Shigeki Arizono

Diffusion-weighted intravoxel incoherent motion imaging of renal tumors with histopathologic correlation

PurposeThe aim of this study was to use intravoxel incoherent motion diffusion-weighted imaging to discriminate subtypes of renal neoplasms and to assess agreement between intravoxel incoherent motion (perfusion fraction, fp) and dynamic contrast-enhanced magnetic resonance imaging (MRI) metrics of tumor vascularity. Subjects and MethodsIn this Health Insurance Portability and Accountability Act–compliant, institutional review board–approved prospective study, 26 patients were imaged at 1.5-T MRI using dynamic contrast-enhanced MRI with high temporal resolution and diffusion-weighted imaging using 8 b values (range, 0-800 s/mm2). Perfusion fraction (fp), tissue diffusivity (Dt), and pseudodiffusivity (Dp) were calculated using biexponential fitting of the diffusion data. Apparent diffusion coefficient (ADC) was calculated with monoexponential fit using 3 b values of 0, 400, and 800 s/mm2. Dynamic contrast-enhanced data were processed with a semiquantitative method to generate model-free parameter cumulative initial area under the curve of gadolinium concentration at 60 seconds (CIAUC60). Perfusion fraction, Dt, Dp, ADC, and CIAUC60 were compared between different subtypes of renal lesions. Perfusion fraction was correlated with CIAUC60. ResultsWe examined 14 clear cell, 4 papillary, 5 chromophobe, and 3 cystic renal cell carcinomas (RCCs). Although fp had higher accuracy (area under the curve, 0.74) for a diagnosis of clear cell RCC compared with Dt or ADC, the combination of fp and Dt had the highest accuracy (area under the curve, 0.78). The combination of fp and Dt diagnosed papillary RCC and cystic RCC with 100% accuracy, and clear cell RCC and chromophobe RCC, with 86.5% accuracy. There was significant strong correlation between fp and CIAUC60 (r = 0.82; P < 0.001). ConclusionIntravoxel incoherent motion parameters fp and Dt can discriminate renal tumor subtypes. Perfusion fraction demonstrates good correlation with CIAUC60 and can assess degree of tumor vascularity without the use of exogenous contrast agent.

MRI Artifact Reduction and Quality Improvement in the Upper Abdomen with PROPELLER and Prospective Acquisition Correction (PACE) Technique

OBJECTIVE The purpose of this study was to evaluate the effectiveness of the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER [BLADE in the MR systems from Siemens Medical Solutions]) with a respiratory compensation technique for motion correction, image noise reduction, improved sharpness of liver edge, and image quality of the upper abdomen. SUBJECTS AND METHODS Twenty healthy adult volunteers with a mean age of 28 years (age range, 23-42 years) underwent upper abdominal MRI with a 1.5-T scanner. For each subject, fat-saturated T2-weighted turbo spin-echo (TSE) sequences with respiratory compensation (prospective acquisition correction [PACE]) were performed with and without the BLADE technique. Ghosting artifact, artifacts except ghosting artifact such as respiratory motion and bowel movement, sharpness of liver edge, image noise, and overall image quality were evaluated visually by three radiologists using a 5-point scale for qualitative analysis. The Wilcoxons signed rank test was used to determine whether a significant difference existed between images with and without BLADE. A p value less than 0.05 was considered to be statistically significant. RESULTS In the BLADE images, image artifacts, sharpness of liver edge, image noise, and overall image quality were significantly improved (p < 0.001). CONCLUSION With the BLADE technique, T2-weighted TSE images of the upper abdomen could provide reduced image artifacts including ghosting artifact and image noise and provide better image quality.

Evaluation of motion correction effect and image quality with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (BLADE) and parallel imaging acquisition technique in the upper abdomen

To evaluate motion correction effect and image quality in the upper abdomen with the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (BLADE) and parallel imaging acquisition technique.

Non-contrast-enhanced hepatic MR angiography with true steady-state free-precession and time spatial labeling inversion pulse: Optimization of the technique and preliminary results

OBJECTIVE To selectively visualize the hepatic arteries using the respiratory-triggered three-dimensional (3D) true steady-state free-precession (SSFP) projection magnetic resonance angiographic sequence with time spatial labeling inversion pulse (T-SLIP), and describe the optimization of this protocol. MATERIALS AND METHODS Twenty healthy volunteers were examined in this study. A respiratory-triggered 3D true SSFP combined with T-SLIP was performed. Among several key factors that affect the image quality, the most important is the inversion time (TI). Therefore, according to the difference in TI, four image groups: group A (TI of 800 ms), group B (TI of 1000 ms), group C (TI of 1200 ms), and group D (TI of 1400 ms), were assigned and compared to detect the optimal TI for hepatic artery visualization. For quantitative assessment, the relative signal intensity, i.e., Cv-l (vessel-to-liver contrast) of the right hepatic artery was measured. For qualitative evaluation, the quality of vessel visualization and the order of identified hepatic artery branches were evaluated by two radiologists. RESULTS Selective and high-contrast visualization of the hepatic arteries was acquired in all cases. Regarding the quantitative assessment, Cv-l decreased in group D due to background signal recovery, but there was no significant difference between groups (p-value >0.05). Regarding the qualitative evaluation, there were significant differences between group A and the other groups (p-value <0.01) and between groups B and C (p-value <0.05). In group C, both the image quality score and mean value for the order of the hepatic artery branches were highest, and a TI of 1200 ms was thought to be optimal regarding the balance between vessel-to-liver contrast and peripheral hepatic artery visualization. CONCLUSION The MR angiographic technique using true SSFP with T-SLIP enabled the selective visualization of hepatic arteries without the need for an exogenous contrast agent or breath-hold.

Non-contrast-enhanced MR portography with time-spatial labeling inversion pulses: comparison of imaging with three-dimensional half-fourier fast spin-echo and true steady-state free-precession sequences.

To compare and evaluate images acquired with two different MR angiography (MRA) sequences, three‐dimensional (3D) half‐Fourier fast spin‐echo (FSE) and 3D true steady‐state free‐precession (SSFP) combined with two time‐spatial labeling inversion pulses (T‐SLIPs), for selective and non‐contrast‐enhanced (non‐CE) visualization of the portal vein.

Hepatic Lesions: Improved Image Quality and Detection with the Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction Technique—Evaluation of SPIO-enhanced T2-weighted MR Images

PURPOSE To evaluate the effectiveness of the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique for superparamagnetic iron oxide (SPIO)-enhanced T2-weighted magnetic resonance (MR) imaging with respiratory compensation with the prospective acquisition correction (PACE) technique in the detection of hepatic lesions. MATERIALS AND METHODS The institutional human research committee approved this prospective study, and all patients provided written informed consent. Eighty-one patients (mean age, 58 years) underwent hepatic 1.5-T MR imaging. Fat-saturated T2-weighted turbo spin-echo images were acquired with the PACE technique and with and without the PROPELLER method after administration of SPIO. Images were qualitatively evaluated for image artifacts, depiction of liver edge and intrahepatic vessels, overall image quality, and presence of lesions. Three radiologists independently assessed these characteristics with a five-point confidence scale. Diagnostic performance was assessed with receiver operating characteristic (ROC) curve analysis. Quantitative analysis was conducted by measuring the liver signal-to-noise ratio (SNR) and the lesion-to-liver contrast-to-noise ratio (CNR). The Wilcoxon signed rank test and two-tailed Student t test were used, and P < .05 indicated a significant difference. RESULTS MR imaging with the PROPELLER and PACE techniques resulted in significantly improved image quality, higher sensitivity, and greater area under the ROC curve for hepatic lesion detection than did MR imaging with the PACE technique alone (P < .001). The mean liver SNR and the lesion-to-liver CNR were higher with the PROPELLER technique than without it (P < .001). CONCLUSION T2-weighted MR imaging with the PROPELLER and PACE technique and SPIO enhancement is a promising method with which to improve the detection of hepatic lesions. (c) RSNA, 2009.

Non-contrast-enhanced MR angiography for selective visualization of the hepatic vein and inferior vena cava with true steady-state free-precession sequence and time-spatial labeling inversion pulses: preliminary results.

To selectively visualize the hepatic vein and inferior vena cava (IVC) using three‐dimensional (3D) true steady‐state free‐precession (SSFP) MR angiography with time‐spatial labeling inversion pulse (T‐SLIP), and to optimize the acquisition protocol.

Unenhanced MR Portography With a Half-Fourier Fast Spin-Echo Sequence and Time-Space Labeling Inversion Pulses: Preliminary Results

OBJECTIVE For this study, we aimed to selectively visualize the intrahepatic portal veins using 3D half-Fourier fast spin-echo (FSE) MR angiography (MRA) with a time-space labeling inversion pulse (T-SLIP) and to optimize the acquisition protocol. SUBJECTS AND METHODS Respiratory-triggered 3D half-Fourier FSE scans were obtained in 25 healthy adult subjects combined with two different T-SLIPs: one placed on the liver and the thorax to suppress signals of the liver parenchyma, hepatic veins, and abdominal arteries and the other on the lower abdomen to suppress the ascending signal of the inferior vena cava. One of the most important factors was the inversion time (TI) of the inversion pulse for the liver and thorax. Image quality was evaluated in terms of signal-to-noise ratio, contrast-to-noise ratio, and mean visualization scores at four different TIs: 800, 1,200, 1,600, and 2,000 milliseconds. RESULTS Selective visualization of the portal vein was successfully achieved in all volunteers, and anatomic variations were also seen in three subjects. A TI of 1,200 milliseconds was optimal in our protocol because it was sufficient for peripheral portal vein visualization and was most suitable for signal suppression of the hepatic veins and liver parenchyma. CONCLUSION Half-Fourier FSE scanning with T-SLIPs enabled selective visualization of the portal vein without an exogenous contrast agent.

High‐spatial‐resolution three‐dimensional MR cholangiography using a high‐sampling‐efficiency technique (SPACE) at 3T: Comparison with the conventional constant flip angle sequence in healthy volunteers

To evaluate the image quality of high‐spatial‐resolution three‐dimensional magnetic resonance cholangiography (MRC) with a high‐sampling‐efficiency technique (sampling perfection with application optimized contrasts using different flip angle evolutions [SPACE]) in comparison with a conventional constant flip angle (FA) sequence at 3T.

High spatial resolution 3D MR cholangiography with high sampling efficiency technique (SPACE): Comparison of 3 T vs. 1.5 T

PURPOSE The aim of this study was to evaluate image quality of 3D MR cholangiography (MRC) using high sampling efficiency technique (SPACE) at 3T compared with 1.5T. METHODS AND MATERIALS An IRB approved prospective study was performed with 17 healthy volunteers using both 3 and 1.5T MR scanners. MRC images were obtained with free-breathing navigator-triggered 3D T2-weighted turbo spin-echo sequence with SPACE (TR, >2700ms; TE, 780ms at 3T and 801ms at 1.5T; echo-train length, 121; voxel size, 1.1mmx1.0mmx0.84mm). The common bile duct (CBD) to liver contrast-to-noise ratios (CNRs) were compared between 3 and 1.5T. A five-point scale was used to compare overall image quality and visualization of the third branches of bile duct (B2, B6, and B8). The depiction of cystic duct insertion and the highest order of bile duct visible were also compared. The results were compared using the Wilcoxon signed-ranks test. RESULTS CNR between the CBD and liver was significantly higher at 3T than 1.5T (p=0.0006). MRC at 3T showed a significantly higher overall image quality (p=0.0215) and clearer visualization of B2 (p=0.0183) and B6 (p=0.0106) than at 1.5T. In all analyses of duct visibility, 3T showed higher scores than 1.5T. CONCLUSION 3T MRC using SPACE offered better image quality than 1.5T. SPACE technique facilitated high-resolution 3D MRC with excellent image quality at 3T.