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Gadolinium-Enhanced Multiphasic 3D MRI of the Liver with Prospective Adaptive Navigator Correction: Phantom Study and Preliminary Clinical Evaluation

¹ Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu, Gifu, Japan 501-1194.
² Research Center of Brain and Oral Science, Kanagawa Dental College, Yokosuka, Japan.
³ Department of Radiology, Gifu University Hospital, Gifu, Japan.
⁴ Department of Physiology and Neuroscience, Kanagawa Dental College, Kanagawa, Japan.
⁵ Philips Electronics Japan, Ltd., Medical Systems, Tokyo, Japan.
⁶ Research Center for Cancer Prevention and Screening, National Cancer Center Hospital, Tokyo, Japan.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Diagram shows pulse sequence architecture of fat-suppressed 3D spoiled turbo field-echo sequence. First fat-suppression prepulse is applied before 2D navigator pulse to avoid fat signal contamination, which can lead to misrecognition of lung-liver interface because 2D navigator pulse is not chemical-shift selective. Second fat-suppression prepulse is used for 3D imaging of liver. Signals generated by navigator pulse are Fourier transformed in real time, and lung-liver interfaces in vivo are determined with cross-correlation method. In craniocaudal axis, prospective correction is achieved by updating frequency of volume-selective radiofrequency excitation pulse. During this 200-millisecond segment, pulse excitation and data acquisition for liver are repeated 39 times over approximately 140 milliseconds. This single segment is repeated 60 times over 12 seconds in single phase.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Diagram shows time course of gadolinium-enhanced multiphasic spoiled turbo field-echo imaging. Scans were started at test-bolus peak enhancement, and central k-space data were acquired 6, 18, 55, and 180 seconds after arrival of contrast medium in abdominal aorta, estimated with test-bolus imaging. Echoes sampled during acquisitions and filled in central k-space lines markedly affected entire image contrast. HAP = hepatic artery-dominant phase, PVP = portal venous phase, EP = equilibrium phase.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Transaxial phantom images. First (A), second (B), and third (C) phase MR images obtained without prospective navigator correction. Without correction, distance between two syringes increases from 24 to 30 to 60 mm in the first, second, and third phases, and transaxial scan levels in first (A) and third (C) phases are clearly different. Image during movement (B) is substantially degraded.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Transaxial phantom images. First (A), second (B), and third (C) phase MR images obtained without prospective navigator correction. Without correction, distance between two syringes increases from 24 to 30 to 60 mm in the first, second, and third phases, and transaxial scan levels in first (A) and third (C) phases are clearly different. Image during movement (B) is substantially degraded.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Transaxial phantom images. First (A), second (B), and third (C) phase MR images obtained without prospective navigator correction. Without correction, distance between two syringes increases from 24 to 30 to 60 mm in the first, second, and third phases, and transaxial scan levels in first (A) and third (C) phases are clearly different. Image during movement (B) is substantially degraded.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Transaxial phantom images. First (D), second (E), and third (F) phase MR images obtained with prospective navigator correction. With correction, distance between two syringes is constant 24 mm and transaxial scan levels in first (D) and third (F) phases are matched perfectly. Image is not degraded during movement (E).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —Transaxial phantom images. First (D), second (E), and third (F) phase MR images obtained with prospective navigator correction. With correction, distance between two syringes is constant 24 mm and transaxial scan levels in first (D) and third (F) phases are matched perfectly. Image is not degraded during movement (E).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —Transaxial phantom images. First (D), second (E), and third (F) phase MR images obtained with prospective navigator correction. With correction, distance between two syringes is constant 24 mm and transaxial scan levels in first (D) and third (F) phases are matched perfectly. Image is not degraded during movement (E).

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —72-year-old man with multiple small hepatocellular carcinomas (HCCs) in moderate cirrhosis. Transverse gadolinium-enhanced spoiled turbo field-echo (TR/TE, 3.3/1.1) MR images obtained with prospective adaptive navigator correction during early hepatic artery-dominant (A), late hepatic artery-dominant (B), portal venous (C), and equilibrium (D) phases. Small hypervascular HCC (arrow), measuring 8 mm in diameter, is constantly imaged in its maximum cross-section, and cine display shows coronal enhancement (arrow, B and C) and washout (arrow, D) of this small hypervascular HCC.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —72-year-old man with multiple small hepatocellular carcinomas (HCCs) in moderate cirrhosis. Transverse gadolinium-enhanced spoiled turbo field-echo (TR/TE, 3.3/1.1) MR images obtained with prospective adaptive navigator correction during early hepatic artery-dominant (A), late hepatic artery-dominant (B), portal venous (C), and equilibrium (D) phases. Small hypervascular HCC (arrow), measuring 8 mm in diameter, is constantly imaged in its maximum cross-section, and cine display shows coronal enhancement (arrow, B and C) and washout (arrow, D) of this small hypervascular HCC.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —72-year-old man with multiple small hepatocellular carcinomas (HCCs) in moderate cirrhosis. Transverse gadolinium-enhanced spoiled turbo field-echo (TR/TE, 3.3/1.1) MR images obtained with prospective adaptive navigator correction during early hepatic artery-dominant (A), late hepatic artery-dominant (B), portal venous (C), and equilibrium (D) phases. Small hypervascular HCC (arrow), measuring 8 mm in diameter, is constantly imaged in its maximum cross-section, and cine display shows coronal enhancement (arrow, B and C) and washout (arrow, D) of this small hypervascular HCC.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —72-year-old man with multiple small hepatocellular carcinomas (HCCs) in moderate cirrhosis. Transverse gadolinium-enhanced spoiled turbo field-echo (TR/TE, 3.3/1.1) MR images obtained with prospective adaptive navigator correction during early hepatic artery-dominant (A), late hepatic artery-dominant (B), portal venous (C), and equilibrium (D) phases. Small hypervascular HCC (arrow), measuring 8 mm in diameter, is constantly imaged in its maximum cross-section, and cine display shows coronal enhancement (arrow, B and C) and washout (arrow, D) of this small hypervascular HCC.

View larger version (46K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —70-year-old man with hypervascular hepatocellular carcinoma (HCC) in moderate cirrhosis. Navigator display shows that lung-liver interface (arrow) continuously moved 14 mm in cranial direction during serial early and late hepatic artery-dominant phases. HAP = hepatic artery-dominant phase, PVP = portal venous phase, and EP = equilibrium phase.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —70-year-old man with hypervascular hepatocellular carcinoma (HCC) in moderate cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hemodynamics in hypervascular 30-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase (B) were well observed on late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) images. Portal venous branches in umbilical portion of liver (arrowhead, B) are constantly observed in same configuration throughout phases.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —70-year-old man with hypervascular hepatocellular carcinoma (HCC) in moderate cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hemodynamics in hypervascular 30-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase (B) were well observed on late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) images. Portal venous branches in umbilical portion of liver (arrowhead, B) are constantly observed in same configuration throughout phases.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —70-year-old man with hypervascular hepatocellular carcinoma (HCC) in moderate cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hemodynamics in hypervascular 30-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase (B) were well observed on late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) images. Portal venous branches in umbilical portion of liver (arrowhead, B) are constantly observed in same configuration throughout phases.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —70-year-old man with hypervascular hepatocellular carcinoma (HCC) in moderate cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hemodynamics in hypervascular 30-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase (B) were well observed on late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) images. Portal venous branches in umbilical portion of liver (arrowhead, B) are constantly observed in same configuration throughout phases.

View larger version (44K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —86-year-old man with multiple hepatocellular carcinomas (HCCs) in severe cirrhosis. Navigator display shows that patient did not hold his breath at beginning (arrow) of portal venous phase and that liver moved substantially at beginning of portal venous phase. HAP = hepatic artery-dominant phase, PVP = portal venous phase, and EP = equilibrium phase.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —86-year-old man with multiple hepatocellular carcinomas (HCCs) in severe cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hypervascular 20-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase is depicted in same cross-section in late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) phases. Image quality in portal venous phase (D) is moderately degraded despite navigator correction, but slice position is maintained, allowing observation of hemodynamics of tumor.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —86-year-old man with multiple hepatocellular carcinomas (HCCs) in severe cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hypervascular 20-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase is depicted in same cross-section in late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) phases. Image quality in portal venous phase (D) is moderately degraded despite navigator correction, but slice position is maintained, allowing observation of hemodynamics of tumor.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —86-year-old man with multiple hepatocellular carcinomas (HCCs) in severe cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hypervascular 20-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase is depicted in same cross-section in late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) phases. Image quality in portal venous phase (D) is moderately degraded despite navigator correction, but slice position is maintained, allowing observation of hemodynamics of tumor.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —86-year-old man with multiple hepatocellular carcinomas (HCCs) in severe cirrhosis. Gadolinium-enhanced multiphasic 3D spoiled turbo field-echo MR images (TR/TE, 3.3/1.1) obtained with navigator correction. Hypervascular 20-mm HCC (arrow, B) imaged in maximum cross-section during early hepatic artery-dominant phase is depicted in same cross-section in late hepatic artery-dominant (C), portal venous (D), and equilibrium (E) phases. Image quality in portal venous phase (D) is moderately degraded despite navigator correction, but slice position is maintained, allowing observation of hemodynamics of tumor.

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