Elsevier

Magnetic Resonance Imaging

Volume 61, September 2019, Pages 116-123
Magnetic Resonance Imaging

Original contribution
Gadoxetate acid disodium-enhanced MRI: Multiple arterial phases using differential sub-sampling with cartesian ordering (DISCO) may achieve more optimal late arterial phases than the single arterial phase imaging

https://doi.org/10.1016/j.mri.2019.05.033Get rights and content

Abstract

Background

To prospectively determine whether the use of a multiple arterial phase imaging (DISCO) improve the capturing rate of late arterial phase with less motion artifact than single arterial phase obtained with gadoxetate acid disodium.

Materials and methods

From 06/2017 to 10/2018, prospectively acquired data of 132 patients who underwent either single (n = 67) or multiple arterial phase (n = 65) gadoxetate acid-enhanced MR imaging were analyzed. Two readers independently assessed arterial phase timing and the degree of motion artifact using a five-point scale. The kappa test was used to determine the agreement between the two readers, χ2 or fisher exact test were used for the categorical variables and Student t-test or Mann-Whitney U test were used for the comparison of the motion artifacts.

Results

Good to perfect inter-observer agreement was obtained for the arterial phase timing and degree of motion artifact (all kappa value >0.70). Optimal timing of arterial phase was observed in 95.4% (62/65) of multiple arterial phase compared with 73.1% (49/67) of single arterial phase (χ2 = 12.209, p < 0.001). Motion artifact score of the late arterial phase images measured using single arterial phase acquisition (3.22 ± 0.68) was significantly higher than the multiple arterial phase (2.42 ± 0.74) group (t = 5.921, p < 0.001). For the multiple arterial phase comparison, motion artifact score of the 2nd, 3rd and 4th phases were also significant reduced compared with 1st, 5th and 6th phases (all p < 0.05).

Conclusion

The use of multiple arterial phase acquisition with gadoxetate acid disodium can improve the capturing rate of well-timed late arterial phase with less motion artifact.

Introduction

Gadoxetate acid disodium is a widely used hepatobiliary specific contrast agents which can offer the hepatobiliary phase (HBP) in addition to the early dynamic phases obtained with other conventional extracellular gadolinium-based contrast media (GBCM), thus, enables more accurate detection, characterization of focal liver lesions [[1], [2], [3], [4]]. However, accumulative evidences have shown that gadoxetate acid disodium yielded poorer arterial phase images compared with other conventional GBCM due to the high frequency happening of the transient severe motion that caused the severe motion artifacts [[5], [6], [7]]. Several strategies have been used to reduce the severe motion artifacts, including low injection rate, contrast dilution, shorten the scanning time and modified breath-holding method [[8], [9], [10], [11], [12]]. Of all these strategies, the data acquisition method was mainly based on the single arterial phase acquisition and once the transient severe motion occurs, the image quality cannot be guaranteed.

Differential sub-sampling with cartesian ordering (DISCO) is a high spatial-temporal resolution dynamic contrast-enhanced magnetic resonance (MR) technique that combines multiple features: a dual echo spoiled gradient echo (SPGR) acquisition for DIXON water-fat separation, a pseudo-random variable density k-space segmentation, parallel imaging and a view sharing reconstruction [13,14]. It offers the advantage of high imaging speed as the central k-space region were fully sampled every time while the outer regions were sub-sampled with a pseudo-random scheme [13]. Compared with the T1-weighted three-dimensional (3D) SPGR referred as LAVA-Flex sequence which was often used for single arterial phase acquisition, DISCO can achieve multiple arterial phase acquisitions in a single breath-hold period without sacrificing spatial resolution. Thus, with DISCO acquisition, it is high likely that at least one motion-free arterial phase image can be guaranteed. Furthermore, DISCO may also have the potential to increase the chance of capturing rate of the late arterial phase image as which is critical for the diagnosis of hepatocellular carcinoma (HCC) and other hypervascular metastasis [14]. To our knowledge, few studies have investigated the clinical benefit of multiple arterial phase images with DISCO in comparison with single arterial phase images in terms of the capturing rate of well-timed late arterial phase and reduce the motion artifact with gadoxetate acid-enhanced MR to date.

The purpose of this study was to prospectively determine the usefulness of multiple arterial phase imaging using DISCO can provide arterial phase images with less motion artifact and improve the capturing rate of well-timed late arterial phase in comparison to single arterial phase with gadoxetate acid-enhanced MR imaging.

Section snippets

Participants

This study was approved by the institutional review board, and written informed consent was obtained from all patients. Between June 2017 and October 2018, a total of 175 patients who were suspected of having malignant focal hepatic lesions identified with ultrasonography or computed tomography (CT) underwent with preoperative gadoxetate acid-enhanced MR examination. A simple randomization was conducted before the MR examination according to random number table and all the patients were

Clinicopathologic characteristics

The final population included for analysis consisted of 132 patients (mean age, 51.66 ± 11.98 years; range, 24–75 years), including 90 men (51.63 ± 11.42 years; range, 33–75 years) and 42 women (51.71 ± 13.28 years; range, 25–69 years). Of these, 65 patients (51.52 ± 11.94 years) including 67 tumors (6.46 ± 3.98 cm) underwent with the multiple arterial phase imaging with DISCO acquisition and 67 patients (51.79 ± 12.13 years) including 72 tumors (6.72 ± 3.72 cm) underwent with the single

Discussion

The results of this study demonstrated that the use of multiple arterial phase acquisition with DISCO captured well-timed hepatic late arterial phase images more frequently than single arterial phase imaging with LAVA-Flex. Furthermore, less motion artifacts were also observed of the late arterial phase images using multiple arterial phase imaging compared with the single arterial phase imaging. Thus, multiple hepatic arterial phase acquisition may result in more optimal late arterial phase and

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    These authors contributed equally to this work.

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