Portal MR Venography
with slides borrowed from
Tom Grist, MDJorg Debatin, MDQian Dong, MDRuth Carlos, MDDavid Stafford-Johnson, MDMohammed Neimatallah, MDBrian Hamilton, MDJochen 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
Venous Phase
Hepatoma
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-of-View = 320 x 320 x 96 mm, Matrix 256 x 160 x 32, Centric Ordering of k-space, 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.
Main Portal Vein
MIP of Entire 3D Volume
Main Portal Vein
SMV
Sub-Volume MIP
Axial Reformation
MIP of Entire 3D Volume
Axial Reformation
Sub-Volume MIP
Right Hepatic vein
Right Hepatic vein
Portal hypertension with varices
55 year old female prior to TIPS
Coronal 3D Gd MRA MIP during venous phase
Thick MIP Thin MIP
Varices
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-of-View = 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
Maximum intensity projection
Minimun intensity projections
Portal and hepatic vein thrombosus
Maximum intensity projection
Minimun intensity projections
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
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