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31.25 |
31.25 |
62.50 |
83.33 |
62.50 |
62.50 |
31.25 |
15.63 |
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ETL |
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BSP TI |
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Prep Time |
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Auto |
Auto |
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ADDITIONAL
PARAMETERS (see attached instructions) |
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SAT |
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I,S |
F: sp |
F: sp |
Fat |
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Multiphase
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Phase/loc:1
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Phases/loc: 3 Delay: 120 ms |
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ACQUISITION
TIMING |
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Freq |
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256 |
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256 |
256 |
256 |
512 |
512 |
256 |
256 |
256 |
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Phase |
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128 |
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256 |
224 |
128 |
128 |
128 |
160 |
256 |
128 |
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NEX |
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2 |
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1 |
1 |
1 |
1 |
4 |
1 |
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Phase FOV |
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1 |
0.60 |
0.75 |
1 |
1 |
1 |
1 |
1 |
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