Patient Preparation
• Education
• Approximate duration of the exam
• Breath-holding
• Stress importance
• Expiration
• If cannot sustain BH, slowly inhale over time
• Practice with patient
• Describe sensations of Gd infusion
• 2L NC O
2
• No O
2 if patient has
COPD/emphysema: ASK!
• Patient Position
• Supine
• Feet first
• Cushion under knees to relieve back pressure
• Arms at sides
• Coil Position
• 3 fingers below xyphoid process
• Ensure parallel positioning
• Other
• Ear plugs
• Emergency button
• Anxiolytic
• Music

• Ensure coil is placed properly for optimized liver imaging.
• Run calibration (reference) sequence for ASSET/SENSE.
• 2 with BH Exp, 2 Free Breath
• If patient moves or coil position is changed, rerun calibration scan.
• Clinical
• Quick eval of spine

•
Coronal SSFSE/SSTSE T2
• FOV <48 cm
• SLT/gap: 8 mm/0
•
• ASSET/SENSE: none
BH (Arms Up if Possible)
• Axial SSFSE/SSTSE T2
• FOV <34 cm
• SLT/gap: 8 mm/0
• ASSET/SENSE: none
• BH
• Liver through kidneys
• Two acquisitions if necessary
•
•
Overlap acquisitions
NO INTERLEAVE
• Clinical
• Overview of anatomy
• Fluid-filled structures
• Liver size

•
•
Parameters
•
•
• FOV: 38 cm
SLT/gap: 3-4 mm/reconstructed to 1-2 mm
ASSET/SENSE: min
•
• BH
Liver through pancreas
• Arms Up if possible- Fold over
Clinical
• Poor man’s MRCP
• Decreases dephasing in patients with significant ascites

• Parameters
•
• FOV: <34 cm
SLT/gap: 5 mm
•
•
•
ASSET/SENSE: min
BH: (resp-trig uncooperative patient)
Liver through bottom of kidneys
• Clinical
• Vascular patency: important if unable to adequately BH during post-Gd sequences

• Parameters
•
•
FOV: <34 cm
SLT/gap: 7 mm/1
•
•
•
•
•
ASSET/SENSE: none
BH
•
•
Two acquisitions if necessary
Overlap acquisitions
NO INTERLEAVE
Repeat as necessary to optimize image quality
Run 3D Dixon on MR1 for In/Out Phase imaging
• Clinical
• Detect lipid and iron
• Evaluate kidneys
• T1 appearance of lesions

•
•
Parameters
• FOV: <34 cm
•
• SLT/gap: 7 mm/1
ASSET/SENSE: None
•
•
Respiratory Triggered
Liver through bottom of kidneys
• Position gating trigger on dome of diaphragm half in lung field/half in liver
Clinical
•
• Increased lesion conspicuity
T2 characteristics
• Lymphadenopathy

•
•
•
•
•
Parameters
FOV <34 cm
SLT/gap: 4-5 mm/reconstructed to 2 mm
•
•
•
ASSET/SENSE: 1.5, max
BH
Liver through bottom of kidneys
Breath-holding
•
•
•
•
•
Expiration
Practice breathing with patient
Watch respiratory graph so breathing cycle not interrupted
Stress importance of these images
If can’t hold breath long enough, slowly and steadily inhale (as had practiced before the exam)
Precontrast
•
•
•
•
•
Ensure :
Adequate coverage
Adequate fat suppression
Patient understands BH
No artifacts through liver

•
Post-Contrast
•
•
•
•
•
•
•
•
•
Arterial: 25s after start of injection – MOST INPORTANT SCAN prior to scanning this sequence, please remind patient of the importance of this sequence
Arterial Phase is for Hepatic Artery uptake, NOT early arterial (30sec k0 time)
This time depends on k0 time, injection rate, cardiac output, hemodynamics
We may be switching back to bolus tracking because of these variables.
Portal: 60s after start of injection
Late Portal: 100s after start of injection
Equilibrium: 180s after start of injection
10-min Delay (FSPGR)
• Please send images to PACS in proper fashion (Philips)!
• Clinical
• Lesion detection and characterization

•
•
•
Parameters
• FOV <34 cm
•
• SLT/gap: 4-5 mm/reconstructed to 2 mm
BH
• Liver through bottom of kidneys
Breath-holding
•
• Faster scan and better fat sat than THRIVE
ONLY available on MR1 Philips
• 3D Dixon will also replace In/Out Phase on MR-1
Ensure :
•
•
•
•
Adequate coverage
Adequate fat suppression
Patient understands BH
No artifacts through liver

•
Parameters
•
•
•
•
•
•
• FOV <34 cm
SLT/gap: 7 mm/1
ASSET/SENSE: None
BH
Liver through Aortic Bifurcation
Two acquisitions if necessary
•
•
Overlap acquisitions
NO INTERLEAVE
Repeat as necessary to optimize image quality
• Clinical
• Evaluate for delayed contrast enhancement

•
DWI
•
• Parameters: as specified on the Philips Scanner
Through the liver
•
•
Please be sure to perform ADC map
Clinical: Lesion detection, esp. for metastatic lesions to liver
• EOVIST Protocol
•
• Axial Post-contrast LAVA/THRIVE at 5 min’s and 20 min’s
Axial and coronal Pre- and Post-contrast “STEALTH” as required by the radiologist oncologists
• Clinical: Lesion detection



 Rad will specify if study to be done without contrast

 FOV: <34 cm
 SLT/gap: 1.4 mm/0
 ASSET/SENSE: minimum
 Respiratory Triggered
 Through bottom 2/3 of liver, including pancreas

•
•
•
•

Parameters:





FOV: 32 cm
SLT/gap: 4-5 mm/0
Slices: 15, each
ASSET/SENSE: None
BH
Coronal RAO LAO
•
•
Off Axial image, select image showing CBD through pancreatic head
Coronal
Image posterior to CBD as it passes through the pancreatic head to anterior to the porta hepatis
Whole gallbladder should be included although can be sacrificed to image whole CBD
•
•

RAO Coronal Oblique
Rotate 20-30 ⁰ counterclockwise
Include CBD
Gallbladder not necessarily included
•
•
•
LAO Coronal Oblique
Rotate 20-30⁰ clockwise from straight coronal
Center on CBD
Entire gallbladder included

•
•
•




FOV: 32 cm
SLT/gap: 40 mm/0
Slices: 12
 ASSET/SENSE: None
 BH
RADIAL
Off Axial image, select image showing Pancreatic Duct
(Pancreatic Head)
Multiple slabs off different angles (15-30 ⁰ intervals)
Adequate pause to eliminate crosstalk