Diagnosis of Hepatic Metastasis: Comparison of Respiration-Triggered Diffusion-Weighted Echo-Planar MRI and Five T2-Weighted Turbo Spin-Echo Sequences

Bruegel, Melanie; Gaa, Jochen; Waldt, Simone; Woertler, Klaus; Holzapfel, Konstantin; Kiefer, Berthold; Rummeny, Ernst J.

doi:10.2214/ajr.07.3279

Cited by 132 publications

(93 citation statements)

References 33 publications

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“…ADC map for PACE DWI shows better lesion delineation and less noise contamination. compared with T2-weighted sequences (15). In a separate study (16), the same group reported an excellent performance of PACE DWI for lesion characterization, with sensitivity and specificity of 90% and 86%, respectively, for diagnosis of malignant lesions (using a threshold ADC Ͻ 1.63 mm 2 /s).…”

Section: Discussionmentioning

confidence: 96%

“…Few recent studies have reported the use of respiratory triggered liver DWI without (28 -30) or with a navigator echo (15,16). Gourtsoyianni et al (29) assessed the accuracy of ADC obtained with non navigator echo respiratory triggered SS EPI DWI sequence (n ϭ 38) for characterization of liver lesions, and found sensitivity and specificity of 100% for diagnosis of malignancy using lesion ADC Ͻ 1.26 ϫ 10 Ϫ3 mm 2 /s, similar to our reported sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

“…Gourtsoyianni et al (29) assessed the accuracy of ADC obtained with non navigator echo respiratory triggered SS EPI DWI sequence (n ϭ 38) for characterization of liver lesions, and found sensitivity and specificity of 100% for diagnosis of malignancy using lesion ADC Ͻ 1.26 ϫ 10 Ϫ3 mm 2 /s, similar to our reported sensitivity and specificity. Bruegel et al (15,16) used the same MR system used in our study and a similar PACE DWI sequence to detect and characterize liver lesions. They observed better performance of DWI Figure 3.…”

Section: Discussionmentioning

confidence: 99%

“…THERE IS A GROWING interest in using liver diffusionweighted imaging (DWI) for lesion detection and characterization, prediction of treatment response and assessment of chronic liver disease, by means of apparent diffusion coefficient (ADC) measurement (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The interest in DWI is motivated by the recently described risk of nephrogenic systemic fibrosis (21)(22)(23)(24), which makes DWI an attractive alternate method to Gadolinium-enhanced sequences.…”

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confidence: 99%

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Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Taouli

Sandberg

Stemmer

et al. 2009

Magnetic Resonance Imaging

147

122

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Purpose: To compare a free breathing navigator triggered single shot echoplanar imaging (SS EPI) diffusion-weighted imaging (DWI) sequence with prospective acquisition correction (PACE) with a breathhold (BH) DWI sequence for liver imaging. Materials and Methods:Thirty-four patients were evaluated with PACE-DWI and BH DWI of the liver using bvalues of 0, 50, and 500 s/mm 2 . There were 29 focal liver lesions in 18 patients. Qualitative evaluation was performed on a 3-point scale (1-3) by two independent observers (maximum score 9). Quantitative evaluation included estimated SNR (signal to noise ratio), lesion-to-liver contrast ratio, liver and lesion apparent diffusion coefficients (ADCs), and coefficient of variation (CV) of ADC in liver parenchyma and focal liver lesions (estimate of noise contamination in ADC).Results: PACE-DWI showed significantly better image quality, higher SNR and lesion-to-liver contrast ratio when compared with BH DWI. ADCs of liver and focal lesions with both sequences were significantly correlated (r ϭ 0.838 for liver parenchyma, and 0.904 for lesions, P Ͻ 0.0001), but lower with the BH sequence (P Ͻ 0.02). There was higher noise contamination in ADC measurement obtained with BH DWI (with a significantly higher SD and CV of ADC). Conclusion:The use of a navigator echo to trigger SS EPI DWI improves image quality and liver to lesion contrast, and enables a more precise ADC quantification compared with BH DWI acquisition. THERE IS A GROWING interest in using liver diffusionweighted imaging (DWI) for lesion detection and characterization, prediction of treatment response and assessment of chronic liver disease, by means of apparent diffusion coefficient (ADC) measurement (1-20). The interest in DWI is motivated by the recently described risk of nephrogenic systemic fibrosis (21-24), which makes DWI an attractive alternate method to Gadolinium-enhanced sequences. Most prior studies have used breathhold (BH) single shot echoplanar imaging (SS EPI) to acquire diffusion-weighted images, using various sets of b-values. SS EPI sequences are very fast, however, suffer from limited image quality, mostly related to limited signal to noise ratio (SNR) especially at higher b-values, and limited spatial resolution, which constitute an obstacle for its widespread use in clinical practice. Techniques such as parallel imaging (25,26) and pulse triggering (27) have been proposed to improve SS EPI image quality and precision of ADC measurement.There are several recent reports on the use of respiratory triggered acquisitions for liver DWI (15,16,[28][29][30][31]. However, only two studies have specifically compared different diffusion acquisition schemes for liver imaging (28,30). The first study (28) included a population of patients with liver lesions, and compared image quality and ADC of free breathing versus BH DWI. The second study included healthy volunteers, and compared BH, free breathing and respiratory triggered DWI (without navigator echoes) (30). There are, however, no reports on the use of a...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Taouli

Sandberg

Stemmer

et al. 2009

Magnetic Resonance Imaging

147

122

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“…The acquisition of "black blood" images with DW SS-EP sequences makes it possible to easily differentiate vessels from focal small-sized lesions in the liver [8,9] . Parallel techniques reduce artifacts, such as "blurring" or magnetic susceptibility artifacts, increasing the signal-to-noise ratio (SNR) [10,11] ; moreover, respiratory-triggered sequences offer a better possibility of SNR compared to breath-hold techniques [12] . Many studies have recently started to compare DWI to T1-weighted acquisition in the detection and characterization of liver lesions [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Palmucci

Mauro²,

Messina³

et al. 2012

WJR

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AIM:To evaluate the role of diffusion-weighted imaging (�WI) in the detection of focal liver lesions (FLLs), using a conventional magnetic resonance imaging (MRI) protocol. METHODS:Fifty-two patients (22 males, average age 55.6 years, range: 25-82 years), studied using a 1.5 Tesla magnetic resonance scanner, were retrospectively analyzed; detection of FLLs was evaluated by considering the number of lesions observed with the following sequences: (1) respiratory-triggered diffusion-weighted single-shot echo-planar (�W SS-EP) sequences; (2) fat-suppressed fast spin-echo (fs-FSE) T2 weighted sequences; (3) steady-state free precession (SSFP) images; and (4) dynamic triphasic gadolinium-enhanced images, acquired with three-dimensional fast spoiled gradient-echo (3� FSPGR). Two radiologists independently reviewed the images: they were blinded to their respective reports. �W SS-EP sequences were compared to fs-FSE, SSFP and dynamic gadolinium-enhanced acquisitions using a t -test. Pairs were compared for the detection of: (1) all FLLs; (2) benign FLLs; (3) malignant FLLs; (4) metastases; and (5) hepatocellular carcinoma (HCC). RESULTS:Interobserver agreement was very good (weighted k = 0.926, CI = 0.880-0.971); on the consensus reading, 277 FLLs were detected. In the comparison with fs-FSE, DW SS-EP sequences had a significantly higher score in the detection of all FLLs, benign FLLs, malignant FLLs and metastases; no statistical difference was observed in the detection of hepatocellular carcinoma (HCCs). In the comparison with SSFP sequences, DW SS-EP had significantly higher scores (P < 0.05) in the detection of all lesions, benign lesions, malignant lesions, metastases and HCC. All FLLs were better detected by dynamic 3� FSGR enhanced acquisition, with P = 0.0023 for reader 1 and P = 0.0086 for reader 2 in the comparison with �W SS-EP sequences; with reference to benign FLLs, �W SS-EP showed lower values than 3� FSPGR enhanced acquisition (P < 0.05). No statistical differences were observed in the detection of malignant lesions and metastases; considering HCCs, a very slight difference was reported by reader 1 (P = 0.049), whereas no difference was found by reader 2 (P = 0.06). CONCLUSION:In lesion detection, �WI had higher scores than T2 sequences; considering malignant FLLs, no statistical difference was observed between �WI and dynamic gadolinium images.

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Diffusion Weighted Imaging in Cancer

Messiou

deSouza

1996

eMagRes

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Diagnosis of Hepatic Metastasis: Comparison of Respiration-Triggered Diffusion-Weighted Echo-Planar MRI and Five T2-Weighted Turbo Spin-Echo Sequences

Abstract: 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.

Cited by 132 publications

References 33 publications

Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Diffusion‐weighted imaging of the liver: Comparison of navigator triggered and breathhold acquisitions

Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Diffusion Weighted Imaging in Cancer

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