Applications of Quantitative Perfusion and Permeability in the Liver

Abstract Because of the unique hepatic structure, quantification of perfusion is more challenging in the liver than in other organs. The liver is a large, mobile organ that moves significantly during respiration. Moreover, it has a dual vascular supply and the normal hepatic sinusoids are fenestrated, explaining that dedicated pharmacokinetic models must be developed for liver perfusion quantification. The recent introduction of three-dimensional (3D) time-resolved Magnetic Resonance Imaging (MRI) perfusion sequences with or without image registration offers the opportunity to obtain good quality, free-breathing images of the liver with a time resolution of 2 s per hepatic volume. Perfusion imaging is mostly used to assess hepatic tumors and chronic liver diseases. In oncology, perfusion has been used for tumor detection and characterization, but most studies have focused on monitoring the tumor response to a wide variety of systemic and locoregional treatments. In chronic liver diseases, it has been shown that perfusion MRI performed with extracellular contrast agents offers the opportunity to assess the severity of advanced liver fibrosis and cirrhosis. Moreover, dynamic MRI with hepatobiliary contrast agents enables quantification of both liver perfusion and hepatocyte transport function using pluri-compartment pharmacokinetic models.