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Portal MR Venography with slides borrowed from Tom Grist, MD Jorg Debatin, MD Qian Dong, MD Ruth Carlos, MD David Stafford-Johnson, MD Mohammed Neimatallah,

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Presentation on theme: "Portal MR Venography with slides borrowed from Tom Grist, MD Jorg Debatin, MD Qian Dong, MD Ruth Carlos, MD David Stafford-Johnson, MD Mohammed Neimatallah,"— Presentation transcript:

1 Portal MR Venography with slides borrowed from Tom Grist, MD Jorg Debatin, MD Qian Dong, MD Ruth Carlos, MD David Stafford-Johnson, MD Mohammed Neimatallah, MD Brian Hamilton, MD Jochen Gaa, MD

2 Arterial phase Portal venous phase

3 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 ( ) Three phases Arterial Portal venous Equilibrium

4 Mesenteric Portal Protocol SequenceTime SagSSFSE0:56 Axial T15:32 Axial T2 & fat sat6:04 MRCP (optional) Coronal 3D Gd (3 phases) 0:30 x 3 Axial 2D TOF (optional) Total imaging time~15-25 minutes

5 Arterial Phase Venous Phase

6 Hepatoma

7 Fig 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.

8 Main Portal Vein MIP of Entire 3D Volume Main Portal Vein SMV Sub-Volume MIP Axial Reformation

9 MIP of Entire 3D Volume Axial Reformation Sub-Volume MIP Right Hepatic vein

10 Portal hypertension with varices

11 55 year old female prior to TIPS Coronal 3D Gd MRA MIP during venous phase

12 Thick MIP Thin MIP Varices

13 Portal hypertension

14 Spleno-renal shunt Anterior MIP Posterior MIP

15 Fig 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

16 56 year old female with abdominal pain Maximum intensity projection Minimun intensity projections

17 Portal and hepatic vein thrombosus Maximum intensity projection Minimun intensity projections

18 Acute thrombosis of portal vein (arrows) with perithrombus enhancement (arrowheads) Maximum Intensity Projection

19 Cavernous Transformation

20 32-year-old female with abdominal pain

21 Budd Chiari

22 Fig 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

23 IVC anastomotic narrowing

24 13 year old female post liver and kidney transplant Arterial Phase Portal-venous Phase

25 Post Liver Transplant

26 Post Liver Transplant with abcess narrowing portal vein

27 Pancreatic mass encasing celiac and spleno -portal confluence

28 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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