MRI with Contrast

[nuhepper]

Does anyone know why they don't use an MRI with contrast to diagnose the condition of the liver?  They are much better than a cat scan, are the not?  

nuhepper

[yodennis]

They do. I've had 3 over the last 3 years and it confirmed my initial dg. of cirrhosis. It was prescribed by a prominent NYC hepatologist!

[nuhepper]

Thank you for your great answers.  It will take me awhie to look up the rest of the links.  

nuhepper

[HectorSF]

Does anyone know why they don't use an MRI with contrast to diagnose the condition of the liver?  
What condition? Fibrosis?
A biopsy is the standard to diagnose the inflammation and stage of liver disease and can also be used to detect the cause of the liver disease. Transient elastography (FibroScan) can be used to detect liver stiffness which correlates to the stage of liver disease.

A biopsy removes enough of the liver to view under the microscope to see the structure of the liver lobules and see where and how much collagen has been made by the injury to the liver caused by hepatitis C for example. A liver biopsy can cost between $1,500 - $2,000 or so. A dynamic contrast enhanced MRI that I have regularly performed costs $5,000. More than twice the price.

Patients with cirrhosis have an increased chance of developing HCC than the general population. They should have cancer surveillance every 6 months with an ultrasound and the AFP tumor marker blood test. If a lesion is seen or the AFP is rising or very high it must be determined if the growth is cancer. A dynamic contrast enhanced MRI is the best way to diagnosis the existence of HCC (liver cancer) as it has the highest resolution. HCC is vascular tumor. By observing the blood flow through the liver and lesion in its different phases, HCC can do diagnosed because of has a certain pattern of blood flow is seen. HCC is hypervascular in the arterial phase with washout in the portal venous or delayed phase if demonstrates this the lesion should be treated as HCC. In other words all HCC tumors are feed by arterial blood not venous blood. The IV contrast makes the tumor stand out from the surrounding liver cells during the arterial phase.

Here is a MRI of HCC during the different phases of blood flow. You can see have the contrast bring out the tumor.
http://ars.els-cdn.com/content/image/1-s2.0-S0720048X05004122-gr7.jpg

For a patient who has cirrhosis and is listed for a liver transplant their are certain protocols that must be followed to confirm diagnosis of HCC with an MRI. It is a complex protocol and also it takes a very experienced pathologist to have the most accurate diagnosis. That is why anyone with cirrhosis should have their cancer screen MRI at a transplant center where they diagnose liver cancer on a routine basis. You don't want the tumor to be missed and then progress too far as early diagnosis is the key to survival as it is in many cancers. HCC is a very deathly cancer. If caught too late (metastasis) it is fatal within usually 4-6 months.

A CT can also be used but since patients may have this done twice a year for many years while they await a liver transplant it is advisable to avoid the radiation from the CT machine. Ultrasound and MRI do not use radiation.


Take care!
Hector

[Idyllic]

A noninvasive way to detect fibrosis. It's a good question.  I have always understood MRIs are used to diagnose &/or monitor cancer or more advanced stages of liver disease (surface or structural things) but that is about it.

Look, here is a study about MRI to detect fibrosis (it's currently recruiting participants.)
http://clinicaltrials.gov/show/NCT01600105

http://www.diagnosticimaging.com/display/article/113619/1183987
Here's a link related to MRI vs Biopsy
____________________-

Here is an exciting thread. Mike (the OP) posted the question about the MRE and if you follow the thread he actually ended up coming to America and participating in a study for the technique he originally asked about.

The method is this
http://www.youtube.com/watch?v=CcmZi0J_u3Y

http://www.medhelp.org/posts/Hepatitis-C/A-better-test-for-staging-liver-fibrosis-cirrhosis-MRE/show/1832957