Liver imaging can be performed with sonography, computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound is, caused by the easy access, still the first-line imaging method of choice; CT and MRI are applied whenever ultrasound imaging yields vague results. Indications are the characterization of metastases and primary liver tumors e.g., benign lesions such as focal nodular hyperplasia (FNH), adenoma, hemangioma and malignant lesions (cancer) such as hepatocellular carcinomas (HCC). The decision, which medical imaging modality is more suitable, MRI or CT, is dependent on the different factors. CT is less costly and more widely available; modern multislice scanners provide high spatial resolution and short scan times but has the disadvantage of radiation exposure.
With the introduction of high performance MR systems and advanced sequences the image quality of MRI for the liver has gained substantially. Fast spin echo or single shot techniques, often combined with fat suppression, are the most common T2 weighted sequences used in liver MRI procedures. Spoiled gradient echo sequences are used as ideal T1 weighted sequences for evaluating of the liver. The repetition time (TR) can be sufficiently long to acquire enough sections covering the entire liver in one pass, and to provide good signal to noise. The TE should be the shortest in phase echo time (TE), which provides strong T1 weighting, minimizes magnetic susceptibility effects, and permits acquisition within one breath hold to cover the whole liver. A flip angle of 80° provides good T1 weighting and less of power deposition and tissue saturation than a larger flip angle that would provide comparable T1 weighting.
Liver MRI is very dependent on the administration of contrast agents, especially when detection and characterization of focal lesions are the issues. Liver MRI combined with MRCP is useful to evaluate patients with hepatic and biliary disease.
Gadolinium chelates are typical non-specific extracellular agents diffusing rapidly to the extravascular space of tissues being cleared by glomerular filtration at the kidney. These characteristics are somewhat problematic when a large organ with a huge interstitial space like the liver is imaged. These agents provide a small temporal imaging window (seconds), after which they begin to diffuse to the interstitial space not only of healthy liver cells but also of lesions, reducing the contrast gradient necessary for easy lesion detection. Dynamic MRI with multiple phases after i.v. contrast media (Gd chelates), with arterial, portal and late phase images (similar to CT) provides additional information.
An additional advantage of MRI is the availability of liver-specific contrast agents (see also Hepatobiliary Contrast Agents). Gd-EOB-DTPA (gadoxetate disodium, Gadolinium ethoxybenzyl dimeglumine, EOVIST Injection, brand name in other countries is Primovist) is a gadolinium-based MRI contrast agent approved by the FDA for the detection and characterization of known or suspected focal liver lesions.
Gd-EOB-DTPA provides dynamic phases after intravenous injection, similarly to non-specific gadolinium chelates, and distributes into the hepatocytes and bile ducts during the hepatobiliary phase. It has up to 50% hepatobiliary excretion in the normal liver.
Since ferumoxides are not eliminated by the kidney, they possess long plasmatic half-lives, allowing circulation for several minutes in the vascular space. The uptake process is dependent on the total size of the particle being quicker for larger particles with a size of the range of 150 nm (called superparamagnetic iron oxide). The smaller ones, possessing a total particle size in the order of 30 nm, are called ultrasmall superparamagnetic iron oxide particles and they suffer a slower uptake by RES cells. Intracellular contrast agents used in liver MRI are primarily targeted to the normal liver parenchyma and not to pathological cells. Currently, iron oxide based MRI contrast agents are not marketed.
Beyond contrast enhanced MRI, the detection of fatty liver disease and iron overload has clinical significance due to the potential for evolution into cirrhosis and hepatocellular carcinoma. Imaging-based liver fat quantification (see also Dixon) provides noninvasively information about fat metabolism; chemical shift imaging or T2*-weighted imaging allow the quantification of hepatic iron concentration.

See also Abdominal Imaging, Primovistâ„¢, Liver Acquisition with Volume Acquisition (LAVA), T1W High Resolution Isotropic Volume Examination (THRIVE) and Bolus Injection.

For Ultrasound Imaging (USI) see Liver Sonography at Medical-Ultrasound-Imaging.com.

Quick Overview
Please note that there are different common names for this artifact.

Flow effects in MRI produce a range of artifacts, e.g. intravascular signal void by time of flight effects; turbulent dephasing and first echo dephasing, caused by flowing blood.
Through movement of the hydrogen nuclei (e.g. blood flow), there is a location change between the time these nuclei experience a radio frequency pulse and the time the emitted signal is received (because the repetition time is asynchronous with the pulsatile flow).
The blood flow occasionally produces intravascular high signal intensities due to flow related enhancement, even echo rephasing and diastolic pseudogating. The pulsatile laminar flow within vessels often produces a complex multilayered band that usually propagates outside the head in the phase encoded direction. Blood flow artifacts should be considered as a special subgroup of motion artifacts.

Artifacts can be reduced by reduction of phase shifts with flow compensation (gradient moment nulling), suppression of the blood signal with saturation pulses parallel to the slices, synchronization of the imaging sequence with the heart cycle (cardiac triggering) or can be flipped 90° by swapping the phase//frequency encoding directions.

See also Flow Related Enhancement and Flow Effects.

This method synchronize the heartbeat with the beginning of the TR, whereat the r wave is used as the trigger. Cardiac gating times the acquisition of MR data to physiological motion in order to minimize motion artifacts. ECG gating techniques are useful whenever data acquisition is too slow to occur during a short fraction of the cardiac cycle.
Image blurring due to cardiac-induced motion occurs for imaging times of above approximately 50 ms in systole, while for imaging during diastole the critical time is of the order of 200-300 ms. The acquisition of an entire image in this time is only possible with using ultrafast MR imaging techniques. If a series of images using cardiac gating or real-time echo planar imaging EPI are acquired over the entire cardiac cycle, pixel-wise velocity and vascular flow can be obtained.
In simple cardiac gating, a single image line is acquired in each cardiac cycle. Lines for multiple images can then be acquired successively in consecutive gate intervals. By using the standard multiple slice imaging and a spin echo pulse sequence, a number of slices at different anatomical levels is obtained. The repetition time (TR) during a ECG-gated acquisition equals the RR interval, and the RR interval defines the minimum possible repetition time (TR). If longer TRs are required, multiple integers of the RR interval can be selected. When using a gradient echo pulse sequence, multiple phases of a single anatomical level or multiple slices at different anatomical levels can be acquired over the cardiac cycle.
Also called cardiac triggering.