Ultrasound imaging is the primary fetal monitoring modality during pregnancy, nevertheless fetal MRI is increasingly used to image anatomical regions and structures difficult to see with sonography. Given its long record of safety, utility, and cost-effectiveness, ultrasound will remain the modality of first choice in fetal screening. However, MRI is beginning to fill a niche in situations where ultrasound does not provide enough information to diagnose abnormalities before the baby's birth. Magnetic resonance imaging of the fetus provides multiplanar views also in sub-optimal positions, better characterization of anatomic details of e.g. the fetal brain, and information for planning the mode of delivery and airway management at birth.

Indications:
Modern fetal MRI requires no sedatives or muscle relaxants to control fetal movement. Ultrafast MRI techniques (e.g., single shot techniques like Half Fourier Acquisition Single shot Turbo spin Echo HASTE) enable images to be acquired in less than one second to eliminate fetal motion. Such technology has led to increased usage of fetal MRI, which can lead to earlier diagnosis of conditions affecting the baby and has proven useful in planning fetal surgery and designing postnatal treatments. As MR technology continues to improve, more advances in the prenatal diagnosis and treatment of fetal abnormalities are to expect. More advances in in-utero interventions are likely as well. Eventually, fetal MRI may replace even some prenatal tests that require invasive procedures such as amniocentesis.

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

The definition of imaging is the visual representation of an object. Medical imaging began after the discovery of x-rays by Konrad Roentgen 1896. The first fifty years of radiological imaging, pictures have been created by focusing x-rays on the examined body part and direct depiction onto a single piece of film inside a special cassette. The next development involved the use of fluorescent screens and special glasses to see x-ray images in real time.
A major development was the application of contrast agents for a better image contrast and organ visualization. In the 1950s, first nuclear medicine studies showed the up-take of very low-level radioactive chemicals in organs, using special gamma cameras. This medical imaging technology allows information of biologic processes in vivo. Today, PET and SPECT play an important role in both clinical research and diagnosis of biochemical and physiologic processes. In 1955, the first x-ray image intensifier allowed the pick up and display of x-ray movies.
In the 1960s, the principals of sonar were applied to diagnostic imaging. Ultrasonic waves generated by a quartz crystal are reflected at the interfaces between different tissues, received by the ultrasound machine, and turned into pictures with the use of computers and reconstruction software. Ultrasound imaging is an important diagnostic tool, and there are great opportunities for its further development. Looking into the future, the grand challenges include targeted contrast agents, real-time 3D ultrasound imaging, and molecular imaging.
Digital imaging techniques were implemented in the 1970s into conventional fluoroscopic image intensifier and by Godfrey Hounsfield with the first computed tomography. Digital images are electronic snapshots sampled and mapped as a grid of dots or pixels. The introduction of x-ray CT revolutionised medical imaging with cross sectional images of the human body and high contrast between different types of soft tissue. These developments were made possible by analog to digital converters and computers. The multislice spiral CT technology has expands the clinical applications dramatically.
The first MRI devices were tested on clinical patients in 1980. The spread of CT machines is the spur to the rapid development of MRI imaging and the introduction of tomographic imaging techniques into diagnostic nuclear medicine. With technological improvements including higher field strength, more open MRI magnets, faster gradient systems, and novel data-acquisition techniques, MRI is a real-time interactive imaging modality that provides both detailed structural and functional information of the body.
Today, imaging in medicine has advanced to a stage that was inconceivable 100 years ago, with growing medical imaging modalities:
All this type of scans are an integral part of modern healthcare. Because of the rapid development of digital imaging modalities, the increasing need for an efficient management leads to the widening of radiology information systems (RIS) and archival of images in digital form in picture archiving and communication systems (PACS). In telemedicine, healthcare professionals are linked over a computer network. Using cutting-edge computing and communications technologies, in videoconferences, where audio and visual images are transmitted in real time, medical images of MRI scans, x-ray examinations, CT scans and other pictures are shareable.
See also Hybrid Imaging.

See also the related poll results: 'In 2010 your scanner will probably work with a field strength of', 'MRI will have replaced 50% of x-ray exams by'

Generic name: Liposomes, central moiety: different, contrast effect: paramagnetic, distribution: different
Liposomes are lipid containing nanoparticles, or fat molecules, surrounding a water core. Liposomes were the first type of nanoparticles created to be used as carriers for lipophilic MRI contrast agents with novel characteristics.
Liposomes loaded with gadolinium-containing chelates have potential as blood pool agents, caused by modifications of the surface (e.g., with polyethylene glycol) leading to longer blood retention times.
The incorporation of contrast agents into either the the bilayer membrane or the aqueous inner cavity is possible. These MRI contrast agents has been used to image the lymph nodes using liposomes containing Gd-DTPA as well as dextran coated iron oxide particles.
To image the liver or the hepatobiliary system, liposomes containing Gd-HPDO3A, or MnDPDP, have been tested.
Liposomes containing gadolinium were conjugated to antibodies and targeted to a specific organ system.
A method of targeting tumors with ultrasound that also uses MRI to watch the cell destroying, uses liposomes loaded with cytotoxic drugs and also with gadolinium to make them show up in MRI. As well as used as an imaging technique, ultrasound can also be used to destroy cancer cells. Once the drugs have been administered, focusing the ultrasound on the target area makes blood vessels permeable. The liposomes leak out of the blood vessel into the target area, watched by MRI, where the cytotoxic drug can then go to work.

See also Memosomes, Superparamagnetic Iron Oxide, Classifications, Characteristics, etc. and Mangafodipir Trisodium.

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.

General MRI of the abdomen can consist of T1 or T2 weighted spin echo, fast spin echo (FSE, TSE) or gradient echo sequences with fat suppression and contrast enhanced MRI techniques. The examined organs include liver, pancreas, spleen, kidneys, adrenals as well as parts of the stomach and intestine (see also gastrointestinal imaging). Respiratory compensation and breath hold imaging is mandatory for a good image quality.
T1 weighted sequences are more sensitive for lesion detection than T2 weighted sequences at 0.5 T, while higher field strengths (greater than 1.0 T), T2 weighted and spoiled gradient echo sequences are used for focal lesion detection. Gradient echo in phase T1 breath hold can be performed as a dynamic series with the ability to visualize the blood distribution. Phases of contrast enhancement include the capillary or arterial dominant phase for demonstrating hypervascular lesions, in liver imaging the portal venous phase demonstrates the maximum difference between the liver and hypovascular lesions, while the equilibrium phase demonstrates interstitial disbursement for edematous and malignant tissues.
Out of phase gradient echo imaging for the abdomen is a lipid-type tissue sensitive sequence and is useful for the visualization of focal hepatic lesions, fatty liver (see also Dixon), hemochromatosis, adrenal lesions and renal masses. The standards for abdominal MRI vary according to clinical sites based on sequence availability and MRI equipment. Specific abdominal imaging coils and liver-specific contrast agents targeted to the healthy liver tissue improve the detection and localization of lesions.
See also Hepatobiliary Contrast Agents, Reticuloendothelial Contrast Agents, and Oral Contrast Agents.

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