Body MR Imaging

Fast, Efficient, and Comprehensive

Bong Soo Kim, MDa, Wirana Angthong, MDb, Yong-Hwan Jeon, MDb,
Richard C. Semelka, MDb,*

KEYWORDS
 Abdominal MR imaging  Uncooperative patient  Motion-resistant MR imaging
 New MR imaging techniques  Artifacts

KEY POINTS
 Magnetic resonance (MR) imaging of the abdomen should be performed in a fast, efficient, and
comprehensive fashion and provide consistent image quality and display of disease processes.
 Separation of protocols for cooperative and cooperation-challenged patients is necessary because
inability of noncooperative patients to hold their breath impairs the image quality on abdominal MR
imaging.
 Motion-resistant protocols including fast imaging and radial acquisition techniques radically
improve imaging quality in noncooperative patients.

INTRODUCTION it is necessary to develop separate protocols for

A major strength of magnetic resonance (MR) im-
aging is the variety of types of information that it
is able to generate. As a result, abdominal MR im-
aging can provide comprehensive information on
organ systems and disease entities. The use of
fast scanning techniques provides consistently
high image quality and good conspicuity of dis-
ease with a decrease of imaging times.13 Ex-
amination time is critical because the longer MR
studies could result in worsening of imaging quality
because of motion, which tends to progress
through the course of the study from patient
exhaustion. The sequence acquisition time in
routine MR protocols could generally be too long
for high-diagnostic-quality abdominal MR imaging
in noncooperative patients such as those who
are agitated, sedated, or unconscious. Therefore,
noncooperative patients,46 distinct from a stan-
dard cooperative protocol. To provide appropriate
abdominal MR work-up in cooperative and nonco-
operative patients, this article provides basic infor-
mation about different sequences and core
information about image interpretation.
COOPERATIVE PROTOCOL
In practice, it is important to recognize which
technique is the most consistent in showing
various diseases in order to target lesions in an im-
aging protocol. Attention to length of examination
is critical because longer examinations result in
fewer patients who can be examined and a
decreased in patient cooperation. The different se-
quences used should ideally be of short duration
and breath held or breathing independent. Another
radiologic.theclinics.com

Disclosure: None of the authors has a conflict of interest.

a
Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine,
1753-3, Ara-1-dong, Jeju-si, Jeju-do 690-716, Korea; b Department of Radiology, University of North Carolina
Hospitals, University of North Carolina at Chapel Hill, CB 7510, 2001 Old Clinic Building, Chapel Hill, NC 27599-
7510, USA
* Corresponding author.
E-mail address: richsem@med.unc.edu

Radiol Clin N Am 52 (2014) 623636

http://dx.doi.org/10.1016/j.rcl.2014.02.007
0033-8389/14/$ see front matter 2014 Elsevier Inc. All rights reserved.
624 Kim et al

consideration is reproducibility of examination fibrous tissue content, which appear as low

protocols, because efficient operation of an MR
imaging system requires the use of set protocols,
which serves to speed up examinations, render
examinations reproducible, and increases use by
familiarity with a standard approach. Table 1 lists
the parameters of the MR sequences used in
cooperative patients on 1.5-T and 3.0-T scanners.
For most patients, it is possible to complete the
core sequences within 15 minutes.
T1-Weighted Sequences
In-phase two-dimensional spoiled gradient
echo sequence
In-phase imaging has become a routine part of
liver MR imaging for investigating disease of
the abdomen. This sequence is primarily used
to provide the following information: presence
of subacute blood or concentrated protein, which
both have high signal intensity (Fig. 1); presence
of fat as high-signal-intensity tissue (Fig. 2);
and abnormally increased fluid content or
signal intensity.
Out-of-phase two-dimensional spoiled
gradient echo sequence
Out-of-phase images show a sharply defined
black rim around organs with a fat-water inter-
face, and the kidneys are a good organ to look
for this. Out-of-phase sequences are helpful for
the recognition of diseased tissue in which fat
and water protons are present within the same
voxel. Signal loss is maximal when fat content
approaches 50%. This sequence plays an impor-
tant role in detecting the presence of fat (steato-
sis) within the liver and lipid within adrenal
masses to characterize them as adenomas,
which are shown as loss of signal intensity relative
to the in-phase sequence (Fig. 3). In addition, it
is important to use in-phase/out-of-phase
sequences to show magnetic susceptibility ef-
fects from the presence of iron (exogenous
or endogenous) or air. Examples include iron
storage diseases, such as hemochromatosis or

Table 1
Parameters for cooperative patients used at 1.5 T and 3.0 T on MR imaging scanners

Precontrast Sequences Postcontrast Sequences

T1-weighted
2D-SGE
In Phase/Out of Dynamic T1-weighted
Phase T2-weighted SS-ETSE 3D-GREa
Parameter (T) 3.0 1.5 3.0 1.5 3.0 1.5
Plane of acquisition Axial Axial
Axial, Axial, Axial, Axial,
coronal coronal coronal coronal
TR (ms) 169 142 2000 1500 3.07 4.3
TE (ms) 2.5/1.58 4.4/2.2 95 90 1.32 1.6
Flip angle ( ) 57 70 150 180 13 10
Echo-train length 179 156
BW/pixel (Hz) 400 490 781 651 500 350
Matrix (phase  frequency) 204  256 192  256 204  256 192  256 192  256 160  320
FOV (mm) 400  400 350  350 350  350 400  400 400  400 360  360
No. of section 28 19 30 20 72 72
Section thickness (mm) 8 8 8 8 3 3.5
Intersectional gap (mm) 1.6 1.6 1.6 1.6 0 0
No. of signal acquisition 1 1 1 1 1 1
Fat suppression None None Fat saturation for Fat Fat
axial, none for saturation saturation
coronal
Respiratory control BH BH BI BI BH BH

Abbreviations: BH, breath-holding; BI, breathing-independent; BW, bandwidth; FOV, field of view; GRE, gradient echo;
Hz, hertz; sat, saturation; SGE, spoiled gradient echo; SS-ETSE, single-shot echo-train spin-echo; TE, echo time; TR, repe-
tition time; 2D, two dimensional; 3D, three dimensional.
a
Dynamic 3D-GRE sequences were used to acquire all 3 postcontrast phases in 3.0-T and 1.5-T scanners.
 Body Magnetic Resonance Imaging 625

Fig. 1. MR images in a 27-year-old woman with a hemorrhagic corpus luteal cyst. Axial T1-weighted two-dimen-
sional (2D) SGE in-phase (A) and T1-weighted fat-suppressed three-dimensional (3D) GRE (B) images show high
signal intensity within an ovarian cystic mass (arrows) in the pelvic cavity, suggesting a hemorrhagic cyst. Hemo-
peritoneum is also visualized in the pelvic cavity.

hemosiderosis. Susceptibility effects increase volume coverage in a single breath-hold im-

with increase in echo time (TE) because of pro-
nounced decay of transverse magnetization,
which appears as lower-signal tissue on longer
TE sequences (Fig. 4).7,8
Coronal two-dimensional spoiled gradient
echo sequence
Coronal T1-weighted images are obtained for an
overview of the abdomen. Coronal MR images
allow an additional perspective that may not
clearly be shown on transverse images, and in-
crease the confidence of diagnosis. Coronal im-
ages are useful for viewing the aorta, para-aortic
lymph nodes, and mesenteric vessels, which
display the vascular structures along their longitu-
dinal axes. The coronal views should also be used
to inspect the lung bases and the inferior and su-
perior surfaces of the liver for the presence of me-
tastases and other disease processes.
Fat-suppressed T1-weighted three-dimensional
gradient recalled echo sequence
Three-dimensional (3D) gradient recalled echo
(GRE) sequences in combination with fat-
suppression techniques provide high-quality im-
aging and very thin sections with adequate
aging time. 3D GRE is suitable for dynamic
contrast-enhanced MR studies because of its
excellent inherent fat suppression and sensitivity
to enhancement in tissues after gadolinium-
based contrast agents (GBCAs) are given.
Fat-suppression techniques are useful for the
diagnosis of diseased tissues composed predom-
inantly of fat, such as ovarian dermoid cyst, angio-
myolipoma, lipoma, and myelolipoma (see Fig. 2),
which are confidently diagnosed by showing the
lesion to show high signal on in-phase images
and dark on noncontrast fat-suppressed GRE
images.9 Fat-suppression technique improves
the delineation of pancreatic borders and the
pancreas, which appears homogeneously bright
compared with surrounding low-signal-intensity
fat and other abdominal organs (see Fig. 2). It is
excellent for identifying chronic pancreatitis (less
intense than normal high-intensity pancreas)
and pancreatic masses such as small ductal
adenocarcinoma (Fig. 5) and pancreatic neuroen-
docrine tumors.10,11 The fat-suppression tech-
nique also allows the best visualization of renal
corticomedullary differentiation, which is reduced
in renal transplant rejection and chronic renal
insufficiency.12

Fig. 2. MR images in a 56-year-old woman with an adrenal myelolipoma. Axial T1-weighted 2D SGE in-phase im-
age (A) shows a lesion with high signal intensity (arrows) in left adrenal gland with suppression (arrows) on the
T1-weighted fat-suppressed 3D GRE image (B). The normal pancreas is well shown as high signal intensity on axial
T1-weighted fat-suppressed 3D GRE image.
626 Kim et al

Fig. 3. MR images in a 51-year-old man with an adrenal adenoma. A right adrenal mass (arrow) has substantial
signal reduction from the axial T1-weighted 2D SGE in-phase image (A) to the axial T1-weighted 2D SGE out-of-
phase image (B).

T2-weighted Sequences signal intensity (see Fig. 4); and (4) the presence
of lymph nodes in the porta hepatis, which have
Single-shot echo-train spin-echo sequence
high signal intensity compared with liver paren-
The important information that T2-weighted im-
chyma (Fig. 6). Fat suppression should generally
ages provide includes (1) the presence of
be applied for at least one set of T2-weighted im-
abnormal increased fluid content in diseased tis-
ages of the liver, and it may also be helpful to
sue and fluid-containing tumors (cysts, hamarto-
perform this in a different plane, to obtain an addi-
mas, and hemangiomas), which results in high
tional benefit from a second data acquisition. One
signal intensity; (2) the presence of chronic fibrotic
common circumstance in which fat suppression is
tissue, which results in low-signal-intensity le-
useful on T2-weighted sequences is when the
sions, and the presence of low-fluid-content le-
patient may have liver metastases and the back-
sions, which results in a range of signal intensity
ground liver has steatosis. Without fat suppres-
from mildly low to mildly high; (3) the presence of
sion, fatty liver has high signal intensity on a
iron deposition, which appears as markedly low

Fig. 4. MR images in a 62-year-old woman with idiopathic hemochromatosis. Axial T1-weighted 2D SGE out-of-
phase image (echo time of 2.2 ms) (A) and axial T1-weighted 2D SGE in-phase image (echo time of 4.4 ms) (B)
show a marked reduction in signal intensity in the liver, pancreas, and focal areas of the spleen in the image
with the longer echo time. There is decreased signal intensity of liver and pancreas (arrow) on coronal T2-
weighted fat-suppressed SS-ETSE (C).
 Body Magnetic Resonance Imaging 627

Fig. 5. MR images in a 49-year-old man with a small pancreatic cancer. Axial T1-weighted fat-suppressed 3D GRE
image (A) shows a small mass arising in the pancreatic head, which invades the common bile duct and is shown as
a low-signal-intensity lesion (arrow) with normal pancreas appearing bright. On the axial T1-weighted fat-sup-
pressed 3D GRE arterial dominant phase image (B), a low-signal-intensity tumor (arrow) is identified in the
head, clearly demarcated from uniformly well-enhancing normal pancreatic tissue.

standard single-shot echo-train spin-echo (SS-
ETSE) sequence, because fat signal is high with
this technique, thereby diminishing contrast with
most liver lesions, whereas with fat suppression
the liver becomes darker, ensuring optimal
contrast with lesions that show mildly intrinsic
high T2 signal. Coronal T2-weighted images are
also obtained for an overall review of the
abdomen. They are particularly useful for viewing
the structures of the bowel and biliary system.
An additional advantage is that this sequence is
resistance to susceptibility artifact. As a result, the
bowel wall can clearly be seen and susceptibility
artifact from metallic devices is minimal. In these
settings it may be important to not use fat sup-
pression to minimize susceptibility effects. Often
a more complex fat-suppression sequence is
important to minimize persistent fat signal on this
sequence, such as combining fat suppression
with inversion recovery.

Fig. 6. MR images in a 45-year-old man with chronic liver disease and an enlarged porta hepatis lymph node.
Axial T2-weighted fat-suppressed SS-ETSE image (A) shows the best delineation of a lymph node (arrow) in porta
hepatis, compared with axial T1-weighted fat-suppressed 3D GRE arterial dominant phase (B) and early hepatic
venous phase images (C). On the axial T2-weighted fat-suppressed SS-ETSE image, lymph nodes have moderately
high signal intensity and both liver and background fat are low signal, rendering excellent conspicuity.
628 Kim et al
Contrast-enhanced Fat-suppressed T1-
weighted 3D GRE Sequence
Hepatic arterial dominant phase
The hepatic arterial dominant (capillary) phase
(HADP) is the single most important data set
when using a nonspecific extracellular GBCA.13
Capillary phase image acquisition is achieved by
using a short-duration sequence initiated immedi-
ately after gadolinium injection. These images are
identified by the presence of contrast in hepatic ar-
teries and portal veins and its absence in the he-
patic veins. Greater enhancement of normal
pancreas than the liver can be reliably judged on
HADP. Hypervascular liver tumors, especially he-
patocellular carcinomas, focal nodular hyperplasia
(Fig. 7), and hypervascular metastases are well
recognized as intensely enhancing lesions on
HADP, compared with background liver. HADP
images are essential to observe hepatic perfusion
abnormalities, such as are present in the full range
of inflammatory conditions (Fig. 8). The pancreas
shows uniform capillary blush on HADP, which
renders it markedly high in signal intensity. In gen-
eral, pancreatic adenocarcinoma usually appears
as a focal hypovascular mass that is readily de-
tected and characterized on HADP (see Fig. 5).
In these instances, the tumor is well demarcated
from adjacent uninvolved pancreas, which shows
greater enhancement.
Early hepatic venous phase
Images for this phase are acquired 45 to 60 sec-
onds after initiation of the GBCA and are recog-
nized by the presence of contrast in hepatic and
portal veins. In this phase, the hepatic paren-
chyma is maximally enhanced so that hypo-
vascular lesions such as cysts, hypovascular
metastases, and scar tissue are most clearly iden-
tified as regions of absent or diminished en-
hancement. This phase is also useful in lesion
Fig. 7. MR images in a 41-year-old woman with a focal nodular hyperplasia. Axial T1-weighted fat-suppressed 3D
GRE arterial dominant phase image (A) shows an intensely enhancing mass in the liver with central scar shown by
low signal intensity. On early hepatic venous phase image (B), the tumor fades to near isointensity with back-
ground parenchyma and a central scar showing delayed enhancement.
characterization of hypervascular tumors, such
as hepatocellular carcinoma, which show washout
(that is, they become darker than liver) on early he-
patic venous phase, and focal nodular hyper-
plasia, which shows fading (that is, it becomes
isointense with liver) (see Fig. 7). This phase also
clearly shows patency or thrombosis of portal
and hepatic veins. The perfusion abnormalities
on HADP such as compromised portal venous
flow, acute-on-chronic hepatitis, inflammatory re-
actions to adjacent infection (eg, acute cholecys-
titis, liver abscess), and Budd-Chiari syndrome
usually disappear on early hepatic venous or in-
terstitial phases (see Fig. 8) and this often forms
an important part of the diagnostic criteria for a
phenomenon being vascular or inflammatory-
vascular in nature.
Interstitial phase
This phase is acquired 90 seconds to 5 minutes af-
ter initiation of the contrast material injection. The
interstitial phase shows computed tomography
(CT)like images when performed with fat sup-
pression. Late enhancement features of focal liver
lesions are shown, which aid in lesion character-
ization. These findings assist in establishing a
diagnosis of hepatocellular carcinoma by showing
washout and delayed capsular enhancement;
mass-forming intrahepatic cholangiocarcinoma,
which shows progressive enhancement; and
hemangioma, which shows coalescence and
centripetal progression of enhancing nodules.
Enhancement of peritoneal metastasis, inflamma-
tory disease, and pulmonary nodules are well
shown at this phase. The coronal interstitial im-
ages are acquired after 3 sets of transverse im-
ages. These images provide a general survey
view of the abdomen from a surgeons vantage
point. These images are useful for detecting me-
tastases of the musculoskeletal system (especially
 Body Magnetic Resonance Imaging 629

Fig. 8. MR images in a 40-year-old man with multiple liver and bone metastases from pancreatic head cancer. This
patient has multiple ringlike enhancing metastases in the liver. On axial T1-weighted fat-suppressed 3D GRE arte-
rial dominant phase imaging (A), sharply demarcated wedge-shaped perilesional enhancements are shown with
disappearance on early hepatic venous (B) and interstitial phases (C), suggesting perfusion abnormalities. Coronal
T1-weighted fat-suppressed 3D GRE interstitial phase image (D) shows a small enhancing metastasis (arrow) in the
right ilium.

thoracolumbar spines, pelvis, and femoral heads)
(see Fig. 8),14 peritoneal disease, retroperitoneal
disease, and metastases of lung bases. The
coronal interstitial images also provide valuable in-
formation about bowel and mesenteric abnor-
malities and may be used to define abnormal
enhancement in tumoral and inflamed regions of
bowel. Direct coronal imaging (rather than refor-
matting transverse images) is strongly advised at
this phase to substantiate the patency or throm-
bosis of the portal vein and superior mesenteric
veins, which is important for the assessment of
liver cirrhosis and pancreatic cancer. Artifacts,
including flow artifacts, are a more serious prob-
lem with MR than with CT, and an important
means for compensating for this is to acquire im-
ages in orthogonal planes. If a defect in a vessel
represents thrombosis rather than flow, it should
be apparent, with the same anticipated location,
from one plane to the next. Flow artifacts show
different morphologies from one plane to the next.
MOTION-RESISTANT PROTOCOLS
Motion-resistant protocols achieve improved im-
age quality in settings of noncooperation by either
acquiring the critical data for image creation
during only a small fraction of the time for free
breathing, rendering this technique insensitive to
the patients motion (single-shot approaches) or
by modifying the data acquisition to minimize ef-
fects of motion (eg, radial acquisition, multiple
data averages). To facilitate patient throughput
at our center, the primary individual determining
whether a motion-resistant protocol should
be performed is the scanning technologist, who
decides whether the patient is following com-
mands or whether they have difficulty breathing
holding, and, if they are having difficulty, then the
scanning technologist implements the motion-
resistant protocol. To perform an adequate MR ex-
amination in noncooperative patients, it is useful to
obtain the following sequences: T1-weighted dual-
echo magnetization-prepared rapid-acquisition
gradient echo (MP-RAGE), T1-weighted MP-
RAGE before and after gadolinium, T1-weighted
water excitation MP-RAGE (WE-MP-RAGE) after
gadolinium, T1-weighted radial GRE sequence
before and after gadolinium, and T1-weighted
SS-ETSE. Table 2 provides the MR imaging pa-
rameters for motion-resistant protocols on 1.5-T
and 3.0-T scanners.
 630
Kim et al
Table 2
Parameters for motion-resistant protocol used on 1.5-T and 3.0-T MR imaging scanners

Precontrast Sequences Postcontrast Sequences

T1-weighted 2D
MP-RAGE In Phase/ T1-weighted MP- T1-weighted WE-MP- T1-weighted Radial
Out of Phase T2-weighted SS-ETSE RAGE RAGE 3D-GRE
Parameter (T) 3.0 1.5 3.0 1.5 3.0 1.5 3.0 1.5 3.0 1.5
Plane of acquisition Axial Axial Axial, Axial, Axial Axial Axial, Axial, Axial, Axial,
coronal coronal coronal coronal coronal coronal
TR (ms) 1800 1540 2000 1500 2000 2000 2000 2000 3.8 3.8
TE (ms) 2.3/3.6 4.1/2.3 95 90 2.5 1.7 2.8 6.2 1.6 1.6
TI (ms) 1200 900 1200 700 1200 700
Flip angle ( ) 20 15 150 180 20 15 20 15 10 10
Echo-train length 179 156
BW/pixel (Hz) 190/180 180/150 781 651 600 180 600 180 600 350
Matrix (phase  frequency) 256  189 256  156 204  256 192  256 180  256 180  256 180  256 128  192 380  380 380  380
FOV (mm) 380  380 380  380 350  350 400  400 400  400 350  350 400  400 350  350 380  380 380  380
No. of sections 40 38 30 20 28 20 28 20 72 80
Section thickness (mm) 5 6 8 8 8 8 8 8 3.0 3.0
Intersectional gap (mm) 1.0 1.2 1.6 1.6 1.6 1.6 1.6 1.6 0 0
No. of signal acquisition 1 2 1 1 1 1
Fat suppression None None Fat sat for axial, none None None Fat sat Fat sat Fat sat Fat sat
for coronal
Respiratory control BI BI BI BI BI BI BI BI FB FB

Abbreviations: FB, free breathing; MP-RAGE, magnetization-prepared rapid-acquisition gradient echo; sat, saturation; TI, inversion time; WE-MP-RAGE, water excitation
magnetization-prepared rapid-acquisition gradient echo.
 Body Magnetic Resonance Imaging 631

T1-weighted Sequences Standard in-phase/out-of-phase GRE imaging

are performed as multislice GRE acquisitions that
Two-dimensional MP-RAGE sequence
require patients to suspend respiration, because
MP-RAGE, for example turbo fast low-angle shot
sequences are generally 10 to 20 seconds in dura-
(FLASH), is a single shottype sequence that oper-
tion. New implementations of MP-RAGE in-phase/
ates as a slice-by-slice single-shot technique and
out-of-phase images are able to show the pres-
can generate T1-weighted images that are resis-
ence of fat, which is necessary to evaluate the liver
tant to deterioration from respiratory motion
and also adrenal masses in patients who cannot
(Figs. 9 and 10). This sequence can be used to
cooperate with standard in-phase/out-of-phase
obtain motion-free and moderate-quality images
GRE imaging, such as in the elderly, the severely
with acquisition times as short as 1 second. It
debilitated, and young children (see Fig. 10;
has the intrinsic issue that signal/noise ratio
Fig. 11).1618 Image quality and lesion conspicuity
(SNR) and contrast/noise ratio (CNR) are lower
of MP-RAGE in-phase/out-of-phase imaging are
than in regular gradient echo images.15 An inver-
also comparable with standard in-phase/out-of-
sion pulse leads to the longitudinal magnetization
phase GRE imaging.18
that creates the T1 contrast. The sequence ac-
quires data using a very short repetition time (TR)
and low flip-angle excitation pulses to reduce Two-dimensional WE-MP-RAGE
acquisition time and maintain the prepared Spatial-spectral selective water excitation is a
magnetization. newer fat-attenuation technique that selectively

Fig. 9. MR images in a 10-year-old boy. Standard axial T1-weighted 2D SGE in-phase (A) and out-of-phase (B) im-
ages shows motion artifacts caused by respiration. In this patient, who could not suspend respiration, the study
was switched to a motion-resistant protocol because unacceptable image quality was expected. The motion-
resistant protocol included axial T1-weighted 2D MP-RAGE in-phase (C), axial T1-weighted 2D MP-RAGE
out-of-phase (D), axial T1-weighted radial 3D GRE (E), axial T2-weighted fat-suppressed SS-ETSE (F), contrast-
enhanced axial T1-weighted 2D MP-RAGE (G), contrast-enhanced axial T1-weighted 2D-WE-MP-RAGE (H), and
contrast-enhanced axial T1-weighted radial 3D GRE images (I). This protocol shows substantially reduced artifacts
and motion-free high-quality images in this difficult-to-scan child.
632 Kim et al

Fig. 10. MR images in a 64-year-old man with liver cirrhosis. There is a reticular pattern fibrosis through the liver,
which has low signal intensity on T1-weighted images. Axial 2D SGE in-phase (A) and axial out-of-phase (B) im-
ages show motion artifacts caused by breathing and parallel imaging artifacts. No motion artifacts are present on
axial 2D MP-RAGE in-phase (C) and out-of-phase (D) images. The fine pattern of fibrosis is particularly well shown
on the axial 2D MP-RAGE out-of-phase image.

Fig. 11. MR images in a 48-year-old woman with liver steatosis and liver metastasis. The liver shows a reduction of
signal intensity on the axial 2D SGE out-of-phase image (B) compared with the axial 2D SGE in-phase image (A).
This reduction of signal intensity is also visualized on axial 2D MP-RAGE out-of-phase imaging (D), comparing
with axial 2D MP-RAGE in-phase imaging (C). A small liver metastasis (arrow) is appreciated in S8 of the liver, bet-
ter depicted in axial 2D MP-RAGE out-of-phase (D) than in axial 2D SGE out-of-phase (B) imaging.
 Body Magnetic Resonance Imaging 633

excites water protons leaving protons in fat unper-
turbed, rather than exciting all protons and then
spoiling the signal from fat protons. This is a faster
fat-attenuating scheme than conventional
exciting-spoiling fat suppression, and this speed
is necessary for use on a rapid gradient technique
such as MP-RAGE. WE-MP-RAGE can provide
fat-attenuated contrast-enhanced T1-weighted
images (Fig. 12). WE-MP-RAGE at 3 T can achieve
better image quality and fat attenuation than at
1.5 T because of the intrinsic properties of the
higher field strength, such as higher SNR and
CNR, and increased chemical frequency shift be-
tween fat and water that reduces the duration of
WE-radiofrequency pulses and data acquisition
time.4 This sequence, similar to fat-suppressed
spoiled gradient echo (SGE), could be used to
detect abnormally increased fluid content or
fibrous tissue content that appears as low signal
intensity, and presence of subacute blood or
concentrated protein, which are both high signal
intensity.
3D radial GRE sequence
Standard T1-weighted GRE sequences acquire
k-space data on a horizontal-filling line-by-line ba-
sis, which is a scheme that is sensitive to motion
artifacts. Radial acquisition technique (projection
reconstruction) has higher sampling density for
central k-space (which contributes the bulk of
the signal in images), because it acquires data in
a radial spoke-wheel fashion, and undersamples

Fig. 12. MR images in a 25-year-old man with Crohn disease and abscess involving liver and psoas muscle. Mul-
tiple abscesses in liver are clearly shown in a noncooperative patient on axial T2-weighted fat-suppressed SS-ETSE
(A), contrast-enhanced axial 2D MP-RAGE (B), contrast-enhanced axial 2D WE-MP-RAGE (C), and contrast-
enhanced axial 3D radial GE (D) images. The abscess in psoas muscle (arrow) is well visualized on contrast-
enhanced axial 2D WE-MP-RAGE (E), and contrast-enhanced axial 3D radial GE (F) images. Mild pixel graininess
is present on contrast-enhanced axial 2D MP-RAGE (B) and contrast-enhanced axial 2D WE-MP-RAGE (C, E) im-
ages. Axial 3D radial GRE images (D, F) show clear definition of abdominal structure and lesion conspicuity by
using a higher matrix and the thinner section slice in this sequence.
634 Kim et al

Fig. 13. MR images in a 68-year-old man with an oncocytoma in the left kidney. MR images on precontrast T1-
weighted fat-suppressed 3D GRE (A) and T1-weighted fat-suppressed 3D GRE at arterial dominant phase (C)
show blurred resolution of the tumor and pancreatic margin caused by motion. Better sharpness of tumor and
pancreatic edge and clearer depiction of intrahepatic vessels are shown on precontrast radial GRE and interstitial
phase radial GRE images (B, D).

the margins of k-space, with the net effect that
images are less sensitive to motion artifacts
from phase errors.1924 In clinical practice, free-
breathing fat-suppressed 3D radial GRE sequence
can provide excellent motion-controlled images
with high spatial resolution in noncooperative pa-
tients, especially sedated children (see Fig. 12;
Fig. 13).5 3D radial GRE sequence can generate
streak artifacts, which are not seen with conven-
tional rectilinear 3D GRE sequence, but these arti-
facts are usually of a mild degree and the images
are of good diagnostic quality despite their pres-
ence.5 They are most apparent in large patients,
and are virtually absent in children (Fig. 14). The
lesser presence of streak artifacts in pediatric pa-
tients relates to their smaller abdominal transverse

Fig. 14. MR images in a 2-year-old boy with a neuroblastoma in the right adrenal gland. Precontrast T1-weighted
fat-suppressed axial 3D radial GRE image (A) shows a bulky, heterogenous, solid mass with hemorrhagic compo-
nent. The mass extends across the midline adjacent to the aorta at the level of the renal arteries and displaces the
inferior vena cava and pancreatic head on contrast-enhanced T1-weighted fat-suppressed axial 3D radial GRE im-
aging (B). Radial 3D GRE imaging shows high image quality with minimal motion artifacts in this difficult-to-scan
child.

Fig. 15. MR images in a 51-year-old man with 2 small hemangiomas in the liver. Gadolinium-enhanced 3D GRE at
3 T (A) shows more increased conspicuity of hemangiomas (arrows) than at 1.5 T (B) because of higher SNR and
CNR at 3.0 T compared with 1.5 T. MR images show more characteristics of hemangiomas (peripheral globular
enhancement) at 3.0 T than at 1.5 T. Higher SNR at 3.0 T improves visualization of portal veins and hepatic veins
beyond those at 1.5 T.
dimensions compared with adults. In the near
future, the development of compressed sensing,
parallel technique and radial sampling in radial
3D GRE may make it possible to achieve image
acquisition at high temporal resolution using a
smaller number of radial spokes, which will allow
dynamic gadolinium-enhanced imaging, including
in the hepatic arterial phase, in clinical practice.25
T2-weighted Sequences
SS-ETSE sequence
The SS-ETSE sequence is a breathing-independent
technique that is useful both in standard and
motion-resistant protocols. This technique ac-
quires the full image after a single excitation pulse.
A variety of strategies compensate for the entire
k-space not being acquired over this short time
period, and what is described as half-acquisition
is a common approach that samples approximately
60% of k-space in the horizontal filling approach,
and uses the added 10% to correct for the under-
sampling by filling in the remaining 40% of k-space.
Images are obtained in less than a second with
virtually no motion artifact even during free breath-
ing (see Fig. 12).15 This sequence is discussed in
more detail earlier.
HIGH-RESOLUTION IMAGES
Parallel MR Imaging
Parallel MR imaging with suitable phased-array
coils can be used in combination with most MR se-
quences to reduce scan time. Parallel imaging is
often used to increase spatial resolution, decrease
data acquisition time, and most often a combina-
tion of both. This technique makes high temporal
resolution possible in noncooperative patients,
as well as higher spatial resolution (useful in the
pelvis), reduced effective interecho spacing
(eg, less image blurring and image distortion in
Body Magnetic Resonance Imaging 635
SS-ETSE), and reduced specific absorption rate
caused by shorter echo trains at 3 T.
3.0-T MR Imaging
3-T MR imaging can provide higher SNR and
CNR than 1.5-T MR imaging, which leads to
improved image resolution.26,27 The higher SNR
combined with higher in-plane and through-
plane spatial resolution at 3 T improves lesion
conspicuity on gadolinium-enhanced 3D GRE se-
quences (Fig. 15). 3-T MR images have many ad-
vantages compared with 1.5-T images, including
use in small children because of the higher SNR
on MP-RAGE, small-volume disease in general,
and concurrent vascular imaging with tissue imag-
ing (visualization of arteries especially but also
venous structures) using the tissue-imaging
sequence of 3D-GRE alone.
SUMMARY
To achieve routine use in clinical practice, abdom-
inal MR imaging must consistently provide both
superior and important information on organ sys-
tems and disease entities. The suppression of, or
compensation for, motion artifacts is the most
important determinant of diagnostic efficacy in up-
per abdominal MR imaging. This suppression or
compensation can largely be achieved by the
use of separate protocols for cooperative and
noncooperative patients. The clinical MR study
should be performed in a fast, efficient, and com-
prehensive fashion, should focus on the benefit
to the patient, and should emphasize clinically
essential strategies.
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