Routine liver protocol

Indications

This protocol is used to evaluate the liver parenchyma for suspected mass, including screening for hepatocellular carcinoma, evaluation for metastatic disease, and characterization of lesions detected on other modalities (CT or ultrasound). Other common indications include elevated liver function tests and evaluation of tumor extent (i.e. multifocality).

Preparation

• IV contrast agent: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s

• Oral contrast agent: none

• 2 L nasal oxygen

• At least 24-gauge IV; connect to power injector

• Cover from dome thru entire liver

Exam sequences and what we are looking for

1. (1) Diffusion-weighted imaging b50, 500/ADC – Very sensitive sequence for lesion detection.

2. (2) Coronal T2 single-shot fast-spin echo FS BH – Evaluate biliary tree. Detect T2-bright lesions.

3. (3) Axial T2 SSFSE BH – Identify T2-bright lesions.

4. (4-5) Axial T1 in- and out-of-phase (IP/OOP) – Identify geographic and microscopic focal fat.

5. (6) Axial T1-weighted volume-interpolated gradient echo BH pre – Identify anything that is T1-bright before contrast administration, so we don’t mistake it for enhancement.

6. (7) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 20 s – Evaluate for hypervascular lesions.

7. (8) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 1 minute.

8. (9) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 2 minutes.

9. (10) Axial T1-weighted volume-interpolated gradient echo BH post IV administration of contrast at 3 minutes.