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Double Low-Dose Dual-Energy Liver CT in Patients at High-Risk of HCC: A Prospective, Randomized, Single-Center Study. Invest Radiol 2021; 55:340-348. [PMID: 31917765 DOI: 10.1097/rli.0000000000000643] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical feasibility of the simultaneous reduction of radiation and contrast doses using spectral computed tomography (CT) in patients at high-risk for hepatocellular carcinoma. MATERIALS AND METHODS Between May 2017 and March 2018, this prospective study recruited participants at risk of hepatocellular carcinoma with body mass indexes less than 30 and randomly assigned them to either the standard-dose group or the double low-dose group, which targeted 30% reductions in both radiation and contrast media (NCT03045445). Lesion conspicuity as a primary endpoint and lesion detection rates were then compared between hybrid iterative reconstruction (iDose) images of standard-dose group and low monoenergetic (50 keV) images of double low-dose group. Qualitative and quantitative image noise and contrast were also compared between the 2 groups. Participants and reviewers were blinded for scan protocols and reconstruction algorithms. Lesion conspicuity was analyzed using generalized estimating equation analysis. Lesion detection was evaluated using weighted jackknife alternative free-response receiver operating characteristic analysis. RESULTS Sixty-seven participants (male-to-female ratio, 59:8; mean age, 64 ± 9 years) were analyzed. Compared with the standard-dose group (n = 32), significantly lower CTDIvol (8.8 ± 1.7 mGy vs 6.1 ± 0.6 mGy) and contrast media (116.9 ± 15.7 mL vs 83.1 ± 9.9 mL) were utilized in the double low-dose group (n = 35; P < 0.001). Comparative analysis demonstrated that lesion conspicuity was significantly higher on 50 keV images of double low-dose group than on iDose images of standard dose on both arterial (2.62 [95% confidence interval (CI), 2.31-2.93] vs 2.02 [95% CI, 1.73-2.30], respectively, P = 0.004) and portal venous phases (2.39 [95% CI, 2.11-2.67] vs 1.88 [95% CI, 1.67-2.10], respectively, P = 0.005). No differences in lesion detection capability were observed between the 2 groups (figure of merit: 0.63 in standard-dose group; 0.65, double low-dose group; P = 0.52). Fifty kiloelectronvolt images of double low-dose group showed better subjective image noise and contrast than iDose image of standard-dose group on arterial and portal venous phases (P < 0.001 for all). Contrast-to-noise ratio of the aorta and portal vein was also higher in double low-dose group than in standard-dose group (P < 0.001 for all), whereas there was no significant difference of quantitative image noise between the 2 groups on arterial and portal phases (P = 0.4~0.5). CONCLUSIONS Low monoenergetic spectral CT images (50 keV) can provide better focal liver lesion conspicuity than hybrid iterative reconstruction image of standard-dose CT in nonobese patients while using lower radiation and contrast media doses.
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Nam JG, Lee JM, Lee SM, Kang HJ, Lee ES, Hur BY, Yoon JH, Kim E, Doneva M. High Acceleration Three-Dimensional T1-Weighted Dual Echo Dixon Hepatobiliary Phase Imaging Using Compressed Sensing-Sensitivity Encoding: Comparison of Image Quality and Solid Lesion Detectability with the Standard T1-Weighted Sequence. Korean J Radiol 2019; 20:438-448. [PMID: 30799575 PMCID: PMC6389821 DOI: 10.3348/kjr.2018.0310] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022] Open
Abstract
Objective To compare a high acceleration three-dimensional (3D) T1-weighted gradient-recalled-echo (GRE) sequence using the combined compressed sensing (CS)-sensitivity encoding (SENSE) method with a conventional 3D GRE sequence using SENSE, with respect to image quality and detectability of solid focal liver lesions (FLLs) in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced liver MRI. Materials and Methods A total of 217 patients with gadoxetic acid-enhanced liver MRI at 3T (54 in the preliminary study and 163 in the main study) were retrospectively included. In the main study, HBP imaging was done twice using the standard mDixon-3D-GRE technique with SENSE (acceleration factor [AF]: 2.8, standard mDixon-GRE) and the high acceleration mDixon-3D GRE technique using the combined CS-SENSE technique (CS-SENSE mDixon-GRE). Two abdominal radiologists assessed the two MRI data sets for image quality in consensus. Three other abdominal radiologists independently assessed the diagnostic performance of each data set and its ability to detect solid FLLs in 117 patients with 193 solid nodules and compared them using jackknife alternative free-response receiver operating characteristics (JAFROC). Results There was no significant difference in the overall image quality. CS-SENSE mDixon-GRE showed higher image noise, but lesser motion artifact levels compared with the standard mDixon-GRE (all p < 0.05). In terms of lesion detection, reader-averaged figures-of-merit estimated with JAFROC was 0.918 for standard mDixon-GRE, and 0.953 for CS-SENSE mDixon-GRE (p = 0.142). The non-inferiority of CS-SENSE mDixon-GRE over standard mDixon-GRE was confirmed (difference: 0.064 [−0.012, 0.081]). Conclusion The CS-SENSE mDixon-GRE HBP sequence provided comparable overall image quality and non-inferior solid FFL detectability compared with the standard mDixon-GRE sequence, with reduced acquisition time.
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Affiliation(s)
- Ju Gang Nam
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Sang Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Bo Yun Hur
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - EunJu Kim
- Department of Clinical Science, MR, Philips Healthcare Korea, Seoul, Korea
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Yoneyama M, Takayama Y, Nishie A, Nakamura M, Katsumata Y, Takemura A, Obara M, Okuaki T, Honda H, Van Cauteren M. Differentiation of hypointense nodules on gadoxetic acid-enhanced hepatobiliary-phase MRI using T2 enhanced spin-echo imaging with the time-reversed gradient echo sequence: An initial experience. Eur J Radiol 2017; 95:325-331. [DOI: 10.1016/j.ejrad.2017.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 08/25/2017] [Indexed: 01/17/2023]
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Yoon JH, Lee JM, Yu MH, Kim EJ, Han JK, Choi BI. Fat-suppressed, three-dimensional T1-weighted imaging using high-acceleration parallel acquisition and a dual-echo Dixon technique for gadoxetic acid-enhanced liver MRI at 3 T. Acta Radiol 2015; 56:1454-62. [PMID: 25480475 DOI: 10.1177/0284185114561038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parallel imaging (PI) techniques are used for overcoming lower spatial and time resolution for magnetic resonance imaging (MRI). There is clinical need to overcome inevitable noise by decreased voxel size and signal-to-noise issue by using high-acceleration factor (AF). PURPOSE To determine whether the combination of a modified Dixon three-dimensional (3D) T1-weighted (T1W) gradient echo technique (mDixon-3D-GRE) and high-acceleration ([HA], AF = 5) PI can provide breath-hold (BH) T1W imaging with better image quality than conventional fat-suppressed 3D-T1W-GRE (SPAIR-3D-GRE) for Gd-EOB-DTPA-enhanced liver MR. MATERIAL AND METHODS This retrospective study was approved by our institutional review board and informed consent was waived. There were 138 patients who underwent Gd-EOB-DTPA-enhanced liver MR at 3 T using either standard SPAIR-3D-GRE sequences with an AF of 2.6 (n = 68, Standard group) or mDixon-3D-GRE with an AF of 5 (n = 70, HA group). In the HA group, hepatobiliary phase was obtained three times using HA-mDixon-3D-GRE (AF = 5), HA-SPAIR-3D-GRE (AF = 5), and standard-SPAIR-3D-GRE (AF = 2.6). Image noise, quality, and anatomic depiction of dynamic phase were compared between standard and HA groups, and those of hepatobiliary phase were compared among the three image sets in HA group. RESULTS As for dynamic imaging, the HA-mDixon-3D-GRE images showed better anatomic details and overall image quality than standard-SPAIR-3D-GRE sequence (arterial phase: 3.56 ± 0.63 vs. 2.66 ± 0.69, P < 0.001). In the intra-individual comparison, HA-mDixon-3D-GRE provided better orang depiction and overall image quality than standard-SPAIR-3D-GRE (3.99 ± 0.75 vs. 3.0 ± 0.72, P < 0.001) and better fat suppression and significantly less noise than HA-SPAIR-3D-GRE (4.76 ± 0.43 vs. 3.71 ± 0.54, P < 0.001). CONCLUSION The combined use of mDixon-3D-GRE sequence and high-acceleration PI provided better quality BH-T1W imaging compared with conventional SPAIR-3D-GRE for Gd-EOB-DTPA-enhanced liver MRI.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mi Hye Yu
- Konkuk University Hospital, Seoul, Republic of Korea
| | - Eun Ju Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine Seoul National University College of Medicine, Seoul, Republic of Korea
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Onoda M, Hyodo T, Murakami T, Okada M, Uto T, Hori M, Miyati T. Optimizing signal intensity correction during evaluation of hepatic parenchymal enhancement on gadoxetate disodium-enhanced MRI: Comparison of three methods. Eur J Radiol 2015; 84:339-345. [DOI: 10.1016/j.ejrad.2014.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/08/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
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Detectability of hepatocellular carcinoma on gadoxetic acid-enhanced MRI at 3 T in patients with severe liver dysfunction: clinical impact of dual-source parallel radiofrequency excitation. Clin Radiol 2015; 70:254-61. [DOI: 10.1016/j.crad.2014.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 10/26/2014] [Accepted: 11/10/2014] [Indexed: 01/22/2023]
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Takayama Y, Nishie A, Asayama Y, Ishigami K, Kakihara D, Ushijima Y, Fujita N, Yoshiura T, Takemura A, Obara M, Takahara T, Honda H. Optimization and Clinical Feasibility of Free-breathing Diffusion-weighted Imaging of the Liver: Comparison with Respiratory-Triggered Diffusion-weighted Imaging. Magn Reson Med Sci 2015; 14:123-32. [PMID: 25740235 DOI: 10.2463/mrms.2014-0032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE We compared the image quality of free-breathing diffusion-weighted imaging (FB-DWI) to that of respiratory-triggered DWI (RT-DWI) after proper optimization. MATERIALS AND METHODS Three healthy subjects were scanned to optimize magnetic resonance (MR) parameters of FB-DWI to improve image quality, including spatial resolution, image noise, and chemical shift artifacts. After this optimization, we scanned 32 patients with liver disease to assess the clinical feasibility of the optimized FB-DWI. Of the 32 patients, 14 had a total of 28 hepatocellular carcinomas (HCCs), four had a total of 15 metastatic liver tumors, and the other 14 had no tumor. Qualitatively, we compared the image quality scores of FB-DWI with those of RT-DWI with the Wilcoxon signed-rank test. Quantitatively, we compared the signal-to-noise ratios (SNRs) of the liver parenchyma, lesion-to-nonlesion contrast-to-noise ratios (CNRs) and apparent diffusion coefficient (ADC) values of the liver parenchyma and liver tumor by the paired t-test. RESULTS The average scores of image quality for sharpness of liver contour, image noise, and chemical shift artifacts were significantly higher for FB-DWI than RT-DWI (P < 0.05). SNRs, CNRs, and ADC values of the liver parenchyma and tumors did not differ significantly between the 2 DWI methods. CONCLUSION Compared with RT-DWI, the optimized FB-DWI provided better spatial resolution, fewer artifacts, and comparable SNRs, lesion-to-nonlesion CNRs, and ADC values.
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Affiliation(s)
- Yukihisa Takayama
- Department of Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University
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Toshima T, Shirabe K, Ikegami T, Yoshizumi T, Kuno A, Togayachi A, Gotoh M, Narimatsu H, Korenaga M, Mizokami M, Nishie A, Aishima S, Maehara Y. A novel serum marker, glycosylated Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+)-M2BP), for assessing liver fibrosis. J Gastroenterol 2015; 50:76-84. [PMID: 24603981 DOI: 10.1007/s00535-014-0946-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/07/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently, a novel marker, hyperglycosylated Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+)-M2BP), was developed for liver fibrosis using the glycan "sugar chain"-based immunoassay; however, the feasibility of WFA(+)-M2BP for assessing liver fibrosis has not been proven with clinical samples of hepatitis. METHODS Serum WFA(+)-M2BP values were evaluated in 200 patients with chronic liver disease who underwent histological examination of liver fibrosis. The diagnostic accuracy of WFA(+)-M2BP values was compared with various fibrosis markers, such as ultrasound based-virtual touch tissue quantification (VTTQ), magnetic resonance imaging based-liver-to-major psoas muscle intensity ratio (LMR), and serum markers, including hyaluronic acid, type 4 collagen, and aspartate transaminase to platelet ratio index (APRI). RESULTS Serum WFA(+)-M2BP levels in patients with fibrosis grades F0, F1, F2, F3, and F4 had cutoff indices 1.62, 1.82, 3.02, 3.32, and 3.67, respectively, and there were significant differences between fibrosis stages F1 and F2, and between F2 and F3 (P < 0.01). The area under the receiver operating characteristic curves for the diagnosis of fibrosis (F ≥ 3) using serum WFA(+)-M2BP values (0.812) was almost comparable to that using VTTQ examination (0.814), but was superior to the other surrogate markers, including LMR index (0.766), APRI (0.694), hyaluronic acid (0.683), and type 4 collagen (0.625) (P < 0.01 each). CONCLUSIONS Serum WFA(+)-M2BP values based on a glycan-based immunoassay is an accurate, reliable, and reproducible method for the assessment of liver fibrosis. This approach could be clinically feasible for evaluation of beneficial therapy through the quantification of liver fibrosis in hepatitis patients if this measurement application is commercially realized.
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Affiliation(s)
- Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Takayama Y, Nishie A, Asayama Y, Ushijima Y, Okamoto D, Fujita N, Morita K, Shirabe K, Kotoh K, Kubo Y, Okuaki T, Honda H. T1ρ Relaxation of the liver: A potential biomarker of liver function. J Magn Reson Imaging 2014; 42:188-95. [DOI: 10.1002/jmri.24739] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/12/2014] [Indexed: 01/20/2023] Open
Affiliation(s)
- Yukihisa Takayama
- Department of Radiology Informatics and Network; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Akihiro Nishie
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Yoshiki Asayama
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Koichiro Morita
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Ken Shirabe
- Department of Surgery and Science; Graduate School of Medical Sciences, Kyushu University; 3-1-1 Fukuoka Japan
| | - Kazuhiro Kotoh
- Department of Medicine and Bioregulatory Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Yuichiro Kubo
- Department of Anatomic Pathology, Pathological Sciences; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | | | - Hiroshi Honda
- Department of Clinical Radiology; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
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Yoon JH, Lee JM, Yu MH, Kim EJ, Han JK, Choi BI. High-resolution T1-weighted gradient echo imaging for liver MRI using parallel imaging at high-acceleration factors. ACTA ACUST UNITED AC 2014; 39:711-21. [DOI: 10.1007/s00261-014-0099-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Takayama Y, Nishie A, Asayama Y, Ushijima Y, Fujita N, Shimamoto D, Yoshiura T, Obara M, Takemura A, Yoneyama M, Honda H. Three-dimensional T2-weighted imaging for liver MRI: clinical values of tissue-specific variable refocusing flip-angle turbo spin echo imaging. J Magn Reson Imaging 2014; 41:339-46. [PMID: 24399511 DOI: 10.1002/jmri.24554] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/25/2013] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To assess the clinical utility of tissue-specific variable refocusing flip-angle (VRFA) turbo-spin echo imaging for three-dimensional T2-weighted imaging (3D-T2WI) of the liver. MATERIALS AND METHODS Fifty-nine patients were scanned with three types of fat-suppressed T2WI for the comparison: two-dimensional single-shot turbo spin echo T2WI (ssT2WI), 3D-T2WI with tissue-specific VRFA (VISTA-TSV), and 3D-T2WI with low-constant VRFA (VISTA). Qualitatively, artifacts in the left and right lobes of the liver and black-blood effects in the liver were compared using the Wilcoxon signed-rank test with the Bonferroni correction. The detection and correct characterization rates of liver lesions were compared using McNemar's test. RESULTS VISTA-TSV showed reduced artifacts in the left and right lobes of the liver compared with VISTA (P < 0.017). The artifacts shown by VISTA-TSV were equivalent to those shown by ssT2WI. The black-blood effects of VISTA-TSV and VISTA were better than that of ssT2WI (P < 0.017). VISTA-TSV showed the best detection and correct characterization rate of liver lesions among the three imaging techniques (P < 0.05). CONCLUSION 3D-T2WI with tissue-specific VRFA can reduce artifacts of the liver, sufficiently suppress the signal in blood vessels, and has a potential to improve the detection and correct characterization rates of liver lesions.
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Affiliation(s)
- Yukihisa Takayama
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka City, Fukuoka, Japan
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