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Jia X, Li X, Wei X, Sun J, Han Y, Guo M, Tong W, Qu Y, Zhu S, Guo J. Reducing transient severe motion artifacts of gadoxetate disodium-enhanced MRI by oxygen inhalation: effective for pleural effusion but not ascites. Abdom Radiol (NY) 2024; 49:4584-4591. [PMID: 38995402 DOI: 10.1007/s00261-024-04465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/12/2024] [Accepted: 06/15/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To evaluate the efficacy of low-flow oxygen inhalation in mitigating transient severe motion (TSM) artifacts associated with gadoxetate disodium-enhanced hepatic magnetic resonance imaging (MRI). METHODS Patients undergoing gadoxetate disodium-enhanced MRI were included. During the examination, the experimental group received oxygen at 2 L/min via nasal cannula, while the control group did not. Images and TSM scores were evaluated and compared across precontrast, arterial, venous, and hepatobiliary phases. Subgroup analyses were conducted based on the presence of pleural effusion or ascites. RESULTS A total of 325 patients were included. The motion scores were highest in the arterial phase and lowest in the hepatobiliary phase in both groups, but were significantly lower in the experimental group (p < 0.05). The incidence of TSM was significantly lower in the experimental group (3.29%) compared to the control group (13.29%, p = 0.01). While pleural effusion was associated with reduced image quality in both groups (p < 0.05), the image quality in the pleural effusion category was higher in the experimental group than in the control group. Oxygen inhalation showed limited efficacy in mitigating TSM related to ascites. CONCLUSIONS Low-flow oxygen inhalation can effectively reduce the occurrence of gadoxetate disodium-related TSM. Pleural effusion may impair respiratory function and contribute to TSM, which can be alleviated by oxygen supplementation. However, Oxygen inhalation is less effective under the condition of ascites.
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Affiliation(s)
- Xiaoqian Jia
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Xianjun Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Xiaocheng Wei
- MR Research China, GE Healthcare, Beijing, 100176, China
| | - Jingtao Sun
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Yangyang Han
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Ming Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Wei Tong
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Yuan Qu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Shumeng Zhu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
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Yun SM, Hong SB, Lee NK, Kim S, Ji YH, Seo HI, Park YM, Noh BG, Nickel MD. Deep learning-based image reconstruction for the multi-arterial phase images: improvement of the image quality to assess the small hypervascular hepatic tumor on gadoxetic acid-enhanced liver MRI. Abdom Radiol (NY) 2024; 49:1861-1869. [PMID: 38512517 DOI: 10.1007/s00261-024-04236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To evaluated the impact of a deep learning (DL)-based image reconstruction on multi-arterial-phase magnetic resonance imaging (MA-MRI) for small hypervascular hepatic masses in patients who underwent gadoxetic acid-enhanced liver MRI. METHODS We retrospectively enrolled 55 adult patients (aged ≥ 18 years) with small hepatic hypervascular mass (≤ 3 cm) between December 2022 and February 2023. All patients underwent MA-MRI, subsequently reconstructed with a DL-based application. Qualitative assessment with Linkert scale including motion artifact (MA), liver edge (LE), hepatic vessel clarity (HVC) and image quality (IQ) was performed. Quantitative image analysis including signal to noise ratio (SNR), contrast to noise ratio (CNR) and noise was performed. RESULTS On both arterial phases (APs), all qualitative parameters were significantly improved after DL-based image reconstruction. (LE on 1st AP, 1.22 vs 1.61; LE on 2nd AP, 1.21 vs 1.65; HVC on 1st AP, 1.24 vs 1.39; HVC on 2nd AP, 1.24 vs 1.44; IQ on 1st AP, 1.17 vs 1.45; IQ on 2nd AP, 1.17 vs 1.47, all p values < 0.05). The SNR, CNR and noise were significantly improved after DL-based image reconstruction. (SNR on AP1, 279.08 vs 176.14; SNR on AP2, 334.34 vs 199.24; CNR on AP1, 106.09 vs 64.14; CNR on AP2, 129.66 vs 73.73; noise on AP1, 1.51 vs 2.33; noise on AP2, 1.45 vs 2.28, all p values < 0.05). CONCLUSIONS Gadoxetic acid-enhanced MA-MRI with DL-based image reconstruction improved the qualitative and quantitative parameters. Despite the short acquisition time, high-quality MA-MRI is now achievable.
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Affiliation(s)
- Su Min Yun
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
- Department of Radiology and Research Institute of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Korea.
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yea Hee Ji
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Mok Park
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byeong Gwan Noh
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Gatti M, Maino C, Darvizeh F, Serafini A, Tricarico E, Guarneri A, Inchingolo R, Ippolito D, Ricardi U, Fonio P, Faletti R. Role of gadoxetic acid-enhanced liver magnetic resonance imaging in the evaluation of hepatocellular carcinoma after locoregional treatment. World J Gastroenterol 2022; 28:3116-3131. [PMID: 36051340 PMCID: PMC9331537 DOI: 10.3748/wjg.v28.i26.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Locoregional treatments, as alternatives to surgery, play a key role in the management of hepatocellular carcinoma (HCC). Liver magnetic resonance imaging (MRI) enables a multiparametric assessment, going beyond the traditional dynamic computed tomography approach. Moreover, the use of hepatobiliary agents can improve diagnostic accuracy and are becoming important in the diagnosis and follow-up of HCC. However, the main challenge is to quickly identify classical responses to loco-regional treatments in order to determine the most suitable management strategy for each patient. The aim of this review is to provide a summary of the most common and uncommon liver MRI findings in patients who underwent loco-regional treatments for HCC, with a special focus on ablative therapies (radiofrequency, microwaves and cryoablation), trans-arterial chemoembolization, trans-arterial radio-embolization and stereotactic ablative radiotherapy techniques, considering the usefulness of gadoxetate disodium (Gd-EOB-DTPA) contrast agent.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, University of Milano-Bicocca, Monza 20900, Italy
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Italy
| | | | - Eleonora Tricarico
- Department of Radiology, "F. Perinei" Hospital, Altamura (BA) 70022, Italy
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti (BA) 70021, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, University of Milano-Bicocca, Monza 20900, Italy
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Umberto Ricardi
- Department of Oncology, University of Turin, Turin 10126, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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Gatti M, Maino C, Tore D, Carisio A, Darvizeh F, Tricarico E, Inchingolo R, Ippolito D, Faletti R. Benign focal liver lesions: The role of magnetic resonance imaging. World J Hepatol 2022; 14:923-943. [PMID: 35721295 PMCID: PMC9157713 DOI: 10.4254/wjh.v14.i5.923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/07/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
Liver lesions are common findings in radiologists' daily routine. They are a complex category of pathology that range from solitary benign lesions to primary liver cancer and liver metastases. Benign focal liver lesions can arise from different liver cell types: Epithelial (hepatocytes and biliary cells) and nonepithelial (mesenchymal cells). Liver magnetic resonance imaging (MRI) is a fundamental radiological method in these patients as it allows with its multiparametric approach optimal non-invasive tissue characterization. Furthermore, advanced liver MRI techniques such as diffusion-weighted imaging and hepatobiliary contrast agents have improved the detection of focal liver lesions and can be highly effective in differentiating pseudotumor from tumors, as well as benign from malignant lesions, and can also be used for differential diagnosis. Although histological examination can be useful in making a definitive diagnosis, MRI is an important modality in the diagnosis of liver lesions with a significant impact on patient care. This aim of this review is to provide a comprehensive overview of benign liver lesions on MRI.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy.
| | - Cesare Maino
- Department of Diagnostic Radiology, Ospedale San Gerardo, Monza 20900, Italy
| | - Davide Tore
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Andrea Carisio
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Fatemeh Darvizeh
- School of Medicine, Vita-Salute San Raffaele University, Milan 20121, Japan
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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Kim DW, Choi SH, Park T, Kim SY, Lee SS, Byun JH. Transient Severe Motion Artifact on Arterial Phase in Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging: A Systematic Review and Meta-analysis. Invest Radiol 2022; 57:62-70. [PMID: 34224484 DOI: 10.1097/rli.0000000000000806] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to determine the incidence of transient severe motion artifact (TSM) on arterial phase gadoxetic acid-enhanced magnetic resonance imaging of the liver and to investigate the causes of heterogeneity in the published literature. MATERIALS AND METHODS Original studies reporting the incidence of TSM were identified in searches of PubMed, Embase, and Cochrane Library databases. The pooled incidence of TSM was calculated using random-effects meta-analysis of single proportions. Subgroup analyses were conducted to explore causes of heterogeneity. RESULTS A total of 24 studies were finally included (single arterial phase, 19 studies with 3065 subjects; multiple arterial phases, 8 studies with 2274 subjects). Studies using single arterial phase imaging reported individual TSM rates varying from 4.8% to 26.7% and a pooled incidence of TSM of 13.0% (95% confidence interval, 10.3%-16.2%), which showed substantial study heterogeneity. The pooled incidence of TSM in the studies using multiple arterial phase imaging was 3.2% (95% confidence interval, 1.9%-5.2%), which was significantly less than in those studies using single arterial phase imaging (P < 0.001). In the subgroup analysis, the geographical region of studies and the definition of TSM were found to be causes of heterogeneity. The incidence of TSM was higher in studies with Western populations from Europe or North America than in those with Eastern (Asia/Pacific) populations (16.0% vs 8.8%, P = 0.005). Regarding the definition of TSM, the incidence of TSM was higher when a 4-point scale was used for its categorization than when a 5-point scale was used (20.0% vs 11.0%, P = 0.008), and a definition considering motion artifact on phases other than arterial phase imaging lowered the incidence of TSM compared with it being defined only on arterial phase imaging (11.3% vs 20.3%, P = 0.018). CONCLUSIONS The incidence of TSM on arterial phase images varied across studies and was associated with the geographical region of studies and the definition of TSM. Careful interpretation of results reporting TSM might therefore be needed.
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Affiliation(s)
- Dong Wook Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Ichikawa S, Motosugi U, Sato K, Shimizu T, Wakayama T, Onishi H. Transient Respiratory-motion Artifact and Scan Timing during the Arterial Phase of Gadoxetate Disodium-enhanced MR Imaging: The Benefit of Shortened Acquisition and Multiple Arterial Phase Acquisition. Magn Reson Med Sci 2021; 20:280-289. [PMID: 32863326 PMCID: PMC8424022 DOI: 10.2463/mrms.mp.2020-0064] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose: To investigate whether shortened acquisition or multiple arterial phase acquisition improves image quality of the arterial phase compared with conventional protocol. Methods: This retrospective study was approved by the relevant Institutional Review Board. A total of 615 consecutive patients who underwent gadoxetate disodium-enhanced MRI including one of the following three sequences in three different periods were included: (i) conventional liver acquisition with volume acceleration (LAVA) (between October 2014 and January 2015, n = 149), (ii) Turbo-LAVA (between March and August 2016, n = 216), and (iii) differential sub-sampling with Cartesian ordering (DISCO) (between January and September 2015, n = 250). We monitored the respiratory bellows waveform during breath holding for each patient and recorded breath-hold fidelity of the patients. Two radiologists independently evaluated the degree of respiratory artifact and scan timing on the arterial phase and compared them between the three protocols (i.e., conventional LAVA, Turbo-LAVA, and DISCO), with conventional LAVA as control. Results: The ratio of patients with breath-hold failure was not significantly different among the three protocols (P = 0.6340 and 0.1085). Respiratory artifact was significantly lower in DISCO than in conventional LAVA (P = 0.0424), while there was no significant difference between Turbo-LAVA and conventional LAVA (P = 0.2593). The ratio of adequate scan timing and diagnosable image defined as no or mild artifact and adequate scan timing were higher in DISCO than in conventional LAVA (P = 0.0025 and 0.0019), while there was no significant difference between Turbo-LAVA and conventional LAVA (P = 0.0780 and 0.0657). Conclusion: Compared with conventional protocol, multiple arterial phase acquisition (DISCO) obtained a higher number of diagnosable images by reducing respiratory motion artifact and optimizing the scan timing of arterial phase.
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Affiliation(s)
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi.,Department of Diagnostic Radiology, Kofu Kyoritsu Hospital
| | - Kazuyuki Sato
- Division of Radiology, University of Yamanashi Hospital
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Glessgen CG, Breit HC, Block TK, Merkle EM, Heye T, Boll DT. Respiratory anomalies associated with gadoxetate disodium and gadoterate meglumine: compressed sensing MRI revealing physiologic phenomena during the entire injection cycle. Eur Radiol 2021; 32:346-354. [PMID: 34324024 PMCID: PMC8660712 DOI: 10.1007/s00330-021-08114-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The goal of this study was to investigate the precise timeline of respiratory events occurring after the administration of two gadolinium-based contrast agents, gadoxetate disodium and gadoterate meglumine. MATERIALS AND METHODS This retrospective study examined 497 patients subject to hepatobiliary imaging using the GRASP MRI technique (TR/TE = 4/2 ms; ST = 2.5 mm; 384 × 384 mm). Imaging was performed after administration of gadoxetate (N = 338) and gadoterate (N = 159). All GRASP datasets were reconstructed using a temporal resolution of 1 s. Four regions-of-interest (ROIs) were placed in the liver dome, the right and left cardiac ventricle, and abdominal aorta detecting liver displacement and increasing vascular signal intensities over time. Changes in hepatic intensity reflected respiratory dynamics in temporal correlation to the vascular contrast bolus. RESULTS In total, 216 (67%) and 41 (28%) patients presented with transient respiratory motion after administration of gadoxetate and gadoterate, respectively. The mean duration from start to acme of the respiratory episode was similar (p = 0.4) between gadoxetate (6.0 s) and gadoterate (5.6 s). Its mean onset in reference to contrast arrival in the right ventricle differed significantly (p < 0.001) between gadoxetate (15.3s) and gadoterate (1.8 s), analogously to peak inspiration timepoint in reference to the aortic enhancement arrival (gadoxetate: 0.9s after, gadoterate: 11.2 s before aortic enhancement, p < 0.001). CONCLUSIONS The timepoint of occurrence of transient respiratory anomalies associated with gadoxetate disodium and gadoterate meglumine differs significantly between both contrast agents while the duration of the event remains similar. KEY POINTS • Transient respiratory anomalies following the administration of gadoterate meglumine occurred during a time period usually not acquired in MR imaging. • Transient respiratory anomalies following the administration of gadoxetate disodium occurred around the initiation of arterial phase imaging. • The estimated duration of respiratory events was similar between both contrast agents.
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Affiliation(s)
| | | | - Tobias Kai Block
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, USA
| | - Elmar Max Merkle
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Tobias Heye
- Department of Radiology, University Hospital Basel, Basel, Switzerland
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Ippolito D, Maino C, Pecorelli A, Riva L, Querques G, Talei Franzesi C, Sironi S. Influence of injection rate in determining the development of artifacts during the acquisition of dynamic arterial phase in Gd-EOB-DTPA MRI studies. MAGMA (NEW YORK, N.Y.) 2021; 34:133-140. [PMID: 32562201 DOI: 10.1007/s10334-020-00857-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess whether different Gd-EOB-DTPA injection rates could influence the development of artifacts during the arterial phase of liver MRI studies. MATERIALS AND METHODS All Gd-EOB-DTPA liver MRI studies performed for different clinical indications at a single tertiary referral center were retrospectively evaluated. Each examination was acquired on a 1.5 T scanner with T1 In- and Out-of-Phase, T2 with and without fat-saturation, DWI, and 3D-T1 fat-sat dynamic sequences. Patients were divided into two groups according to the injection rate (1 ml/s and 1.5 ml/s). A single radiologist recorded the presence or absence of artifacts during different acquisition phases, respectively: (1) all examination; (2) only during the arterial phase; (3) only during the portal-venous phase; (4) both in arterial and portal-venous phases. From a total of 748 MRI studies performed, 229 were excluded due to the presence of artifacts during the entire examination. The remaining 519 MRI studies were divided into two groups according to the injection rate. RESULTS The first group (flow rate = 1 ml/s) was composed by 312 (60.1%) patients and the second group (flow rate = 1.5 ml/s) by 207 (39.9%) patients. In the first group, 2 (0.6%) patients showed artifacts in all dynamic sequences; 13 (4%) only in the arterial phase, 16 (5%) only in the portal-venous phase, and 38 (12%) both in arterial and portal-venous phases; a total of 243 (78%) showed no artifacts. In the second group, 3 (1.5%) patients had artifacts in all dynamic sequences, 82 (40%) only in the arterial phase, 20 (10%) only in the portal-venous phase, and 53 (25%) both in arterial and portal-venous phases; a total of 49 (23.5%) showed no artifacts. A significant difference between the two groups regarding the absence of artifacts in all examination and the presence of artifacts only during the arterial phase was found (p < 0.001). CONCLUSION The development of artifacts during the arterial phase of Gd-EOB-DTPA liver MRI studies could be related to the injection rate and its reduction may help to decrease the incidence of artifacts.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Cesare Maino
- Department of Diagnostic Radiology, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Luca Riva
- Department of Diagnostic Radiology, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Giulia Querques
- Department of Diagnostic Radiology, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, University of Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, Papa Giovanni XIII Hospital, Piazza OMS 1, 24127, Bergamo, BG, Italy
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9
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Inchingolo R, Maino C, Gatti M, Tricarico E, Nardella M, Grazioli L, Sironi S, Ippolito D, Faletti R. Gadoxetic acid magnetic-enhanced resonance imaging in the diagnosis of cholangiocarcinoma. World J Gastroenterol 2020; 26:4261-4271. [PMID: 32848332 PMCID: PMC7422539 DOI: 10.3748/wjg.v26.i29.4261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/16/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
The use of liver magnetic resonance imaging is increasing thanks to its multiparametric sequences that allow a better tissue characterization, and the use of hepatobiliary contrast agents. This review aims to evaluate gadoxetic acid enhanced magnetic resonance imaging in the diagnosis and staging of cholangiocarcinoma and its different clinical and radiological classifications proposed in the literature. We also analyze the epidemiology, risk factors in correlation with clinical findings and laboratory data.
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Affiliation(s)
- Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
| | - Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
| | - Eleonora Tricarico
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Michele Nardella
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Luigi Grazioli
- Department of Radiology, Spedali Civili, University of Brescia, Brescia 25123, Italy
| | - Sandro Sironi
- Department of radiology, Papa Giovanni XXIII Hospital, University Milano-Bicocca, Bergamo 20110, Italy
| | - Davide Ippolito
- Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, Monza 20900, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Turin 10126, Italy
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Kromrey ML, Tamada D, Johno H, Funayama S, Nagata N, Ichikawa S, Kühn JP, Onishi H, Motosugi U. Reduction of respiratory motion artifacts in gadoxetate-enhanced MR with a deep learning-based filter using convolutional neural network. Eur Radiol 2020; 30:5923-5932. [PMID: 32556463 PMCID: PMC7651696 DOI: 10.1007/s00330-020-07006-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/17/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022]
Abstract
Objectives To reveal the utility of motion artifact reduction with convolutional neural network (MARC) in gadoxetate disodium–enhanced multi-arterial phase MRI of the liver. Methods This retrospective study included 192 patients (131 men, 68.7 ± 10.3 years) receiving gadoxetate disodium–enhanced liver MRI in 2017. Datasets were submitted to a newly developed filter (MARC), consisting of 7 convolutional layers, and trained on 14,190 cropped images generated from abdominal MR images. Motion artifact for training was simulated by adding periodic k-space domain noise to the images. Original and filtered images of pre-contrast and 6 arterial phases (7 image sets per patient resulting in 1344 sets in total) were evaluated regarding motion artifacts on a 4-point scale. Lesion conspicuity in original and filtered images was ranked by side-by-side comparison. Results Of the 1344 original image sets, motion artifact score was 2 in 597, 3 in 165, and 4 in 54 sets. MARC significantly improved image quality over all phases showing an average motion artifact score of 1.97 ± 0.72 compared to 2.53 ± 0.71 in original MR images (p < 0.001). MARC improved motion scores from 2 to 1 in 177/596 (29.65%), from 3 to 2 in 119/165 (72.12%), and from 4 to 3 in 34/54 sets (62.96%). Lesion conspicuity was significantly improved (p < 0.001) without removing anatomical details. Conclusions Motion artifacts and lesion conspicuity of gadoxetate disodium–enhanced arterial phase liver MRI were significantly improved by the MARC filter, especially in cases with substantial artifacts. This method can be of high clinical value in subjects with failing breath-hold in the scan. Key Points • This study presents a newly developed deep learning–based filter for artifact reduction using convolutional neural network (motion artifact reduction with convolutional neural network, MARC). • MARC significantly improved MR image quality after gadoxetate disodium administration by reducing motion artifacts, especially in cases with severely degraded images. • Postprocessing with MARC led to better lesion conspicuity without removing anatomical details.
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Affiliation(s)
- M-L Kromrey
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
| | - D Tamada
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - H Johno
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - S Funayama
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - N Nagata
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - S Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - J-P Kühn
- Institute of Diagnostic and Interventional Radiology, University Medicine, Carl-Gustav Carus University, Dresden, Germany
| | - H Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - U Motosugi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
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Gatti M, Calandri M, Bergamasco L, Darvizeh F, Grazioli L, Inchingolo R, Ippolito D, Rousset S, Veltri A, Fonio P, Faletti R. Characterization of the arterial enhancement pattern of focal liver lesions by multiple arterial phase magnetic resonance imaging: comparison between hepatocellular carcinoma and focal nodular hyperplasia. LA RADIOLOGIA MEDICA 2020; 125:348-355. [PMID: 31916102 DOI: 10.1007/s11547-019-01127-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/27/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the features of arterial enhancement pattern of focal nodular hyperplasia (FNH) and hepatocellular carcinoma (HCC) by triple-phase arterial magnetic resonance imaging (MRI). METHODS Data were retrospectively collected from 52 consecutive patients who underwent triple-phase arterial MRI using hepatocyte-specific contrast agents (Gd-EOB-DTPA) from January 2017 to October 2017, with a MR imaging diagnosis of HCC or FNH. The images were independently assessed by two blinded readers. Contrast enhancement ratio (CER) and liver-to-lesion contrast ratio (LLCR) were calculated. The lesions were classified visually and also based on the peak of LLCR into the following groups: (1) early arterial, (2) middle arterial and (3) late arterial. Data were eventually analysed using nonparametric tests. RESULTS The CER analysis showed no significant difference between HCC and FNH patients (p > 0.05). LLCRFNH were significantly higher than LLCRHCC in the early arterial (p = 0.01), but not in the middle and late arterial phases (p = 0.20 and p = 0.82, respectively). LLCRHCC presented a meaningful increase from early to middle arterial phase (p = 0.009), whereas LLCRFNH showed a decrease from middle to late arterial phase (p = 0.004). Based on the peak of LLCR, 17 (55%) FNHs were classified into early, 11 (35%) in middle and only 3 (10%) in late arterial phase groups. Similarly, 14 (34%) HCCs were categorized into early, 13 (32%) in middle and 14 (33%) in late arterial phase groups. There was a good agreement between qualitative analysis and LLCR in 85% of cases. CONCLUSION The optimal visualization of FNH has been detected in early and middle arterial phases while HCC has been best observed during middle and late arterial phases.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Marco Calandri
- Department of Oncology, Radiology Unit, University of Torino, Turin, Italy
| | - Laura Bergamasco
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Fatemeh Darvizeh
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia "Spedali Civili", P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, 75100, Matera, Italy
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Stefano Rousset
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Andrea Veltri
- Department of Oncology, Radiology Unit, University of Torino, Turin, Italy
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy
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Wybranski C, Siedek F, Damm R, Gazis A, Wenzel O, Haneder S, Persigehl T, Steinhauser S, Pech M, Fischbach F, Fischbach K. Respiratory motion artefacts in Gd-EOB-DTPA (Primovist/Eovist) and Gd-DOTA (Dotarem)-enhanced dynamic phase liver MRI after intensified and standard pre-scan patient preparation: A bi-institutional analysis. PLoS One 2020; 15:e0230024. [PMID: 32196535 PMCID: PMC7083299 DOI: 10.1371/journal.pone.0230024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objective The objective of this study is to evaluate if intensified pre-scan patient preparation (IPPP) that comprises custom-made educational material on dynamic phase imaging and supervised pre-imaging breath-hold training in addition to standard informative conversation with verbal explanation of breath-hold commands (standard pre-scan patient preparation–SPPP) might reduce the incidence of gadoxetate disodium (Gd-EOB-DTPA)-related transient severe respiratory motion (TSM) and severity of respiratory motion (RM) during dynamic phase liver MRI. Material and methods In this bi-institutional study 100 and 110 patients who received Gd-EOB-DTPA for dynamic phase liver MRI were allocated to either IPPP or SPPP at site A and B. The control group comprised 202 patients who received gadoterate meglumine (Gd-DOTA) of which each 101 patients were allocated to IPPP or SPPP at site B. RM artefacts were scored retrospectively in dynamic phase images (1: none– 5: extensive) by five and two blinded readers at site A and B, respectively, and in the hepatobiliary phase of the Gd-EOB-DTPA-enhanced scans by two blinded readers at either site. Results The incidence of TSM was 15% at site A and 22.7% at site B (p = 0.157). IPPP did not reduce the incidence of TSM in comparison to SPPP: 16.7% vs. 21.6% (p = 0.366). This finding was consistent at site A: 12% vs. 18% (p = 0.401) and site B: 20.6% vs. 25% (p = 0.590). The TSM incidence in patients with IPPP and SPPP did not differ significantly between both sites (p = 0.227; p = 0.390). IPPP did not significantly mitigate RM in comparison to SPPP in any of the Gd-EOB-DTPA-enhanced dynamic phases and the hepatobiliary phase in patients without TSM (all p≥0.072). In the Gd-DOTA control group on the other hand, IPPP significantly mitigated RM in all dynamic phases in comparison to SPPP (all p≤0.031). Conclusions We conclude that Gd-EOB-DTPA-related TSM cannot be mitigated by education and training and that Gd-EOB-DTPA-related breath-hold difficulty does not only affect the subgroup of patients with TSM or exclusively the arterial phase as previously proposed.
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Affiliation(s)
- Christian Wybranski
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Florian Siedek
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- * E-mail:
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Angelos Gazis
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Ortrud Wenzel
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Stefan Haneder
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Susanne Steinhauser
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
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Zech CJ, Ba-Ssalamah A, Berg T, Chandarana H, Chau GY, Grazioli L, Kim MJ, Lee JM, Merkle EM, Murakami T, Ricke J, B. Sirlin C, Song B, Taouli B, Yoshimitsu K, Koh DM. Consensus report from the 8th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 2020; 30:370-382. [PMID: 31385048 PMCID: PMC6890618 DOI: 10.1007/s00330-019-06369-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/27/2019] [Accepted: 07/12/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The 8th International Forum for Liver Magnetic Resonance Imaging (MRI), held in Basel, Switzerland, in October 2017, brought together clinical and academic radiologists from around the world to discuss developments in and reach consensus on key issues in the field of gadoxetic acid-enhanced liver MRI since the previous Forum held in 2013. METHODS Two main themes in liver MRI were considered in detail at the Forum: the use of gadoxetic acid for contrast-enhanced MRI in patients with liver cirrhosis and the technical performance of gadoxetic acid-enhanced liver MRI, both opportunities and challenges. This article summarises the expert presentations and the delegate voting on consensus statements discussed at the Forum. RESULTS AND CONCLUSIONS It was concluded that gadoxetic acid-enhanced MRI has higher sensitivity for the diagnosis of hepatocellular carcinoma (HCC), when compared with multidetector CT, by utilising features of hyperenhancement in the arterial phase and hypointensity in the hepatobiliary phase (HBP). Recent HCC management guidelines recognise an increasing role for gadoxetic acid-enhanced MRI in early diagnosis and monitoring post-resection. Additional research is needed to define the role of HBP in predicting microvascular invasion, to better define washout during the transitional phase in gadoxetic acid-enhanced MRI for HCC diagnosis, and to reduce the artefacts encountered in the arterial phase. Technical developments are being directed to shortening the MRI protocol for reducing time and patient discomfort and toward utilising faster imaging and non-Cartesian free-breathing approaches that have the potential to improve multiphasic dynamic imaging. KEY POINTS • Gadoxetic acid-enhanced MRI provides higher diagnostic sensitivity than CT for diagnosing HCC. • Gadoxetic acid-enhanced MRI has roles in early-HCC diagnosis and monitoring post-resection response. • Faster imaging and free-breathing approaches have potential to improve multiphasic dynamic imaging.
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Affiliation(s)
- Christoph J. Zech
- Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Berg
- Section of Hepatology, Clinic for Neurology; Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, NY 10016 USA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY 10016 USA
| | - Gar-Yang Chau
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, 112 Taiwan
| | - Luigi Grazioli
- Department of Radiology, Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, 120-752 South Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, 110-744 South Korea
| | - Elmar M. Merkle
- Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Takamichi Murakami
- Department of Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, 650-0017 Japan
| | - Jens Ricke
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claude B. Sirlin
- Liver Imaging Group, University of California San Diego, San Diego, CA 92093-0888 USA
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041 People’s Republic of China
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology and Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574 USA
| | - Kengo Yoshimitsu
- Department of Radiology, Fukuoka University Faculty of Medicine, Fukuoka City, 801-1011 Japan
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital and The Institute of Cancer Research, London, SM2 5NG UK
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14
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Kromrey ML, Hori M, Goshima S, Kozaka K, Hyodo T, Nakamura Y, Nishie A, Tamada T, Shimizu T, Kanki A, Motosugi U. Gadoxetate disodium-related event during image acquisition: a prospective multi-institutional study for better MR practice. Eur Radiol 2019; 30:281-290. [DOI: 10.1007/s00330-019-06358-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/21/2019] [Accepted: 07/03/2019] [Indexed: 12/16/2022]
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