Informing Radiologists About Liver Disease on MRI Requisitions
Yes, you should list liver disease on the MRI requisition to inform the radiologist. 1 This clinical information is essential for proper protocol selection, interpretation, and to ensure optimal patient outcomes.
Why Clinical Information About Liver Disease Matters
MRI protocols and interpretation strategies differ significantly based on the presence of liver disease:
Protocol Selection: The ACR Appropriateness Criteria specifically recommends different MRI protocols for patients with chronic liver disease versus those without 1
Contrast Enhancement Patterns: Liver disease affects how lesions enhance with contrast, which is critical for accurate diagnosis of conditions like hepatocellular carcinoma (HCC) 1
Sequence Selection: Radiologists may include additional sequences such as diffusion-weighted imaging (DWI) which is particularly valuable in patients with liver disease 1
Impact on Diagnostic Accuracy
Providing liver disease information directly impacts diagnostic accuracy:
HCC Detection: In patients with chronic liver disease, the sensitivity of MRI for detecting HCC ranges from 59-95%, but proper protocol selection is essential 1
Lesion Characterization: For liver lesions >1cm in patients with known chronic liver disease, specific MRI protocols with IV contrast are recommended as "usually appropriate" 1
Fibrosis Assessment: MR elastography may be added to evaluate fibrosis in patients with known liver disease 1
Protocol Differences Based on Clinical Context
The radiologist will select different protocols based on clinical information:
For patients with chronic liver disease:
- Multiphase contrast-enhanced sequences are essential
- Hepatobiliary contrast agents may be considered
- DWI sequences are routinely included 1
For patients without liver disease:
- Standard protocols may be sufficient
- Different enhancement patterns are expected 1
Common Pitfalls When Liver Disease Is Not Disclosed
Failing to disclose liver disease can lead to:
- Inappropriate Protocol: Standard MRI protocols may miss early HCC in cirrhotic livers
- Misinterpretation: Normal enhancement patterns differ in diseased livers
- Missed Diagnoses: Small HCCs may be overlooked without proper sequences and timing
Best Practice Recommendation
Always include liver disease status on MRI requisitions, specifying:
- Type of liver disease (viral hepatitis, NAFLD, alcoholic, etc.)
- Known cirrhosis status
- Previous liver-directed therapies
- History of HCC or other liver malignancies
This information ensures the radiologist can select the most appropriate protocol and accurately interpret findings, directly impacting patient morbidity and mortality through early detection of complications like HCC.