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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, Sarah; Ambros, Raphael; Messner, Alina; Kristic, Antonia; Hodge, Jacqueline C; Bastati, Nina; Schima, Wolfgang; Chernyak, Victoria; Bashir, Mustafa R; Ba-Ssalamah, Ahmed.
Afiliación
  • Poetter-Lang S; Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria.
  • Ambros R; Department of Diagnostic and Interventional Radiology, Clinic Donaustadt, Vienna Healthcare Group, Vienna, Austria.
  • Messner A; Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria.
  • Kristic A; Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria.
  • Hodge JC; Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria.
  • Bastati N; Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria.
  • Schima W; Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Vienna, Austria.
  • Chernyak V; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
  • Bashir MR; Department of Radiology, Duke University Medical Center, Durham, NC, USA.
  • Ba-Ssalamah A; Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria. ahmed.ba-ssalamah@meduniwien.ac.at.
Eur Radiol ; 34(8): 5215-5227, 2024 Aug.
Article en En | MEDLINE | ID: mdl-38243134
ABSTRACT

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 11 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 11, 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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Imagen por Resonancia Magnética / Artefactos / Medios de Contraste / Gadolinio DTPA Tipo de estudio: Etiology_studies / Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Eur Radiol Asunto de la revista: RADIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Alemania

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Imagen por Resonancia Magnética / Artefactos / Medios de Contraste / Gadolinio DTPA Tipo de estudio: Etiology_studies / Observational_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Eur Radiol Asunto de la revista: RADIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Alemania