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World J Hepatol. Aug 8, 2015; 7(16): 1987-2008
Published online Aug 8, 2015. doi: 10.4254/wjh.v7.i16.1987
Focal liver lesions: Practical magnetic resonance imaging approach
António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka
António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
António P Matos, Miguel Ramalho, Department of Radiology, Hospital Garcia de Orta, 2801-951 Almada, Portugal
Mamdoh AlObaidy, Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh 11461, Saudi Arabia
Author contributions: All authors have contributed equally to this work in form of literature review, manuscript writing/editing, and figure collection/illustration/annotation/captioning.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Richard C Semelka, MD, Professor, Department of Radiology, University of North Carolina, UNC at Chapel Hill CB 7510 - 2001 Old Clinic Bldg., Chapel Hill, NC 27599-7510, United States. richsem@med.unc.edu
Telephone: +1-919-9669676 Fax: +1-919-8437147
Received: April 18, 2015
Peer-review started: April 18, 2015
First decision: June 18, 2015
Revised: June 24, 2015
Accepted: July 23, 2015
Article in press: July 27, 2015
Published online: August 8, 2015
Processing time: 112 Days and 7.8 Hours
Abstract

With the widespread of cross-sectional imaging, a growth of incidentally detected focal liver lesions (FLL) has been observed. A reliable detection and characterization of FLL is critical for optimal patient management. Maximizing accuracy of imaging in the context of FLL is paramount in avoiding unnecessary biopsies, which may result in post-procedural complications. A tremendous development of new imaging techniques has taken place during these last years. Nowadays, Magnetic resonance imaging (MRI) plays a key role in management of liver lesions, using a radiation-free technique and a safe contrast agent profile. MRI plays a key role in the non-invasive correct characterization of FLL. MRI is capable of providing comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. These properties make MRI the mainstay for the noninvasive evaluation of focal liver lesions. In this paper we review the state-of-the-art MRI liver protocol, briefly discussing different sequence types, the unique characteristics of imaging non-cooperative patients and discuss the role of hepatocyte-specific contrast agents. A review of the imaging features of the most common benign and malignant FLL is presented, supplemented by a schematic representation of a simplistic practical approach on MRI.

Keywords: Malignant; Benign; Magnetic resonance imaging; Focal liver lesions; Hepatobiliary contrast agents

Core tip: With the widespread of cross-sectional imaging, a growth of incidentally detected focal liver lesions (FLL) has been observed. A reliable detection and characterization of FLL is critical for optimal patient management. Magnetic resonance imaging (MRI) plays a key role in non-invasive characterization of FLL. The multiparametric ability of pre- and post-contrast sequences is an intrinsic advantage of MRI to reach an accurate diagnosis. New techniques such as diffusion-weighted sequences and hepatocyte-specific contrast agents are being currently used in clinical practice, which might further improve the detection and characterization of FLL.