Korean J Radiol.  2016 Aug;17(4):522-532. 10.3348/kjr.2016.17.4.522.

Triple Arterial Phase MR Imaging with Gadoxetic Acid Using a Combination of Contrast Enhanced Time Robust Angiography, Keyhole, and Viewsharing Techniques and Two-Dimensional Parallel Imaging in Comparison with Conventional Single Arterial Phase

• Yoon JH
• Lee JM
• Yu MH
• Kim EJ
• Han JK

• KMID: 2455422
• DOI: http://doi.org/10.3348/kjr.2016.17.4.522

Abstract

OBJECTIVE
To determine whether triple arterial phase acquisition via a combination of Contrast Enhanced Time Robust Angiography, keyhole, temporal viewsharing and parallel imaging can improve arterial phase acquisition with higher spatial resolution than single arterial phase gadoxetic-acid enhanced magnetic resonance imaging (MRI).
MATERIALS AND METHODS
Informed consent was waived for this retrospective study by our Institutional Review Board. In 752 consecutive patients who underwent gadoxetic acid-enhanced liver MRI, either single (n = 587) or triple (n = 165) arterial phases was obtained in a single breath-hold under MR fluoroscopy guidance. Arterial phase timing was assessed, and the degree of motion was rated on a four-point scale. The percentage of patients achieving the late arterial phase without significant motion was compared between the two methods using the χ2 test.
RESULTS
The late arterial phase was captured at least once in 96.4% (159/165) of the triple arterial phase group and in 84.2% (494/587) of the single arterial phase group (p < 0.001). Significant motion artifacts (score ≤ 2) were observed in 13.3% (22/165), 1.2% (2/165), 4.8% (8/165) on 1st, 2nd, and 3rd scans of triple arterial phase acquisitions and 6.0% (35/587) of single phase acquisitions. Thus, the late arterial phase without significant motion artifacts was captured in 96.4% (159/165) of the triple arterial phase group and in 79.9% (469/587) of the single arterial phase group (p < 0.001).
CONCLUSION
Triple arterial phase imaging may reliably provide adequate arterial phase imaging for gadoxetic acid-enhanced liver MRI.

Keyword

Arterial phase; Gadoxetic acid; Liver; MRI; View sharing

MeSH Terms

Adult
Aged
Aged, 80 and over
Angiography
Arteries/diagnostic imaging/pathology
Artifacts
Contrast Media/*chemistry
Female
Fluoroscopy
Gadolinium DTPA/*chemistry
Humans
Image Interpretation, Computer-Assisted
Liver Neoplasms/diagnosis/diagnostic imaging/pathology
*Magnetic Resonance Imaging
Male
Middle Aged
Neoplasms/*diagnosis/diagnostic imaging/pathology
Retrospective Studies
Young Adult
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 K-space acquisition scheme using combination of CENTRA, keyhole and viewsharing.K-space is divided into central (Kz-Ky) and peripheral portion (R), and central K-space is sampled repeatedly in random manner whilst peripheral K-space is acquired once last to serve as reference scan for each reconstruction (violet arrows). Central K-space is divided into three keyhole fractions including central (C) and two peripheries (P+, P-) and fractions are acquired in alternating fashion between combinations of (P+, C) and (C, P-). To avoid signal discontinuation, P+ or P- of keyhole obtained on previous scan is added to reconstruction of next scan (orange arrows). CENTRA = contrast enhanced time robust angiography

• 

  Fig. 2 Triple arterial phase (TAP) of 80-year-old man with colon cancer.1st, 2nd, and 3rd TAP scans (A-C) provide early arterial phase (A) and two late arterial phases (B, C) with different parenchymal enhancement degrees.

• 

  Fig. 3 Fig. 3. Triple arterial phase of 70-year-old woman with colon cancer liver metastasis.1st scan was deteriorated by significant motion artifacts with truncation artifact, leading to non-diagnostic image (A). Following 2nd (B) and 3rd (C) TAP scans were regarded as optimal late arterial phase imaging, and successfully demonstrate 4 cm rim enhancing mass which was confirmed as metastasis after surgery (arrows). TAP = triple arterial phase

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