Evaluation of a respiratory navigator-gating technique in Gd-EOB-DTPA-enhanced magnetic resonance imaging for the assessment of liver tumors

Effectiveness of deep learning-based reconstruction for improvement of image quality and liver tumor detectability in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging

PURPOSE

To evaluate the effectiveness of deep learning-based reconstruction (DLR) in improving image quality and tumor detectability of isovoxel high-resolution breath-hold fat-suppressed T1-weighted imaging (HR-BH-FS-T1WI) in the hepatobiliary phase (HBP) of Gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI).

MATERIALS AND METHODS

This retrospective evaluated 42 patients with 98 liver tumors who underwent Gd-EOB-MRI between March 2023 and May 2023 using three techniques based on HBP imaging: isovoxel HR-BH-FS-T1WI reconstructed (1) with DLR (BH-DLR +) and (2) without DLR (BH-DLR -) and (3) HR-FS-T1WI scanned with a free-breathing technique using a navigator-echo-triggered technique and DLR (Navi-DLR +). The three techniques were qualitatively and quantitatively compared by the Friedman test and the Bonferroni post-hoc test. Tumor detectability was compared using the McNemar test.

RESULTS

BH-DLR + (3.85, average score of two radiologists) showed significantly better qualitative scores for image noise than BH-DLR - (2.84) and Navi-DLR + (3.37) (p < 0.0167), and Navi-DLR + showed significantly better scores than BH-DLR - (p < 0.0167). BH-DLR + (3.77) and BH-DLR - (3.77) showed significantly better qualitative scores for respiratory motion artifact than Navi-DLR + (2.75) (p < 0.0167), but there was no significant difference in scores between BH-DLR + and BH-DLR - (p > 0.0167). BH-DLR + (0.32) and Navi-DLR + (0.33) showed significantly higher lesion-to-nonlesion CR than BH-DLR - (0.29) (p < 0.0167), but there was no significant difference in lesion-to-nonlesion CR between BH-DLR + and Navi-DLR + (p > 0.0167). BH-DLR + (89.8%) showed significantly better tumor detectability than BH-DLR - (76.0%) and Navi-DLR + (77.6%) (p < 0.05).

CONCLUSION

The use of DLR for isovoxel HR-BH-FS-T1WI was effective in improving image quality and tumor detectability.

An Intra-individual Comparison between Free-breathing Dynamic MR Imaging of the Liver Using Stack-of-stars Acquisition and the Breath-holding Method Using Cartesian Sampling or View-sharing

PURPOSE

To compare the quality of dynamic imaging between stack-of-stars acquisition without breath-holding (DISCO-Star) and the breath-holding method (Cartesian LAVA and DISCO).

METHODS

This retrospective study was conducted between October 2019 and February 2020. Two radiologists performed visual assessments of respiratory motion or pulsation artifacts, streak artifacts, liver edge sharpness, and overall image quality using a 5-point scale for two datasets: Dataset 1 (n = 107), patients with Cartesian LAVA and DISCO-Star; Dataset 2 (n = 41), patients with DISCO and DISCO-Star at different time points. Diagnosable image quality was defined as ≥ 3 points in overall image quality. Whether the scan timing of the arterial phase (AP) was appropriate was evaluated, and results between the pulse sequences were compared. In cases of inappropriate scan timing in the DISCO-Star group, retrospective reconstruction with a high frame rate (80 phases, 3 s/phase) was added.

RESULTS

The overall image quality of Cartesian LAVA was better than that of DISCO-Star in AP. However, noninferiority was shown in the ratio of diagnosable images between Cartesian LAVA and DISCO-Star in AP. There was no significant difference in the ratio of appropriate scan timing between DISCO-Star and Cartesian LAVA; however, the ratio of appropriate scan timing in DISCO-Star with high frame rate reconstruction was significantly higher than that in Cartesian LAVA in both readers. Overall image quality scores between DISCO and DISCO-Star were not significantly different in AP. There was no significant difference in the ratio of appropriate scan timing between DISCO-Star with high frame rate reconstruction and DISCO in both readers.

CONCLUSION

The use of DISCO-Star with high frame rate reconstruction is a good solution to obtain appropriate AP scan timing compared with Cartesian LAVA. DISCO-Star showed equivalent image quality in all phases and in the ratio of appropriate AP scan timing compared with DISCO.

Errors and Misinterpretations in Imaging of Chronic Liver Diseases

MRI is an important problem-solving tool for accurate characterization of liver lesions. Chronic liver disease alters the typical imaging characteristics and complicates liver imaging. Awareness of imaging pitfalls and technical artifacts and ways to mitigate them allows for more accurate and timely diagnosis.

Utility of Stack-of-stars Acquisition for Hepatobiliary Phase Imaging without Breath-holding

Purpose:

Post-contrast liver magnetic resonance imaging is typically performed with breath-hold 3D gradient echo sequences. However, breath-holding for >10 s is difficult for some patients. In this study, we compared the quality of hepatobiliary phase (HBP) imaging without breath-holding using the prototype pulse sequences stack-of-stars liver acquisition with volume acceleration (LAVA) (LAVA Star) with or without navigator echoes (LAVA Star_navi+ and LAVA Star_navi−) and Cartesian LAVA with navigator echoes (Cartesian LAVA_navi+).

Methods:

Seventy-two patients were included in this single-center, retrospective, cross-sectional study. HBP imaging using the three LAVA sequences (Cartesian LAVA_navi+, LAVA Star_navi−, and LAVA Star_navi+) without breath-holding was performed for all patients using a 3T magnetic resonance system. Two independent radiologists qualitatively analyzed (overall image quality, liver edge sharpness, hepatic vein clarity, streak artifacts, and respiratory motion/pulsation artifacts) HBP images taken by the three sequences using a five-point scale. Quantitative evaluations were also performed by calculating the liver-to-spleen, -lesion, and -portal vein (PV) signal intensity ratios. The results were compared between the three sequences using the Friedman test.

Results:

LAVA Star_navi+ showed the best image quality and hepatic vein clarity (P < 0.0001). LAVA Star_navi− showed the lowest image quality (P < 0.0001–0.0106). LAVA Star_navi+ images showed fewer streak artifacts than LAVA Star_navi− images (P < 0.0001), while Cartesian LAVA_navi+ images showed no streak artifacts. Cartesian LAVA_navi+ images showed stronger respiratory motion/pulsation artifacts than the others (P < 0.0001). LAVA Star_navi− images showed the highest liver-to-spleen ratios (P < 0.0001–0.0005). Cartesian LAVA_navi+ images showed the lowest liver-to-lesion and -PV ratios (P < 0.0001–0.0108).

Conclusion:

In terms of image quality, the combination of stack-of-stars acquisition and navigator echoes is the best for HBP imaging without breath-holding.