Skip to main content
SpringerLink
Log in

Navigated three-dimensional T1-weighted gradient-echo sequence for gadoxetic acid liver magnetic resonance imaging in patients with limited breath-holding capacity

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose

To determine whether a navigator-gated three-dimensional T1-weighted gradient-echo sequence (T1W-GRE, navigated LAVA) can improve diagnostic performance for the detection of focal liver lesions (FLLs) compared to standard breath-hold (BH) T1W-GRE breath-hold LAVA (BH-LAVA) during the hepatobiliary phase (HBP) of gadoxetic acid liver magnetic resonance imaging (MRI) in patients with limited breath-holding capacity.

Materials and methods

This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. We included 372 patients who underwent liver MRI including both navigated LAVA and BH-LAVA sequences. Overall image quality of the two HBP image sets was compared. In patients with limited breath-holding capacity, diagnostic performances in detecting FLLs on the two HBP images were compared using jackknife-alternative free-response receiver-operating characteristic (JAFROC) analysis by two reviewers.

Results

There were 13 cases (13/372; 3.5%) of image acquisition failure using the navigated LAVA sequence due to severe irregular breathing, and 50 of 359 patients had limited breath-holding capacity. In these patients, overall image quality of navigated LAVA (2.78 ± 0.95) was significantly better than that of BH-LAVA (2.42 ± 0.81, P < 0.005), and both readers showed significantly higher JAFROC figure-of-merit values with navigated LAVA compared to BH-LAVA (0.94 and 0.86 in reviewer 1, respectively; 0.89 and 0.83 in reviewer 2, respectively, P < 0.005). Overall image quality of navigated LAVA was also better than that of BH-LAVA in patients with sufficient breath-holding capacity (n = 309, 3.96 ± 0.88, 3.81 ± 0.66, respectively, P < 0.001).

Conclusion

The navigated LAVA sequence could provide better image quality and diagnostic performance in detecting FLLs than BH-LAVA in patients with limited breath-holding capacity during HBP of gadoxetic acid MRI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ayuso C, Rimola J, García-Criado Á (2012) Imaging of HCC. Abdom Imaging 37:215–230

    Article  PubMed  Google Scholar 

  2. Mainenti PP, Mancini M, Mainolfi C, et al. (2010) Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. Abdom Imaging 35:511–521

    Article  PubMed  Google Scholar 

  3. Gore R, Thakrar K, Wenzke D, et al. (2012) That liver lesion on MDCT in the oncology patient: is it important? Cancer Imaging 12:373–384

    Article  PubMed Central  PubMed  Google Scholar 

  4. Becker-Weidman DJ, Kalb B, Sharma P, et al. (2011) Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging—comparison to prior same-center results after MR systems improvements. Radiology 261:824–833

    Article  PubMed  Google Scholar 

  5. Lee JM, Zech CJ, Bolondi L, et al. (2011) Consensus report of the 4th International Forum for gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging. Korean J Radiol 12:403–415

    Article  PubMed Central  PubMed  Google Scholar 

  6. Lee KH, Lee JM, Park JH, et al. (2013) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent gadoxetic acid. Korean J Radiol 14:894–904

    Article  PubMed Central  PubMed  Google Scholar 

  7. Berger-Kulemann V, Schima W, Baroud S, et al. (2012) Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol (EJSO) 38:670–676

    Article  CAS  Google Scholar 

  8. Martin DR, Semelka RC (2005) Magnetic resonance imaging of the liver: review of techniques and approach to common diseases Seminars in Ultrasound, CT, and MRI. Elsevier, Philadelphia, pp 116–131

  9. Wile GE, Leyendecker JR (2010) Magnetic resonance imaging of the liver: sequence optimization and artifacts. Magn Reson Imaging Clin N Am 18:525–547

    Article  PubMed  Google Scholar 

  10. Ringe KI, Husarik DB, Gupta RT, Boll DT, Merkle EM (2011) Hepatobiliary transit times of gadoxetate disodium for protocol optimization of comprehensive MR imaging of the biliary system—what is normal? Eur J Radiol 79:201–205

    Article  PubMed  Google Scholar 

  11. Yu MH, Lee JM, Yoon JH, et al. (2013) Clinical application of controlled aliasing in parallel imaging results in a higher acceleration (CAIPIRINHA)-volumetric interpolated breathhold (VIBE) sequence for gadoxetic acid-enhanced liver MR imaging. J Magn Reson Imaging 38:1020–1026

    Article  PubMed  Google Scholar 

  12. Yoon JH, Lee JM, Yu MH, et al. (2014) High-resolution T1-weighted gradient echo imaging for liver MRI using parallel imaging at high-acceleration factors. Abdom Imaging 39:711–721

    Article  PubMed  Google Scholar 

  13. Nagle SK, Busse RF, Brau AC, et al. (2012) High resolution navigated three-dimensional T1-weighted hepatobiliary MRI using gadoxetic acid optimized for 1.5 tesla. J Magn Reson Imaging 36:890–899

    Article  PubMed Central  PubMed  Google Scholar 

  14. Tran PV, Jhaveri KS (2013) Comparison of high spatial resolution respiratory triggered inversion recovery-prepared spoiled gradient echo sequence with standard breathhold T1 sequence MRI of the liver using gadoxetic acid. J Magn Reson Imaging 37:700–706

    Article  PubMed  Google Scholar 

  15. Young PM, Brau AC, Iwadate Y, et al. (2010) Respiratory navigated free breathing 3D spoiled gradient-recalled echo sequence for contrast-enhanced examination of the liver: diagnostic utility and comparison with free breathing and breath-hold conventional examinations. Am J Roentgenol 195:687–691

    Article  Google Scholar 

  16. Asbach P, Warmuth C, Stemmer A, et al. (2008) High spatial resolution T1-weighted MR imaging of liver and biliary tract during uptake phase of a hepatocyte-specific contrast medium. Invest Radiol 43:809–815

    Article  PubMed  Google Scholar 

  17. Motosugi U, Ichikawa T, Morisaka H, et al. (2011) Detection of pancreatic carcinoma and liver metastases with gadoxetic acid–enhanced MR imaging: comparison with contrast-enhanced multi-detector row ct. Radiology 260:446–453

    Article  PubMed  Google Scholar 

  18. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022

    Article  PubMed Central  PubMed  Google Scholar 

  19. Ahn SJ, Kim MJ, Hong HS, Kim KA, Song HT (2011) Distinguishing hemangiomas from malignant solid hepatic lesions: a comparison of heavily T2-weighted images obtained before and after administration of gadoxetic acid. J Magn Reson Imaging 34:310–317

    Article  PubMed  Google Scholar 

  20. Ba-Ssalamah A, Uffmann M, Saini S, et al. (2009) Clinical value of MRI liver-specific contrast agents: a tailored examination for a confident non-invasive diagnosis of focal liver lesions. Eur Radiol 19:342–357

    Article  PubMed  Google Scholar 

  21. Yun E, Choi B, Han J, et al. (1999) Hepatic hemangioma: contrast-enhancement pattern during the arterial and portal venous phases of spiral CT. Abdom Imaging 24:262–266

    Article  CAS  PubMed  Google Scholar 

  22. Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK (1999) CT and MR imaging of benign hepatic and biliary tumors. Radiographics 19:431–451

    Article  CAS  PubMed  Google Scholar 

  23. Hyodo T, Murakami T, Imai Y, et al. (2013) Hypovascular nodules in patients with chronic liver disease: risk factors for development of hypervascular hepatocellular carcinoma. Radiology 266:480–490

    Article  PubMed  Google Scholar 

  24. Golfieri R, Grazioli L, Orlando E, et al. (2012) Which is the best MRI marker of malignancy for atypical cirrhotic nodules: hypointensity in hepatobiliary phase alone or combined with other features? Classification after Gd-EOB-DTPA administration. J Magn Reson Imaging 36:648–657

    Article  PubMed  Google Scholar 

  25. Golfieri R, Renzulli M, Lucidi V, et al. (2011) Contribution of the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI to dynamic MRI in the detection of hypovascular small (≤2 cm) HCC in cirrhosis. Eur Radiol 21:1233–1242

    Article  PubMed  Google Scholar 

  26. Kitao A, Matsui O, Yoneda N, et al. (2011) The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid enhanced MR imaging. Eur Radiol 21:2056–2066

    Article  PubMed  Google Scholar 

  27. Yoon MA, Kim SH, Park HS, et al. (2009) Value of dual contrast liver MRI at 3.0 T in differentiating well-differentiated hepatocellular carcinomas from dysplastic nodules: preliminary results of multivariate analysis. Invest Radiol 44:641–649

    Article  PubMed  Google Scholar 

  28. Vasanawala SS, Iwadate Y, Church DG, Herfkens RJ, Brau AC (2010) Navigated abdominal T1-W MRI permits free-breathing image acquisition with less motion artifact. Pediatr Radiol 40:340–344

    Article  PubMed Central  PubMed  Google Scholar 

  29. Chakraborty DP (2006) Analysis of location specific observer performance data: validated extensions of the jackknife free-response (JAFROC) method. Acad Radiol 13:1187–1193

    Article  PubMed  Google Scholar 

  30. Chakraborty DP, Berbaum KS (2004) Observer studies involving detection and localization: modeling, analysis, and validation. Med Phys 31:2313–2330

    Article  PubMed  Google Scholar 

  31. Zheng B, Chakraborty DP, Rockette HE, Maitz GS, Gur D (2005) A comparison of two data analyses from two observer performance studies using jackknife ROC and JAFROC. Med Phys 32:1031–1034

    Article  CAS  PubMed  Google Scholar 

  32. Sun HY, Lee JM, Shin CI, et al. (2010) Gadoxetic acid-enhanced magnetic resonance imaging for differentiating small hepatocellular carcinomas (≤2 cm in diameter) from arterial enhancing pseudolesions: special emphasis on hepatobiliary phase imaging. Invest Radiol 45:96–103

    Article  CAS  PubMed  Google Scholar 

  33. Knowles B, Welsh FK, Chandrakumaran K, John TG, Rees M (2012) Detailed liver-specific imaging prior to pre-operative chemotherapy for colorectal liver metastases reduces intra-hepatic recurrence and the need for a repeat hepatectomy. HPB 14:298–309

    Article  PubMed Central  PubMed  Google Scholar 

  34. Maniam S, Szklaruk J (2010) Magnetic resonance imaging: review of imaging techniques and overview of liver imaging. World J Radiol 2:309–322

    Article  PubMed Central  PubMed  Google Scholar 

  35. Reiner C, Neville A, Nazeer H, et al. (2013) Contrast-enhanced free-breathing 3D T1-weighted gradient-echo sequence for hepatobiliary MRI in patients with breath-holding difficulties. Eur Radiol 23:3087–3093

    Article  CAS  PubMed  Google Scholar 

  36. Iwadate Y, Brau A, Vasanawala SS, Kabasawa H (2013) Enhancement of respiratory navigator-gated three-dimensional spoiled gradient-recalled echo sequence with variable flip angle scheme. Magn Reson Med 72:172–177

    Article  PubMed  Google Scholar 

  37. Bashir MR, Merkle EM (2011) Improved liver lesion conspicuity by increasing the flip angle during hepatocyte phase MR imaging. Eur Radiol 21:291–294

    Article  PubMed  Google Scholar 

  38. Bashir MR, Husarik DB, Ziemlewicz TJ, et al. (2012) Liver MRI in the hepatocyte phase with gadolinium-EOB-DTPA: does increasing the flip angle improve conspicuity and detection rate of hypointense lesions? J Magn Reson Imaging 35:611–616

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Chris Woo, B.A. (USA), for his editorial assistance.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Jeong Hee Yoon, Jeong Min Lee, Joon Koo Han & Byung Ihn Choi

  2. Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Jeong Min Lee, Joon Koo Han & Byung Ihn Choi

  3. Department of Radiology, National Cancer Center, Goyang-si, Gyeonggi-do, Korea

    Eun Sun Lee

  4. Human Medical Imaging & Intervention Center, Seoul, Korea

    Jeehyun Baek

  5. Global Applied Science Laboratory, GE Healthcare, Seoul, Korea

    Sangwoo Lee

  6. Global Applied Science Laboratory, GE Healthcare, Hino, Tokyo, Japan

    Yuji Iwadate

Authors
  1. Jeong Hee Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeong Min Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eun Sun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeehyun Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sangwoo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuji Iwadate
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joon Koo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Byung Ihn Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong Min Lee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoon, J.H., Lee, J.M., Lee, E.S. et al. Navigated three-dimensional T1-weighted gradient-echo sequence for gadoxetic acid liver magnetic resonance imaging in patients with limited breath-holding capacity. Abdom Imaging 40, 278–288 (2015). https://doi.org/10.1007/s00261-014-0214-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-014-0214-x

Keyword

Search

Navigation