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Utility of Breath-Hold Fast-Recovery Fast Spin-Echo T2 Versus Respiratory-Triggered Fast Spin-Echo T2 in Clinical Hepatic Imaging

¹ All authors: Department of Radiology, David Geffen School of Medicine, Center for the Health Sciences, UCLA Medical Center, BL-428 CHS, Box 951721, Los Angeles, CA 90095-1721.

OBJECTIVE. The objective of our study was to compare a breath-hold fat-suppressed fast-recovery fast spin-echo (FSE) T2-weighted sequence with a respiratory-triggered fat-suppressed FSE T2-weighted sequence to assess the effect on image quality and lesion detection and characterization in clinical hepatic imaging.

MATERIALS AND METHODS. Both the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences were acquired in 46 patients. Two radiologists, blinded to clinical data, independently evaluated randomized images from both sequences. Qualitatively, images were graded on a 5-point scale for five different characteristics. The number and location of lesions were recorded. The confidence of detection and the confidence of characterization (solid vs nonsolid) were graded on a 5-point scale. A consensus review using radiology, clinical, and pathology data served as the standard. Receiver operating characteristic (ROC) curve analysis (area under the ROC curve [A_z]) was used to compare each reviewer's interpretation against the consensus interpretation. Quantitative analysis was performed by calculating the liver signal-to-noise ratio (SNR), liver-to-spleen contrast-to-noise ratio (CNR), and lesion-to-liver CNR. Both one- and two-tailed Student's t tests were used to check for significance.

RESULTS. Qualitatively, both reviewers graded the breath-hold fat-suppressed fast-recovery FSE T2-weighted sequence better than the respiratory-triggered fat-suppressed FSE T2-weighted sequence on all five characteristics (p < 0.005). Of 78 lesions detected, 29 were characterized as solid; 47, nonsolid; and two, indeterminate. On ROC analysis, there were no significant differences between the breath-hold fat-suppressed fast-recovery FSE and respiratory-triggered fat-suppressed FSE T2-weighted sequences in lesion detection (A_z reviewer 1, 0.77 and 0.83, respectively, [p = 0.12]; A_z reviewer 2, 0.84 and 0.80, respectively [p = 0.12]) or in lesion characterization (A_z reviewer 1, 0.86 and 0.92, respectively [p = 0.33]; A_z reviewer 2, 0.90 and 0.91, respectively [p = 0.79]). Quantitatively, liver SNRs, spleen CNRs, and lesion CNRs (solid and nonsolid lesions) were significantly better on the breath-hold fat-suppressed fast-recovery FSE T2-weighted images than on the respiratory-triggered fat-suppressed FSE T2-weighted images (p < 0.005).

CONCLUSION. Breath-hold fat-suppressed fast-recovery FSE T2-weighted images were of better quality than respiratory-triggered fat-suppressed FSE T2-weighted images, and lesion detection and characterization were comparable.

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