47 year old male patient with known Klatskin tumor (stage III). MR images were performed to assess the vascular status of the abdomen and to rule out a pyelothrombosis.

Examination was performed on a 1.5T Siemens MAGNETOM Avanto scanner using a Body Matrix coil.
20 minutes before starting the examination, 300 ml of Lumirem (iron-oxide) were administered p.o. to reduce intraluminal signal from duodenum. Immediately before the MRCP (MR Cholangiopancreatographie) examination, 40 mg of butylscopolamide (Buscopan, Boehringer, Germany) were administered intravenously to suppress bowel peristalsis. Images depicting the abdominal anatomy were acquired using a coronal HASTE, an axial navigator triggered fat suppressed T2-weighted TSE sequence and a T1-weighted breath-hold FLASH 2D sequence.
MRCP was performed using a coronal, heavily T2-weighted TSE 3D sequence with PACE enabling free breathing of the patient during the examination. MR images were postprocessed subsequently using a maximum intensity projection (MIP) algorithm.
2 ml Gadolinium-DTPA were injected as test bolus to measure the circulation time. A coronal angulated FLASH 3D sequence in breath-hold technique was used to acquire pre and post contrast images. The scan delay was calculated according to the following formula: circulation time – time to center of k-space + 4 [s].
Contrast agent dose was 0.15 mmol Gd-DTPA/ kg body weight.
Two sets of post contrast data were acquired. Furthermore, axial fat suppressed FLASH 2D post contrast images were recorded.

1. Klatskin tumor (size 4.2 x 3.0 cm) with potential infiltration of the portal venous system in the right lobe of the liver.
2. Occlusion of the right portal venous branch in the region of the tumor.
3. Infiltration of right and left hepatic arteries without affecting the bile ducts in this area.
4. Intrahepatic cholestasis particularly in the right lobe of the liver.