Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system

국소 간 병변의 발견: 1.5-T 자기공명영상에서의 자유호흡과 호흡유발 확산강조 영상의 비교

  • Park, Hye-Young (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Cho, Hyeon-Je (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Eun-Mi (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Hur, Gham (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Yong-Hoon (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Byung-Hoon (Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine)
  • 박혜영 (인제대학교 일산백병원 영상의학과) ;
  • 조현제 (인제대학교 일산백병원 영상의학과) ;
  • 김은미 (인제대학교 일산백병원 영상의학과) ;
  • 허감 (인제대학교 일산백병원 영상의학과) ;
  • 김용훈 (인제대학교 일산백병원 영상의학과) ;
  • 이병훈 (인제대학교 일산백병원 영상의학과)
  • Received : 2010.03.16
  • Accepted : 2011.01.27
  • Published : 2011.04.30
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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 respiratory-triggered DWI ($87.6{\pm}41.4$, $41.2{\pm}62.5$) were higher than free-breathing DWI ($38.8:{\pm}13.6$, $24.8{\pm}36.8$) (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.

목적: 이 연구의 목적은 간 병변 발견에 있어 1.5-T 자기공명영상에서 자유 호흡 확산강조 영상과 호흡 유발 확산강조 영상의 유용성을 비교하는데 있다. 대상 및 방법: 47명의 환자(평균 57.9세, 남성:여성 = 25:22)가 한번의 간 자기공명 영상검사에서 자유호흡 확산 강조 영상과 호흡유발 확산 강조 영상을 동시에 시행하였다. 이를 두 명의 영상의학과 의사가 호흡유발 이미지 세트(B50, B400, B800 확산강조 영상과 ADC map)와 자유호흡 이미지 세트를 2주간의 시간 간격을 두고 무작위로 후향적 분석을 시행하였다. 영상분석을 위하여 특정영역(ROI)를 설정한 후에 간의 신호대 잡음비 (signal-to-noise ratio, SNR)와 대조도(contrast-to-noise ratio, CNR)를 계산하였다. 결과: 32개의 낭종, 13개의 혈관종, 7개의 간세포암, 6국소 호산구성 간질환, 2개의 전이, 1개의 초점성 결절성 과증식과 글리슨막의 가성지방종을 포함하는 총 62개의 병변이 두 명의 평가자에 의하여 분석되었다. 비록 통계적 유의성을 없었으나, 전체적인 병변 발견의 sensitivity는 호흡유발 확산강조 영상이 [평가자 1:평가자 2, 47/62(75.81%):45/62(72.58%)] 자유호흡 확산강조 영상보다 [44/62(70.97%):41/62(66.13%)] 더 높은 수치를 보였다. 특히 1 cm보다 작은 국소 간 병변 발견의 sensitivity는 호흡유발 확산강조 영상이 [24/30(80%): 21/30(70%)] 지유호흡 확산강조 영상보다 [17/30(56.7%):15/30(50%)] 더 우월하였다. 진단적 정확도활 계산하기 위하여 ROC curve (Az value)를 구하였으며 자유호흡 확산강조 영상과 호흡유발 확산강조 영상간에는 통계적 차이는 없었다. 간의 신호대 잡음비 (SNR)와 대조도 (CNR)는 호흡유발 확산강조 영상이 ($87.6{\pm}41.4$, $41.2{\pm}62.5$) 자유호흡확산강조 영상보다 ($38.8:{\pm}13.6$, $24.8{\pm}36.8$) 높았으며 통계적인 유의성이 있었다. (p value < 0.001). 결론: 1.5-T자기공명 시스템서 1 cm보다 작은 간 병변발견에 있어서 호흡유발 확산강조 영상이 자유호흡 확산강조 영상보다 좋으며 이는 호흡유발 확산강조 영상이 높은 신호대 잡음비 (SNR)와 대조도(CNR)를 보이기 때문이다.

Keywords

References

  1. Elsayes KM, Leyendecker JR, Menias CO, et al. MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility. HPB (Oxford) 2007;9:208-215 https://doi.org/10.1080/13651820701216950
  2. Ward J. New MR techniques for the detection of liver metastases. Cancer Imaging 2006;6:33-42 https://doi.org/10.1102/1470-7330.2006.0007
  3. Muller MF, Prasad P, Siewert B, Nissenbaum MA, Raptopoulos V, Edelman RR. Abdominal diffusion mapping with use of a whole-body echo-planar system. Radiology 1994;190:475-478
  4. Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T. Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. AJR Am J Roentgenol 1998;170:397-402 https://doi.org/10.2214/ajr.170.2.9456953
  5. Namimoto T, Yamashita Y, Sumi S, Tang Y, Takahashi M. Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 1997;204:739-744
  6. Vossen JA, Buijs M, Liapi E, Eng J, BIuemkc DA, Kamel IR. Receiver operating characteristic analysis of diffusion-weighted magnetic resonance imaging in differentiating hepatic hemangioma from other hypervascular liver lesions. J Comput Assist Tomogr 2008;32:750-756 https://doi.org/10.1097/RCT.0b013e31816a6823
  7. Bruegel M, Holzapfcl K, Gaa J, et al. Characterization of focal liver lesions by ADC measurements using a respiratory triggered diffusion-weighted single-shot echo-planar MR imaging technique. Eur Radiol 2008;18:477-485 https://doi.org/10.1007/s00330-007-0785-9
  8. Kwee TC, Takahara T, Koh DM, Nievelstein RA, Luijten PR. Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free-breathing diffusion-weighted MR imaging of the liver. J Magn Reson Imaging 2008;28:1141-1148 https://doi.org/10.1002/jmri.21569
  9. Nasu K, Kuroki Y, Sekiguchi R, Nawano S. The effect of simultaneous use of respiratory triggering in diffusion-weighted imaging of the liver. Magn Reson Med Sci 2006;5: 129-136 https://doi.org/10.2463/mrms.5.129
  10. Gourtsoyianni S, Papanikolaou N, Yarmenitis S, Maris T, Karantanas A, Gourtsoyiannis N. Respiratory gated diffusion-weighted imaging of the liver: value of apparent diffusion coefficient measurements in the differentiation between most commonly encountered benign and malignant focal liver lesions. Eur Radiol 2008;18:486-492 https://doi.org/10.1007/s00330-007-0798-4
  11. Kandpal H, Sharma R, Madhusudhan KS, Kapoor KS. Respiratory-triggered versus breath-hold diffusion-weighted MRI of liver lesions: comparison of image quality and apparent diffusion coefficient values. AJR Am J Roentgenol 2009;192:915-922 https://doi.org/10.2214/AJR.08.1260
  12. Holzapfel K, Bruegel M, Eiber M, et al. Characterization of small (< / = 10mm) focal liver lesions: Value of respiratory-triggered echo-planar diffusion-weighted MR imaging, In: Eur J Radiol, 2009
  13. Quan XY, Sun XJ, Yu ZJ, Tang M. Evaluation of diffusion weighted imaging of magnetic resonance imaging in small focal hepatic lesions: a quantitative study in 56 cases. Hepatobiliary Pancreat Dis Int 2005;4:406-409
  14. Koh DM, Scurr E, Collins DJ, et al. Colorectal hepatic metastases: quantitative measurements using single-shot echoplanar diffusion-weighted MR imaging. Eur Radiol 2006;16:1898-1905 https://doi.org/10.1007/s00330-006-0201-x
  15. Nasu K, Kuroki Y, Nawano S, et al. Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 2006;239:122-130 https://doi.org/10.1148/radiol.2383041384
  16. Xu PJ, Van FH, Wang JH, Lin J, Ji Y. Added value of breathhold diffusion-weighted MRI in detection of small hepatocellular carcinoma lesions compared with dynamic contrast-enhanced MRI alone using receiver operating characteristic curve analysis. J Magn Reson Imaging 2009;29:341-349 https://doi.org/10.1002/jmri.21650
  17. Bruegel M, Gaa J, Waldt S, et al. Diagnosis of hepatic metastasis: comparison of respiration-triggered diffusion-weighted echo-planar MRI and five t2-weighted turbo spin-echo sequences. AJR Am J Roentgenol 2008;191:1421-1429 https://doi.org/10.2214/AJR.07.3279
  18. Parikh T, Drew SI, Lee VS, et al. Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 2008;246:812-822 https://doi.org/10.1148/radiol.2463070432
  19. Nasu K, Kuroki Y, Fujii H, Minami M. Hepatic pseudoanisotropy: a specific artifact in hepatic diffusion-weighted images obtained with respiratory triggering. MAGMA 2007;20:205-211 https://doi.org/10.1007/s10334-007-0084-0
  20. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001;35:421-430 https://doi.org/10.1016/S0168-8278(01)00130-1
  21. Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of Hepatocellular carcinoma. Hepatology 2005;42:1208-1236 https://doi.org/10.1002/hep.20933