Appropriate pancreatic phase image acquisition by free-breathing dynamic contrast-enhanced pancreatic MRI using stack-of-stars radial sampling and Compressed SENSE.

PURPOSE: To evaluate the feasibility of a free-breathing sequence (4D FreeBreathing) combined with Compressed SENSE in dynamic contrast-enhanced pancreatic MRI and compare it with a breath-holding sequence (eTHRIVE). METHOD: Patients who underwent pancreatic MRI, either eTHRIVE or 4D FreeBreathing, from April 2022 to November 2023 were included in this retrospective study. Two radiologists, who were unaware of the scan sequence, independently and randomly reviewed the images at the precontrast, pancreatic, portal venous, and equilibrium phases and assigned confidence scores for motion and streaking artifacts, pancreatic sharpness, and overall image quality using a 5-point scale. Furthermore, the radiologists assessed the appropriateness of the scan timing of the pancreatic phase. Mann-Whitney U and Fisher's exact tests were conducted to compare the confidence scores and adequacy of the pancreatic phase scan timing between eTHRIVE and 4D FreeBreathing. RESULTS: Overall, 48 patients (median age, 71 years; interquartile range, 64-77 years; 24 women) were included. Among them, 20 patients (42%) were scanned using 4D FreeBreathing. The 4D FreeBreathing showed moderate streaking artifact but improved motion artifact (P <.001-.17) at all phases. Pancreatic sharpness and overall image quality were almost comparable between two sequences (P = .17-.96). All 20 examinations in 4D FreeBreathing showed appropriate pancreatic phase images, but only 16 (57%; P <.001 for reviewer 1) and 18 (64%; P = .003 for reviewer 2) examinations showed it in eTHRIVE. CONCLUSION: The use of 4D FreeBreathing combined with Compressed SENSE was feasible in pancreatic MRI and provided appropriate pancreatic phase images in all examinations.

Diagnostic ability of diffusion-weighted imaging using echo planar imaging with compressed SENSE (EPICS) for differentiating hepatic hemangioma and liver metastasis.

PURPOSE: To assess the diagnostic abilities of diffusion-weighted imaging (DWI) with parallel imaging (PI-DWI) and that with Compressed SENSE (EPICS-DWI) for differentiating hepatic hemangiomas (HHs) and liver metastases (LMs). METHOD: This prospective study included 30 participants with HH and/or LM who underwent PI-DWI and EPICS-DWI. Two radiologists assessed the DWI images and assigned confidence scores for hepatic lesions conspicuity using 4-point scale. One of the radiologists additionally calculated the contrast-to-noise ratio (CNR) and measured ADC value of the hepatic lesions. The conspicuity, CNR, and ADC values were compared between the two sequences. A receiver operating characteristic (ROC) analysis was performed to assess the diagnostic abilities of the two sequences for differentiating HHs and LMs. RESULTS: The conspicuity of LMs was better in EPICS-DWI than in PI-DWI (P < .05 in both radiologists). The CNR of LMs was higher in EPICS-DWI than in PI-DWI (P = .008). No difference was found in the CNR of HHs (P = .52), ADC values for HHs (P = .79), and LMs (P = .29) between the two sequences. To differentiate between HHs and LMs, the cutoff ADC values were 1.38 × 10-3 mm2/s in PI-DWI and 1.37 × 10-3 mm2/s in EPICS-DWI. The area under the ROC curve (P = .86), sensitivity (P > .99), and specificity (P > .99) did not vary. CONCLUSIONS: The LMs were more visible in EPICS-DWI than in PI-DWI. However, the cutoff ADC values and diagnostic abilities for differentiating HHs and LMs were almost comparable between the two sequences.

Diffusion-weighted imaging of the abdomen using echo planar imaging with compressed SENSE: Feasibility, image quality, and ADC value evaluation.

OBJECTIVE: To evaluate the feasibility, image quality, and apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) using echo planar imaging (EPI) with Compressed SENSE (EPICS-DWI) of the abdomen and to compare them with conventional single-shot EPI with parallel imaging (PI) technique (PI-DWI). MATERIALS AND METHODS: This prospective study included 46 participants with known or suspected upper abdominal diseases (19 men and 27 women, mean age, 68 years) who underwent MRI. DWI acquisition was performed using free-breathing two-dimensional fat-suppressed PI-DWI and EPICS-DWI with SENSE or compressed sensing (CS) factor, 3.0. Moreover, image noise and contour of liver and pancreas were qualitatively evaluated using a five-point scale. The mean ADC value and standard deviation (SD) of the liver, pancreas, and spleen were measured, and the coefficient of variation (CV) was calculated. Qualitative and quantitative parameters were compared between PI-DWI and EPICS-DWI using the Wilcoxon test. RESULTS: The mean image quality scores for image noise and contour of liver and pancreas were higher in EPICS-DWI compared with PI-DWI (P < 0.0001). Moreover, the mean ADC values of the liver and pancreas were higher in EPICS-DWI compared with PI-DWI (P < 0.0001), but that of spleen was not significantly different. The mean SD and CV of the liver, pancreas, and spleen were lower in EPICS-DWI compared with PI-DWI (P < 0.0001-0.032). CONCLUSION: EPICS-DWI could be feasible in MRI of the abdomen and significantly improve image quality compared with PI-DWI in aggressive setting. ADC value measurements were higher in EPICS-DWI compared with PI-DWI.

Comparison of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted MR imaging models in differentiating hepatic hemangiomas from liver metastases.

PURPOSE: This study aims to compare the diagnostic values of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted imaging (DWI) in differentiating hepatic hemangiomas and liver metastases. METHOD: This prospective study was approved by our institutional review board, and written informed consent was obtained from all patients. In this study, 244 patients with known or suspected liver disease underwent magnetic resonance imaging. Among them, 37 patients who had focal hepatic lesions with a maximum diameter of ≥10 mm were evaluated. Using home-built software, two radiologists measured the DWI parameters of hepatic lesions for the three models: the apparent diffusion coefficient (ADC) from a mono-exponential model; the true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from a bi-exponential model; and the distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from a stretched exponential model. The parameters were compared between hepatic hemangiomas and liver metastases. RESULTS: In total, 64 focal hepatic lesions were evaluated, of which 22 were identified to be hepatic hemangiomas and 42 were liver metastases. ADC, D, f, and DDC values were significantly lower in liver metastases than in hepatic hemangiomas (P <  0.0001, <  0.0001, 0.015, and <  0.0001, respectively); whereas, the α value was significantly higher in liver metastases than in hepatic hemangiomas (P =  0.028). The areas under the ROC curve (AUCs) for differentiating hepatic hemangiomas and liver metastases in ADC, D, D*, f, DDC, and α were 0.940, 0.908, 0.608, 0.686, 0.952, and 0.667, respectively. The AUC values of ADC and DDC were significantly greater than those of D* (P <  0.0001), f (P =  0.0001), and α values (P =  0.0001). CONCLUSION: ADC and DDC values from the mono-exponential and stretched exponential models could be considered as quantitative imaging biomarkers for differentiating hepatic hemangiomas and liver metastases.

Utility of Noncontrast Magnetic Resonance Angiography for Aneurysm Follow-Up and Detection of Endoleaks after Endovascular Aortic Repair.

OBJECTIVE: To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). MATERIALS AND METHODS: We examined four aortic stent-grafts in a phantom study to assess the degree of metallic artifacts. We enrolled 46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both computed tomography angiography (CTA) and b-TFE MRA after EVAR. Vascular measurements on CTA and b-TFE MRA were compared, and signal intensity ratios (SIRs) of the aneurysmal sac were correlated with the size changes in the AAA after EVAR (AAA prognoses). Furthermore, we examined six feasible b-TFE MRA features for the assessment of ELs. RESULTS: There were robust intermodality (r = 0.92-0.99) correlations and interobserver (intraclass correlation coefficient = 0.97-0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, "mottled high-intensity" and "creeping high-intensity with the low-band rim" were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas "no signal black spot" and "layered high-intensity area" were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40-0.88) displayed moderate-to-almost perfect agreement. CONCLUSION: Noncontrast MRA could be a promising imaging modality for ascertaining patient follow-up after EVAR.

Comparison of the Diagnostic Value of Mono-exponential, Bi-exponential, and Stretched Exponential Signal Models in Diffusion-weighted MR Imaging for Differentiating Benign and Malignant Hepatic Lesions.

PURPOSE: To compare the diagnostic value of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted imaging (DWI) for differentiating benign and malignant hepatic lesions. METHODS: This prospective study was approved by our Institutional Review Board and the patients provided written informed consent. Magnetic resonance imaging was acquired for 56 patients with suspected liver disease. This identified 90 focal liver lesions with a maximum diameter >10 mm, of which 47 were benign and 43 were malignant. Using home-built software, two radiologists measured the DWI parameters of hepatic lesions for three models: the apparent diffusion coefficient (ADC) from a mono-exponential model; the true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from a bi-exponential model; and the distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from a stretched exponential model. The parameters were compared between benign and malignant hepatic lesions. RESULTS: ADC, D, D*, f, and DDC values were significantly lower for malignant hepatic lesions than for benign lesions (P < 0.0001-0.03). Although logistic regression analysis demonstrated that DDC was the only statistically significant parameter for differentiating benign and malignant lesions (P = 0.039), however, the areas under the receiver operating characteristic curve for differentiating benign and malignant lesions were comparable between ADC (0.98) and DDC (0.98) values. CONCLUSION: DDC values obtained from the stretched exponential model could be also used as a quantitative imaging biomarker for differentiating benign and malignant hepatic lesions, however, the diagnostic performance was comparable with ADC values.

Pancreatic extracellular volume fraction using T1 mapping in patients with impaired glucose intolerance.

PURPOSE: To evaluate pancreatic T1 mapping and extracellular volume (ECV) fraction's feasibility to assess impaired glucose tolerance (IGT) patients. METHODS: A total of 45 consecutive patients with known or suspected pancreatic disease underwent contrast-enhanced magnetic resonance (MR) imaging, including T1 mapping, using saturation recovery sequence. Patients were classified into three groups based on the American Diabetes Association criteria: no-diabetes subjects, HbA1c < 5.7%; pre-diabetes, 5.7% ≤ HbA1c < 6.5%; and type 2 diabetes mellitus (T2DM), HbA1c ≥ 6.5%. Pre-contrast pancreatic T1 value and ECV of the pancreas were computed, and then pre-contrast pancreatic T1 value, ECV and HbA1c values were compared. The present prospective study was approved by our institutional review board. Written informed consent was obtained from all patients. RESULTS: A positive correlation between HbA1c values and both pre-contrast pancreatic T1 value and ECV (r = 0.79, P < 0.001 and r = 0.60, P < 0.001, respectively) were observed. The pre-contrast pancreatic T1 value and ECV were significantly higher in T2DM vs. no-diabetes subjects and pre-diabetes (P < 0.001). No significant difference between two qualitative values (P = 0.14) was found, however, the sensitivity, specificity, and area under the receiver-operating-characteristic curve differentiating no-diabetes subjects and pre-diabetes from T2DM were superior in ECV (100%, 93.5%, and 0.990) vs. pre-contrast pancreatic T1 values (84.6%, 96.8%, and 0.906). CONCLUSIONS: The ECV of the pancreas could serve as a potential imaging biomarker for the assessment of pancreatic fibrosis leading to IGT.

Hepatocyte fraction: correlation with noninvasive liver functional biomarkers.

PURPOSE: To evaluate the correlation between HeF obtained from gadoxetic acid-enhanced MR imaging and clinical biomarkers for the assessment of liver function. METHODS: This prospective study was approved by our Institutional Review Board, and written informed consent was obtained from the patients. We recruited 48 patients carrying a known or suspected liver disease to undergo gadoxetic acid-enhanced MR imaging. The new model of the HeF was calculated from ΔR1 values of the liver and spleen. The HeF, quantitative liver-to-spleen contrast ratio (Q-LSC), and ΔT1 value (the reduction rate of the T1 value between the pre- and post-contrast images) were compared with the Child-Pugh and end-stage liver disease (MELD) scores. RESULTS: Among 48 patients, 40 were in Child-Pugh class A and 8 were in class B. The median HeF (P = 0.0001), Q-LSC (P = 0.015), and ΔT1 value (P = 0.0023) in patients in Child-Pugh class A were significantly higher than those in class B. The sensitivities, specificities, and area under the receiver-operating-characteristic curves for differentiating Child-Pugh class A and B were 95.0%, 87.5%, and 0.93 in the HeF; 77.5%, 75.0%, and 0.78 in the Q-LSC; and 57.5%, 100.0%, and 0.84 in the ΔT1 value, respectively. The HeF was significantly correlated with Child-Pugh (r = - 0.58, P < 0.0001) and MELD score (r = - 0.57, P < 0.0001). CONCLUSIONS: The HeF was well correlated with Child-Pugh and MELD score and could be a new biomarker to assess liver function.

Predicting Early Response to Chemoradiotherapy for Uterine Cervical Cancer Using Intravoxel Incoherent Motion MR Imaging.

To assess if intravoxel incoherent motion (IVIM) imaging can be used to predict early response to chemoradiotherapy (CRT) in cervical cancer. IVIM imaging before and during CRT (at doses of 20 and 40 Gy) was performed in 17 patients with cervical squamous cell carcinoma. The percentage changes of IVIM parameters were significantly higher for complete remission (CR) than non-CR groups. IVIM may play a supplementary role for predicting early response to CRT in cervical cancer.

Magnetic resonance cholangiopancreatography using optimized integrated combination with parallel imaging and compressed sensing technique.

PURPOSE: To assess the combined parallel imaging (PI) and optimized integrated compressed sensing technique (prototype Compressed SENSE) for magnetic resonance cholangiopancreatography (MRCP) compared with conventional MRCP. METHODS: This prospective study was approved by our Institutional Review Board, and all patients provided written informed consent. A total of 56 consecutive patients (27 men and 29 women; mean age 67.2 years) underwent breath-hold three-dimensional (3D) MRCP with PI alone (BH-MRCP; acquisition time, 23 s), respiratory-triggered 3D MRCP with PI alone (RT-MRCP; 201 s) and respiratory-triggered 3D MRCP with Compressed SENSE (RT-MRCPcs; 45 s). Relative duct-to-periductal contrast ratios (RCs) of the pancreaticobiliary ducts were calculated for quantitative image analyses. Two radiologists graded the visibility of the pancreaticobiliary ducts, pancreatic cystic lesion, motion artifact, and overall image quality using a five-point rating scale for qualitative image analyses. Theses qualitative and quantitative measurements were then compared among the three sequences. RESULTS: RCs of the common bile duct, right hepatic duct (RHD), left hepatic duct (LHD), and main pancreatic duct at the pancreatic head, body, and tail segments, were significantly higher RT-MRCP, followed by RT-MRCPcs and BH-MRCP (P < 0.001). The visibility of the peripheral RHD and LHD was slightly better in RT-MRCP than in RT-MRCPcs and BH-MRCP (P < 0.001). The visibility of other pancreaticobiliary ducts, pancreatic cystic lesion, motion artifact, and overall image quality were almost comparable among three sequences. CONCLUSION: The acquisition time was markedly reduced in RT-MRCPcs compared with conventional RT-MRCP while there were significant differences in both quantitative and qualitative analyses, the differences were small enough that the reduced acquisition time makes up for it.

Thin-slice Free-breathing Pseudo-golden-angle Radial Stack-of-stars with Gating and Tracking T1-weighted Acquisition: An Efficient Gadoxetic Acid-enhanced Hepatobiliary-phase Imaging Alternative for Patients with Unstable Breath Holding.

PURPOSE: To compare four free-breathing scan techniques for gadoxetic acid-enhanced hepatobiliary phase imaging with conventional breath-hold scans. MATERIALS AND METHODS: Gadoxetic acid-enhanced hepatobiliary phase imaging with six image acquisition sets performed in 50 patients. Image acquisition sets included fat-suppressed 3D T1-weighted turbo field echo with free-breathing pseudo-golden-angle radial stack-of-stars (FBRS) acquisition, FBRS with track (FBRST), FBRS with gate and track (FBRSG&T), thin-slice FBRS with gate and track (thin-slice FBRSG&T), free-breathing Cartesian acquisition (CartesianFB), and breath-hold Cartesian acquisition (CartesianBH). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image quality compared to the six-image acquisition sets. RESULTS: Signal-to-noise ratio and CNR were significantly higher in FBRS, FBRST, FBRSG&T, and thin-slice FBRSG&T than in CartesianFB and CartesianBH (P < 0.001). Based on sharpness, motion artifacts, visibility of intrahepatic vessels, and overall image quality, thin-slice FBRSG&T had the highest image quality followed by CartesianBH and FBRSG&T (P < 0.001). Severe motion artifacts were observed in 25 patients in CartesianFB and three patients in CartesianBH, whereas image quality remained above the acceptable range in FBRSG&T, FBRST, FBRS, and thin-slice FBRSG&T in all cases. CONCLUSION: Thin-slice FBRSG&T demonstrated excellent image quality compared with conventional CartesianBH in gadoxetic acid-enhanced hepatobiliary phase imaging. It can be apply to supplemental sequences of patients with unstable breath holding.

Correlation of quantitative pancreatic T1 value and HbA1c value in subjects with normal and impaired glucose tolerance.

BACKGROUND: Signal intensity on T1 -weighted images (T1 WI) is associated with pancreatic fibrosis and HbA1c levels. PURPOSE: To evaluate the feasibility of the pancreatic T1 value for assessment of subjects with normal and impaired glucose tolerance (IGT). STUDY TYPE: A prospective single-institution study. POPULATION: In all, 95 consecutive patients with a known or suspected pancreatic disease. FIELD STRENGTH/SEQUENCES: 3T/fast pancreatic T1 mapping using a modified Look-Locker sequence. ASSESSMENT: Following the American Diabetes Association criteria, patients were classified into three groups, as follows: no-diabetes subject, HbA1c < 5.7%; prediabetes, 5.7% ≤ HbA1c < 6.5%; and type 2 diabetes mellitus (T2DM), HbA1c ≥ 6.5%. Pancreatic T1 value and signal intensity ratio (SIR = SIpancreas /SImuscle ) using T1 WI were compared with the HbA1c values. STATISTICAL TESTS: Quantitative data were assessed with one-way analysis of variance, Fisher's and Mann-Whitney U tests, and receiver-operating characteristic analysis. RESULTS: The pancreatic T1 value was significantly longer in T2DM than in no-diabetes and prediabetes subjects (P < 0.05) and was significantly longer in prediabetes than in no-diabetes subjects (P < 0.05). The mean pancreatic T1 value was significantly lower in the low-value group (HbA1c < 5.7%) (906.3 msec) compared with the high-value group (HbA1c ≥ 6.5%) (993.8 msec) (P < 0.0001). SIR on T1 WI was significantly higher in the low-value group compared with the high-value group (P = 0.029). The sensitivities, specificities, and area under the receiver-operating characteristic curve (AUCs) for differentiating the low- and high-value groups were 74.1%, 83.8%, and 0.82 in the pancreatic T1 values and 77.8%, 54.4%, and 0.63 in SIR on T1 WI, respectively. The specificity (P < 0.0001) and AUC (P = 0.0020) were significantly higher in the pancreatic T1 values than in SIR on T1 WI. DATA CONCLUSION: Pancreatic T1 value has the potential of being an imaging biomarker for the assessment of IGT. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:711-718.

Gadoxetic acid-enhanced dynamic magnetic resonance imaging using optimized integrated combination of compressed sensing and parallel imaging technique.

PURPOSE: To evaluate the feasibility of optimized integrated combination of compressed sensing and parallel imaging technique (prototype Compressed SENSE) in gadoxetic acid-enhanced dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: Sixty-one patients underwent gadoxetic acid-enhanced dynamic imaging using enhanced T1 high-resolution isotropic volume excitation (eTHRIVE) with the Compressed SENSE (CS-eTHRIVE; C SENSE factor, 3.4; acquisition time, 10 s). Results were compared with 61 propensity score-matched patients who underwent conventional eTHRIVE (eTHRIVE; acquisition time, 20 s). For quantitative image analyses, signal intensity ratio (SIR) and signal-to-noise ratio (SNR), coefficient of variation (CV) of liver parenchyma were calculated in each dynamic phase. For qualitative image analyses, two radiologists rated the homogeneity of liver parenchyma, sharpness of liver edge and left external lobe, motion artifacts, and overall image quality in each dynamic phase using a five-point scale. RESULTS: SIRs of liver parenchyma with CS-eTHRIVE were significantly higher than with eTHRIVE in the hepatic arterial phase (HAP) (1.70 vs. 1.52) and transitional phase (TP) (2.18 vs. 2.06) (P ≤ 0.030). SNR of liver parenchyma were comparable between the two sequences in all phases. CV of liver parenchyma in HAP with eTHRIVE (0.079) was significantly higher than with CS-eTHRIVE (0.065) (P < 0.001). Motion artifacts were significantly reduced with CS-eTHRIVE compared with eTHRIVE in all phases (P ≤ 0.005). The appearance ratio of extensive motion artifacts in HAP with CS-eTHRIVE (0/61; 0%) were significantly reduced compared with eTHRIVE (4/61; 6.6%) (P = 0.042). Overall image quality with CS-eTHRIVE was significantly better than with eTHRIVE in all phases (P ≤ 0.039). CONCLUSION: CS-eTHRIVE compared with eTHRIVE effectively reduced the acquisition time and extensive motion artifacts without degradation of image quality.

Quantitative characterization of carotid plaque components using MR apparent diffusion coefficients and longitudinal relaxation rates at 3T: A comparison with histology.

BACKGROUND: There is limited evidence of parametric MR mapping to characterize carotid plaques associated with cerebral ischemic events. PURPOSE: To explore the apparent diffusion coefficients (ADCs) and longitudinal relaxation rates (R1 ) of carotid plaques, including areas of hemorrhage, lipid-rich/necrotic core (LR/NC) without hemorrhage, and fibrous tissue (Fbr) STUDY TYPE: Prospective. SUBJECTS: Twelve patients who underwent carotid endarterectomy. FIELD STRENGTH/SEQUENCE: R1 was measured using double angle Look-Locker acquisition on 3T systems. Single-shot spin-echo echo-planar imaging with fat suppression and outer-volume suppression (OVS-DWEPI) with b values of 10 and 500 s/mm2 was used for diffusion-weighted imaging. ASSESSMENT: A phantom study using diluted gadolinium solutions and polyvinyl alcohol solutions was used to validate the two protocols. Regions of interest (ROIs) were manually outlined on MR images for areas of LR/NC, hemorrhage, and Fbr based on histological cross-sections. Pixel-based R1 and ADC values in the ROIs were plotted for each component. The probability density function of the plots determined the optimum contours to separate the three components in the ADC-R1 plane. The LR/NC, hemorrhage, and Fbr regions were mapped on MR images based on the above results and compared to histological results. STATISTICAL TESTS: The R1 values of the phantom measurements were tested using Bland-Altman analysis. The accuracies of the MRI classification were calculated. RESULTS: R1 values <8 s-1 calculated using our method agreed with those calculated using an inversion-recovery fast-spin-echo sequence (error, ≤0.1 s-1 ). ADC values obtained using OVS-DWEPI were 4.1% higher than those obtained using standard echo-planar imaging. LR/NC (R1 , 0.4-1.2 s-1 ; ADC, 0-1.5 µm2 /ms), hemorrhage (R1 ≥ 1.5 s-1 ; ADC, 0.5-1.5 µm2 /ms), and Fbr (R1 , 0.2-0.8 s-1 ; ADC, 1.5-2.9 µm2 /ms) were separated on the plots. The accuracies of MRI classification were LR/NC, 0.86; hemorrhage, 0.79; and Fbr, 0.77. CONCLUSION: The combination of ADC and R1 values measured using our method enabled differentiation among LR/NC, hemorrhage, and Fbr. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1657-1667.

Simultaneous acquisition of MR angiography and diagnostic images of abdomen at view-sharing multiarterial phases and comparing the effect of two different contrast agents.

BACKGROUND: Simultaneous acquisition of magnetic resonance angiography (MRA) and diagnostic images is challenging in contrast-enhanced upper abdominal MRI. PURPOSE: To evaluate the image quality of MRA of the abdomen acquired simultaneously with diagnostic MR images, and to compare the contrast effect, conspicuity of aortic branches, and pancreatic lesions in MRA between gadobutrol and gadoterate meglumine. STUDY TYPE: Prospective. POPULATION: Eighty-eight patients with known and suspected upper abdominal disease. FIELD STRENGTH/SEQUENCES: 3T/4D-eTHRIVE (T1 -weighted fat-suppressed 3D fast gradient echo) for multiarterial phase imaging. ASSESSMENT: The artery-to-muscle signal intensity ratio (SIR), conspicuity of aortic branches on the axial, maximum intensity projection (MIP), and volume-rendered (VR) images, and conspicuity of focal pancreatic lesions were compared between gadobutrol and gadoterate meglumine. The diameters of aortic branches were measured on axial MRA and computed tomography angiography (CTA) images and then compared. STATISTICAL TESTS: Quantitative and qualitative data were assessed with the Mann-Whitney U-test. The diameters of aortic branches between MRA and CTA were compared with a Spearman rank correlation test. RESULTS: View-sharing multiarterial phase imaging was successfully performed in all patients. The SIRs of common hepatic artery (P = 0.0051) and left renal artery (RA) (P = 0.045), vascular conspicuities of right and left hepatic arteries (P = 0.010 and 0.030) and right and left RAs on axial (P = 0.0065 and 0.036), and that of gastroduodenal artery on MIP (P = 0.039) with gadobutrol were significantly higher than those with gadoterate meglumine. The conspicuity of focal pancreatic lesions were comparable between the gadobutrol and gadoterate meglumine (P = 0.73). The vascular diameters on MRA and CTA were strongly correlated in all aortic branches (r = 0.842-0.942, P < 0.0001). DATA CONCLUSION: High-quality MRA of the abdomen was obtained simultaneously with the diagnostic MR images using view-sharing multiarterial phase imaging that also demonstrated comparable image quality between gadobutrol and gadoterate meglumine. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2017.

Gadoxetic acid-enhanced high temporal-resolution hepatic arterial-phase imaging with view-sharing technique: Impact on the LI-RADS category.

PURPOSE: To evaluate the value of view-sharing multi-hepatic arterial-phase (mHAP) imaging for diagnosis of hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty-seven consecutive patients with HCC underwent gadoxetic acid-enhanced magnetic resonance (MR) imaging before angiographic and lipiodol CT. Hepatic arterial-phase images were obtained at 5 consecutive phases with shared central k-space of 25%, followed by portal venous, late (2 and 3min), and hepatobiliary phase imaging. One-hundred-eight HCC nodules (size: 5-88mm, mean size: 18.2mm) confirmed on angiographic CT and lipiodol CT were evaluated for LI-RADS category and compared with single arterial-phase and mHAP findings regarding wash out, capsule, corona enhancement, and image quality. RESULTS: Twenty-four HCCs (22.2%) (size: 6-19mm, mean size: 12.3mm) were categorized as LR-3 based on the single arterial-phase. Capsule appearance (25.9%) and washout (57.4%) were most frequently observed in late phase (2min). Corona enhancement was observed in 73.1% of all HCCs on mHAP. For the 24 HCCs of LR-3, corona enhancement was observed in 75% on mHAP and contributed to upgrade category. No significant difference was found in the frequency of corona enhancement between mHAP and angiographic CT (P=0.11). Image quality was valued as good or excellent in all cases. CONCLUSION: View-sharing mHAP was feasible without compromising image quality and contributed to the improvement in diagnostic confidence for hypervascular HCC in gadoxetic acid-enhance MR imaging.

Biliary tract enhancement in gadoxetic acid-enhanced MRI correlates with liver function biomarkers.

PURPOSE: To evaluate the association between gadoxetic-acid-enhanced magnetic resonance (MR) imaging measurements and laboratory and clinical biomarkers of liver function and fibrosis. MATERIALS AND METHODS: One hundred thirty nine consecutive patients with suspected liver disease or liver tumor underwent gadoxetic-acid-enhanced MR imaging. MR imaging measurements during the hepatobiliary phase included biliary tract structure-to-muscle signal intensity ratio (SIR). These measurements were compared with Child-Pugh classification, end-stage liver disease (MELD) score, and aspartate aminotransferase-to-platelet ratio index (APRI). RESULTS: The SIRs of cystic duct and common bile duct were significantly correlated with Child-Pugh classification (P=0.012 for cystic duct and P<0.0001 for common bile duct), MELD score (P=0.0016 and P=0.0033), and APRI (P=0.0022 and P=0.0015). The sensitivity, specificity, and area under the receiver-operating-characteristic curve were: (74%, 88%, 0.86) with the SIR of common bile duct for the detection of patients with Child-Pugh class B or C; (100%, 87%, 0.94) with the SIR of cystic duct for MELD score (>10); (65%, 76%, 0.70) with the SIR of common bile duct for APRI (>1.5). CONCLUSION: Gadoxetic-acid contrast enhancement of cystic duct and common bile duct could be used as biomarkers to assess liver function.

Findings in pancreatic MRI associated with pancreatic fibrosis and HbA1c values.

PURPOSE: To evaluate the diagnostic performance of noncontrast-enhanced magnetic resonance imaging (MRI) to grade pancreatic fibrosis and to assess hemoglobin (Hb) A1c values. MATERIALS AND METHODS: Twenty-nine consecutive patients with pancreatic or biliary malignancy who underwent pancreatectomy were evaluated. Patients were classified into three groups: HbA1c < 5.7 (group 1), 5.7 ≤ HbA1c < 6.5 (group 2), and HbA1c ≥ 6.5 (group 3). MRI of the pancreas was performed using a 1.5T MR system. The pancreas-to-muscle signal intensity ratio (SIR) on in- and opposed-phase T1 -, T2 -, and diffusion-weighted images, as well as the apparent diffusion coefficient were calculated. MRI measurements, degrees of pancreatic fibrosis, and HbA1c values were compared using multiple regression analysis and Kruskal-Wallis test. RESULTS: The pancreatic fibrosis grade was negatively correlated with the SIR on in-phase T1 -weighted images (r = -0.67, P = 0.0002). The pancreatic fibrosis grade and HbA1c value were negatively correlated with the SIR on opposed-phase T1 -weighted images (r = -0.47, P = 0.019 and r = -0.51, P = 0.0089, respectively). SIRs on in- and opposed-phase T1 -weighted images were significantly lower in group 3 than in groups 1 and 2 (P < 0.05). CONCLUSION: The pancreas-to-muscle SIRs on in- and opposed-phase T1 -weighted images could be a potential biomarker for pancreatic fibrosis and elevated HbA1c values.

Perfusion imaging of parotid gland tumours: usefulness of arterial spin labeling for differentiating Warthin's tumours.

OBJECTIVE: To assess prospectively the efficacy of arterial spin labelling (ASL) against conventional and diffusion-weighted (DW) MR imaging for differentiating parotid gland tumours. METHODS: We included 10 pleomorphic adenomas, 12 Warthin's tumours, and nine malignant tumours of the parotid glands. Only tumours larger than 10 mm were included in this study. All parotid gland tumours underwent T1-weighted, T2-weighted, DW, and ASL imaging. Tumour-to-parotid gland signal intensity ratios (SIRs) and apparent diffusion coefficients (ADCs) of solid components were correlated with these pathologies. RESULTS: SIRs on T2-weighted images and ADCs were higher in pleomorphic adenomas than in Warthin's tumours (p < .01) and malignant tumours (p < .01). SIRs on ASL were higher in Warthin's tumours than in pleomorphic adenomas (p < .01) and malignant tumours (p < .05). Az value of SIRs on ASL for differentiating Warthin's tumours from the other pathologies was 0.982. The sensitivity, specificity, and accuracy of SIRs on ASL for the diagnosis of Warthin's tumours at an optimal SIR threshold of over 8.70 were 91.7%, 94.7%, and 93.5%, respectively. CONCLUSIONS: ASL with SIR measurements could non-invasively evaluate tumour blood flow of parotid gland tumours and differentiate Warthin's tumours from pleomorphic adenomas and malignant tumours. KEY POINTS: • ASL non-invasively evaluates tumour blood flow of parotid gland tumours • ASL differentiates Warthin's tumours from pleomorphic adenomas and malignant tumours • ASL cannot differentiate between pleomorphic adenomas and malignant tumours.

Characterizing focal hepatic lesions by free-breathing intravoxel incoherent motion MRI at 3.0 T.

BACKGROUND: Diffusion-weighted (DW) imaging is commonly used to distinguish between benign and malignant liver lesions. PURPOSE: To prospectively evaluate the true molecular-diffusion coefficient (D), perfusion-related diffusion coefficient (D*), perfusion fraction (f), and ADC of focal hepatic lesions using a free-breathing intravoxel incoherent motion (IVIM) DW sequence, and to determine if these parameters are useful for characterizing focal hepatic lesions. MATERIAL AND METHODS: One hundred and twenty hepatic lesions (34 metastases, 32 hepatocellular carcinoma [HCC], 33 hemangiomas, and 21 liver cysts) in 74 patients were examined. Mean D, D*, f, and ADC values of hepatic lesions were compared among pathologies. ROC curve analyses were performed to assess the performances of D, D*, f, and ADC values for the characterization of liver lesions as benign or malignant. RESULTS: The mean D and ADC values of benign lesions were greater than those of malignant lesions (P < 0.001). Although the mean D and ADC values of liver cysts were greater than those of hemangiomas (P < 0.001), and these values were not significantly different between metastases and HCCs (P = 0.99). Area under the ROC curve for ADC values (0.98) was significantly greater (P = 0.048) than that for D values (0.96) for the differentiation of benign and malignant lesions. Sensitivity and specificity for the detection of malignant lesion were 89% and 98%, respectively, when an ADC cut-off value of 1.40 was applied. CONCLUSION: D and ADC values have more potential for characterizing focal hepatic lesions than D* or f values, and for the differentiation of malignancy and benignity.