We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Skip to main content
SpringerLink
Log in

Variable refocusing flip angle single-shot fast spin echo imaging of liver lesions: increased speed and lesion contrast

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate acquisition time and clinical image quality of a variable refocusing flip angle (vrf) single-shot fast spin echo (SSFSE) sequence in comparison with a conventional SSFSE sequence for imaging of liver lesions in patients undergoing whole-body PET/MRI for oncologic staging.

Methods

A vrfSSFSE sequence was acquired in 43 patients with known pancreatic neuroendocrine tumors undergoing 68Ga-DOTA-TOC PET on a simultaneous time-of-flight 3.0T PET/MRI. Liver lesions ≥1.5 cm with radionucleotide uptake were analyzed. Contrast-to-noise ratios (CNRs) were measured, and four blinded radiologists assessed overall image quality. Differences in repetition time and CNR were assessed using a paired Student’s t test with p < 0.05 considered statistically significant. Inter-reader variability was assessed with Fleiss’ kappa statistic.

Results

53 eligible lesions in 27 patients were included for analysis. vrfSSFSE demonstrated higher mean lesion CNR compared to SSFSE (9.9 ± 4.1 vs. 6.7 ± 4.1, p < 0.001). Mean repetition time (TR) was 679 ± 97 ms for the vrfSSFSE sequence compared to 1139 ± 106 ms for SSFSE (p < 0.0001), corresponding to a 1.7-fold decrease in acquisition time. Overall quality of liver lesion and common bile duct images with the vrfSSFSE sequence was graded as superior than or equivalent to the SSFSE sequence for 59% and 67% of patients, respectively.

Conclusions

Compared to conventional SSFSE, vrfSSFSE resulted in improved lesion contrast on simultaneous PET/MRI in patients with liver metastases. Due to decreased SAR demands, vrfSSFSE significantly decreased TR, allowing coverage of the entire liver in a single twenty-second breath hold. This may have important clinical implications in the setting of PET/MRI, where scan time is limited by the necessity of whole-body image acquisition in addition to bed specific imaging.

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

Similar content being viewed by others

References

  1. Hicks RM, Yee J, Ohliger MA, et al. (2016) Comparison of diffusion-weighted imaging and T2-weighted single shot fast spin-echo: implications for LI-RADS characterization of hepatocellular carcinoma. Magn Reson Imaging 34(7):915–921

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reiner CS, Stolzmann P, Husmann L, et al. (2014) Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection. Eur J Nucl Med Mol Imaging 41(4):649–658

    Article  PubMed  Google Scholar 

  3. Vitellas KM, Keogan MT, Spritzer CE, Nelson RC. (2000) MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics 20(4):939–957; quiz 1107–1108, 12.

  4. Merkle EM, Dale BM (2006) Abdominal MRI at 3.0 T: the basics revisited. AJR Am J Roentgenol 186(6):1524–1532

    Article  PubMed  Google Scholar 

  5. Yang RK, Roth CG, Ward RJ, et al. (2010) Optimizing abdominal MR imaging: approaches to common problems. Radiographics 30(1):185–199

    Article  PubMed  Google Scholar 

  6. Bhosale P, Ma J, Choi H (2009) Utility of the FIESTA pulse sequence in body oncologic imaging: review. AJR Am J Roentgenol 192(6 Suppl):S83–93 (Quiz S4–7).

  7. Semelka RC, Kelekis NL, Thomasson D, et al. (1996) HASTE MR imaging: description of technique and preliminary results in the abdomen. J Magn Reson Imaging 6(4):698–699

    Article  CAS  PubMed  Google Scholar 

  8. Fowler KJ, McConathy J, Narra VR (2014) Whole-body simultaneous positron emission tomography (PET)-MR: optimization and adaptation of MRI sequences. J Magn Reson Imaging 39(2):259–268

    Article  PubMed  Google Scholar 

  9. Sotoudeh H, Sharma A, Fowler KJ, et al. (2016) Clinical application of PET/MRI in oncology. J Magn Reson Imaging 44(2):265–276

    Article  PubMed  Google Scholar 

  10. von Schulthess GK, Veit-Haibach P (2014) Workflow considerations in PET/MR imaging. J Nucl Med 55(Supplement 2):19S–24S

    Article  Google Scholar 

  11. Busse RF, Brau AC, Vu A, et al. (2008) Effects of refocusing flip angle modulation and view ordering in 3D fast spin echo. Magn Reson Med 60(3):640–649

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hennig J, Weigel M, Scheffler K (2003) Multiecho sequences with variable refocusing flip angles: optimization of signal behavior using smooth transitions between pseudo steady states (TRAPS). Magn Reson Med 49(3):527–535

    Article  PubMed  Google Scholar 

  13. Loening AM, Litwiller DV, Saranathan M, Vasanawala SS (2017) Increased speed and image quality for pelvic single-shot fast spin-echo imaging with variable refocusing flip angles and full-fourier acquisition. Radiology 282(2):561–568

    Article  PubMed  Google Scholar 

  14. Loening AM, Saranathan M, Ruangwattanapaisarn N, et al. (2015) Increased speed and image quality in single-shot fast spin echo imaging via variable refocusing flip angles. J Magn Reson Imaging 42(6):1747–1758

    Article  PubMed  PubMed Central  Google Scholar 

  15. Levin CS, Maramraju SH, Khalighi MM, et al. (2016) Design features and mutual compatibility studies of the time-of-flight PET capable GE SIGNA PET/MR system. IEEE Trans Med Imaging 35(8):1907–1914

    Article  PubMed  Google Scholar 

  16. Hope TA, Pampaloni MH, Nakakura E, et al. (2015) Simultaneous (68)Ga-DOTA-TOC PET/MRI with gadoxetate disodium in patients with neuroendocrine tumor. Abdom Imaging. 40(6):1432–1440

    Article  PubMed  Google Scholar 

  17. Hope TA, Verdin EF, Bergsland EK, et al. (2015) Correcting for respiratory motion in liver PET/MRI: preliminary evaluation of the utility of bellows and navigated hepatobiliary phase imaging. EJNMMI Phys 2(1):21

    Article  PubMed  PubMed Central  Google Scholar 

  18. Busse RF, Hariharan H, Vu A, Brittain JH (2006) Fast spin echo sequences with very long echo trains: design of variable refocusing flip angle schedules and generation of clinical T2 contrast. Magn Reson Med 55(5):1030–1037

    Article  PubMed  Google Scholar 

  19. Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17(3):205–216

    Article  PubMed  PubMed Central  Google Scholar 

  20. Coenegrachts K, Delanote J, Ter Beek L, et al. (2007) Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques. Br J Radiol 80(955):524–531

    Article  CAS  PubMed  Google Scholar 

  21. Hussain SM, De Becker J, Hop WC, et al. (2005) Can a single-shot black-blood T2-weighted spin-echo echo-planar imaging sequence with sensitivity encoding replace the respiratory-triggered turbo spin-echo sequence for the liver? An optimization and feasibility study. J Magn Reson Imaging 21(3):219–229

    Article  PubMed  Google Scholar 

  22. Phelps AS, Naeger DM, Courtier JL, et al. (2015) Pairwise comparison versus Likert scale for biomedical image assessment. AJR Am J Roentgenol 204(1):8–14

    Article  PubMed  Google Scholar 

  23. Kanematsu M, Kondo H, Goshima S, et al. (2006) Imaging liver metastases: review and update. Eur J Radiol 58(2):217–228

    Article  PubMed  Google Scholar 

  24. Ruangwattanapaisarn N, Loening AM, Saranathan M, et al. (2015) Faster pediatric 3-T abdominal magnetic resonance imaging: comparison between conventional and variable refocusing flip-angle single-shot fast spin-echo sequences. Pediatr Radiol 45(6):847–854

    Article  PubMed  Google Scholar 

  25. Adamic P, Babiy V, Janicki R, et al. (2009) Pairwise comparisons and visual perceptions of equal area polygons. Percept Mot Skills 108(1):37–42

    Article  CAS  PubMed  Google Scholar 

  26. Good WF, Gur D, Feist JH, et al. (1994) Subjective and objective assessment of image quality–a comparison. J Digit Imaging 7(2):77–78

    Article  CAS  PubMed  Google Scholar 

  27. Gur D, Rubin DA, Kart BH, et al. (1997) Forced choice and ordinal discrete rating assessment of image quality: a comparison. J Digit Imaging 10(3):103–107

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Albaum G (1997) The Likert scale revisited: an alternate version. J Mark Res Soc 39(2):331–348

    Google Scholar 

  29. Blaikie N (2003) Analysing quantitative data. London: Sage Publications

    Book  Google Scholar 

  30. Clegg F (1998) Simple statistics. Cambridge: Cambridge University Press

    Google Scholar 

  31. Jamieson S (2004) Likert scales: how to (ab)use them. Med Educ 38(12):1217–1218

    Article  PubMed  Google Scholar 

  32. Dietrich O, Raya JG, Reeder SB, et al. (2008) Influence of multichannel combination, parallel imaging and other reconstruction techniques on MRI noise characteristics. Magn Reson Imaging 26(6):754–762

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0628, USA

    Robert M. Hicks, Michael A. Ohliger & Thomas A. Hope

  2. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Andreas M. Loening & Shreyas S. Vasanawala

  3. Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA

    Michael A. Ohliger

  4. Department of Radiology, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA

    Thomas A. Hope

Authors
  1. Robert M. Hicks
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas M. Loening
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael A. Ohliger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shreyas S. Vasanawala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas A. Hope
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas A. Hope.

Ethics declarations

Funding

None.

Conflict of interest

T.A.H and S.S.V. receive grant support from GE Healthcare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hicks, R.M., Loening, A.M., Ohliger, M.A. et al. Variable refocusing flip angle single-shot fast spin echo imaging of liver lesions: increased speed and lesion contrast. Abdom Radiol 43, 593–599 (2018). https://doi.org/10.1007/s00261-017-1252-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1252-y

Keywords

Search

Navigation