Multiarterial Phase Acquisition in Gadoxetic Acid–Enhanced Liver MRI for the Detection of Hypervascular Hepatocellular Carcinoma in High-Risk Patients

Abstract

The aim of this study was to compare compressed sensing (CS) and view sharing (VS) techniques for single breath-hold multiarterial phase imaging with respect to image quality and focal liver observation detectability during gadoxetic acid-enhanced magnetic resonance imaging in patients at high risk for hepatocellular carcinoma (HCC). Materials and Methods: A total of 385 patients who underwent gadoxetic acidenhanced magnetic resonance imaging, including triple arterial phases using either CS (n = 224) or VS (n = 161) techniques, were retrospectively included. Among them, 117 patients had 171 focal liver observations (median diameter, 1.3 cm), which were classified according to Liver Imaging Reporting and Data System version 2018. The acquisition rate of optimally timed late arterial phase (LAP) was assessed, and image quality, including respiratory motion artifact and observation conspicuity, was rated on a 4-point scale by 3 radiologists. The Mann-Whitney U test and nonparametric test for repeated measures data were used for image quality and observation conspicuity analysis. The jackknife alternative free-response receiver operating characteristics method was used to compare the observation detectability between the 2 techniques. Results: The CS technique showed significantly higher acquisition rate of optimally timed LAP without transient severe motion (82.1% [184/224] vs 71.4% [115/161]; P = 0.013) than the VS technique. The CS technique also demonstrated significantly improved overall image quality (3.42 ± 0.70 vs 2.97 ± 0.61; P < 0.001) compared with the VS technique. Regarding the detection of hyperenhancing observations, there was no significant difference between the figure of merits of CS and VS techniques (0.660 vs 0.665; P = 0.890). However, the CS technique showed a higher detection rate in Liver Imaging Reporting and Data System M (LR-M, probably or definitely malignant but not HCC specific) observations than the VS technique (100.0% [9/9] vs 44.4% [8/18]; P = 0.009). Conclusion:The CS technique tended to provide optimally timed LAP without transient severe motion and demonstrated greater detection rate of LR-M observations than the VS technique in patients at high risk of HCC.

Strategies and Techniques for Liver Magnetic Resonance Imaging: New and Pending Applications for Routine Clinical Practice

“…Rapid imaging techniques may facilitate adherence to this timeframe. For example, compressed sensing-based rapid imaging has been successfully adopted for T1-weighted imaging in full MRI protocols [ 55 ]. Deep-learning-based T2- or diffusion-weighted imaging may shorten acquisition times while simultaneously improving image quality and lesion detection [ 56 57 58 ].…”

Multiple arterial‐phase MRI with gadoxetic acid improves diagnosis of hepatocellular carcinoma ≤3.0 cm

“…Because multiple arterial‐phase images were obtained on the basis of peak aortic enhancement determined by test bolus injection, and the acquisition time in our study was shorter than that in a previous study (14 vs. 23 s), 12 the probability of optimal arterial‐phase timing may have been higher, and the probability of image distortion by motion artefact lower. Furthermore, considering that several new MRI techniques such as compressed sensing or compressed sensing with parallel imaging, and non‐cartesian imaging techniques such as golden‐angle radial sparse parallel imaging are under investigation, 30–33 further promising results for MA‐MRI can be expected.…”

“…Furthermore, considering that several new MRI techniques such as compressed sensing or compressed sensing with parallel imaging, and non-cartesian imaging techniques such as golden-angle radial sparse parallel imaging are under investigation, [30][31][32][33] further promising results for MA-MRI can be expected.…”

Gadoxetic Acid–Enhanced Liver MRI

“…Multiphasic AP imaging may assist in overcoming this problem by providing 1 or more image sets with minimal artifacts and adequate AP scan timing. 79,80 Free-breathing dynamic MRI with stack-of-stars acquisition can help produce continuous images from the AP to the PVP and TP in a single scan; therefore, the scan timing is not a concern. 81,82 In patients able to hold their breath, free-breathing dynamic MRI with stack-of-stars acquisition may not yield images of higher quality versus breath-holding Cartesian sampling and multiphasic AP imaging.…”

“…Half of the injection volume is used for GA versus GBCAs; this results in a shorter duration, allowing optimal scan timing of the AP. Multiphasic AP imaging may assist in overcoming this problem by providing 1 or more image sets with minimal artifacts and adequate AP scan timing 79,80 . Free-breathing dynamic MRI with stack-of-stars acquisition can help produce continuous images from the AP to the PVP and TP in a single scan; therefore, the scan timing is not a concern 81,82 .…”