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Poetter-Lang S, Dovjak GO, Messner A, Ambros R, Polanec SH, Baltzer PAT, Kristic A, Herold A, Hodge JC, Weber M, Bastati N, Ba-Ssalamah A. Influence of dilution on arterial-phase artifacts and signal intensity on gadoxetic acid-enhanced liver MRI. Eur Radiol 2022; 33:523-534. [PMID: 35895119 DOI: 10.1007/s00330-022-08984-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the effect of saline-diluted gadoxetic acid, done for arterial-phase (AP) artifact reduction, on signal intensity (SI), and hence focal lesion conspicuity on MR imaging. METHODS We retrospectively examined 112 patients who each had at least two serial gadoxetic acid-enhanced liver MRIs performed at 1 ml/s, first with non-diluted (ND), then with 1:1 saline-diluted (D) contrast. Two blinded readers independently analyzed the artifacts and graded dynamic images using a 5-point scale. The absolute SI of liver parenchyma, focal liver lesions (if present), aorta, and portal vein at the level of the celiac trunk and the SI of the paraspinal muscle were measured in all phases. The signal-to-norm (SINorm) of the vascular structures, hepatic parenchyma and focal lesions, and the contrast-to-norm (CNorm) of focal liver lesions were calculated. RESULTS AP artifacts were significantly reduced with dilution. Mean absolute contrast-enhanced liver SI was significantly higher on the D exams compared to the ND exams. Likewise, SINorm of liver parenchyma was significantly higher in all contrast-enhanced phases except transitional phase on the D exams. SINorm values in the AP for the aorta and in the PVP for portal vein were significantly higher on the diluted exams. The CNorm was not significantly different between ND and D exams for lesions in any imaging phase. The interclass correlation coefficient was excellent (0.89). CONCLUSION Gadoxetic acid dilution injected at 1ml/s produces images with significantly fewer AP artifacts but no significant loss in SINorm or CNorm compared to standard non-diluted images. KEY POINTS • Diluted gadoxetic acid at slow injection (1 ml/s) yielded images with higher SINorm of the liver parenchyma and preserved CNorm for focal liver lesions. • Gadoxetic acid-enhanced MRI injected at 1 ml/s is associated with arterial-phase (AP) artifacts in 31% of exams, which may degrade image quality and limits focal liver lesion detection. • Saline dilution of gadoxetic acid 1:1 combined with a slow injection rate of 1 ml/s significantly reduced AP artifacts from 31 to 9% and non-diagnostic AP artifacts from 16 to 1%.
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Affiliation(s)
- Sarah Poetter-Lang
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gregor O Dovjak
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alina Messner
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan H Polanec
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Antonia Kristic
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Herold
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nina Bastati
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital of Vienna (AKH), Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Ringe KI, von Falck C, Raatschen HJ, Wacker F, Hinrichs J. Evaluation of transient respiratory motion artifact at gadoxetate disodium-enhanced MRI-Influence of different contrast agent application protocols. PLoS One 2018; 13:e0200887. [PMID: 30024930 PMCID: PMC6053213 DOI: 10.1371/journal.pone.0200887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/05/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate transient severe respiratory motion artifacts (TSM) at gadoxetate disodium-enhanced MRI dependent on the mode of contrast agent application. METHODS 200 patients (71f, 129m; mean 51y) were included in this retrospective IRB-approved study. Contrast application protocols (n = 4) differed with regards to injection rate (2ml or 1ml/sec), dose (weight-based or fixed 10ml) and supplemental oxygen administration (yes/no). SNR measurements were performed in the aorta and portal vein. Qualitatively, three readers assessed arterial phase image quality and TSM independently (4- and 5-point scale, respectively). Quantitative and qualitative results were compared (Kruskal-Wallis test, Dunn's multiple comparison test). The influence of different contrast agent application parameters on the occurrence of respiratory motion artifacts was assessed (univariate analysis). Interrater agreement and reliability were calculated (intraclass correlation coefficient, ICC)). RESULTS Use of a lower contrast injection rate resulted in significantly higher arterial SNR in the aorta and portal vein (p<0.05). TSM was observed in 12% of examinations. Neither injection rate, contrast dose, nor oxygen had a significant influence. Interrater agreement and reliability for evaluation of image quality and respiratory motion were substantial/ almost perfect (ICC = 0.640-0.915). CONCLUSIONS Technical factors regarding the specific mode of contrast application do not seem to significantly reduce the incidence of severe transient respiratory motion artifacts.
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Affiliation(s)
- Kristina I. Ringe
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Christian von Falck
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Hans-Jürgen Raatschen
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Frank Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Jan Hinrichs
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
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Liu X, Jiang H, Chen J, Zhou Y, Huang Z, Song B. Gadoxetic acid disodium-enhanced magnetic resonance imaging outperformed multidetector computed tomography in diagnosing small hepatocellular carcinoma: A meta-analysis. Liver Transpl 2017; 23:1505-1518. [PMID: 28886231 DOI: 10.1002/lt.24867] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 02/05/2023]
Abstract
Early detection of small hepatocellular carcinoma (HCC) lesions can improve longterm patient survival. A systematic review and meta-analysis of the diagnostic performance of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) was performed in diagnosing small HCCs measuring up to 2 cm (≤2 cm). Two investigators searched multiple databases for studies in which the performances of either Gd-EOB-DTPA-enhanced MRI or MDCT were reported with sufficient data to construct 2 × 2 contingency tables for diagnosing HCCs up to 2 cm on a per-lesion or per-patient level. Diagnostic performances were quantitatively pooled by a bivariate random-effect model with further meta-regression and subgroup analyses. A total of 27 studies (14 on Gd-EOB-DTPA-enhanced MRI, 9 on MDCT, and 4 on both) were included, enrolling a total of 1735 patients on Gd-EOB-DTPA-enhanced MRI and 1781 patients on MDCT. Gd-EOB-DTPA-enhanced MRI demonstrated significantly higher overall sensitivity than did MDCT (0.96 versus 0.65; P < 0.01), without substantial loss of specificity (0.94 versus 0.98; P > 0.05). Area under the summary receiver operating characteristic curve was 0.97 with Gd-EOB-DTPA-enhanced MRI and 0.85 with MDCT. Regarding Gd-EOB-DTPA-enhanced MRI, sensitivity was significantly higher for studies from non-Asian countries than Asian countries (0.96 versus 0.93; P < 0.01), for retrospective studies than prospective studies (0.95 versus 0.91; P < 0.01), and for those with Gd-EOB-DTPA injection rate ≥ 1.5 mL/s than that of <1.5 mL/s (0.97 versus 0.90; P < 0.01). In conclusion, Gd-EOB-DTPA-enhanced MRI demonstrated higher sensitivity and overall diagnostic accuracy than MDCT, and thus should be the preferred imaging modality for diagnosing small HCCs measuring up to 2 cm. Liver Transplantation 23 1505-1518 2017 AASLD.
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Affiliation(s)
- Xijiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - You Zhou
- Systems Immunity Research Institute, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Yoo JL, Lee CH, Park YS, Kim JW, Lee J, Kim KA, Seol HY, Park CM. The Short Breath-Hold Technique, Controlled Aliasing in Parallel Imaging Results in Higher Acceleration, Can Be the First Step to Overcoming a Degraded Hepatic Arterial Phase in Liver Magnetic Resonance Imaging: A Prospective Randomized Control Study. Invest Radiol 2017; 51:440-6. [PMID: 26807896 DOI: 10.1097/rli.0000000000000249] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether a short breath-hold technique can improve hepatic arterial phase (HAP) image quality in gadoxetic acid-enhanced magnetic resonance (MR) imaging compared with a conventional long breath-hold technique. MATERIALS AND METHODS Institutional review board approval and patient consent were obtained for this prospective randomized control study. One hundred nineteen patients undergoing gadoxetic acid-enhanced MR imaging were randomly assigned to groups A or B. Group A patients underwent an 18-second long breath-hold MR technique (conventional VIBE [volumetric interpolated breath-hold examination] technique with GRAPPA [generalized autocalibrating partially parallel acquisition]), and group B patients underwent a 13-second short breath-hold MR technique (VIBE technique with CAIPIRINHA [controlled aliasing in parallel imaging results in higher acceleration]). Respiratory-related graphs of the precontrast and HAP were acquired. The breath-hold degree was graded based on the standard deviation (SD) value of respiratory waveforms. Gadoxetic acid-related dyspnea was defined as when the SD value of the HAP was 200 greater than that of the precontrast phase without degraded image quality in the portal and transitional phases (SD value of the HAP - SD value of the precontrast phase). The overall image quality and motion artifacts of the precontrast and HAP images were evaluated. The groups were compared using the Student t or Fisher exact test, as appropriate. RESULTS The incidence of breath-holding difficulty (breath-hold grades 3 and 4) during the HAP was 43.6% (27/62) and 36.8% (21/57) for group A and B, respectively. The SD value during the precontrast phase and the SD value difference between the precontrast and HAP were both significantly higher in group A than in group B (P = 0.047 and P = 0.023, respectively). Gadoxetic acid-related dyspnea was seen in 19.4% (12/62) of group A and 7.0% (4/57) of group B. Group B showed better precontrast and HAP image quality than group A (P < 0.001). Degraded HAP (overall image quality ≥4) was observed in 9.7% (6/62) and 3.5% (2/57) of group A and B, respectively. CONCLUSIONS The short breath-hold MR technique, CAIPIRINHA, showed better HAP image quality with less degraded HAP and a lower incidence of breath-hold difficulty and gadoxetic acid-related dyspnea than the conventional long breath-hold technique.
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Affiliation(s)
- Jung Lim Yoo
- From the Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
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Does injection flow rate have an impact on arterial phase image degradation in liver MRI? A comparison of gadoxetic acid versus gadobutrol. Clin Radiol 2017; 72:994.e1-994.e8. [DOI: 10.1016/j.crad.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/12/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
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Song JS, Choi EJ, Park EH, Lee JH. Comparison of transient severe motion in gadoxetate disodium and gadopentetate dimeglumine-enhanced MRI: effect of modified breath-holding method. Eur Radiol 2017; 28:1132-1139. [DOI: 10.1007/s00330-017-5070-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/13/2017] [Accepted: 09/11/2017] [Indexed: 01/07/2023]
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Im WH, Song JS, Park EH, Kwak HS. Transient severe motion in the arterial phase during gadoxetate disodium-enhanced MR imaging: evaluation of patients with multiple MR examinations. Abdom Radiol (NY) 2017; 42:2393-2401. [PMID: 28396919 DOI: 10.1007/s00261-017-1145-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine whether patients undergoing multiple gadoxetate disodium-enhanced magnetic resonance (MR) examinations who experienced transient severe motion (TSM) in the arterial phase were affected by the TSM noted in the first examination. MATERIALS AND METHODS 214 patients who underwent three or more repeated gadoxetate disodium-enhanced MR imaging were retrospectively analyzed. Three radiologists scored all of the examinations demonstrating a motion artifact using a five-point rating scale. Risk factor analysis and comparison of TSM recurrence rates were performed in the whole study population as well as in a subpopulation of patients with TSM. RESULTS The overall incidence of TSM was 5.9% (54/922), which was observed in 40 patients. Thirty-two patients had one episode of TSM, and eight patients had recurrent TSM. Although TSM in the first examination increased the risk of recurrent TSM in the whole population (OR 24.45; P < 0.001), the incidence of recurrent TSM was low (2.4%, 22/922). On subpopulation analysis, TSM in the first examination did not influence recurrent TSM (OR 0.36; P = 0.250). CONCLUSION Patients undergoing multiple gadoxetate disodium-enhanced MR examinations who experienced recurrent TSM were not affected by TSM in the first examination. Therefore, a single episode of TSM should not be considered a risk factor of recurrent TSM.
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Affiliation(s)
- Won Hyeong Im
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
| | - Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.
- Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.
| | - Eun Hae Park
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
- Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
| | - Hyo Sung Kwak
- Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
- Biomedical Research Institute of Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea
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Comparison of the Timing of Hepatic Arterial Phase and Image Quality Using Test-Bolus and Bolus-Tracking Techniques in Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced Hepatic Dynamic Magnetic Resonance Imaging. J Comput Assist Tomogr 2017; 41:638-643. [PMID: 28240635 PMCID: PMC5516670 DOI: 10.1097/rct.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives The aim of this study was to compare the image quality, the degree of artifacts and the percentage of timing of the optimal hepatic arterial phase (HAP) between test-bolus and bolus-tracking methods on gadolinium–ethoxybenzyl–diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)–enhanced magnetic resonance imaging (MRI). Methods In this prospective study, 60 patients who underwent 3-dimensional dynamic Gd-EOB-DTPA–enhanced hepatic 3-T MRI were enrolled in this study. We randomly assigned the 30 patients to the bolus-tracking method, and another 30 patients to the test-bolus method. Signal-to-noise ratios of the liver and spleen in HAP were compared in the 2 groups. Two radiologists independently assessed the ratio of optimal timing of HAP and the degree of ringing and motion artifacts of the 2 protocols. Results The signal-to-noise ratios of the liver (24.0 [SD, 6.4] vs 20.4 [SD, 4.0]) and spleen (30.0 [SD, 13.3] vs 23.6 [SD, 9.9]) were significantly higher in the test-bolus protocol than in the bolus-tracking protocol. The ratio of optimal timing was also significantly higher with the test-bolus protocol than with the bolus-tracking protocol (76.7% vs 40.0%). The degree of ringing and motion artifacts of test-bolus protocol was significantly lower than that of the bolus-tracking protocol (P < 0.01). Conclusions The test-bolus protocol in dynamic 3-T MRI can yield better qualitative image quality and more optimal timing of HAP images, while reducing the degree of artifacts compared with the bolus-tracking protocol.
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Respiratory motion artifacts during arterial phase imaging with gadoxetic acid: Can the injection protocol minimize this drawback? J Magn Reson Imaging 2017; 46:1107-1114. [DOI: 10.1002/jmri.25657] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023] Open
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Clark TJ, Wilson GJ, Maki JH. Effect of injection rate on contrast-enhanced MR angiography image quality: Modulation transfer function analysis. Magn Reson Med 2016; 78:357-369. [DOI: 10.1002/mrm.26349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/20/2022]
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Sugimoto K, Moriyasu F, Takeuchi H, Kojima M, Ogawa S, Sano T, Furuichi Y, Kobayashi Y, Nakamura I. Optimal injection rate of ultrasound contrast agent for evaluation of focal liver lesions using an automatic power injector: a pilot study. SPRINGERPLUS 2016; 5:749. [PMID: 27386232 PMCID: PMC4912499 DOI: 10.1186/s40064-016-2364-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the optimal bolus injection rate of ultrasound (US) contrast agent in vascular imaging for focal liver lesions. METHODS Thirteen patients with 13 focal liver lesions (5 hepatocellular carcinomas (HCCs) with cirrhosis, 4 liver metastases, 2 hemangiomas, 1 intrahepatic cholangiocarcinoma, 1 focal nodular hyperplasia) received two bolus injections of Sonazoid (at 0.5 and 2.0 mL/s) using an automatic power injector. The lesion-to-liver contrast ratio at peak enhancement was quantitatively evaluated. Enhancement of the lesions compared to liver parenchyma was assessed by two independent readers using a five-point scale and qualitatively evaluated by receiver operating characteristic (ROC) analysis. RESULTS For all lesions, the contrast ratio was not significantly different between the two injection rates. For HCCs, the contrast ratio was higher at 0.5 mL/s (7.41 ± 6.56) than at 2.0 mL/s (4.28 ± 4.66, p = 0.025). For all lesions, the mean area under the ROC curve (AUC) was not significantly different between the two injection rates. For HCCs, the AUC was greater at 0.5 mL/s than at 2.0 mL/s (AUC: 0.86, p = 0.013). CONCLUSION In contrast-enhanced US, an injection rate of 0.5 mL/s is superior to an injection rate of 2.0 mL/s for the quantitative and qualitative analysis of HCCs in the cirrhotic liver.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Mayumi Kojima
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Saori Ogawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Takatomo Sano
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Yoshihiro Furuichi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Yoshiyuki Kobayashi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Ikuo Nakamura
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
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Huh J, Kim SY, Yeh BM, Lee SS, Kim KW, Wu EH, Wang ZJ, Zhao LQ, Chang WC. Troubleshooting Arterial-Phase MR Images of Gadoxetate Disodium-Enhanced Liver. Korean J Radiol 2015; 16:1207-15. [PMID: 26576109 PMCID: PMC4644741 DOI: 10.3348/kjr.2015.16.6.1207] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/28/2015] [Indexed: 12/22/2022] Open
Abstract
Gadoxetate disodium is a widely used magnetic resonance (MR) contrast agent for liver MR imaging, and it provides both dynamic and hepatobiliary phase images. However, acquiring optimal arterial phase images at liver MR using gadoxetate disodium is more challenging than using conventional extracellular MR contrast agent because of the small volume administered, the gadolinium content of the agent, and the common occurrence of transient severe motion. In this article, we identify the challenges in obtaining high-quality arterial-phase images of gadoxetate disodium-enhanced liver MR imaging and present strategies for optimizing arterial-phase imaging based on the thorough review of recent research in this field.
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Affiliation(s)
- Jimi Huh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143-0628, USA
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul 05505, Korea. ; Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
| | - En-Haw Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Taoyuan County 333, Taiwan
| | - Z Jane Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143-0628, USA
| | - Li-qin Zhao
- Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Chou Chang
- Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
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Benz MR, Vargas HA, Sala E. Functional MR Imaging Techniques in Oncology in the Era of Personalized Medicine. Magn Reson Imaging Clin N Am 2015; 24:1-10. [PMID: 26613872 DOI: 10.1016/j.mric.2015.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
DW and DCE MR imaging contribute significantly to diagnosis, treatment planning, response assessment, and prognosis in personalized cancer medicine. Nevertheless, the need for further standardization of these techniques needs to be addressed. Whole-body DW MR imaging is an exciting field; however, future studies need to investigate in more depth the biologic significance of the findings depicted, their prognostic relevance, and cost-effectiveness in comparison with MDCT and PET/CT. New MR imaging probes, such as targeted or activatable contrast agents and dynamic nuclear hyperpolarization, show great promise to further improve the care of patients with cancer in the near future.
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Affiliation(s)
- Matthias R Benz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, Basel 4031, Switzerland.
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Transient respiratory motion artifact during arterial phase MRI with gadoxetate disodium: risk factor analyses. AJR Am J Roentgenol 2015; 204:1220-7. [PMID: 26001231 DOI: 10.2214/ajr.14.13677] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this article is to identify risk factors for arterial phase respiratory motion artifact in gadoxetate disodium-enhanced liver MRI. MATERIALS AND METHODS We retrospectively identified 220 consecutive patients who underwent 357 MRI examinations, including 68 patients who underwent multiple MRI examinations, with gadoxetate disodium between 2010 and 2013. The arterial phase timing was determined by a fluoroscopic-triggering method. T1-weighted unenhanced and contrast-enhanced images were reviewed to record respiratory motion artifact, which was graded on a 5-point scale. Arterial phase transient severe motion was considered to be present if the motion score was 4 or greater on the arterial phase images and if the motion scores were 2 or less on unenhanced and other contrast-enhanced images. Patient characteristics and risk factors (e.g., age, sex, weight, body mass index, medical and radiologic history, allergy to MRI and iodinated contrast agents, estimated glomerular filtration rate, Child-Pugh class, and findings on current MRI examinations) were recorded. We included a history of transient severe motion on prior MRI as a predictor variable. We performed univariable and multivariable analysis using the generalized estimated equations to adjust for clustering. RESULTS The incidence of transient severe motion was 12.9% (46/357). On univariable analysis, a history of transient severe motion (odds ratio [OR] = 3.31; p = 0.04) on prior MRI and allergy to iodinated contrast agent (OR = 3.03; p = 0.01) statistically significantly increased the incidence of transient severe motion for a given MRI examination. These associations were not seen on multivariable analysis (adjusted OR = 2.38 and p = 0.23 for a history of transient severe motion; adjusted OR = 1.93 and p = 0.23 for allergy to CT contrast agent). CONCLUSION The occurrence of transient severe motion during arterial phase MRI with gadoxetate disodium is 12.9% and is poorly predicted on the basis of risk factors.
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Merkle EM, Zech CJ, Bartolozzi C, Bashir MR, Ba-Ssalamah A, Huppertz A, Lee JM, Ricke J, Sakamoto M, Sirlin CB, Ye SL, Zeng M. Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 2015; 26:674-82. [PMID: 26070500 PMCID: PMC4747985 DOI: 10.1007/s00330-015-3873-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 12/13/2022]
Abstract
Objectives Liver-specific MRI is a fast-growing field, with technological and protocol advancements providing more robust imaging and allowing a greater depth of information per examination. This article reports the evidence for, and expert thinking on, current challenges in liver-specific MRI, as discussed at the 7th International Forum for Liver MRI, which was held in Shanghai, China, in October 2013. Methods Topics discussed included the role of gadoxetic acid-enhanced MRI in the differentiation of focal nodular hyperplasia from hepatocellular adenoma and small hepatocellular carcinoma (HCC) from small intrahepatic cholangiocarcinoma (in patients with chronic liver disease), the differentiation of low-grade dysplastic nodule (DN) from pre-malignant high-grade DN and early HCC, and treatment planning and assessment of treatment response for patients with HCC and colorectal liver metastasis. Optimization of the gadoxetic acid-enhanced MRI protocol to gain robust arterial and hepatobiliary phase images was also discussed. Results and conclusions Gadoxetic acid-enhanced MRI demonstrates added value for the detection and characterization of focal liver lesions and shows promise in a number of new indications, including regional liver functional assessment and patient monitoring after therapy; however, more data are needed in some areas, and further developments are needed to translate cutting-edge techniques into clinical practice. Key Points • Liver-specific MRI is a fast-growing field, with many technological and protocol advancements. • Gadoxetic acid-enhanced MRI demonstrates value for detecting and characterizing focal liver lesions. • Gadoxetic acid-enhanced MRI shows promise in regional functional assessment and patient monitoring. • Further developments are needed to translate cutting-edge techniques into clinical practice.
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Affiliation(s)
- Elmar M Merkle
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
| | - Christoph J Zech
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | | | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Ba-Ssalamah
- Department of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | | | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, California, USA
| | - Sheng-Long Ye
- Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Mengsu Zeng
- Radiologic Diagnostic Department, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Consensus Statements From a Multidisciplinary Expert Panel on the Utilization and Application of a Liver-Specific MRI Contrast Agent (Gadoxetic Acid). AJR Am J Roentgenol 2015; 204:498-509. [PMID: 25714278 DOI: 10.2214/ajr.13.12399] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Usefulness of controlled aliasing in parallel imaging results in higher acceleration in gadoxetic acid-enhanced liver magnetic resonance imaging to clarify the hepatic arterial phase. Invest Radiol 2014; 49:183-8. [PMID: 24276676 DOI: 10.1097/rli.0000000000000011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to determine whether the controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique could improve the image quality of the hepatic arterial phase of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging. MATERIALS AND METHODS A total of 320 patients underwent gadoxetic acid-enhanced liver MR imaging: a conventional protocol (a fixed scan delay and 2-mL/s injection) using a standard 3-T MR system (Trio-Tim; Siemens, commercialized since 2005) (group A), an optimized protocol (bolus tracking and 1-mL/s injection) using a standard 3-T MR (group B), an optimized protocol using a new 3-T MR (Skyra; Siemens, commercialized since 2012) (group C), and an optimized protocol with CAIPIRINHA using a new 3-T MR (group D). The image quality of the hepatic arterial phase was graded using a 4-point rating scale from 1 (no artifacts) to 4 points (non-diagnostic images with severe artifacts). The differences in image quality scores among the 4 groups were evaluated. In addition, the detection rates of hypervascular hepatocellular carcinomas among the 4 groups were evaluated. RESULTS Scores of 4 points were observed in groups A (n = 7), B (n = 5), and C (n = 3) but not in group D. The median image quality score was 2 in groups A and B and 1 in groups C and D. From group A to group D, the median image quality score decreased significantly (P = 0.0001). The median image quality score was significantly lower in group D than in groups A and B (P = 0.0001 and 0.001, respectively), whereas there was no significant difference observed between groups C and D (P = 0.656). The detection rates of hypervascular hepatocellular carcinomas on the hepatic arterial phase were not significantly different among the groups (all P > 0.03), except between groups A and D (P = 0.007). CONCLUSIONS The CAIPIRINHA technique improved the image quality of hepatic arterial phase imaging with gadoxetic acid, reducing the number of non-diagnostic arterial phase studies.
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Kim SM, Heo SH, Kim JW, Lim HS, Shin SS, Jeong YY, Kang HK. Hepatic arterial phase on gadoxetic acid-enhanced liver MR imaging: a randomized comparison of 0.5 mL/s and 1 mL/s injection rates. Korean J Radiol 2014; 15:605-12. [PMID: 25246821 PMCID: PMC4170161 DOI: 10.3348/kjr.2014.15.5.605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/14/2014] [Indexed: 01/10/2023] Open
Abstract
Objective To compare gadoxetic acid injection rates of 0.5 mL/s and 1 mL/s for hepatic arterial-phase magnetic resonance (MR) imaging. Materials and Methods In this prospective study, 101 consecutive patients with suspected focal liver lesions were included and randomly divided into two groups. Each group underwent dynamic liver MR imaging using a 3.0-T scanner after an intravenous injection of gadoxetic acid at rates of either 0.5 mL/s (n = 50) or 1 mL/s (n = 51). Arterial phase images were analyzed after blinding the injection rates. The signal-to-noise ratios (SNRs) of the liver, aorta, portal vein, hepatic vein, spleen, and pancreas were measured. The contrast-to-noise ratios (CNRs) of the hepatocellular carcinomas (HCC) were calculated. Finally, two experienced radiologists were independently asked to identify, if any, HCCs in the liver on the images and score the image quality in terms of the presence of artifacts and the proper enhancement of the liver, aorta, portal vein, hepatic vein, hepatic artery, spleen, pancreas, and kidney. Results The SNRs were not significantly different between the groups (p = 0.233-0.965). The CNRs of the HCCs were not significantly different (p = 0.597). The sensitivity for HCC detection and the image quality scores were not significantly different between the two injection rates (p = 0.082-1.000). Conclusion Image quality and sensitivity for hepatic HCCs of arterial-phase gadoxetic acid-enhanced MR were not significantly improved by reducing the contrast injection rate to 0.5 mL/s compared with 1 mL/s.
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Affiliation(s)
- Sung Mo Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
| | - Jin Woong Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju 501-757, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
| | - Heoung Keun Kang
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
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Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014; 272:635-54. [PMID: 25153274 PMCID: PMC4263631 DOI: 10.1148/radiol.14132361] [Citation(s) in RCA: 323] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computed tomography (CT) and magnetic resonance (MR) imaging play critical roles in the diagnosis and staging of hepatocellular carcinoma (HCC). The first article of this two-part review discusses key concepts of HCC development, growth, and spread, emphasizing those features with imaging correlates and hence most relevant to radiologists; state-of-the-art CT and MR imaging technique with extracellular and hepatobiliary contrast agents; and the imaging appearance of precursor nodules that eventually may transform into overt HCC.
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Affiliation(s)
- Jin-Young Choi
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
| | - Jeong-Min Lee
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea (J.Y.C.); Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (J.M.L.); and Liver Imaging Group, Department of Radiology, University of California, San Diego Medical Center, 408 Dickinson St, San Diego, CA 92103-8226 (C.B.S.)
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Schalkx HJ, van Stralen M, Coenegrachts K, van den Bosch MAAJ, van Kessel CS, van Hillegersberg R, van Erpecum KJ, Verkooijen HM, Pluim JPW, Veldhuis WB, van Leeuwen MS. Liver perfusion in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI): comparison of enhancement in Gd-BT-DO3A and Gd-EOB-DTPA in normal liver parenchyma. Eur Radiol 2014; 24:2146-56. [DOI: 10.1007/s00330-014-3275-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/26/2014] [Accepted: 06/03/2014] [Indexed: 01/01/2023]
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