Motion and solution in hepatobiliary agent-enhanced dynamic MRI: solid evidence and unanswered question

Takehara, Yasuo

doi:10.1007/s11604-019-00900-9

Cited by 2 publications

(1 citation statement)

References 11 publications

(12 reference statements)

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“…Using fluoroscopic triggering rather than the test bolus technique, we injected 1:1 saline-diluted GA at 1 ml/s, evaluating AP images for artifacts, acquisition timing, and hypervascular lesion visibility. Furthermore, we also wished to see how well TA and TSM could be distinguished [ 3 , 4 , 16 – 18 ] since visually, TSM artifacts extend beyond the abdominal wall, typically occurring in the phase-encoding direction [ 19 ] and cause blurring at organ boundaries [ 3 , 4 , 16 – 18 ], while TA or Gibbs phenomenon appears as a ringing artifact confined to the abdomen [ 9 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Are dilution, slow injection and care bolus technique the causal solution to mitigating arterial-phase artifacts on gadoxetic acid–enhanced MRI? A large-cohort study

Poetter-Lang,

Ambros,

Messner

et al. 2024

Eur Radiol

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Objective Arterial-phase artifacts are gadoxetic acid (GA)–enhanced MRI’s major drawback, ranging from 5 to 39%. We evaluate the effect of dilution and slow injection of GA using automated fluoroscopic triggering on liver MRI arterial-phase (AP) acquisition timing, artifact frequency, and lesion visibility. Methods and materials Saline-diluted 1:1 GA was injected at 1 ml/s into 1413 patients for 3 T liver MRI. Initially, one senior abdominal radiologist, i.e., principal investigator (PI), assessed all MR exams and compared them to previous and follow-up images, as well as the radiology report on record, determining the standard of reference for lesion detection and characterization. Then, three other readers independently evaluated the AP images for artifact type (truncation (TA), transient severe motion (TSM) or mixed), artifact severity (on a 5-point scale), acquisition timing (on a 4-point scale) and visibility (on a 5-point scale) of hypervascular lesions ≥ 5 mm, selected by the PI. Artifact score ≥ 4 and artifact score ≤ 3 were considered significant and non-significant artifacts, respectively. Results Of the 1413 exams, diagnostic-quality arterial-phase images included 1100 (77.8%) without artifacts, 220 (15.6%) with minimal, and 77 (5.4%) with moderate artifacts. Only 16 exams (1.1%) had significant artifacts, 13 (0.9%) with severe artifacts (score 4), and three (0.2%) non-diagnostic artifacts (score 5). AP acquisition timing was optimal in 1369 (96.8%) exams. Of the 449 AP hypervascular lesions, 432 (96.2%) were detected. Conclusion Combined dilution and slow injection of GA with MR results in well-timed arterial-phase images in 96.8% and a reduction of exams with significant artifacts to 1.1%. Clinical relevance statement Hypervascular lesions, in particular HCC detection, hinge on arterial-phase hyperenhancement, making well-timed, artifact-free arterial-phase images a prerequisite for accurate diagnosis. Saline dilution 1:1, slow injection (1 ml/s), and automated bolus triggering reduce artifacts and optimize acquisition timing. Key Points • There was substantial agreement among the three readers regarding the presence and type of arterial-phase (AP) artifacts, acquisition timing, and lesion visibility. • Impaired AP hypervascular lesion visibility occurred in 17 (3.8%) cases; in eight lesions due to mistiming and in nine lesions due to significant artifacts. • When AP timing was suboptimal, it was too late in 40 exams (3%) and too early in 4 exams (0.2%) of exams.

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