MRI ABDOMEN W/WO

These images are the abdomen of a 35 year old male. He came in with abdomen pain and had an abnormal CT scan and ultrasound. The patient has a mass in his liver. It is large measuring 7x6cm. The radiologist read this hepatic lesion to most likely be a giant hemangioma due to its enhancement characteristics. In the images I provided you can clearly see the pathology in the patients liver. I found this exam to be very interesting because I have not seen a lot of abdomen scans in MRI. CT is usually the first choice for an abdomen scan because MRIs can be very time consuming and the pt has to do numerous breath holds and may not be in a suitible condition to do so especially if they are in a lot of pain.

CONTRAST ENHANCEMENT

This is an exam I did earlier in the semester that I found interesting. The patient was an 85 yr old man with history of lung cancer. The patient had a screening MRI of the brain about six months prior to the one we did in October to observe for mets due to mental status changes. His GFR was low and the radiologists had the tech do the study without contrast when usually anyone with a cancer history has studies with unless their are contradictions like kidney function. This time the patients GFR was still low but not as low as it was and this radiologist gave us the go ahead to inject contrast due to the patients history. These images are not the best because I took them off the screen at work with my camera phone but you can still see what I am talking about. In the pre images you can see maybe one are that might be something but might be atrophy due to age, it is uncertain if it is a pathology or metastatic disease. Then the injection is given and all I could say was oh my gosh!! All I could keep comparing this man's brain to was a dalmation dogs spots. It was unreal what you could see with the contrast enhancement that you couldn't without it! I wondered if all the mets had been there six months prior when contrast was not used? Look at the images and you will see why I was so shocked at the differences. They didn't upload in the order I wanted them to but the bottom two are the pre images.

MRI

Clinicals are still going smoothly. I am learning a lot. We have two new radiologist and one of them has a thing for MRI so he has been changing many of our protocols. We have also done a lot more abdomen MRIs than normal so I am beginning to get very familiar and comfortable with them. We are using a new contrast called Eovist that is specially designed for liver lesion enhancment. The magnet we work on is a Philips Acheiva 1.5T. It is a closed magnet but seems more open than others because it has a short bore. The short bore is very nice for the patients but sometimes it causes fat sat issues with our images. The lead tech said they have had problems with it ever since they got it and Philips said it is just something the short bore magnets run into sometimes. It usually only comes up when scanning feet and breast. One end of the foot might fat sat and the other not. It is really frustrating when doing a breast MRI because they are so lengthy. The majority of the time the fat sat does not work properly on patients with breast implants and we have to make different adjustments with techniques and factors and just keep running scans and keep changing factors until it works. Not the same changes work with every patient, it is like certain things work according to the patients tissue make up. I'm beginning to learn what adjustments to make with the shim box, spir and spair, etc. All in all it is a great learning experience having to know what to do when something doesn't go completely as planned.