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Objective: The purposes of this study were to evaluate the effect of contrast material flow rate (3 mL/sec vs 5 mL/sec) on the detection and visualization of hepatocellular carcinoma (HCC) with MDCT and the safety profile of iodixanol at different injection rates., Subjects and Methods: In a prospective, randomized multicenter trial, 97 patients (83 men and 14 women, with a mean age of 64 years) suspected of having HCC underwent quadruple-phase (double arterial, portal venous, delayed phase) 4-16-MDCT. Patients were randomized to receive iodixanol, 320 mg I/mL (1.5 mL/kg body weight), at a flow rate of 3 mL/sec (48 patients) or 5 mL/sec (49 patients). Qualitative (lesion detection, image quality) and quantitative (liver and aortic enhancement, tumor-liver contrast) analyses and safety assessment were performed., Results: Overall, 145 HCCs were detected in the 5 mL/sec group and 100 HCCs in the 3 mL/sec group (p < 0.05). More lesions equal to or less than 1 cm were detected at 5 mL/sec (33 vs 16 lesions). The late arterial phase showed significantly more lesions than the early, arterial phase (133 vs 100 and 96 vs 67 lesions, respectively, p < 0.0001). Hyperattenuating HCCs were better visualized in the late arterial phase at 5 mL/sec (excellent visualization: 54% vs 27%). Using a flow of 5 mL/sec did not increase the rate of patient discomfort or contrast media-related adverse events. Most discomfort in both groups was of mild intensity and there was no severe discomfort., Conclusion: For detection of HCC with MDCT, a higher flow rate of 5 mL/sec is recommended. Visualization of hyperattenuating HCC is improved with no greater discomfort or adverse events.

Objective: In our multi center trial we compared the potentials of biphasic contrast-enhanced computed tomography (CT) and a novel tissue-specific magnetic resonance imaging (MRI) contrast agent gadoxetic acid disodium in liver lesion characterization., Methods: A total of 176 patients with 252 liver lesions were analyzed. There were 104 malignant and 148 benign lesions. High-field strength (1.0 T or 1.5 T) MR systems with T1-and T2-weighted sequences were used with and without fat suppression. After gadoxetic acid disodium injection, dynamic imaging and hepatocyte phase MR imaging were performed. Biphasic with 150 mg I/kg of body weight (100-200 mL) spiral CT was also performed. Image reading consisted of on-site (by study investigators) and fully blinded off-site (by E.S.P; C.R; and A.S) evaluations. The classification (benign or malignant) and characterization (lesion type) outcomes of both techniques were assessed. All imaging results were verified against a standard of reference., Results: Both on-site and off-site evaluations demonstrated increases in the lesion classification accuracy with gadoxetic acid disodium-enhanced MRI when compared with spiral CT. This improvement was also shown for characterization. Gadoxetic acid disodium was well tolerated., Conclusions: Gadoxetic acid disodium offers a safe and diagnostically powerful tool for the evaluation of patients with focal liver lesions with a reliable assessment of lesion classification and characterization.

Purpose: To prospectively evaluate accuracy of gadolinium-enhanced three-dimensional (3D) magnetic resonance (MR) angiography with gadodiamide and gadopentetate dimeglumine (0.1 mmol/kg), with intraarterial DSA as reference standard, for imaging abdominal and iliac arterial stenoses., Materials and Methods: The study was approved by all institutional review boards; informed consent was obtained from each subject before procedures. Two hundred forty-seven subjects were included; 240 received either contrast agent and were available for safety analysis; 222 were available for accuracy analysis. Enhanced 3D MR angiography and DSA were performed; image data were evaluated in a double-blinded randomized study. Stenoses were classified as not relevant (<50% stenosis) or relevant (> or =50%). For detection of main stenosis, accuracy with enhanced 3D MR angiography compared with that with DSA was determined., Results: The difference in accuracy for imaging with gadodiamide and gadopentetate was 3.6%. Noninferiority was inferred because the lower bound of the exact two-sided 95% confidence interval was -10.1 and was above the noninferiority margin (-15%). Accuracy for detection of the main stenosis was low, 56.4% for gadodiamide and 52.8% for gadopentetate group. Subgroup analysis with exclusion of inferior mesenteric artery and internal iliac arteries and the most false-positive stenosis classifications yielded better results: 76.6% and 71.6%, respectively. Sensitivity, specificity, and negative and positive predictive values did not differ substantially between study groups. In the main analysis, values were 44%, 96%, 35%, and 97% for gadodiamide and 44%, 83%, 30%, and 90% for gadopentetate, respectively. In the subgroup analysis, values were 66%, 95%, 61%, and 96% for gadodiamide and 63%, 86%, 58%, and 88% for gadopentetate, respectively., Conclusion: Noninferiority of gadodiamide versus gadopentetate was verified based on the primary end point, which was accuracy for detection of the main stenosis with enhanced 3D MR angiography compared with DSA., (Copyright RSNA, 2006.)

The purpose of this study was to evaluate the potential of transarterial embolization (TAE) for the treatment of focal nodular hyperplasia (FNH). Four women with the diagnosis of FNH underwent superselective transarterial embolization with contour particles between 2001 and 2004. The indications were progressive increase in size in three of the patients and abdominal pain in the fourth patient. No immediate or delayed postembolization complications were encountered in any of our patients. All patients presented angiographically with characteristic findings, such as feeding artery, a tumor blush, and septations. In two patients, the embolization resulted in a constant size or volume decrease in the 1-year follow-up. In the other two patients, a complete resolution of the FNH was observed in the MRI follow-up after 1 year. This group presented with a homogeneous devascularization in the immediate postembolization exam. In conclusion, transarterial embolization of focal nodular hyperplasia can be considered as a possible alternative treatment method to surgery.

Purpose: To prospectively evaluate to what extent image quality in 16-detector row computed tomographic (CT) coronary angiography is a function of the heart rate and the image reconstruction technique used., Materials and Methods: A total of 70 patients (49 men, 21 women; mean age, 59.1 years +/- 5.8 [standard deviation]) consecutively underwent multi-detector row CT coronary angiography; 49 patients additionally underwent coronary angiography. Image reconstruction was based on both relative and absolute timing. A total of 20 equidistant relative and absolute image reconstructed intervals were assessed by applying a four-step grading scale. Cluster and discrimination analysis, Spearman correlation analysis, and Wilcoxon and chi2 tests were used for statistical analysis. Institutional review board approval and written informed consent were obtained., Results: Though significantly (P < .001) better image quality was observed for image reconstruction based on absolute timing and in patients with lower heart rates, influence on diagnostic accuracy was not significant. Irrespective of the reconstruction technique used, best image quality was observed in patients with a low heart rate for middiastolic reconstruction intervals (starting points: 61% of R-R interval [range, 40%-75%] and 599.3 msec after R [range, 450-840 msec]) and in patients with a high heart rate for end-systolic or early-diastolic intervals (starting points: 27.3% of R-R interval [range, 10%-45%] and 202.3 msec after R [range, 82-336 msec]). With regard to the vessel section and reconstruction technique, cutoff heart rates of the intervals were 64.0-68.5 beats per minute. Patients with stenoses of more than 50% were identified with 86% sensitivity and specificity, and there was no significant difference between relative and absolute timing (P = .99)., Conclusion: In multi-detector row CT coronary angiography, image quality depends on the choice of a suited reconstruction interval. In patients with high heart rates, the best image quality can be obtained with end-systolic and early-diastolic intervals; in patients with low heart rates, the best results are achieved with middiastolic intervals., (RSNA, 2006.)

Purpose: Demonstration of techniques and clinical value of imaging diagnostics for screening, detection, interventional follow-up and therapy control of hepatocellular carcinoma (HCC). Diagnostic techniques for screening, detection and differential diagnosis of HCC are presented using color-coded duplex sonography (US), computer tomography (CT) and contrast-enhanced magnetic resonance techniques like MRI, MR angiography and MR cholangiopancreaticography (MRCP). Therapy control with imaging was performed for surgical methods like resection and liver transplantation as for well as transarterial chemoembolization (TACE), radiofrequency ablation (RF) and laser-induced thermotherapy (LITT). In screening, HCC color-coded duplex sonography reveals a sensitivity from 45 to 92 % and a specificity from 78 to 90 % when liver cirrhosis is present. The diagnostic results of CT were further improved with the newly developed techniques of multislice CT. The highest diagnostic accuracy can currently be achieved using contrast-enhanced MRI with a sensitivity from 82 to 96 %. TACE presents a palliative therapy concept; MR-guided LITT and radiofrequency ablation are used as thermoablative methods for local therapy and the therapy control is based on the above imaging techniques. Contrast-enhanced MRI proves to be the superior imaging technique for the early diagnosis, differential diagnosis and follow-up of hepatocellular carcinoma.

Purpose: Demonstration of clinical value of contrast-enhanced multislice CT (MS-CT) for evaluating abdominal neoplasias with focus on primary liver tumors, pancreatic carcinoma and colorectal carcinoma., Material and Methods: Optimized examination protocols for multislice CT are presented using oral and intravenous application of contrast agent., Results: For primary liver tumors like hepatocellular carcinoma and cholangiocellular carcinoma diagnostic accuracies are achieved from 82 to 94% and for pancreatic carcinomas from 85 to 96%. For diagnosis of colorectal carcinoma results are relevant for staging of primary tumor, lymph node metastases and further metastases in liver and lung. The results achieve values from 86 to 92% for sensitivity, specificity and diagnostic accuracy., Conclusion: Contrast-enhanced multislice CT proves to be a quick and reliable examination technique for detection and staging of abdominal neoplasms with a focus on the epigastric region and colorectal carcinoma.

Purpose: To evaluate the clinical value of the renal clearance using MR imaging with different doses of gadolinium ethoxybenzyl-DTPA (Gd-EOB-DTPA) in comparison to gadolinium DTPA (Gd-DTPA)., Material and Methods: In a double-blind and randomized clinical phase II study. MR imaging at 1.5 T was performed in 61 patients with five different doses of Gd-EOB-DTPA (3, 6, 12.5, 25 and 50 micromol/kg b. w. as a bolus injection). The study protocol comprised T(1)- and T(2)-weighted spin-echo magnetic resonance and two-dimensional fast low-angle shot imaging before and at increasing intervals for up to 45 min after injection of Gd-EOB-DTPA. These images were compared with Gd-DTPA-enhanced imaging (0.1 mmol/kg b. w. as a bolus injection)., Results: After bolus injection of the hepatobiliary MR contrast agent Gd-EOB-DTPA a renal elimination was observed. Immediately after the injection of Gd-EOB-DTPA until the eighth minute a corticomedullary enhancement of the kidney was conspicuous. After the fourth minute a contrast enhancement could be seen in the renal pelvis. The best enhancement was noted after 20 minutes in the FLASH GRE and T(1)-weighted images with good pelvicaliceal contrast. After 45 minutes an outflow of Gd-EOB-DTPA into the ureter could be observed., Conclusion: In addition to the hepatobiliary secretion Gd-EOB-DTPA appears useful for the evaluation of renal structures and renal function on account of the renal excretion without diuretic preparation of the patients.

Purpose: Demonstration of imaging techniques for the diagnosis and interventional follow up of hepatocellular carcinoma., Material and Methods: Examination strategies are presented using color coded duplex-sonography (US), computed tomography and magnetic resonance techniques like MRI, MR-angiography and MR-cholangiopancreaticography (MRCP)., Results: Color coded sonography reveals a sensitivity of 85-92% and a specificity of 78-90% for the detection of HCC. The diagnostic results of CT could be further improved via the newly developed techniques of multislice-CT. The highest diagnostic accuracy could be achieved via the use of contrast enhanced MRI with advantageous results for superparamagnetic contrast agents versus hepatobiliary and extracellular drugs., Conclusion: Contrast enhanced MRI proves as the superior imaging technique for the early diagnosis, differential diagnosis and follow up of hepatocellular carcinoma.

For the diagnosis of liver cirrhosis ultrasound, computed tomography, magnetic resonance imaging, and angiography are recommended as imaging modalities. Ultrasound of the liver is used as a screening imaging tool in cases of patients suspicious for diffuse liver disease and is helpful in the term of follow-up examinations. Computed tomography is mainly performed to clarify the presence of liver disease detected by ultrasound. In this context, accurate examination of the vascular structures of the liver as well as extrahepatic situation, is of the essence. Diagnosis of diffuse liver disease and characterization of morphologic changes is improved using contrast-enhanced MR imaging with liver specific contrast media. Combined magnetic resonance imaging can provide comprehensive evaluation of cirrhosis. An improved detection rate and characterization of regenerating nodules can be achieved compared to imaging modalities such as ultrasound and computed tomography. MR imaging can be performed in a one-stop-technique using unenhanced and liver-specific-contrast-enhanced sequence protocols to evaluate the liver parenchyma itself, MR cholangiography to verify the bile duct system, and MR angiography to specify the vascular situation. This technique is the optimal protocol for diagnostic imaging in patients suffering from liver cirrhosis and the method of choice to reach the final diagnosis.

The development in oncologic liver surgery as well as modified interventional therapy strategies of the liver have resulted in improved diagnostic imaging. The evolution of contrast agents for MR imaging of the liver has proceeded along several different paths with the common goal of improving liver-lesion contrast. In MRI contrast agents act indirectly by their effects on relaxation times. Contrast agents used for hepatic MR imaging can be categorized in those that target the extracellular space, the hepatobiliary system, and the reticuloendothelial system. The first two result in a positive enhancement, the last one in a negative enhancement. Positive enhancers allow a better characterization of liver metastases using dynamic sequence protocols. Detection rate of liver metastases is increased using hepatobiliary contrast-enhanced MRI compared to unenhanced MRI. Negative enhancers, iron oxide particles, significantly increase tumor-to-liver contrast and allow detection of more lesions than other diagnostic methods. Iron-oxide enhanced MRI enables differential diagnosis of liver metastases comparing morphologic features using T2 and T1-weighted sequences.

Purpose: To analyse characteristics of benign and malignant liver tumours in dynamic and static MR imaging with the superparamagnetic MR contrast medium Resovist., Material and Methods: All 30 patients were examined on a 1.5 Tesla MR unit (Magnetom 63 SP, Siemens AG, Erlangen, Germany) using proton density (PD) weighted (w), T2-weighted-spin-echo, a T1-weighted SE, and a T1-weighted FLASH-2 D gradient echo (GRE) sequence before, during and after the application of Resovist. Dynamic imaging was performed using a T2-weighted GRE-sequence (TurboFLASH; TR/TE = 11/30; flip angle = 10 degrees; Tl = 600 ms). Histopathology revealed benign liver lesions in 8 patients and malignant lesions in 22 patients., Results: Dynamic T2-weighted sequence revealed an early loss of signal intensity in normal liver parenchyma (percentage signal intensity loss (PSIL) = 40.0 +/- 12.2% by 4 mumol Fe/kg, 47.2 +/- 18.8% by 8 mumol Fe/kg and 62.7 +/- 13.0% by 16 mumol Fe/kg), in the spleen, as well as in FNH (PSIL = 49.5 +/- 7.3% by 8 mumol Fe/kg), and regenerating nodules in the first minute after application of Resovist. In two of 4 cases with HCC a short drop in signal intensity was immediately observed after the application, whereas signal intensity remained unchanged in all other malignant liver tumours. Enhanced PDw and T2-weighted SE-sequences revealed an improved detection and delineation of malignant liver lesions versus plain MR imaging. 17 liver lesions of a size lower 10 mm were additionally detected in postcontrast T2-weighted SE-sequences in 4 patients., Conclusion: Dynamic and static versus plain MR imaging of primary and secondary liver lesions is markedly improved by the superparamagnetic contrast material Resovist, especially in case of intravenous bolus application of this liver-specific contrast medium.

Objective: Our objective was to evaluate the accuracy of contrast-enhanced transrectal MR imaging in staging rectal adenoma and carcinoma by correlating with histopathologic findings., Subjects and Methods: Thirty-five patients underwent transrectal MR imaging on a 1.5-T superconducting unit using unenhanced T1-weighted and T2-weighted spin-echo and turbo spin-echo sequences, a dynamic gadopentetate dimeglumine-enhanced turbo fast low-angle shot sequence, and enhanced T1-weighted spin-echo sequences. For all patients, histopathologic correlation was available from biopsy (n = 15) or surgical resection (n = 20). Two radiologists unaware of each other's interpretations of the scans interpreted each case from which we evaluated qualitative and quantitative data., Results: Rectal adenomas (n = 15) were identified when imaging revealed an intact muscularis mucosae, a homogeneous internal structure, and high contrast enhancement of the lesion. Carcinomas staged as T1 by TNM criteria (n = 6) were best revealed by dynamic turbo fast low-angle shot sequences, in which an intact muscularis propria could be seen. Visualization of enhancing tumor tissue in the muscularis propria indicated T2 carcinoma (n = 5). All T3 (n = 5) and T4 (n = 4) carcinomas were correctly staged with dynamic and static MR imaging. The stage revealed by MR imaging correlated well with histologic staging results in 89% (observer 1) and 86% (observer 2) of interpretations. However, when interpreting MR imaging, observers tended to overstage and never understaged., Conclusion: Transrectal surface-coil MR imaging provided reliable information in staging patients before surgery and in evaluating rectal adenoma and carcinoma.

Rationale and Objectives: The authors assess the efficacy of static and dynamic magnetic resonance (MR) imaging using the superparamagnetic iron oxide SHU-555A (Resovist) versus standard dose of gadolinium (Gd)-DTPA in patients with focal liver lesions., Methods: Magnetic resonance imaging was performed in 30 patients suffering from histopathologically verified malignant (n = 22) and benign (n = 8) liver lesions. T2-weighted conventional and fat-suppressed as well as T1-weighted sequences were used before, during, and after fast intravenous administration of Resovist (1 mL/minute) at three doses of 4, 8, and 16 mumol/kg body weight. One week before the Resovist-enhanced MR imaging study 20 patients underwent Gd-DTPA-enhanced MR imaging., Results: Detection rate was improved for metastatic lesions revealing 36 lesions unenhanced versus 53 focal lesions using Resovist-enhanced MR imaging. Gadolinium-DTPA-enhanced scans showed no additional lesion versus unenhanced and Resovist-enhanced MR imaging. Static and dynamic imaging demonstrated no measurable percentage signal intensity loss (PSIL) using Resovist-enhanced MR imaging versus a percentage enhancement of 79.7% in Gd-DTPA enhanced scans. In the dynamic T2-weighted sequences, hepatocellular carcinoma nodules (n = 4) showed a rapid decrease in signal intensity starting at 44 seconds. Postinfusion of Resovist followed by a low, constant increase in signal intensity. Gadolinium-DTPA enhanced scans showed a percentage enhancement of 73.4 focal nodular hyperplasia (FNH) and hemangioma revealed a strong and early dose-dependent PSIL 44 to 60 seconds postinfusion with a prolonged signal loss for the FNH in the late study. Statistical evaluation revealed a statistically significant superiority of Resovist-enhanced MR imaging concerning the detection and delineation of focal liver lesions compared with unenhanced and Gd-DTPA enhanced scans (P < 0.05)., Conclusions: The fast infusion of the new superparamagnetic contrast agent Resovist shows advantages for dynamic and static MR imaging of focal liver lesions.

Purpose: In a phase III/III-B trial the specific contrast enhancement of benign liver tumors, especially FNH and adenoma, versus malignant liver tumors such as HCC and metastases (colorectal and endocrine tumors) was evaluated using the superparamagnetic iron oxide ENDOREM., Material and Methods: 57 patients were prospectively investigated using T2-(TR/TE=2000/90) and T1-(550/15) weighted spinecho (SE), FLASH-2D-gradientecho (GE), and fat suppressed (FATSAT) sequences before and after administration of ENDOREM (concentration: 0.2 mmol Fe/ml, dose: 15 micromol/kg (b.w.) in transverse slice orientation on a 1.5 Tesla MAGNETOM (Siemens, 63 SP). In 8 patients an in vivo-in vitro correlation 30 minutes after resection was performed. In 12 patients benign primary liver tumors (FNH (n = 10), adenoma (n = 1), and hemangioma (n = 1) were histopathologically proved. Malignant liver tumors (HCC (n = 11, cholangiocarcinoma (n = 1), metastases from colorectal carcinoma (n = 13), and endocrine tumors (n = 4)) were found in 29 patients. 11 patients with liver cirrhosis due to Wilson's disease and 5 with cirrhosis due to other reasons were investigated., Results: Contrast-enhanced studies allowed detection of more lesions in 19 of 41 patients with liver tumors. Benign liver tumors showed significant loss of signal intensity of 43.0% +/- 17.9 for FNH, 32.4% for adenoma and 10.2% for hemangioma in proton density-weighted SE images. Malignant tumors showed only minimal signal loss: HCC: 5.3% +/- 17, cholangiocarcinoma: -1.6%, colorectal: -2.0% +/- 11.1, endocrine metastases: 4.2% +/-4.1. Normal liver parenchyma and spleen tissue demonstrated significant signal loss of 59.2% +/- 14.9 and 42.3 +/- 012.5. In ten patients and 13 lesions of FNH, a capsule was seen in 7.7% plain and 23.1% enhanced. Scar tissue was found in 30.8% plain, 84.6% enhanced. In the patient with adenoma, capsule with contrast enhancement was seen, but no scar was detected, whereas in patients with HCC a capsule was seen in three cases enhanced. Statistical analysis (Friedman-test, Wilcoxon-test) showed a statistically significant difference in signal loss between benign and malignant liver lesions (p < 0.05)., Conclusion: The use of superparamagnetic iron oxide ENDOREM) allows differentiation of benign and malignant liver tumors on the basis of contrast enhancement, existence and specific enhancement of capsule or scar. In vitro correlation show some limitations of in vivo MRI.

In a prospective study MR-guided laser-induced thermotherapy (LITT) of liver metastases was optimized and the clinical parameters evaluated. Seventeen patients (4 women, 13 men) with a total of 29 lesions underwent LITT in 25 sessions through 1 March 1994. Twelve of them suffered from colorectal carcinomas, 5 from other primary tumors. Under local anesthesia a maximum of 5 lesions per patient were treated. For MR-guided LITT a neodymium yttrium aluminum garnet laser (Nd-YAG 1064 nm) with energy varying from 3 to 7.5 W was used. Energy and application time were defined through a computer program; they varied, dependent on the lesion size, location and consistency. To monitor the progress of LITT two special thermosensitive MR sequences (Thermo-Turbo-FLASH and FLASH-2D sequences) were individually optimized, whereby the increase in temperature correlates with an increase in signal loss. All procedures were well tolerated without significant early or late side effects. In only one patient was minimal air documentated in the pleural cavity with spontaneous resorption. Patients were dismissed without complaints after 24-h hospitalization. The control parameters of the contrast-enhanced dynamic MRI documented at optimal response a hypointense signal around the tip of the laser applicator, in accordance with laser-induced necrosis. In lesions 20 mm or smaller, nearly 100% tumor necrosis was achieved and in lesions larger than 20 mm, only 50%. Follow-up evaluation 6 months after treatment shows a significantly better response in lesions with a diameter of 20 mm or smaller, with a local tumor control rate of 66%. In lesions larger than 20 mm only a local tumor control rate of 35% could be achieved. Laser-induced thermotherapy (LITT) represents a new, minimally invasive technique for tumor destruction and a high response rate in small liver metastases.

The value of the superparamagnetic contrast medium AMI-25 and its clinical acceptability was investigated in a phase-III-multicenter study. 18 patients with primary and secondary hepatic tumours were studied using T2- and T1-weighted spin-echo sequences, FATSAT sequences and FLASH-2-D-breathold sequences, both before and after intravenous application of AMI-25 (0.2 mmol GE/ml 15 mmol/kg KG in 100 ml 5% glucose infusion), using a 1.5 Tesla MRT (Magnetom 63 SP, Siemens). In 6 patients the MRT findings could be correlated with in vitro results within 30 minutes following surgical resection. In 8 patients a diagnosis of metastases was made. Amongst patients with primary liver tumours (FNH 6 cases, HCC 3 cases, adenomatosis 1 case) 3 of the 10 patients showed more lesions following the injection of contrast; similarly, in 4 patients of the 8 with secondary tumours contrast increased the number of visible lesions. The absence of contrast enhancement separated primary from secondary lesions. Amongst the patients with secondary liver tumours, in vitro correlation always showed more tumours than had been visualised whereas there was exact in vivo/in vitro correlation amongst patients with primary liver tumours.

To show that Wilson's disease is one likely cause of multiple low-intensity nodules of the liver we obtained MR images in 16 patients with clinically and histopathologically confirmed Wilson's disease. Corresponding to morphological changes MRI enabled the subdivision of the patients into two groups. Using a T2-weighted spin-echo sequence (TR/TE = 2000/45-90) liver parenchyma showed multiple tiny low-intensity-nodules surrounded by high-intensity septa in 10 out of 16 patients. 5 patients had also low-intensity nodules in T1-weighted images (TR/TE = 600/20). In patients of this group histopathology revealed liver cirrhosis (n = 7) and fibrosis (n = 2). Common feature of this patient group was marked inflammatory cell infiltration into fibrous septa, increase of copper concentration in liver parenchyma and distinct pathological changes of laboratory data. In the remaining 6 patients no pathological change of liver morphology was demonstrated by MRI corresponding to slight histopathological changes of parenchyma and normal laboratory data. As low-intensity nodules surrounded by high intensity septa can be demonstrated in patients with marked inflammatory infiltration of liver parenchyma MRI may help to define Wilson patients with poorer prognosis. In patients with low-intensity nodules of the liver and unknown cause of liver cirrhosis laboratory data and histopathology should be checked when searching for disorders of copper metabolism.

In a prospective study we examined the diagnostic value of MRI and MR cholangiography (MRC) in patients suffering from hepatobiliary disease. By using hepatobiliary contrast media (Mn-DPDP, Gd-BOPTA), sensitivity and specificity of MRI were significantly increased. In 65 patients we comparatively analyzed the diagnostic results of MRI and MRC versus ultrasound, CT and invasive techniques such as ERCP. We conclude that the use of MRI and MRC improves the diagnostic evaluation of patients with hepatobiliary disease.

Generalised lymphangiomatosis is a rare benign congenital abnormality of the lymphatic vessels with a complex pattern. 3 patients with different types of lymphangiomatosis were studied by MRT and MRA and histopathologically. All patients had multiple organ involvement in the abdomen, the skeleton and the skull. The basis in each case was lymphangiomatosis of capillary-cavernous, cystic or cavernous type. The results of MRT and MRA in diagnosing splenic, vascular and skeletal changes correlated accurately with operative findings and with the histopathological classification. In summary, MRT combined with MRA and using paramagnetic contrast media are the diagnostic methods of choice for the investigation of generalised lymphangiomatosis with multiple organ involvement.