Synopsis
The short
breath-hold high-resolution MR technique showes better HAP image quality with less
degraded HAP and lower incidences of breath-hold difficulty and gadoxetic acid related dyspnea than the conventional
long breath-hold MR technique.Background
The hepatic arterial phase (HAP) in liver magnetic
resonance imaging (MRI) is a critical phase essential for detection and
characterization of focal liver lesions (1-4).
The image quality of the HAP must be optimal without artifacts in order to
accurately diagnosis focal liver lesions. Recently, gadoxetic acid-enhanced MRI
has been widely used for liver imaging as it offers standard dynamic images as
well as hepatobiliary phase images within only 20 minutes (2, 3, 5-8). However, degraded HAP imaging has
been more frequently reported with contrast-enhanced MRI using gadoxetic acid than
with other gadolinium contrast agents (1, 6,
9-11). There have been previous reports on gadoxetic acid-related acute
transient dyspnea that may cause respiratory motion-related artifacts in the HAP,
leading to suboptimal or non-diagnostic HAP imaging (6, 9-11). Dyspnea, whether induced by gadoxetic acid or as the
result of breathlessness due to long breath-hold time, may disturb
breath-holding and degrade HAP image quality. Therefore, reducing breath-hold
time during the HAP may be crucial in reducing dyspnea and motion artifacts
resulting in improved HAP image quality.
Purpose
1. To explain whether short breath hold CAIPIRINHA sequence improves the image quality of arterial phase images with reduction of the artifacts in gadoxetic acid enhanced liver MRI
2. To evaluated whether CAIPIRINHA sequence overcome the degraded arterial phase by respiratory related dyspnea in gadoxetic acid enhanced liver MRI
3. To investigate the respiratory-related log file which can be extracted from the MR machine: This evaluation includes the frequency of free respiration during breath hold period of arterial phase, the height of respiration-related graph, and possible statistical values of the respiration-related graph (such as mean, max, min, and SD).
4. To evaluate the correlation between respiration related graph and image quality of arterial phase in these two groups.
Contents
1. Overview
2. What’s wrong with arterial phase?
a. Review of previous article regarding optimization in GD-EOB-DTPA enhanced MRI
b. Review of current article for acute transient dyspnea
3. To Clarify the arterial phase: What did we do?
a) Injection rate: 1 cc vs. 2 cc , b) Saline infusion, c) K-space: linear vs. centric, d) Short breath hold time
4. New Short Breath hold Sequence: CAIPIRINHA (Controlled Aliasing In Parallel Imaging Results IN Higher Acceleration): a) Principle, b) Literature review, c) Our experience & Pilot study: comparison between CAIPIRINHA and conventional VIBE, d) Optimal Parameter
5. How to get Respiratory-related graph
6. Respiratory pattern analysis
7. Survey Questionnaire
8. Correlation between image quality and breath hold degree
9. Qualitative and quantitative analyses between short breath hold (13 secs) and conventional long breath hold (18 secs) technique
10. Comparison between mean image quality scores of patients with and without gadoxetic acid related dyspnea (GARD) in precontrast and hepatic arterial phase
Summary
1 . Objective evaluation of respiratory patterns during MRI can be useful for evaluating GARD and its effect on HAP image quality, resulting in improved image quality.
2. Short breath-hold high-resolution MR techniques can guarantee lower rates of dyspnea-related, non-diagnostic HAP imaging in gadoxetic acid-enhanced liver MRI.
3. Using this short breath hold sequence, Re-examination of MRI can be avoided and it results time-saving effect.
4. We presume that CAIPIRINHA can lead to cost savings by overcoming spoiled arterial phase image and decreasing arterial phase artifact.
Acknowledgements
We thank Yun Mi
Seo, MS for conducting the Respiratory Graph.References
1. Park YS, Lee CH, Kim IS,
Kiefer B, Woo ST, Kim KA, et al. 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 Mar;49(3):183-8. PubMed PMID: 24276676.
2. Goodwin MD, Dobson JE, Sirlin CB, Lim BG, Stella DL.
Diagnostic challenges and pitfalls in MR imaging with hepatocyte-specific
contrast agents. Radiographics : a review publication of the Radiological
Society of North America, Inc. 2011 Oct;31(6):1547-68. PubMed PMID: 21997981.
3. Ringe KI, Husarik DB, Sirlin CB, Merkle EM. Gadoxetate
disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion
appearance in the noncirrhotic liver. AJR American journal of roentgenology.
2010 Jul;195(1):13-28. PubMed PMID: 20566794.
4. Willatt JM, Hussain HK, Adusumilli S, Marrero JA. MR
Imaging of hepatocellular carcinoma in the cirrhotic liver: challenges and
controversies. Radiology. 2008 May;247(2):311-30. PubMed PMID: 18430871.
5. Cruite I, Schroeder M, Merkle EM, Sirlin CB. Gadoxetate
disodium-enhanced MRI of the liver: part 2, protocol optimization and lesion
appearance in the cirrhotic liver. AJR American journal of roentgenology. 2010
Jul;195(1):29-41. PubMed PMID: 20566795.
6. Davenport MS, Viglianti BL, Al-Hawary MM, Caoili EM, Kaza
RK, Liu PS, et al. Comparison of acute transient dyspnea after intravenous
administration of gadoxetate disodium and gadobenate dimeglumine: effect on
arterial phase image quality. Radiology. 2013 Feb;266(2):452-61. PubMed PMID:
23192781.
7. Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific
MR contrast agents: role in imaging the liver and biliary tree. Radiographics :
a review publication of the Radiological Society of North America, Inc. 2009
Oct;29(6):1725-48. PubMed PMID: 19959518.
8. Frydrychowicz A, Nagle SK, D'Souza SL, Vigen KK, Reeder SB.
Optimized high-resolution contrast-enhanced hepatobiliary imaging at 3 tesla: a
cross-over comparison of gadobenate dimeglumine and gadoxetic acid. Journal of
magnetic resonance imaging : JMRI. 2011 Sep;34(3):585-94. PubMed PMID: 21751288.
Pubmed Central PMCID: 3202678.
9. Bashir MR, Castelli P, Davenport MS, Larson D, Marin D,
Hussain HK, et al. Respiratory motion artifact affecting hepatic arterial phase
MR imaging with gadoxetate disodium is more common in patients with a prior
episode of arterial phase motion associated with gadoxetate disodium.
Radiology. 2015 Jan;274(1):141-8. PubMed PMID: 25162310.
10. Pietryga JA, Burke LM, Marin D, Jaffe TA, Bashir MR.
Respiratory motion artifact affecting hepatic arterial phase imaging with gadoxetate
disodium: examination recovery with a multiple arterial phase acquisition.
Radiology. 2014 May;271(2):426-34. PubMed PMID: 24475864.
11. Park YS, Lee CH, Yoo JL, Kim
IS, Kiefer B, Woo ST, et al. Hepatic Arterial Phase in Gadoxetic Acid-Enhanced
Liver Magnetic Resonance Imaging: Analysis of Respiratory Patterns and Their
Effect on Image Quality. Invest Radiol. 2015 Sep 25. PubMed PMID: 26418367.