Feasibility of Quadruple Arterial Phase of Motion Insensitive Radial Volumetric Imaging Breath-Hold Examination with k-Space Weighted Image Contrast in the Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease

Min Ah Lee; Bong Soo Kim; Jeong Sub Lee; Seung Hyoung Kim; Guk Myung Choi; Ho Kyu Lee; Kyung Ryeol Lee

doi:10.3348/jksr.2018.79.4.181

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Lee, Kim, Lee, Kim, Choi, Lee, and Lee: Feasibility of Quadruple Arterial Phase of Motion Insensitive Radial Volumetric Imaging Breath-Hold Examination with k-Space Weighted Image Contrast in the Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease

Original Article

J Korean Soc Radiol 2018;79(4):181-190.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.4.181

Feasibility of Quadruple Arterial Phase of Motion Insensitive Radial Volumetric Imaging Breath-Hold Examination with k-Space Weighted Image Contrast in the Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease

Min Ah Lee, MD, Bong Soo Kim, MD, Jeong Sub Lee, MD, Seung Hyoung Kim, MD, Guk Myung Choi, MD, Ho Kyu Lee, MD, Kyung Ryeol Lee, MD

Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea

^∗Corresponding author: Bong Soo Kim, MD Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju 63241, Korea. Tel. 82-64-717-1373 Fax. 82-64-717-1372 E-mail: 671228kbs@naver.com

Received 16 March 2018 Revised 23 May 2018 Accepted 14 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To evaluate the detection performance of hepatocellular carcinoma and image quality in patients with chronic liver disease with quadruple arterial MR imaging using radial volumetric imaging breath-hold examination (VIBE) with k-space weighted image contrast (KWIC).

Materials and Methods:

Forty-four patients underwent liver MR examinations with quadruple arterial imaging using radial VIBE-KWIC sequence (full-frame and four sub-frame images). Diagnostic performance was evaluated with receiver operating characteristics (ROC) for detection of hepatocellular carcinoma. The image quality and severity of artifact were scored by using the five-point scale.

Results:

The area under the ROC curve (Az) value of Hepatocelluar Carcinoma (HCC) detectability was the highest on third sub-frame images, followed by full-frame images. The Az values of third sub-frame and full-frame about the detection of HCC were statistically significantly different from the Az value of first sub-frame images. The full-frame and four sub-frame images showed acceptable image quality and low degree artifact with rating of higher than grade 3.

Conclusion:

Quadruple arterial MRI using radial VIBE-KWIC is a feasible method for detecting hepatocellular carcinoma in patients with chronic liver disease without deterioration of image quality. The third sub-frame and full-frame image are superior to other sub-frame images in detecting hepatocellular carcinoma.

Keywords: Carcinoma, Hepatocelluar, Magnetic Resonance Imaging, Gadolinium Ethoxybenzyl DTPA, Breath-Holding

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Fig. 1

Schematic timing diagram for T1-weighted quadruple arterial MR imaging using radial VIBE-KWIC. KWIC = k-space weighted image contrast, T1CE = contrast-enhanced T1-weighted image, VIBE = volumetric imaging breath-hold examination

Fig. 2

Principles of the radial acquisition with KWIC reconstruction technique. A. Schematic diagram of the four-interleaf angle-bisection reordering acquisition shows simple example composed of eight projection views. For making full-frame image, k-space data are serially obtained radially projection views which are grouped into four interleaved subsets. And data from all subsets are combined for the reconstruction of full-frame images. B. For the reconstruction of sub-frame images, KWIC divides the k-space into three regions based on the circular Nyquist radius and fills the spokes. For example, spokes obtained first among all acquired radial spokes are filled in k-space. The next spokes are filled without the center. The last obtained spokes are used to fill only the outermost part of the k-space so that it has little effect on the resolution. Therefore four sub-frame KWIC images have different k-space cores and the surrounding k-space is similar. KWIC = k-space weighted image contrast

Fig. 3

MR images obtained in a 64-year-old man with a hepatocellular carcinoma. Contrast-enhanced 3D Radial k-space weighted image contrast, volumetric imaging breath-hold examination during hepatic arterial dominant phase imaging comprised one full-frame and four sub-frame images (A-E). The full-frame and sub-frame images show a focal enhancing lesion (arrows) in right hepatic lobe. Third sub-frame image (D) shows tumor with greater conspicuity and best arterial enhancement than other arterial images (A-C, E). Much better image quality and lesser artifacts were seen on full-frame image. The arterial enhancing lesion was pathologically proved to be a hepatocellular carcinoma after right anterior sectionectomy.

Fig. 4

MR and CT images obtained in a 63-year-old man with a hepatocellular carcinoma. Full-frame and four sub-frame images using contrast-enhanced 3D Radial k-space weighted image contrast, volumetric imaging breath-hold examination during multiple hepatic arterial dominant phases at 5-second temporal resolution (A-E), show gradually increasing enhancing lesion (arrows) in left hepatic lobe. Third sub-frame image (D) depicts an enhancing tumor (arrow) more clearly with best arterial enhancement than other arterial images (A-C, E). Three months follow-up CT (F) after transcatheter arterial chemoembolization demonstrates accumulation of iodized oil (arrow) in a hepatocellular carcinoma in left hepatic lobe. TACE = transcatheter arterial chemoembolizatio

Table 1.

Mean Area Under the ROC Curve for Detection of Hepatocellular Carcinoma

	Az Value for the HCC Detection	p-Value^†
	Az Value for the HCC Detection	F	A1	A2	A3	A4
F	0.884 ± 0.025	-	0.009∗	0.151	0.744	0.572
A1	0.812 ± 0.031	-	-	0.218	0.017∗	0.115
A2	0.846 ± 0.028	-	-	-	0.130	0.460
A3	0.894 ± 0.023	-	-	-	-	0.359
A4	0.869 ± 0.026	-	-	-	-	-

Values are the mean ± standard deviation.

∗Results were considered statistically significant at p-value < 0.05.

^†p-value based on pairwise comparison of ROC curves.

A1 = first sub-frame, A2 = second sub-frame, A3 = third sub-frame, A4 = fourth sub-frame, F = full-frame, HCC = Hepatocelluar Carcinoma, ROC = receiver operating characteristics

Table 2.

Composite Sensitivity, Specificity, PPV, and NPV for Detection of Hepatocellular Carcinoma

	F	A1	A2	A3	A4
Sensitivity (%)	91/118 (77)	81/118 (69)	84/118 (71)	91/118 (77)	89/118 (75)
Specificity (%)	525/586 (90)	533/586 (91)	533/586 (91)	536/586 (91)	536/586 (91)
PPV (%)	91/152 (60)	81/134 (60)	84/137 (61)	91/141 (65)	89/139 (64)
NPV (%)	525/552 (95)	533/570 (94)	533/567 (94)	536/563 (95)	536/565 (95)

A1 = first sub-frame, A2 = second sub-frame, A3 = third sub-frame, A4 = fourth sub-frame, F = full-frame, NPV = negative predictive value, PPV = positive predictive value

Table 3.

Results of Overall Image Quality of Quadruple Arterial MRI Using Radial VIBE-KWIC

	Overall Image Quality^‡	p-Value^†
	Overall Image Quality^‡	F	A1	A2	A3	A4
F	4.057 ± 0.904	-	0.001∗	0.000∗	0.002∗	0.005∗
A1	3.761 ± 0.937	-	-	0.774	0.454	0.572
A2	3.739 ± 0.852	-	-	-	0.289	0.421
A3	3.818 ± 0.815	-	-	-	-	0.941
A4	3.807 ± 0.816	-	-	-	-	-

Values are the mean ± standard deviation.

∗Results were considered statistically significant at p-value < 0.05.

^†p-value based on pairwise comparison of ROC curves.

^‡Image quality parameter scores, where 1 = unacceptable and 5 = excellent.

A1 = first sub-frame, A2 = second sub-frame, A3 = third sub-frame, A4 = fourth sub-frame, F = full-frame, KWIC = k-space weighted image contrast, VIBE = volumetric imaging breath-hold examination

Table 4.

Results of Artifact Severity of Quadruple Arterial MRI Using Radial VIBE-KWIC

	Artifact Severity^‡	p-Value^†
	Artifact Severity^‡	F	A1	A2	A3	A4
F	3.841 ± 0.888	-	0.007∗	0.008∗	0.044∗	0.010∗
A1	3.648 ± 0.846	-	-	0.717	0.777	0.782
A2	3.625 ± 0.779	-	-	-	0.523	0.990
A3	3.659 ± 0.713	-	-	-	-	0.462
A4	3.614 ± 0.799	-	-	-	-	-

Values are the mean ± standard deviation.

∗Results were considered statistically significant at p-value < 0.05.

^†p-value based on pairwise comparison of ROC curves.

^‡Image quality parameter scores, where 1 = non-diagnostic and 5 = no artifact.

A1 = first sub-frame, A2 = second sub-frame, A3 = third sub-frame, A4 = fourth sub-frame, F = full-frame, KWIC = k-space weighted image contrast, VIBE = volumetric imaging breath-hold examination

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