Clinical Update: Breath-Hold 3D Gadolinium-Enhanced Multiphasic Abdominal MR

Matthew P. Evitts, DO, Scott B. Hoefer, MD, Udo P. Schmiedl, MD, PhD

Appl Radiol. 2003;32(1) 

In This Article

Clinical Application

This technique can be used in place of CT to evaluate many abdominal and pelvic disease processes. The dynamic gadolinium-enhanced sequence is an adjunct to standard T1- and T2-weighted sequences and is helpful in characterizing renal masses (Figures 1 and 2), primary and secondary liver tumors (Figures 3 and 4), hepatic vascular disease (Figure 5), periportal masses (Figure 6), pancreatic masses (Figures 7 and 8), and rectal lesions (Figures 9 and 10).

A 54-year-old woman with renal cell carcinoma. (A) Coronal, noncontrast image demonstrates an isointense mass in the upper pole of the right kidney. The region of interest (ROI) over the mass was 34. (B) Coronal arterial-phase image demonstrates minimal heterogeneous enhancement with an ROI of 78.

A 71-year-old man with transitional cell carcinoma and prior right nephrectomy.

A 49-year-old with elevated alpha fetoprotein (AFP) and multifocal hepatocellular carcinoma. (A) Arterial-phase axial image demonstrates hypervascular nodules in the posterior segment of the right hepatic lobe and medial segment left lobe (arrows). Enhancing tumor thrombus fills the right portal vein (arrowheads). (B) Delayed-phase axial images show the hypervascular areas to be nearly isodense to the remaining liver tissue.

A 49-year-old with metastatic gastrinoma post right hepatic lobectomy. (A) Spin-echo T1-weighted axial image demonstrates an oval hypointense nodule in the hypertrophied left lobe (arrow). (B) Axial arterial phase shows the lesion is markedly hyper-vascular. (C) Axial portal-venous phase image demonstrates "washout" of contrast from the nodule. Note peripheral rim of remaining enhancement. (D) Axial fast-spin-echo T2-weighted image showing marked nodule hyperintensity.

A 50-year-old woman with acute Budd-Chiari syndrome. (A) Axial late hepatic arterial-phase image shows normal enhancement of the left lateral segment and caudate but delayed heterogeneous enhancement of the left medial segment and right lobe. Note the lack of enhancement of the hepatic veins within the involved segments (arrows). (B) Axial delayed-phase image with reversal of the enhancement pattern shown previously in Figure 5A ("flip-flop" pattern). This is due to washout of contrast from the normally perfused left lateral segment and continued delayed enhancement of the abnormal left medial segment and right lobe. (C) Coronal delayed-phase image demonstrates the same pattern as in Figures 5A and 5B. Note the patent, enhancing hepatic vein to the lateral segment (arrowhead), and thrombosed vein to the right lobe (black arrow).

A 35-year-old man with round blue cell tumor of the porta hepatis. (A) Coronal portal venous phase showing a mass superior and inferior to the main portal vein (arrowheads). A portion of the tumor is also seen anterior to the splenic vein (arrow). (B) Coronal portal-phase image performed more posteriorly shows that the mass anterior to the inferior vena cava enhances heterogeneously and extends superiorly almost to the level of the hepatic veins (arrow). In this case, the gadolinium enhanced images, especially in the coronal plane, better delineate the mass and its relationship to adjacent vessels.

A 57-year-old man with pancreatic adenocarcinoma. (A) Axial arterial-phase image demonstrates a poorly defined hypo-enhancing mass in the pancreatic tail (arrow-head). (B) Axial image more superior to A. The mass obstructs the splenic vein (arrow).

A 35-year-old man with multiple endocrine neoplasia type I and pancreatic glucagonoma. (A) Axial arterial-phase image showing hypervascular nodule in pancreatic head (arrow). (B) Axial portal-venous phase image demonstrates the nodule to be isodense.

A 32-year-old woman with rectal angiosarcoma. (A) Axial image at the level of the pubic symphysis demonstrates infiltrative enhancing tissue involving the rectum, adjacent levator ani muscles (arrows), and the vagina (black arrowhead). Also note the enhancement of the lateral walls of the ischiorectal fossa. (B) Axial image more superiorly shows extensive invasion of the perirectal soft tissues.

Anal fistula. (A) Axial image demonstrates gas bubble within the internal sphincter complex (arrow) and a "horseshoe" abscess violating the puborectalis muscle (arrowheads). (B) Axial image more inferior shows the enhancing fistula tracts (arrowheads), which exited the skin more inferiorly.

Breath-hold 3D gadolinium-enhanced multiphasic abdominal MR is a widely available technique that can be used, with excellent results, in the detection and characterization of a wide variety of abdominal and pelvic diseases. Breath-hold imaging eliminates respiratory motion and improves anatomic sharpness. The 3D data set can, when needed, be viewed in other planes. Lesion vascularity can be assessed similar to multiphasic CT. Its use is suggested when CT with iodinated contrast is either contraindicated or equivocal.

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