T2-weighted MRI of the Upper Abdomen:: Comparison of Four Fat-Suppressed T2-weighted Sequences Including PROPELLER (BLADE) Technique

doi:10.1016/j.acra.2009.10.015

Academic Radiology

Volume 17, Issue 3, March 2010, Pages 368-374

https://doi.org/10.1016/j.acra.2009.10.015 Get rights and content

Rationale and Objectives

The aim of this study was to compare four different fat-suppressed T2-weighted sequences with different techniques with regard to image quality and lesion detection in upper abdominal magnetic resonance imaging (MRI) scans.

Materials and Methods

Thirty-two consecutive patients referred for upper abdominal MRI for the evaluation of various suspected pathologies were included in this study. Different T2-weighted sequences (free-breathing navigator-triggered turbo spin-echo [TSE], free-breathing navigator-triggered TSE with restore pulse (RP), breath-hold TSE with RP, and free-breathing navigator-triggered TSE with RP using the periodically rotated overlapping parallel lines with enhanced reconstruction technique [using BLADE, a Siemens implementation of this technique]) were used on all patients. All images were assessed independently by two radiologists. Assessments of motion artifacts; the edge sharpness of the liver, pancreas, and intrahepatic vessels; depictions of the intrahepatic vessels; and overall image quality were performed qualitatively. Quantitative analysis was performed by calculation of the signal-to-noise ratios for liver tissue and gallbladder as well as contrast-to-noise ratios of liver to spleen.

Results

Liver and gallbladder signal-to-noise ratios as well as liver to spleen contrast-to-noise ratios were significantly higher (P < .05) for the BLADE technique compared to all other sequences. In qualitative analysis, the severity of motion artifacts was significantly lower with T2-weighted free-breathing navigator-triggered BLADE sequences compared to other sequences (P < .01). The edge sharpness of the liver, pancreas, and intrahepatic vessels; depictions of the intrahepatic vessels; and overall image quality were significantly better with the BLADE sequence (P < .05).

Conclusion

The T2-weighted free-breathing navigator-triggered TSE sequence with the BLADE technique is a promising approach for reducing motion artifacts and improving image quality in upper abdominal MRI scans.

Section snippets

Patients

From November 2007 to April 2008, 35 consecutive adult patients referred for MRI of the upper abdomen for the evaluation of various suspected pathologies were included in this study and examined. Three patients were retrospectively excluded from the study because of lack of cooperation. Therefore, a total of 32 patients (20 women, 16 men; age range, 29–71 years; mean age, 50 ± 16 years) were included. Our institutional review board approved this study, and written informed consent was obtained

Qualitative Analysis

Table 2 shows the results for motion artifacts; the edge sharpness of the liver, pancreas, and intrahepatic vessels; depictions of the intrahepatic vessels; and overall image quality as evaluated by the two observers for the four different sequences (Fig 1). The severity of motion artifacts induced by respiratory ghosting, vascular pulsation, peristalsis, and susceptibility was significantly lower in BLADE T2W TSE with RP images compared to the other sequences (P < .01). The edge sharpness of

Discussion

Patient motion is a significant problem in MRI of the upper abdomen, leading to a reduction in image quality and a loss of diagnostic information. Motion caused by respiration and cardiac and vascular pulsation occurring during data acquisition causes image artifacts, a loss of resolution, and a reduction in SNR 26, 27. It also may reduce anatomic details and lead to lesions' being obscured in images. The BLADE technique offers advantages over other methods used for patient motion correction,

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To evaluate the clinical performance of a deep learning-accelerated single-breath-hold half-Fourier acquisition single-shot turbo spin echo (HASTE_DL)-sequence for T2-weighted fat-suppressed MRI of the abdomen at 1.5 T and 3 T in comparison to standard T2-weighted fat-suppressed multi-shot turbo spin echo-sequence. A total of 320 patients who underwent a clinically indicated liver MRI at 1.5 T and 3 T between August 2020 and February 2021 were enrolled in this single-center, retrospective study. HASTE_DL and standard sequences were assessed regarding overall and organ-based image quality, noise, contrast, sharpness, artifacts, diagnostic confidence, as well as lesion detectability using a Likert scale ranging from 1 to 4 (4 = best). The number of visible lesions of each organ was counted and the largest diameter of the major lesion was measured. HASTE_DL showed excellent image quality (median 4, interquartile range 3-4), although BLADE (median 4, interquartile range 4-4) was rated significantly higher for overall and organ-based image quality of the adrenal gland (P < .001), contrast (P < 0.001), sharpness (P < 0.001), artifacts (P < 0.001), as well as diagnostic confidence (P < .001). No significant differences were found concerning noise (P = 0.886), organ-based image quality of the liver, pancreas, spleen, and kidneys (P = 0.120-0.366), number and measured diameter of the detected lesions (ICC = 0.972-1.0). Reduction of the aquisition time (TA) was at least 89% for 1.5 T images and 86% for 3 T images. HASTE_DL provided excellent image quality, good diagnostic confidence and lesion detection compared to a standard T2-sequences, allowing an eminent reduction of the acquisition time.
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However, there are still some substantial technical challenges for liver T2WI sequence, such as long acquisition time and motion artifacts [8,9]. In order to overcome these shortcomings, multiple breath-hold T2WI based on Fast spin echo (FSE) sequence has been utilized to maintain the image quality at the cost of lower sampling efficiency [10,11]. Besides, the diagnostic performance of multiple breath-hold acquisitions was occasionally impaired by the spatial mismatch of the acquired sections due to varying breath-hold positions [8].
To investigate the clinical feasibility of single-breath-hold T2-weighted (SBH-T2WI) liver MRI using Artificial Intelligence-assisted Compressed Sensing (ACS) technique in liver imaging as compared with conventional respiratory-triggered T2WI (RT-T2WI).
From January 2021 to October 2021, 81 patients suspected of liver lesions were enrolled in this prospective study. The liver MRI was performed, including both RT-T2WI and ACS SBH-T2WI. Two experienced radiologists reviewed all images of each studied sequence, and recorded the lesion location and the largest diameter of the lesions. The image quality was quantitatively and qualitatively analyzed regarding signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contrast ratio (CR), motion artifact, lesion conspicuity, liver boundary sharpness, and overall image quality. The lesion detection and image quality were compared between two sequences using the Chi-square test or Wilcoxon signed-rank test.
For lesion detection, 64 lesions were identified in 53 enrolled patients as the reference standard. The average size was 12.09 ± 7.4 mm for the benign lesions and 45.89 ± 22.01 mm for the malignant lesions. Of 64 liver lesions, ACS SBH-T2WI detected 60 lesions (93.8%), and RT-T2WI detected 58 lesions (90.6%). For image quality analysis, the motion artifact of ACS SBH-T2WI sequence was significantly reduced compared with the conventional RT-T2WI sequence (p < 0.05). The SNR, liver boundary sharpness, and overall image quality showed no statistical differences between the two sequences. While the CNR, CR, and lesion conspicuity of ACS SBH-T2WI were significantly better than RT-T2WI (all p < 0.05).
The SBH-T2WI with ACS technique showed promising performance as it provided significantly better image quality and lesion detectability with a considerable decrease in scanning time as compared with the conventional RT-T2WI.
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Motion artifacts are further reduced through averaging at low spatial frequencies. The MV method is used extensively to reduce motion artifacts as a motion-robust scanning technique [1–10]. It has also been employed for shoulder joint MRI [11,12].
Motion artifacts caused by breathing or involuntary motion of patients, which may lead to reduced image quality and a loss of diagnostic information, are a major problem in shoulder magnetic resonance imaging (MRI). The MultiVane (MV) technique decreases motion artifacts; however, it tends to prolong the acquisition time. As a parallel imaging technique, SENSitivity Encoding (SENSE) can be combined with the compressed sensing method to produce compressed SENSE (C-SENSE), resulting in a markedly reduced acquisition time. This study aimed to evaluate the use of C-SENSE MV for MRI of the shoulder joint.
Thirty-one patients who were scheduled to undergo MRI of the shoulder were included. This prospective study was approved by our institution’s medical ethics committee, and written informed consent was obtained from all 31 patients. Two sets of oblique coronal images derived from the standard protocol were acquired without (standard) or with C-SENSE MV: proton-density weighted imaging (PDWI), PDWI with C-SENSE MV, T2-weighted imaging (T2WI) with fat suppression (fs), and T2WI fs with C-SENSE MV. Two radiologists graded motion artifacts and the detectability of anatomical shoulder structures on a 4-point scale (3, no artifacts/excellent delineation; 0, severe artifacts/difficulty with delineation). The Wilcoxon signed-rank test was used to compare the data for the standard and C-SENSE MV images.
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In conclusion, in shoulder MRI the newly developed C-SENSE MV technique reduces motion artifacts and increases the detectability of anatomical structures compared with standard sequences.
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K-space under-sampling reconstruction technology is an effective means to improve the speed of magnetic resonance imaging. Among its many reconstruction algorithms, split Bregman iteration is an effective method to solve multi-constrained models. This model often contains TV variational regularization terms, the generalized threshold shrinkage operator often used to solve TV constraints subproblem. However, when the generalized threshold shrinkage operator is performing the shrinking operation, it does not consider the inconsistency of the elements in the image matrix, which will cause the loss of image details.
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MR imaging has a wide range of clinical applications, and at least 70 million cases are examined annually by MR imaging. However, the scanning time of MR imaging is long and the scanning speed is slow [1], which may lead to blurred images due to organ motion and cannot provide dynamic real-time images and navigation. The shortcomings of MR imaging limit the promotion of functional imaging and bring additional sickness to the patient.
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Original investigationT2-weighted MRI of the Upper Abdomen:: Comparison of Four Fat-Suppressed T2-weighted Sequences Including PROPELLER (BLADE) Technique

Rationale and Objectives

Materials and Methods

Results

Conclusion

Section snippets

Patients

Qualitative Analysis

Discussion

Magn Reson Imaging

Clin Imaging

Acad Radiol

Liver T2-weighted MR imaging: comparison of fast and conventional half-Fourier single-shot turbo spin-echo, breath-hold turbo spin-echo, and respiratory-triggered turbo spin-echo sequences

Radiology

Hepatic lesions: discrimination of nonsolid, benign lesions from solid, malignant lesions with heavily T2-weighted fast spin-echo MR imaging

Radiology

T-weighted MR imaging for focal hepatic lesion detection: supplementary value of breath-hold imaging with half-Fourier single-shot fast spin-echo and multishot spin-echo echoplanar sequences

J Magn Reson Imaging

Single breath-hold T2-weighted MR imaging of the liver: value of single-shot fast spin-echo and multishot spin-echo echoplanar imaging

AJR Am J Roentgenol

Liver: T2-weighted MR imaging with breath-hold fast–recovery optimized fast spin-echo compared with breath-hold half-Fourier and non-breath-hold respiratory-triggered fast spin-echo pulse sequences

Radiology

Focal liver lesions: breathhold gradient and spin-echo T2-weighted imaging for detection and characterization

J Magn Reson Imaging

MRI of the liver: can true FISP replace HASTE?

J Magn Reson Imaging

Breath-hold fast spin echo MR imaging of the liver: a technique for high-quality T2-weighted images

Radiology

Liver masses: replacement of conventional T2-weighted spin-echo MR imaging with breath-hold MR imaging

Radiology

Comparison of multishot turbo spin echo and HASTE sequences for T2-weighted MRI of liver lesions

J Magn Reson Imaging

Improving the detectability of focal liver lesions on T2-weighted MR images: ultrafast breath-hold or respiratory-triggered thin section MRI?

J Magn Reson Imaging

Focal hepatic lesion detection: comparison of four fat-suppressed T2-weighted MR imaging pulse sequences

Radiology

Original investigation
T2-weighted MRI of the Upper Abdomen:: Comparison of Four Fat-Suppressed T2-weighted Sequences Including PROPELLER (BLADE) Technique