Post-processing of dynamic gadolinium-enhanced magnetic resonance Imaging exams of the liver: Explanation and potential clinical applications for color-coded qualitative and quantitative analysis

The purpose of this article is to explain and illustrate the current status and potential applications of automated and color-coded post-processing techniques for the analysis of dynamic multiphasic gadolinium-enhanced magnetic resonance imaging (MRI) of the liver. Post-processing of these images on dedicated workstations allows the generation of time-intensity curves (TIC) as well as color-coded images, which provides useful information on (neo)-angiogenesis within a liver lesion, if necessary combined with information on enhancement patterns of the surrounding liver parenchyma. Analysis of TIC and color-coded images, which are based on pharmacokinetic modeling, provides an easy-to-interpret schematic presentation of tumor behavior, providing additional characteristics for adequate differential diagnosis. Inclusion of TIC and color-coded images as part of the routine abdominal MRI workup protocol may help to further improve the specificity of MRI findings, but needs to be validated in clinical decision-making situations. In addition, these tools may facilitate the diagnostic workup of disease for detection, characterization, staging, and monitoring of antitumor therapy, and hold incremental value to the widely used tumor response criteria.