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Hepatic MR Angiography

A Multiobserver Comparison of Visualization Methods

Peter L. Choyke1, Peter Yim1, Hani Marcos1, Vincent B. Ho2, Rakesh Mullick1 and Ronald M. Summers1

1 Diagnostic Radiology Department, The Clinical Center, National Institutes of Health, Bldg. 10, Rm. 1C660, Bethesda, MD 20892-1182.
2 Department of Radiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814-4799.



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  		Fig. 1A. —47-year-old man with colon carcinoma and metastases to liver. Hepatic MR angiograms show normal arterial anatomy. Maximum-intensity-projection image shows arterial supply poorly.

 


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  		Fig. 1B. —47-year-old man with colon carcinoma and metastases to liver. Hepatic MR angiograms show normal arterial anatomy. Targeted maximum-intensity-projection images show portions of hepatic anatomy.

 


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  		Fig. 1C. —47-year-old man with colon carcinoma and metastases to liver. Hepatic MR angiograms show normal arterial anatomy. Targeted maximum-intensity-projection images show portions of hepatic anatomy.

 


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  		Fig. 1D. —47-year-old man with colon carcinoma and metastases to liver. Hepatic MR angiograms show normal arterial anatomy. Isointensity surface rendering shows incomplete hepatic vessels because of thresholding.

 


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  		Fig. 1E. —47-year-old man with colon carcinoma and metastases to liver. Hepatic MR angiograms show normal arterial anatomy. Connected isointensity surface rendering markedly truncates vascular anatomy.

 


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  		Fig. 1F. —47-year-old man with colon carcinoma and metastases to liver. Hepatic MR angiograms show normal arterial anatomy. Skeleton shows celiac and hepatic arteries in red and superior mesenteric artery in blue. Arteries are more reliably detected with skeletonization.

 


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  		Fig. 2A. —54-year-old woman with ocular melanoma. Hepatic MR angiograms show aberrant vascular anatomy with replaced right hepatic artery. Maximum-intensity-projection image shows hepatic artery and superior mesenteric artery, but origin of hepatic artery is ambiguous.

 


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  		Fig. 2B. —54-year-old woman with ocular melanoma. Hepatic MR angiograms show aberrant vascular anatomy with replaced right hepatic artery. Targeted maximum-intensity-projection images show origin of right hepatic artery from superior mesenteric artery.

 


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  		Fig. 2C. —54-year-old woman with ocular melanoma. Hepatic MR angiograms show aberrant vascular anatomy with replaced right hepatic artery. Targeted maximum-intensity-projection images show origin of right hepatic artery from superior mesenteric artery.

 


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  		Fig. 2D. —54-year-old woman with ocular melanoma. Hepatic MR angiograms show aberrant vascular anatomy with replaced right hepatic artery. Isointensity surface rendering shows origin of right hepatic artery from superior mesenteric artery, but image has distracting clutter.

 


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  		Fig. 2E. —54-year-old woman with ocular melanoma. Hepatic MR angiograms show aberrant vascular anatomy with replaced right hepatic artery. Connected isointensity surface rendering shows aberrant right hepatic artery with less clutter than isointensity surface.

 


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  		Fig. 2F. —54-year-old woman with ocular melanoma. Hepatic MR angiograms show aberrant vascular anatomy with replaced right hepatic artery. Skeletonized MR angiogram shows hepatic artery arising from superior mesenteric artery. Smaller branches are better visualized than with other techniques. Observers had higher confidence with skeletonized angiography than with other techniques.

 


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  		Fig. 3. —Graph shows receiver operator characteristic (ROC) curves for visualization methods. Skeletons display best performance and highest area under the curve (Az) value. {diamondsuit} = skeleton, {blacksquare} = isosurface, {blacktriangleup} = targeted maximum intensity projection, [UNK] = connected isosurface, [UNK] = maximum intensity projection.

 


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  		Fig. 4. —Bar chart shows kappa scores for five visualization methods. a versus b (gray) and c versus d (black) = two reviewers' pairwise comparisons of five methods, mean (white) = average values for all comparisons.

 

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