Usefulness of Short Breath Hold High Resolution Technique (CAIPIRINHA) in Gadoxetic acid-enhanced Liver MRI: To Overcome Degraded Arterial Phase
Chang-Hee Lee1 and Cheol Min Park2

1Radiology, Korea University Guro Hospital, Seoul, Korea, Republic of, 2Korea University Guro Hospital, Seoul, Korea, Republic of

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

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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.



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
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