Foreword to the First Edition

It is with pleasure that I am writing the foreword for this textbook entitled "MRI of the Liver: Imaging Techniques, Contrast Enhancement, Differential Diagnosis" by Drs. Schneider, Grazioli and Saini.

If the liver has become the key organ to image in the abdomen, magnetic resonance (MR) imaging has become an indispensable modality for its evaluation. The absence of ionizing radiation, unparalleled soft tissue contrast, inherent multiplanar capability and high temporal resolution in dynamic gadolinium-enhanced imaging are major advantages over other imaging techniques. Furthermore, the introduction of contrast agents with liver specific properties has increased the usefulness of MRI for the detection and characterization of liver lesions.

This book fills a void in the current literature, giving radiologists and other physicians (primarily hepatologists and liver surgeons) interested in liver diseases the opportunity to have an up-to-date, single source of knowledge on MRI applied to the liver. This book is a combination of a manual, a reference textbook and an atlas. The first chapter constitutes a manual of liver MRI including modern imaging techniques and sequences. By including common imaging protocols tailored for the main manufacturers, it offers to practicing radiologists cookbook recipes to obtain superb liver MRI studies like the ones obtained by experts such as the authors. Current approaches to MRI of the liver using phased-array multicoils, enhanced gradients and motion reduction techniques allow us to have images with superb contrast resolution and acceptable spatial and temporal resolution. In chapter two, the authors cover the contrast administration strategy for MRI of the liver, detailing the use of both extracellular and liver specific contrast agents. The reasoning for the intravenous administration of extracellular gadolinium contrast agents as a useful adjunct in liver MRI is discussed. The increase in differences in signal intensity between normal hepatic parenchyma and hypo- or hypervascular neoplastic tissues is discussed, as are the specific enhancement patterns observed in different phases of perfusion following gadolinium administration. In addition, the rationale for using liver specific MR contrast agents is presented, with examples given for both manganese and iron oxide-based agents.

Chapter three presents a detailed overview of the histological classification of focal and diffuse liver pathologies, focusing on the essential needs of radiologists. In addition, possible classifications of focal liver lesions are presented based on their appearance on both unenhanced and contrast-enhanced MRI. Specifically, flow charts and tables for the differential diagnoses of liver lesions are presented, thereby consolidating in a single source the charts and tables found in a multiplicity of books and articles on abdominal and hepatobiliary imaging.

Chapters four and five constitute a reference on liver MRI of focal liver disease, discussing the radiological features of benign and malignant focal lesions in a systematic fashion. All benign and malignant primary liver lesions are presented from the most common such as hemangioma or hepatocellular carcinoma to the rarest such as nodular regenerative hyperplasia or epithelial hemangioendothelioma. Both pediatric and adult liver tumors are included. The sections on secondary liver lesions cover not only metastases and lymphoma, but also inflammatory and parasitic lesions. Where appropriate, the imaging features observed with other techniques (computed tomography and ultrasound) are presented for comparison.

The role of MRI in the characterization and monitoring of diffuse liver disease is recognized with a whole chapter dedicated to cirrhosis, iron overload and vascular pathol ogy. For completion a chapter is included on MRI of the liver post-surgery/post-ablation, an increasing challenge for abdominal radiologists given the increased frequency with which these techniques are performed.

This textbook is very well illustrated with more than 600 figures of high quality, which allow it to be seen as an atlas on liver MRI.

This textbook on MRI of the liver taps on the expertise of three obvious leaders in liver imaging, namely Drs. G√ľnther Schneider, Luigi Grazioli and Sanjay Saini. Their respective institutions, the University Clinic of Homburg-Saar, Germany, the University Hospital of Brescia, Italy, and the Mass. General Hospital in Boston, USA, are well-known for their interest in liver radiology and, specifically, liver MRI. This truly international effort has produced a fully-encompassing source for radiologists anywhere with current and practical information. I predict that this book will influence the way we practice liver imaging: the protocols will be improved, the differential diagnosis charts will be copied and pinned up in reading rooms in many departments and overall it will have a beneficial impact.

I invite you to read the work of Drs. Schneider, Grazioli and Saini with the certainty that you will enjoy their material and information.

November, 2002

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