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Gadolinium enhanced three-dimensional magnetic resonance portography with subtraction

N Nishida, MD, G Sakai, MD, A Morimoto, MD, M Isota, MD, T Kaminou, MD, T Matsuoka, MD, K Nakamura, MD and R Yamada, MD

Osaka City University Medical School, Department of Radiology, 1-4-3, Asahi-machi, Abeno-ku, Osaka City 545-8585, Japan



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  		Figure 1. 49-year-old man with gastric and duodenal varices due to liver cirrhosis. (a) A partial maximum intensity projection (MIP) image of portal venous phase image (non-subtraction three-dimension magnetic resonance portography (3D-MRP)) demonstrates excellent visualization of the portal vein. The gastric varices (arrowheads) and duodenal varices (arrows) are not clearly visualized owing to enhancement of the aorta and right kidney. (b) A partial MIP image after subtraction of the arterial phase data set from the portal venous phase data set (subtraction 3D-MRP) demonstrates effective suppression of the aortic signal intensity and the right kidney enhancement, and superior visualization of portal collateral venous systems compared with (a). The portal vein is clearly depicted. (c,d) Percutaneous transhepatic portal venogram and (e) retrograde balloon occluded venogram from the left adrenal vein also shows the portal collateral venous systems.

 


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  		Figure 2. 33-year-old man with duodenal varix due to liver cirrhosis. (a) Non-subtraction three-dimension magnetic resonance portography (3D-MRP) image. (b) Subtraction 3D-MRP demonstrates effective suppression of the aortic signal intensity and the enhancement of pancreas and intestine. Superior visualization of the duodenal varix (arrows) compared with (a). (c) Percutaneous transhepatic portal venogram also shows the duodenal varix.

 


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  		Figure 3. 52-year-old man with gastric varix due to liver cirrhosis. (a) Source image of portal venous phase. (b) Source image after subtraction of an arterial phase image from a portal venous phase image shows that the signal of the aorta is completely eliminated, but enhancement of the left kidney is not entirely eliminated. (c) Non-subtraction three-dimension magnetic resonance portography (3D-MRP) image. (d) Subtraction 3D-MRP demonstrates effective suppression of the arterial signal and the enhancement of adjacent organs, even in these imperfect subtraction conditions. The portal collateral venous systems (arrows) are more clearly visualized compared with (c). (e) Retrograde balloon occluded venogram from the left adrenal vein also shows the gastric varix.

 




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