J Korean Soc Radiol.  2011 May;64(5):465-473. 10.3348/jksr.2011.64.5.465.

Diffusion-Weighted MR Imaging of Upper Abdomen: Comparison of Breath-Hold, Free-Breathing, and Respiratory-Triggered Techniques

• Cho KE
• Yu JS
• Chung JJ
• Kim JH
• Kim KW

• KMID: 2040815
• DOI: http://doi.org/10.3348/jksr.2011.64.5.465

Abstract

PURPOSE
To compare the image quality and stability of apparent diffusion coefficient (ADC) in diffusion-weighted MRI (DWI) of the upper abdomen among the breath-hold (BH), free-breathing (FB) and respiratory-triggered (RT) techniques.
MATERIALS AND METHODS
We analyzed the qualitative and quantitative parameters of 204 consecutive patients who underwent DWI (BH-DWI, FB-DWI or RT-DWI; n=68 in each technique). Qualitative parameters included liver contour, vascular landmarks, intra-slice homogeneity, and inter-slice discontinuity on DWI with a b-factor of 800 s/mm2 and a four-grade scale. Quantitative parameters included inter-slice or intraslice inhomogeneity of ADC in the spleen.
RESULTS
RT-DWI showed better liver contour compared to BH-DWI (p < 0.001) or FB-DWI (p = 0.001). As for the quality of the vascular landmarks, BH-DWI was inferior to FB-DWI (p = 0.025) and RT-DWI (p < 0.001). FB-DWI had the poorest result (p < 0.001) for inter-slice discontinuity compared to the other techniques. FB-DWI showed significantly larger inter-slice differences between the highest and the lowest ADCs in the spleen compared with those of RT-DWI (p < 0.001). Intra-slice homogeneity was significantly better in RT-DWI and FB-DWI than in BH-DWI (p < 0.001).
CONCLUSION
Compared with BH or FB techniques, RT-DWI appears to result in the best imaging by providing better anatomic detail without skipping continuous slices, in addition to more homogeneous ADCs.

MeSH Terms

Abdomen
Adenosine Monophosphate
Diffusion
Diffusion Magnetic Resonance Imaging
Humans
Liver
Magnetic Resonance Imaging
Spleen
Adenosine Monophosphate

Figure

• 

  Fig. 1 Representative examples of diffusion-weighted MR images of b=800 mm2/s with breath-hold, free-breathing, and respiratory-triggered methods in three different patients. A-C. Vascular landmarks are poorer on breath-hold image (A) due to the lower signal-to-noise ratio compared to the free-breathing (B) or respiratory-triggered images (C). Respiratory-triggered imaging (C) shows better overall image quality in the liver contour, especially for the left lobe, when compared to the other images.

• 

  Fig. 2 A representative example of five contiguous slices of diffusion-weighted imaging (b=800 mm2/s) with use of the free-breathing technique in a 64-year-old man with a cirrhotic liver. A-E. From (A) to (E), the axial image slices are markedly discontinuous, passing around the liver dome to right hepatic vein level. The signal intensities of the hepatic parenchyma are not homogeneous between the slices due to a serious misregistration effect during the free-breathing.

• 

  Fig. 3 Box-plots of mean inter-slice differences of apparent diffusion coefficients (ADCs) measured in the spleen on the three diffusion-weighted images of the breath-hold (BH), free-breathing (FB) and respiratory-triggered (RT) techniques. The decimal numbers on the y-axis are inter-slice differences of ADCs (×10-3 mm2/s). FB shows a significantly greater interslice difference between the highest and lowest ADCs compared to RT.

• 

  Fig. 4 A representative example of automatically calculated apparent diffusion coefficient (ADC) maps at the level of the maximum diameter of the spleens in three different patients. A-C. The region-of-interest is placed as the largest area possible in the spleen in each image by the breath-hold image (A), and shows largest standard deviation compared with free-breathing (B) or respiratory-triggered (C) images. The standard deviations of ADCs in the above images are as follows: breath-hold, 1.50×10-3 mm2/s; free-breathing, 0.88×10-3 mm2/s; respiratory-triggered, 0.93×10-3mm2/s.

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