Table Of ContentMR Imaging of the Abdomen and Pelvis
Bernd Hamm, MD Volkmar Nicolas, MD
ProfessorofRadiologyandChairman ProfessorofRadiologyandChairman
DepartmentofRadiology,CampusMitte DepartmentofDiagnosticandInterventional
ClinicofRadiology, RadiologyandNuclearMedicine
CampusVirchow-Klinikum BerufsgenossenschaftlichesUniversityHospital
Charité–UniversitätsmedizinBerlin Bergmannsheil
Berlin,Germany Bochum,Germany
Gabriel Paul Krestin, MD Matthias Taupitz, MD
ProfessorofRadiologyandChairman ProfessorofRadiologyandPhysicist
DepartmentofRadiology DepartmentofRadiology
ErasmusMC Charité–UniversitätsmedizinBerlin
Rotterdam,theNetherlands Berlin,Germany
Michael Laniado, MD
ProfessorofRadiologyandChairman
DepartmentofDiagnosticRadiology
CarlGustavCarusUniversityHospital
TechnicalUniversityofDresden
Dresden,Germany
With contributionsby
P.Asbach,D.Beyersdorf,F.Dammann,H.B.Gehl,C.R.Habermann,B.Hamm,C.M.Heyer,C.Klessen,
C.Kluener,G.P.Krestin,G.Krupski-Berdien,R.A.Kubik-Huch,M.Laniado,M.Lorenzen,W.Luboldt,
A.E.Mahfouz,U.G.Mueller-Lisse,M.R.Muehler,V.Nicolas,W.Pennekamp,P.Reimer,M.Reuter,
B.Stoever,M.Taupitz,R.Vosshenrich
1060 illustrations
Thieme
Stuttgart·NewYork
IV
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MRimagingoftheabdomenandpelvis/BerndHamm...[etal.]; tinuallyexpandingourknowledge,inparticularourknowledgeof
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resonanceimaging. I.Hamm,Bernd,Prof.Dr.II.Title. anteeorresponsibilityonthepartofthepublishersinrespecttoany
[DNLM:1.Abdomen--pathology.2.MagneticResonanceImaging. dosageinstructionsandformsofapplicationsstatedinthebook.
3. Pelvis--pathology. WI900M93952009a] Every user is requested to examine carefully the manufacturers’
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V
Preface
Magneticresonanceimaginghasdevelopeddramatically be aware that the specific contrast media may not have
inrecentyears,andthetechnicaladvanceshaveexpanded been approved for all countries or continents and that
therangeofdiagnosticapplications.Intheabdomenand theirapprovalstatusissubjecttochange.
pelvis,MRIhaslongdevelopedbeyondtheexperimental WorkingonthisEnglisheditionhasmadeusawareof
stageandisnowthemethodofchoiceformanyindica- how difficult it is to keep abreast of technical develop-
tions.Withincreasingexperience,refinedandhighlyspe- mentsinsuchadynamicfieldasMRI.Thus,newinsights
cializedimagingtechniqueshaveemergedforthediffer- at the time of publication might already have outpaced
entorgansystems,makingMRIoftheabdomenandpelvis thestateoftheartatthetimeofwriting.
acomplexfieldofitsown. Many radiologists directly involved in the scientific
This book provides a comprehensive overview of the developmentofabdominaland pelvicMRI,eitherinco-
technicallydemanding,interesting,andclinicallyrelevant operation with us or as independent researchers, have
fieldofabdominopelvicMRI.Eachorganororgansystem contributed to this book as authors or co-authors. We
istreatedinaseparatechapterthatcanbereadindepend- thank all of them for their dedicated, supportive, and
entlyandbeginswithaconcisedescriptionofthespecific inspiring cooperation. Our thanks also go to the staff of
imagingtechnique. Thieme Publishers for making possible this English edi-
Theindividualchapterscanbereadasacookbookwith tionandtoBettinaHerwigforthetranslation.
regardtothespecificimagingtechniqueandindications Wehopethatthisbookwillbeausefulresourcetoour
forMRI.Thepresentationofpathologicentitiesislavishly colleagues interested in abdominal and pelvic MRI and
illustrated and iscompleted byadescriptionof theMRI helpthemmakeuseofMRItothebenefitofourpatients.
findingsanddifferentialdiagnoses.
UniquetoMRI,especiallyofthehepatobiliarysystem, B.Hamm
istheavailabilityofalargenumberofcontrastagents.MRI G.P.Krestin
of the liver can be performed with different nonspecific M.Laniado
contrastmedia,whichareavailableallovertheworld,or V.Nicolas
withoneofseveraltissue-specificagents.Readersshould M.Taupitz
VI
Contributors
PatrickAsbach,MD ClaudiaKluener,MD
AssistantProfessorofRadiology DepartmentofRadiologyandNeuroradiology
DepartmentofRadiology OldenburgEvangelicalHospital
Charité–UniversitätsmedizinBerlin Oldenburg,Germany
Berlin,Germany
GerritKrupski-Berdien,MD
DirkBeyersdorff,MD ProfessorofRadiology
AssociateProfessorRadiology DepartmentofDiagnosticandInterventionalRadiology
DepartmentofRadiology ReinbekSt.Adolf-StiftHospital
Charité–UniversitätsmedizinBerlin Reinbek,Germany
Berlin,Germany
RahelA.Kubik-Huch,MD
FlorianDammann,MD ProfessorofRadiology
ProfessorofRadiology DepartmentofRadiology
DepartmentofRadiology KantonsspitalBadenAG
KlinikamEichert Baden,Switzerland
Göppingen,Germany
MarenLorenzen,MD
Hans-BjoernGehl,MD RadiologyPracticeHeegbarg
ProfessorofRadiology Hamburg,Germany
DepartmentofRadiology
Bielefeld-MitteCityHospitals WolfgangLuboldt,MD,MSc
Bielefeld,Germany AssociateProfessorofRadiologyandNuclearMedicine
Physicist
ChristianR.Habermann,MD DepartmentofRadiology
AssociateProfessorofRadiology UniversityHospitalFrankfurt
DiagnosticCenter,DepartmentofDiagnostic Frankfurta.M.,Germany
andInterventionalRadiology
UniversityMedicalCenterHamburg-Eppendorf Ahmed-EmadMahfouz,MD
Hamburg,Germany ProfessorofRadiology
HamadMedicalCorporation
ChristophM.Heyer,MD RadiologyDepartment
AssociateProfessorofRadiology Doha,Quatar
DepartmentofDiagnosticandInterventionalRadiology
andNuclearMedicine MatthiasR.Muehler,MD
BerufsgenossenschaftlichesUniversityHospital AssistantProfessorofRadiology
Bergmannsheil DepartmentofRadiology
Bochum,Germany Charité–UniversitätsmedizinBerlin
Berlin,Germany
ChristianKlessen,MD
CenterforDiagnosticRadiologyand UllrichGerdMueller-Lisse,MD
MinimallyInvasiveTherapy AssociateProfessorofRadiology
TheJewishHospitalBerlin DepartmentofClinicalRadiology
Berlin,Germany MunichUniversityHospital,Innenstadt
Munich,Germany
Contributors VII
WernerPennekamp,MD MichaelReuter,MD
AssistantProfessorofRadiology ProfessorofRadiology
DepartmentofDiagnosticandInterventionalRadiology DepartmentofRadiologyandInterventionalTreatment
andNuclearMedicine VivantesHospitalNeukölln
BerufsgenossenschaftlichesUniversityHospital Berlin,Germany
Bergmannsheil
Bochum,Germany BrigitteStoever,MD
ProfessorofRadiology
PeterReimer,MD DepartmentofPediatricRadiology
ProfessorofRadiology Charité–UniversitätsmedizinBerlin
DepartmentofRadiology Berlin,Germany
KarlsruheMunicipalHospital
AcademicTeachingHospitaloftheUniversityofFreiburg RolfVosshenrich,MD
Karlsruhe,Germany ProfessorofRadiology
MRIPracticeFriederikenstift
Hanover,Germany
VIII
Abbreviations
1D,2D,3D One-dimensional,two-dimensional,three- Gd-BOPTA Gadobenicacid(relaxation-enhancing
dimensional componentoftheMRcontrastmedium
Multihance)
ACTH Adrenocorticotropichormone Gd-DOTA Gadoterate(relaxation-enhancingcompo-
ADPKD Autosomaldominantpolycystickidney nentoftheMRcontrastmediumDotarem)
disease Gd-DTPA Gadopentetate(relaxation-enhancing
ASSET Arrayspatialsensitivityencoding componentoftheMRcontrastmedium
technique Magnevist)
Gd-DTPA-BMAGadodiamide(relaxation-enhancingcom-
BPH Benignprostatichyperplasia ponentoftheMRcontrastmediumOm-
BCS Budd–Chiarisyndrome niscan)
Gd-EOB-DTPA Gadoxeticacid(relaxation-enhancing
CCA Cholangiocarcinoma componentoftheMRcontrastmedium
CCC Cholangiocellularcarcinoma Primovist)
CNR Contrast-to-noiseratio Gd-HP-DO3A Gadoteridol(relaxation-enhancingcompo-
CSF Cerebrospinalfluid nentoftheMRcontrastmediumMulti-
CSI Chemicalshiftimaging hance)
CT Computedtomography GI Gastrointestinal
CTA Computedtomographyangiography GIST Gastrointestinalstromaltumor
CTAP Computedtomographyduringarterial GMR Gradientmomentrephasing
portography GRASE Gradientspinecho
D&C Dilatationandcurettage GRASS Gradient-recalledacquisitioninasteady
state
DER Digitalrectalexamination GRE Gradientecho
DRG Diagnosis-relatedgroup
DSA Digitalsubtractionangiography HASTE HalfFourier-acquiredsingleshotturbospin
DWI Diffusion-weightedimaging echo
HCC Hepatocellularcarcinoma
EPI Echoplanarimaging HF Highfrequency
ERCP Endoscopicretrogradecholangiopancrea- IMH Intramuralhematoma
tography IMHN Intraductalmucin-hypersecretingneopla-
ETL Echotrainlength sia
FAST Fourier-acquiredsteadystate IP In-phase
FE Fieldecho iPAT Integratedparallelacquisitiontechniques
FFE Fastfieldecho IPMT Intraductalpapillarymucinoustumor
FID Freeinductiondecay IR Inversionrecovery
FISP Fastimagingwithsteadystatefree IUD Intrauterinedevice
precession IV Intravenous
FLASH Fastlowangleshot
FNH Focalnodularhyperplasia MEN Multipleendocrineneoplasia
FOV Fieldofview MFH Malignantfibroushistiocytoma
FS Fatsuppression,fat-suppressed MIP Maximumintensityprojection
FSE Fastspinecho Mn-DPDP Mangafodipir(relaxation-enhancingcom-
ponentoftheMRcontrastmediumTesla-
Gd Gadolinium scan)
Abbreviations IX
MPR Multiplanarreconstruction/reformation s Second
MP-RAGE Magnetization-preparedrapidacquisition SAR Specificabsorptionrate
gradientecho SCT Spiralcomputedtomography
MPS Mononuclearphagocytesystem SE Spinecho
MRA Magneticresonanceangiography SENSE Sensitivityencoding
MRC Magneticresonancecolonography SI Signalintensity
MRCP Magneticresonancecholangiopancreatog- SIRS Systemicinflammatoryresponsesyndrome
raphy SNR Signal-to-noiseratio
MRE Magneticresonanceelastography SPGR SpoiledGRASS
MRI Magneticresonanceimaging SPIO Superparamagneticironoxide
MRS Magneticresonancespectroscopy SPIR Spectralpresaturationbyinversion
MRSI Magneticresonancespectroscopicimaging SR Saturationrecovery
MRU Magneticresonanceurography SSD Shadedsurfacedisplay
ms Millisecond SSFP Steadystatefreeprecession
MSCT Multislicespiralcomputedtomography SSFSE Singleshotfastspinecho
NASH Nonalcoholicsteatohepatitis STEAM Stimulatedechoacquisitionmode
NEX Numberofexcitations STIR Shorttauinversionrecovery
NHL Non-Hodgkinlymphoma
NSF Nephrogenicsystemicfibrosis T Tesla
T1w,T2w T1-weighted,T2-weighted
OP Opposed-phase T2* EffectiveT2relaxationtime(T2star)
TCC Transitionalcellcarcinoma
PACE Prospectiveacquisitioncorrection TE Timetoecho(echotime)
PAU Penetratingatheroscleroticulcer TEE Transesophagealechocardiography
PBC Primarybiliarycirrhosis TFE Turbofieldecho
PBS Primarybiliarysclerosis TI Timetoinversion(inversiontime)
PC Phasecontrast TIM Totalimagingmatrix
PCOS Polycysticovarysyndrome TIPS Transjugularintrahepaticportosystemic
PD Protondensity shunt
PET Positronemissiontomography TIRM Turboinversionrecoverymagnitude
PID Pelvicinflammatorydisease TME Totalmesorectalexcision
PIN Prostaticintraepithelialneoplasm TOF Timeofflight
PNET Primitiveneuroectodermaltumor TR Timetorepetition(repetitiontime)
ppm Partspermillion TRUS Transrectalultrasound
PRESS Point-resolvedspectroscopy TVUS Transvaginalultrasound
PSA Prostate-specificantigen TSE Turbospinecho
PSC Primarysclerosingcholangitis TUR Transurethralresection
PSIF InvertedFISP TURP Transurethralresectionoftheprostate
PTC Percutaneoustranshepaticcholangiogra-
phy UAE Uterinearteryembolization
PWI Perfusion-weightedimaging US Ultrasound
USPIO Ultra-smallsuperparamagneticironoxide
RARE Rapidacquisitionwithrelaxationen-
hancement VIBE Volume-interpolatedbreath-holdexami-
RAS Renalarterystenosis nation
RCC Renalcellcarcinoma VIP Vasoactiveintestinalpolypeptide
ROI Regionofinterest VOI Volumeofinterest
ROPE Respiratoryorderingofphaseencoding
RPF Retroperitonealfibrosis
