Liver: T2-weighted MR imaging with breath-hold fast-recovery optimized fast spin-echo compared with breath-hold half-Fourier and non-breath-hold respiratory-triggered fast spin-echo pulse sequences

Deep learning HASTE sequence compared with T2-weighted BLADE sequence for liver MRI at 3 Tesla: a qualitative and quantitative prospective study

OBJECTIVES

To qualitatively and quantitatively compare a single breath-hold fast half-Fourier single-shot turbo spin echo sequence with deep learning reconstruction (DL HASTE) with T2-weighted BLADE sequence for liver MRI at 3 T.

METHODS

From December 2020 to January 2021, patients with liver MRI were prospectively included. For qualitative analysis, sequence quality, presence of artifacts, conspicuity, and presumed nature of the smallest lesion were assessed using the chi-squared and McNemar tests. For quantitative analysis, number of liver lesions, size of the smallest lesion, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in both sequences were assessed using the paired Wilcoxon signed-rank test. Intraclass correlation coefficients (ICCs) and kappa coefficients were used to assess agreement between the two readers.

RESULTS

One hundred and twelve patients were evaluated. Overall image quality (p = .006), artifacts (p < .001), and conspicuity of the smallest lesion (p = .001) were significantly better for the DL HASTE sequence than for the T2-weighted BLADE sequence. Significantly more liver lesions were detected with the DL HASTE sequence (356 lesions) than with the T2-weighted BLADE sequence (320 lesions; p < .001). CNR was significantly higher for the DL HASTE sequence (p < .001). SNR was higher for the T2-weighted BLADE sequence (p < .001). Interreader agreement was moderate to excellent depending on the sequence. Of the 41 supernumerary lesions visible only on the DL HASTE sequence, 38 (93%) were true-positives.

CONCLUSION

The DL HASTE sequence can be used to improve image quality and contrast and reduces artifacts, allowing the detection of more liver lesions than with the T2-weighted BLADE sequence.

CLINICAL RELEVANCE STATEMENT

The DL HASTE sequence is superior to the T2-weighted BLADE sequence for the detection of focal liver lesions and can be used in daily practice as a standard sequence.

KEY POINTS

• The half-Fourier acquisition single-shot turbo spin echo sequence with deep learning reconstruction (DL HASTE sequence) has better overall image quality, reduced artifacts (particularly motion artifacts), and improved contrast, allowing the detection of more liver lesions than with the T2-weighted BLADE sequence. • The acquisition time of the DL HASTE sequence is at least eight times faster (21 s) than that of the T2-weighted BLADE sequence (3-5 min). • The DL HASTE sequence could replace the conventional T2-weighted BLADE sequence to meet the growing indication for hepatic MRI in clinical practice, given its diagnostic and time-saving performance.

Magnetic Resonance Imaging and Magnetic Resonance Imaging Cholangiopancreatography of the Pancreas in Small Animals

Simple Summary

In human medicine Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) play a consistent role in the investigation of pancreatic and pancreatic duct disorders. In veterinary medicine the number of studies focused on MR and MRCP for pancreatic disease is scant, and the protocols are not yet standardized. This review will focus on the MRI and MRCP technical aspects of the protocols used for the investigation of pancreatic disease in veterinary medicine. The aim of this review is to elucidate the value and the potential of each MR and MRCP sequence listed in the different protocols, either in canine or feline patients, with the intention to build a valid and solid tool for further innovative studies.

Abstract

Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) have emerged as non-invasive diagnostic techniques for the diagnosis of pancreatic and pancreatic duct disorders in humans. The number of studies focused on MR and MRCP for pancreatic disease in small animals is very limited. MR has been described for the evaluation of insulinoma in dogs and to investigate pancreatitis in cats. The studies were based on a standard protocol with T2 weighted (w) fast recovery fast spin-echo (FRFSE) with and without fat suppression, T1w FSE pre-contrast and T1w FSE post-contrast with and without fat suppression. MRCP after secretin stimulation has been described in cats to assess the pancreatic ductal system, taking advantage of pulse sequences heavily T2w as rapid acquisition with rapid enhancement (RARE), fast-recovery fast spin-echo (FRFSE) sequences and single-shot fast spin-echo (SSFSE) sequences. In addition to the standard protocol, fast spoiled gradient recalled echo pulse sequences (fSPGR) and volume interpolated 3D gradient-echo T1w pulse sequences pre and post-contrast have also been used in cats, reaching the goal of assessing the biliary tree and the pancreatic duct with the same sequence and in multiple planes. Despite the small amount of data, the results show potential, and the most recent technical innovations, in particular, focused on diffusion MRI and fast acquisition, further support the need for continued evaluation of MRI as an effective instrument for the investigation of pancreatic disease.

Advanced imaging techniques in pediatric body MRI

While there are many challenges specific to pediatric abdomino-pelvic MRI, many recent advances are addressing these challenges. It is therefore essential for radiologists to be familiar with the latest advances in MR imaging. Laudable efforts have also recently been implemented in many centers to improve the overall experience of pediatric patients, including the use of dedicated radiology child life specialists, MRI video goggles, and improved MR suite environments. These efforts have allowed a larger number of children to be scanned while awake, with fewer studies being done under sedation or anesthesia; this has resulted in additional challenges from patient motion and difficulties with breath-holding and tolerating longer scan times. In this review, we highlight common challenges faced in imaging the pediatric abdomen and pelvis and discuss the application of the newest techniques to address these challenges. Additionally, we highlight the newest advances in quantified imaging techniques, specifically in MR liver iron quantification. The techniques described in this review are all commercially available and can be readily implemented.

Quantitative Versus Qualitative Methods in Evaluation of T2 Signal Intensity to Improve Accuracy in Diagnosis of Pheochromocytoma

OBJECTIVE

The purpose of this study was to assess T2 signal intensity (SI) of adrenal pheochromocytoma at 1.5 T using the rapid acquisitions with relaxation enhancement (RARE) sequence. We also sought to determine whether quantitative parameters can distinguish pheochromocytoma from other adrenal lesions with better accuracy than conventional qualitative methods.

MATERIALS AND METHODS

MRI examinations of 74 patients (26 with pheochromocytoma, 25 with lipid-poor adenomas, 18 with malignant adrenal lesions, and five with adrenal cysts) were retrospectively reviewed. MRI sequences included single-shot fast spin-echo (n = 38) and fast-recovery fast spin-echo (n = 36) acquisitions. T2 SI of lesions was qualitatively compared with CSF. Quantitative evaluation included applying ROI measurements and calculating SI ratio of each mass to liver, spleen, paraspinal muscle, and CSF. Twoway ANOVA compared SI ratios between different adrenal lesions and between two pulse sequences. ROC analysis determined the optimal threshold SI ratio for distinguishing pheochromocytomas from other adrenal lesions.

RESULTS

Sixty-nine percent of pheochromocytomas displayed isointensity to CSF (p < 0.005), resulting in 81% specificity and 69% sensitivity for differentiation of pheochromocytomas from lipid-poor adenomas and malignant lesions. Adrenal-to-muscle SI ratio was the strongest discriminator for differentiation of pheochromocytomas from other lesions. A threshold of at least 3.95 yielded 88% specificity and 81% sensitivity for distinguishing pheochromocytomas from lipid-poor adenomas and malignant adrenal lesions.

CONCLUSION

Quantitative normalization of T2 SI with reference to muscle improves the sensitivity and specificity profile for differentiation of pheochromocytoma compared with qualitative assessment alone. At 1.5 T field strength, an adrenal-to-muscle SI ratio of at least 3.95 is recommended.

T2-Weighted Liver MRI Using the MultiVane Technique at 3T: Comparison with Conventional T2-Weighted MRI

Objective

To assess the value of applying MultiVane to liver T2-weighted imaging (T2WI) compared with conventional T2WIs with emphasis on detection of focal liver lesions.

Materials and Methods

Seventy-eight patients (43 men and 35 women) with 86 hepatic lesions and 20 pancreatico-biliary diseases underwent MRI including T2WIs acquired using breath-hold (BH), respiratory-triggered (RT), and MultiVane technique at 3T. Two reviewers evaluated each T2WI with respect to artefacts, organ sharpness, and conspicuity of intrahepatic vessels, hilar duct, and main lesion using five-point scales, and made pairwise comparisons between T2WI sequences for these categories. Diagnostic accuracy (Az) and sensitivity for hepatic lesion detection were evaluated using alternative free-response receiver operating characteristic analysis.

Results

MultiVane T2WI was significantly better than BH-T2WI or RT-T2WI for organ sharpness and conspicuity of intrahepatic vessels and main lesion in both separate reviews and pairwise comparisons (p < 0.001). With regard to motion artefacts, MultiVane T2WI or BH-T2WI was better than RT-T2WI (p < 0.001). Conspicuity of hilar duct was better with BH-T2WI than with MultiVane T2WI (p = 0.030) or RT-T2WI (p < 0.001). For detection of 86 hepatic lesions, sensitivity (mean, 97.7%) of MultiVane T2WI was significantly higher than that of BH-T2WI (mean, 89.5%) (p = 0.008) or RT-T2WI (mean, 84.9%) (p = 0.001).

Conclusion

Applying the MultiVane technique to T2WI of the liver is a promising approach to improving image quality that results in increased detection of focal liver lesions compared with conventional T2WI.

Advances in T1-weighted and T2-weighted imaging in the abdomen and pelvis

Utilization of abdominopelvic MR imaging continues to increase in volume and gain widespread clinical acceptance. Many factors such as diaphragmatic respiratory motion, bulk patient motion, and the need for large volumetric coverage while maintaining clinically feasible scan times have proven challenging for body applications of MRI. However, many advances in MR acquisition, including non-Cartesian T1-weighted and T2-weighted acquisitions, advanced Dixon sequences, and 3-dimensional volumetric T2-weighted imaging have helped to mitigate some of the issues which have hampered abdominopelvic MR. This article will summarize these advances in T1-weighted and T2-weighted imaging, with an emphasis on clinical applications and implementation.

Free-breathing 3D T1-weighted gradient-echo sequence with radial data sampling in abdominal MRI: preliminary observations

OBJECTIVE

The purposes of this study were to evaluate the feasibility of a free-breathing 3D gradient-recalled echo sequence with radial data sampling (radial 3D GRE) in abdominal MRI compared with a standard 3D GRE volumetric interpolated breath-hold examination (VIBE) sequence for imaging of cooperative patients and to perform a preliminary assessment in imaging of noncooperative patients.

MATERIALS AND METHODS

Fifty-five consecutively registered patients who underwent unenhanced and contrast-enhanced abdominal MRI with the free-breathing radial 3D GRE technique constituted the study population. Two readers independently and blindly evaluated the images.

RESULTS

Overall image quality with the contrast-enhanced radial 3D GRE sequence was lower than but rated at least nearly as good as that with the 3D GRE VIBE sequence (p < 0.0001). Higher scores were recorded for 3D GRE VIBE images with respect to pixel graininess, streaking artifact, and sharpness (p = 0.0009 to p < 0.0001). Except for sharpness of vessels on unenhanced images, results for the radial 3D GRE sequence did not differ significantly in the comparison of cooperative and noncooperative patients (p = 0.004). For imaging of noncooperative patients, radial 3D GRE images of children had higher ratings for shading (unenhanced, p = 0.0004; contrast-enhanced, p < 0.0001) and streaking artifacts on contrast-enhanced images (p = 0.0017) than did those of adults. Overall image quality was higher for pediatric patients. In lesion analysis, use of the 3D GRE VIBE sequence was associated with significantly greater detectability, confidence, and conspicuity than was use of the radial 3D GRE sequence (p = 0.00026-0.011).

CONCLUSION

A free-breathing radial 3D GRE sequence is feasible for abdominal MRI and may find application in imaging of patients who are unable to suspend respiration, especially children.

Magnetic resonance imaging of the liver: sequence optimization and artifacts

The liver is one of the most challenging organs of the body to image with magnetic resonance because it is large and mobile, receives a dual blood supply, and is surrounded by organs and structures that contribute to artifacts from flow and susceptibility. Recent advances in imaging hardware, in addition to improvements in temporal resolution and development of hepatocyte-specific contrast agents, make imaging of the liver more approachable than in the past; however, it remains a complex process that requires compromise. In this article the authors discuss development and optimization of a liver imaging protocol at 1.5 T, with common variations in each element of the protocol, as well as the strengths and weaknesses associated with the relevant sequences.

T2-weighted MRI of the upper abdomen: comparison of four fat-suppressed T2-weighted sequences including PROPELLER (BLADE) technique

RATIONALE AND OBJECTIVES

The aim of this study was to compare four different fat-suppressed T2-weighted sequences with different techniques with regard to image quality and lesion detection in upper abdominal magnetic resonance imaging (MRI) scans.

MATERIALS AND METHODS

Thirty-two consecutive patients referred for upper abdominal MRI for the evaluation of various suspected pathologies were included in this study. Different T2-weighted sequences (free-breathing navigator-triggered turbo spin-echo [TSE], free-breathing navigator-triggered TSE with restore pulse (RP), breath-hold TSE with RP, and free-breathing navigator-triggered TSE with RP using the periodically rotated overlapping parallel lines with enhanced reconstruction technique [using BLADE, a Siemens implementation of this technique]) were used on all patients. All images were assessed independently by two radiologists. Assessments of motion artifacts; the edge sharpness of the liver, pancreas, and intrahepatic vessels; depictions of the intrahepatic vessels; and overall image quality were performed qualitatively. Quantitative analysis was performed by calculation of the signal-to-noise ratios for liver tissue and gallbladder as well as contrast-to-noise ratios of liver to spleen.

RESULTS

Liver and gallbladder signal-to-noise ratios as well as liver to spleen contrast-to-noise ratios were significantly higher (P < .05) for the BLADE technique compared to all other sequences. In qualitative analysis, the severity of motion artifacts was significantly lower with T2-weighted free-breathing navigator-triggered BLADE sequences compared to other sequences (P < .01). The edge sharpness of the liver, pancreas, and intrahepatic vessels; depictions of the intrahepatic vessels; and overall image quality were significantly better with the BLADE sequence (P < .05).

CONCLUSION

The T2-weighted free-breathing navigator-triggered TSE sequence with the BLADE technique is a promising approach for reducing motion artifacts and improving image quality in upper abdominal MRI scans.

Fast spin-echo triple-echo Dixon: initial clinical experience with a novel pulse sequence for fat-suppressed T2-weighted abdominal MR imaging

PURPOSE

To evaluate a prototype fast spin echo (FSE) triple-echo-Dixon (fTED) technique for breath-hold, fat-suppressed, T2-weighted abdominal imaging.

MATERIALS AND METHODS

Forty patients underwent breath-hold T2-weighted abdominal imaging with fTED and conventional fast recovery (FR) FSE with chemical shift-selective saturation (CHESS). FRFSE and fTED images were compared for overall image quality, homogeneity of fat suppression, image sharpness, anatomic detail, and phase artifact. Depiction of disease was recorded separately for FRFSE and fTED images.

RESULTS

FTED successfully reconstructed water-only and fat-only images from source images in all 40 cases. Water and fat separation was perfect in 36 (0.90) patients. Homogeneity of fat suppression was superior on the fTED images in 38 (0.95) of 40 cases. FTED images showed better anatomic detail in 27 (0.68), and less susceptibility artifact in 20 (0.50). FRFSE images showed less vascular pulsation artifact in 30 (0.75) cases, and less phase artifact in 21 (0.53) cases. There was no difference in depiction of disease for FRFSE and fTED images.

CONCLUSION

FTED is a robust sequence providing breath-hold T2-weighted images with superior fat suppression, excellent image quality, and at least equal depiction of disease compared to conventional breath-hold T2-weighted FRFSE imaging.

Diagnosis of hepatic metastasis: comparison of respiration-triggered diffusion-weighted echo-planar MRI and five t2-weighted turbo spin-echo sequences

OBJECTIVE

The purpose of this study was to compare the value of respiration-triggered diffusion-weighted (DW) single-shot echo-planar MRI (EPI) and five variants of T2-weighted turbo spin-echo (TSE) sequences in the diagnosis of hepatic metastasis.

MATERIALS AND METHODS

Fifty-two patients with extrahepatic primary malignant tumors underwent 1.5-T MRI that included DW EPI and the following variants of T2-weighted TSE techniques: breath-hold fat-suppressed HASTE, breath-hold fat-supressed TSE, respiration-triggered fat-suppressed TSE, breath-hold STIR, and respiration-triggered STIR. Images were reviewed independently by two blinded observers who used a 5-point confidence scale to identify lesions. Results were correlated with surgical and histopathologic findings and follow-up imaging findings. The accuracy of each technique was measured with free-response receiver operating characteristic analysis.

RESULTS

A total of 118 hepatic metastatic lesions (mean diameter, 12.8 mm; range, 3-84 mm) were evaluated. Accuracy values were higher (p < 0.001) with DW EPI (0.91-0.92) than with the T2-weighted TSE techniques (0.47-0.67). Imaging with the HASTE sequence (0.47-0.52) was less accurate (p < 0.05) than imaging with the breath-hold TSE, breath-hold STIR, respiration-triggered TSE, and respiration-triggered STIR sequences (0.59-0.67). Sensitivity was higher (p < 0.001) with DW EPI (0.88-0.91) than with T2-weighted TSE techniques (0.45-0.62). For small (< or = 10 mm) metastatic lesions only, the differences in sensitivity between DW EPI (0.85) and T2-weighted TSE techniques (0.26-0.44) were even more pronounced.

CONCLUSION

DW EPI was more sensitive and more accurate than imaging with T2-weighted TSE techniques. Because of the black-blood effect on vessels and low susceptibility to motion artifacts, DW EPI was particularly useful for the detection of small (< or = 10 mm) metastatic lesions.

High resolution T2 weighted liver MR imaging using functional residual capacity breath-hold with a 1.0-Tesla scanner

PURPOSE

During acquisition of rapid high resolution (HR) T2 weighted (T2W) liver magnetic resonance (MR) images using a 1.0-Tesla (T) scanner, the liver is segmented into odd and even sections that are acquired at two different times using the multi-breath-hold (MBH) strategy. Misalignment between the two breath-hold (B-H) images may result in the occurrence of a blind area and a decrease in diagnostic accuracy. Here, a functional residual capacity (FRC) B-H method was developed to overcome this problem.

MATERIAL AND METHODS

Twenty-five volunteers were enrolled. The sagittal images were reconstructed from whole liver transverse images. When the B-H phases are different, misalignment may occur in the craniocaudal and anterior-posterior (AP) directions. In this study, misalignments of the abdominal wall were measured in the AP direction. The misalignment was compared between four B-H phases, maximum inspiration (MI), maximum expiration (ME), voluntary expiration (VE) and FRC using one-way repeated measures ANOVA. Differences between groups were compared using the t-test for multi-group comparisons. In addition, qualitative analysis of misalignment was performed between VE and FRC in 52 clinical patients and the chi(2) test was performed.

RESULTS

The misalignment widths of FRC, ME, MI and VE B-Hs were 2.7+/-3.8, 6.4+/-7.4, 9.1+/-8.4 and 6.0+/-6.7 mm, respectively. Misalignment of the liver position using FRC was significantly smaller than for the other B-H methods (p<0.05). Significant differences between the VE B-H and FRC B-H were also observed in the qualitative analysis (p<0.05).

CONCLUSION

The liver positions obtained when using FRC B-H were significantly more reproducible than when using the other B-H methods. The FRC B-H method resulted in a reduction in the blind area and an extension of the diagnostic area to the whole liver.

Fast-recovery fast spin-echo T2-weighted MR imaging: a free-breathing alternative to fast spin-echo in the pediatric abdomen

In the mid 1990s, the fast spin-echo (FSE) and turbo spin-echo (TSE) T2-weighted (T2-W) sequences became available and are now widely accepted alternatives to conventional spin-echo sequences since they result in reduced acquisition times while maintaining tissue contrast. Since that time, there has been continued development of new sequences to further decrease acquisition times, minimize artifacts, and preserve lesion detection. The purpose of this pictorial essay is to qualitatively illustrate the newly available fast recovery (FR) FSE T2-W MR images of the abdomen compared with the images acquired using the routine FSE T2-W sequence in non-breath-hold studies in children.

Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging

PURPOSE

To retrospectively compare diffusion-weighted (DW) magnetic resonance (MR) imaging with standard breath-hold T2-weighted MR imaging for focal liver lesion (FLL) detection and characterization, by using consensus evaluation and other findings as the reference standard.

MATERIALS AND METHODS

Approval for this retrospective HIPAA-compliant study was obtained from the institutional review board; informed consent was waived. Fifty-three consecutive patients (30 men, 23 women; mean age, 60.7 years) with at least one FLL of 1 cm or greater in diameter were evaluated. Two independent observers reviewed DW (b values of 0, 50, and 500 sec/mm(2)) and T2-weighted images for FLL detection and characterization. Reference standard for diagnosis was obtained from consensus review by the two observers of DW, T2-weighted, and dynamic contrast material-enhanced images, pathologic data, and follow-up imaging results. Apparent diffusion coefficient (ADC) was measured for FLLs identified at consensus review. DW and T2-weighted images were compared for FLL detection and characterization by using a binary logistic regression model. Receiver operating characteristic curve analyses were conducted to evaluate the utility of ADC for diagnosis of malignancy.

RESULTS

Two hundred eleven FLLs (136 malignant, 75 benign) were detected at consensus review. Overall detection rate (averaged for two observers) was significantly higher for DW (87.7%) versus T2-weighted (70.1%) imaging (P < .001). FLL characterization was not significantly different between DW (89.1%) and T2-weighted (86.8%) imaging (P = .51). ADCs of malignant FLLs were significantly lower than those of benign FLLs (P < .001). The area under the curve for diagnosis of malignancy was 0.839, with sensitivity of 74.2%, specificity of 77.3%, positive predictive value of 85.5%, negative predictive value of 62.3%, and accuracy of 75.3%, by using a threshold ADC of less than 1.60 x 10(-3) mm(2)/sec.

CONCLUSION

DW MR imaging was better than standard breath-hold T2-weighted imaging for FLL detection and was equal to breath-hold T2-weighted imaging for FLL characterization.

Quantification of missing and overlapping data in multiple breath hold abdominal imaging

Magnetic resonance imaging (MRI) of the abdomen is often performed in multiple breath holds which are designed to contiguously cover the region of interest. This technique may result in a failure to image all the appropriate area, and the extent of this failure is difficult to appreciate on a set of 2D slices. With reference to three patient cases, we present a method to quantify the extent of this problem and suggest a solution. First, we manually delineate the region of interest on a single breath hold fast spoiled gradient echo (FSPGR) sequence. Subsequently, we align images acquired in separate breath holds to this reference volume. A coloured 3D presentation makes the extent of unimaged and repeatedly imaged areas clearly visible to the clinician. The alignment also helps radiologists to accurately determine the location of individual slices. The described method can easily be automated and is ideally implemented at the scanner console, ensuring the availability of contiguously sampled datasets to radiologists with minimum user interaction from the radiographer. Such datasets enable the deployment of robust 3D analysis algorithms.

Hepatobiliary MRI: current concepts and controversies

Evaluation of the liver and biliary system is a frequent indication for abdominal MRI. Hepatobiliary MRI comprises a set of noninvasive techniques that are usually very effective in answering most clinical questions. There are significant limitations, however, as well as considerable variation and disagreement regarding the optimal protocols for standard hepatic MRI and magnetic resonance cholangiopancreaticography (MRCP). This review discusses pulse sequences most often used in hepatic MRI and MRCP, examines a few sources of controversy in the current literature, and summarizes some recent and future developments in the field.

Image quality and focal lesion detection on T2-weighted MR imaging of the liver: Comparison of two high-resolution free-breathing imaging techniques with two breath-hold imaging techniques

PURPOSE

To evaluate image quality and accuracy for the detection of focal hepatic lesions depicted on T2-weighted images obtained with two high-resolution free-breathing techniques (navigator-triggered turbo spin-echo [TSE] and respiratory-triggered TSE) and two standard-resolution breath-hold techniques (breath-hold TSE with restore pulse and half-Fourier acquisition single-shot TSE [HASTE]).

MATERIALS AND METHODS

Our institutional review board approved this study, and written informed consent was obtained from all patients. Two readers independently reviewed 200 T2-weighted imaging sets obtained with four sequences in 50 patients. Both readers identified all focal lesions in session 1 and only solid lesions in session 2. The readers' confidence was graded using a scale of 1-4 (1 <or= 50%; 4 >or= 95%). The diagnostic accuracies of the four MR sequences were evaluated using the free-response receiver operating characteristic (ROC) method. Region-of-interest (ROI) measurements were performed for the mean signal intensity (SI) in the liver, spleen, hepatic lesions, and background noise.

RESULTS

The accuracy of navigator-triggered TSE and respiratory-triggered TSE was superior to that of breath-hold TSE with restore pulse and HASTE for the detection of all focal or solid hepatic lesions. The mean lesion-to-liver contrast-to-noise ratio (CNR) of solid lesions in navigator-triggered (P < 0.001) and respiratory-triggered TSE (P < 0.005) was significantly higher than that in HASTE.

CONCLUSION

High-resolution, free-breathing, T2-weighted MRI techniques can significantly improve the detectability of focal hepatic lesions and provide higher lesion-to-liver contrast of solid lesions compared to breath-hold techniques.

[Fundamental study of turbo spin echo sequence with driven equilibrium pulse]

When MR images are obtained with the turbo spin echo (TSE) sequence, DRIVE can be used as a sequence in which the driven equilibrium pulse (DE pulse), a reset pulse, is applied at the TSE echo train to accelerate relaxation time and return to the equilibrium of Mz magnetization. In this study, we examined the extent to which TR could be shortened in DRIVE and how the other parameters of the turbo spin echo sequence influence it.

RESULTS

1) DRIVE is effective when the T2 value is long. 2) It is necessary to set TR at 1000 ms or more to obtain image contrast with free water and fat in T2-weighted images for which a conventional turbo spin echo sequence using DRIVE is employed in clinical examination. 3) It is not necessary to consider the influence of the TSE factor when using DRIVE.

Focal liver lesions: Breathhold gradient- and spin-echo T2-weighted imaging for detection and characterization

PURPOSE

To evaluate breathhold gradient- and spin-echo (GRASE) T2-weighted imaging for the detection and characterization of focal liver lesions.

MATERIALS AND METHODS

Two GRASE sequences with different echo times (75 and 90 msec, GRASE75 and GRASE90) were compared with respiratory-triggered fast spin-echo (SE) and breathhold fast SE in 64 patients with 103 malignant and 51 benign lesions. Compared with respiratory-triggered and breathhold fast SE, GRASE reduced scan time by 77% to 82% and 21% to 27%, respectively. Two independent readers evaluated image quality and reviewed 504 liver segments on a segment-by-segment basis. Observer performance was evaluated with receiver operating characteristic (ROC) curve analysis. The signal-to-noise ratio (SNR) of liver and spleen, and lesion-to-liver contrast-to-noise ratio (CNR) were also measured.

RESULTS

The overall quality of the GRASE images was higher than that of the respiratory-triggered and breathhold fast SE images, although signal inhomogeneities were more frequently observed with GRASE. No significant difference in the values of the area under the ROC curve (Az) for malignant lesion detection was found. The mean SNR and CNR were highest for respiratory-triggered fast SE.

CONCLUSION

T2-weighted breathhold GRASE has the potential to provide faster liver imaging.

[Modern visualization of the liver with MRT. Current trends and future perspectives]

This contribution provides an overview and imparts basic knowledge on pertinent technical developments in magnetic resonance imaging (MRI) of the liver: 3D sequences, respiratory triggering, parallel imaging, and 3 Tesla (3T). 3D sequences can be used as T1-weighted (T1w) sequences for analyzing dynamics of contrast enhancement or as T2w sequences for MR cholangiography. Consistent improvements in respiratory triggering make it possible to obtain good image quality on T2w scans even in patients unable to hold their breath. Parallel imaging as a universal technique to accelerate image acquisition is particularly appropriate for MRI of the liver, and it has been shown that the reduced acquisition time is not achieved at the expense of image quality. Further progress in MRI of the liver can be expected with use of the 3T systems, but hitherto irrelevant problems must still be solved. Overall the innovations presented here, applied alone or in combination, facilitate rapid, robust, and high-quality MRI diagnostic assessment of the liver.

Utility of Breath-Hold Fast-Recovery Fast Spin-Echo T2 Versus Respiratory-Triggered Fast Spin-Echo T2 in Clinical Hepatic Imaging

OBJECTIVE

The objective of our study was to compare a breath-hold fat-suppressed fast-recovery fast spin-echo (FSE) T2-weighted sequence with a respiratory-triggered fat-suppressed FSE T2-weighted sequence to assess the effect on image quality and lesion detection and characterization in clinical hepatic imaging.

MATERIALS AND METHODS

Both the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences were acquired in 46 patients. Two radiologists, blinded to clinical data, independently evaluated randomized images from both sequences. Qualitatively, images were graded on a 5-point scale for five different characteristics. The number and location of lesions were recorded. The confidence of detection and the confidence of characterization (solid vs nonsolid) were graded on a 5-point scale. A consensus review using radiology, clinical, and pathology data served as the standard. Receiver operating characteristic (ROC) curve analysis (area under the ROC curve [A(z)]) was used to compare each reviewer's interpretation against the consensus interpretation. Quantitative analysis was performed by calculating the liver signal-to-noise ratio (SNR), liver-to-spleen contrast-to-noise ratio (CNR), and lesion-to-liver CNR. Both one- and two-tailed Student's t tests were used to check for significance.

RESULTS

Qualitatively, both reviewers graded the breath-hold fat-suppressed fast-recovery FSE T2-weighted sequence better than the respiratory-triggered fat-suppressed FSE T2-weighted sequence on all five characteristics (p < 0.005). Of 78 lesions detected, 29 were characterized as solid; 47, nonsolid; and two, indeterminate. On ROC analysis, there were no significant differences between the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences in lesion detection (A(z) reviewer 1, 0.77 and 0.83, respectively, [p = 0.12]; A(z) reviewer 2, 0.84 and 0.80, respectively [p = 0.12]) or in lesion characterization (A(z) reviewer 1, 0.86 and 0.92, respectively [p = 0.33]; A(z) reviewer 2, 0.90 and 0.91, respectively [p = 0.79]). Quantitatively, liver SNRs, spleen CNRs, and lesion CNRs (solid and nonsolid lesions) were significantly better on the breath-hold fat-suppressed fast-recovery FSE T2-weighted images than on the respiratory-triggered fat-suppressed FSE T2-weighted images (p < 0.005).

CONCLUSION

Breath-hold fat-suppressed fast-recovery FSE T2-weighted images were of better quality than respiratory-triggered fat-suppressed FSE T2-weighted images, and lesion detection and characterization were comparable.

Current Concepts and Advances in Clinical Parallel Magnetic Resonance Imaging

Parallel imaging (PI) is one of the most promising recent advances in MRI technology and has, similar to the introduction of multidetector helical scanning in CT, revolutionized MR imaging. The speed of all conventional MRI methods has been limited by either gradient strength or their switching times. The basic idea in PI is to use some of the spatial information contained in the individual elements of a radiofrequency (RF) receiver coil array to increase imaging speed. These PI techniques are removing some of the previous limitations in speed of MRI scanners and set the basis for accelerated image formation. Initially, PI was motivated by the wish to accelerate image acquisition without reducing the spatial resolution of the image. However, depending on the application, it turned out that PI harbors several other advantages. Among those is the possibility for higher spatial resolution, shorter breath-holds or multiple averaging to diminish motion artifacts, reduced image blurring and geometric distortions, better temporal resolution, and means for navigator correction. This overview focuses on technical aspects, clinical applications, and ongoing research in different areas of the human body. The critical review demonstrates PI's great versatility as well as the current trends to use this unique technique in the majority of clinical scan protocols.

High-resolution MR-imaging of the liver with T2-weighted sequences using integrated parallel imaging: Comparison of prospective motion correction and respiratory triggering

PURPOSE

To compare high-resolution T2-weighted images of the liver with and without integrated parallel acquisition techniques (iPAT) using either breath-hold sequences in combination with prospective acquisition motion correction (PACE) or respiratory triggering.

MATERIALS AND METHODS

Ten volunteers and 10 patients underwent each four different high-resolution fast spin echo (FSE) T2-weighted sequences with 5 mm slice thickness and a full 320 matrix: a multi-breath-hold FSE sequence with and without iPAT and PACE and a respiratory-triggered FSE sequence with and without iPAT. Image quality was rated with a five-point scale by two independent readers. Signal intensity measurements were performed on a water phantom.

RESULTS

The sequences with iPAT required a substantially shorter acquisition time without loss of image quality. Overall image quality was rated equal for all sequences by both readers. Image time for nine slices with iPAT was 13 seconds (19 seconds without iPAT) with multi-breath-hold and on average 4:00 minutes (7:02 minutes without iPAT) with respiratory triggering. Imaging with the PACE technique resulted in more correct positioning of the image stacks.

CONCLUSION

T2-weighted fast imaging with iPAT is feasible and results in high-quality images within a short acquisition time. Overall image quality is not negatively affected by iPAT.

[Evaluation of the increase in signal intensity from applying the fast recovery technique to fast spin echo images]

The aim of the present study was to evaluate the increase in signal intensity caused by applying the fast recovery (FR) technique to fast spin echo (FSE) images, that is, the fast recovery fast spin echo (FR-FSE) method. All images of phantoms, whose T(2) values were different, were acquired with a Signa 1.5 Tesla system (GE Medical Systems) using the three-dimensional (3D) FSE and 3D FR-FSE sequences. We assessed the increased signal intensity as follows: (signal intensity on the FR-FSE image - FSE image) / FSE image (%). Our results showed that the increased signal intensity became high when 1) T(2) of the phantom was prolonged, 2) TR was shortened, and 3) echo train length (ETL) was decreased. By utilizing the results of this study, the increased signal caused by the FR technique could be estimated quantitatively when the TR, ETL, and T(2) of investigated substances were determined. For example, when TR, ETL, and T(2) were 1500 msec, 16-64, and 1500 msec, respectively, the increase in signal intensity was estimated to be approximately 70%. In addition, when T(2) was less than approximately 250 msec, signal intensity was not significantly increased by the FR pulses, that is, the FR-FSE image was the same as the FSE image. Accordingly, the FR-FSE method was confirmed to enhance the signal in substances with longer T(2), while maintaining the same contrast of the image as that obtained by the conventional FSE method. Our results are useful for evaluating the increased signal intensity caused by employing the FR technique.