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Improved Detection of Hypervascular Liver Lesions With CAIPIRINHA–Dixon–TWIST–Volume-Interpolated Breath-Hold Examination

Kazmierczak, Philipp M. MD*; Theisen, Daniel MD*; Thierfelder, Kolja M. MD*; Sommer, Wieland H. MD*; Reiser, Maximilian F. MD*; Notohamiprodjo, Mike MD*†; Nikolaou, Konstantin MD*†

doi: 10.1097/RLI.0000000000000118
Original Article

Objectives The aim of this study was to assess the diagnostic performance of a dynamic, multiphasic contrast-enhanced volume-interpolated sequence with advanced parallel imaging techniques, Dixon fat saturation, and view sharing with 5 hepatic arterial subphases for the detection of focal liver lesions.

Materials and Methods Twenty-four consecutive patients (13 females, 11 males; mean [SD] age, 58 [15] years) with focal liver lesions were included in this prospective study. The examination was performed at a 3-T magnetic resonance imaging system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). Five dynamic arterial subphases with a temporal resolution of 2.6 seconds, starting 17 seconds after injection of the hepatobiliary contrast agent gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Eovist; Bayer HealthCare, Leverkusen, Germany), were acquired using an accelerated parallel imaging volume-interpolated sequence with view sharing (multiarterial controlled aliasing in parallel imaging results in higher acceleration–Dixon–time-resolved angiography with interleaved stochastic trajectories–volumetric interpolated breath-hold examination [MA-CDT-VIBE]). The fourth of the 5 arterial acquisition phases (ie, at 24.8 seconds after the start of contrast agent injection) was considered the equivalent of a standard hepatic arterial phase (equivalent standard arterial phase [ESAP]). The diagnostic value of all 5 dynamic arterial phases for the detection of focal liver lesions, as compared with the single ESAP, was judged in 2 independent consensus readings. The 2 consensus reading groups were blinded to each others’ results. The complete, comprehensive multisequence magnetic resonance imaging examination, including T1-weighted, T2-weighted, and multiphasic contrast-enhanced sequences, served as the standard of reference for lesion detection.

Results Forty-six percent of the patients (11/24) had hypervascular lesions. In 79 % of all patients (19/24), the best arterial parenchymal contrast of one of the MA-CDT-VIBE acquisition phases was considered better than that of the ESAP. In one third of all cases (8/24 for the first and 6/24 for the second consensus reading), MA-CDT-VIBE showed an improved lesion detection rate compared with ESAP, especially in hypervascular lesions (4/11, representing 36% of all patients with hypervascular lesions). There was a high degree of interrater agreement between the 2 consensus reading groups (the Cohen κ, 0.71–1.00; P < 0.001).

Conclusions Compared with a standard hepatic arterial phase, MA-CDT-VIBE with 5 hepatic arterial subphases demonstrated greater diagnostic accuracy for the detection of hypervascular focal liver lesions and provided a robust and optimized hepatic arterial acquisition phase.

From the *Department of Clinical Radiology, University Hospitals Munich, Munich; and †Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.

Received for publication August 20, 2014; and accepted for publication, after revision, October 9, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Philipp M. Kazmierczak, MD, Department of Clinical Radiology, University Hospitals Munich, Marchioninistrasse 15, 81377 Munich, Germany. E-mail:

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