J Korean Soc Magn Reson Med.  2011 Apr;15(1):22-31. 10.13104/jksmrm.2011.15.1.22.

Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system

• Park HY
• Cho HJ
• Kim EM
• Hur G
• Kim YH
• Lee BH

• KMID: 2041224
• DOI: http://doi.org/10.13104/jksmrm.2011.15.1.22

Abstract

PURPOSE
To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions.
MATERIALS AND METHODS
This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI.
RESULTS
Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratorytriggered DWI (87.6+/-41.4, 41.2+/-62.5) were higher than free-breathing DWI (38.8+/-13.6, 24.8+/-36.8) (p value <0.001, respectively).
CONCLUSION
Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

Keyword

Diffusion-weighted imaging; Magnetic resonance imaging (MRI); Liver; Single shot EPI

MeSH Terms

Abscess
Carcinoma, Hepatocellular
Diffusion
Eosinophils
Ethics Committees, Research
Focal Nodular Hyperplasia
Hemangioma
Humans
Liver
Neoplasm Metastasis
Retrospective Studies
ROC Curve

Figure

• 

  Fig. 1 64-year-old man with a tiny cyst. A 0.5 cm cyst (long arrow) was incidentally found during survey of hepatocellular carcinoma (not shown here). It was detected by two reviewers on respiratory-triggered DWI (e to h), but obscure on free-breathing DWI (a to d) and not detected. Note that the lesion was more depictive and brighter on respiratory-triggered DWI.

• 

  Fig. 2 52-year-old man with hepatocellular carcinoma. Both reviewers detected a 1.4 cm hepatocellular carcinoma (long arrow) on free-breathing DWI (a to d) and respiratory-triggered DWI (e to h). However the lesion demonstrated sharper margin and increased CNR on respiratory-triggered DWI. Note the high signals on high b value, representing water restriction. Enhanced dynamic study showed arterial enhancement and early washout (i). HCC had grown on short-term follow-up CT (j) and treated successfully with radiofrequency ablation. Note a tiny cyst (arrowhead) behind HCC.

• 

  Fig. 3 57-year-old man with common bile duct (CBD) stone. As well as increased depiction of liver edge and intrahepatic vessels, the edge of CBD was also increased, so a dark signal 0.6 cm sized stone (long arrow) was depicted finely on respiratory-triggered DWI (e to h) compared with free breathing DWI (a to d). It showed dense calcification on CT examination (i) and filling defect (large arrow) on MRCP (j). Note another small stone (arrowhead) in distal CBD on MRCP. Note sharp margin of right diaphragmatic crura (asterisk) on respiratory-triggered DWI.

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