Portal mr venography
This presentation is the property of its rightful owner.
Sponsored Links
1 / 28

Portal MR Venography PowerPoint PPT Presentation


  • 245 Views
  • Uploaded on
  • Presentation posted in: General

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. Portal venous phase. Arterial phase. Coronal 3D Gd MRA of Portal Vein. Coronal Plane

Download Presentation

Portal MR Venography

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Portal mr venography

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


Portal mr venography

Portal venous phase

Arterial phase


Portal mr venography

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


Portal mr venography

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


Portal mr venography

Arterial Phase

Venous Phase


Portal mr venography

Hepatoma

Venous Phase


Portal mr venography

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.


Portal mr venography

MIP of Entire 3D Volume

Sub-Volume MIP

Main Portal Vein

SMV

Main Portal Vein

Axial Reformation


Portal mr venography

MIP of Entire 3D Volume

Sub-Volume MIP

Right Hepatic vein

Right Hepatic vein

Axial Reformation


Portal mr venography

Portal hypertension with varices


Portal mr venography

55 year old female prior to TIPS

Coronal 3D Gd MRA MIP during venous phase


Portal mr venography

Varices

Thick MIP

Thin MIP


Portal mr venography

Portal hypertension


Portal mr venography

Spleno-renal shunt

Anterior MIP

Posterior MIP


Portal mr venography

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.


Portal mr venography

56 year old female with abdominal pain

Minimun intensity projections

Maximum intensity projection


Portal mr venography

Portal and hepatic vein thrombosus

Minimun intensity projections

Maximum intensity projection


Portal mr venography

Acute thrombosis of portal vein (arrows) with perithrombus enhancement (arrowheads)

Maximum Intensity Projection


Portal mr venography

Cavernous Transformation


Portal mr venography

32-year-old female with abdominal pain


Portal mr venography

Budd Chiari


Portal mr venography

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


Portal mr venography

IVC anastomotic narrowing


Portal mr venography

13 year old female post liver and kidney transplant

Portal-venous Phase

Arterial Phase


Portal mr venography

Post Liver Transplant


Portal mr venography

Post Liver Transplant with

abcess narrowing portal vein


Portal mr venography

Pancreatic mass encasing celiac and spleno-portal confluence


Portal mr venography

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


  • Login