Portal MR Venography

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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, MD Brian Hamilton, MD Jochen Gaa, MD
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Portal venous phase
Arterial phase
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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 lt 10 msec
• TE lt 3 msec
• Partial Fourier imaging (0.5 NEX)
• Adjust phase encoding steps (128-224)
• Three phases
• Arterial
• Portal venous
• Equilibrium

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Mesenteric Portal Protocol

• Sequence Time
• Sag SSFSE 056
• Axial T1 532
• Axial T2 fat sat 604
• MRCP (optional)
• Coronal 3D Gd (3 phases) 030 x 3
• Axial 2D TOF (optional)
• Total imaging time 15-25 minutes

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Arterial Phase
Venous Phase
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Hepatoma
Venous Phase
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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.
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MIP of Entire 3D Volume
Sub-Volume MIP
Main Portal Vein
SMV
Main Portal Vein
Axial Reformation
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MIP of Entire 3D Volume
Sub-Volume MIP
Right Hepatic vein
Right Hepatic vein
Axial Reformation
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Portal hypertension with varices
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55 year old female prior to TIPS
Coronal 3D Gd MRA MIP during venous phase
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Varices
Thick MIP
Thin MIP
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Portal hypertension
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Spleno-renal shunt
Anterior MIP
Posterior MIP
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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.
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56 year old female with abdominal pain
Minimun intensity projections
Maximum intensity projection
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Portal and hepatic vein thrombosus
Minimun intensity projections
Maximum intensity projection
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Acute thrombosis of portal vein (arrows) with
perithrombus enhancement (arrowheads)
Maximum Intensity Projection
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Cavernous Transformation
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32-year-old female with abdominal pain
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Budd Chiari
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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
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IVC anastomotic narrowing
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13 year old female post liver and kidney
transplant
Portal-venous Phase
Arterial Phase
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Post Liver Transplant
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Post Liver Transplant with abcess narrowing
portal vein
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Pancreatic mass encasing celiac and spleno-portal
confluence
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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