Detection of focal liver lesions in unenhanced and ferucarbotran-enhanced magnetic resonance imaging: a comparison of T2-weighted breath-hold and respiratory-triggered sequences

Purpose

To investigate the image quality and detection rate of focal liver lesions by comparing a T2-weighted breath-hold single-shot sequence and a T2-weighted high spatial resolution fast spin-echo sequence with respiratory triggering via unenhanced and superparamagnetic iron oxide (SPIO)-enhanced liver imaging.

Materials and Methods

The study was approved by the local ethical review board; informed consent was waived. Liver-lesion contrast was measured and a qualitative consensus evaluation of image quality and lesion detection was performed in 42 consecutive patients using a 1.5-T MR system.

Results

The liver-lesion contrast was significantly higher (P<.05) for the respiratory-triggered sequence compared to the breath-hold sequence regarding unenhanced and SPIO-enhanced imaging. The respiratory-triggered sequences revealed significantly higher image quality scores as well as higher numbers of detected liver lesions compared to the breath-hold sequence on unenhanced and SPIO-enhanced imaging. The SPIO contrast did not significantly improve the number of detected lesions on the respective sequences (P>.05).

Conclusion

We find that respiratory-triggered fast spin-echo sequences produce a higher image quality and a more precise liver-lesion detection rate thereby justifying the increased acquisition time necessary for this method.     

MR imaging of the liver and spleen: a comparison of the effects on signal intensity of two superparamagnetic iron oxide agents

We compared the effects of two superparamagnetic iron oxide (SPIO) contrast agents, ferumoxides and SHU-555A, in MR imaging of the liver and spleen. Thirty-six patients with known malignant lesions of the liver underwent T2W turbo spin-echo (TSE) and T1WGRE FLASH opposed-phase imaging before and after SPIO injection on a 1.0 T MR system. Post-ferumoxides images were obtained in 18 patients 90 min after infusion of 15 micrommol Fe/kg of the agent. In 18 other patients SHU-555A was administered as a rapid bolus at a dose of 7.0-12.9 micrommol Fe/kg. T1WGRE FLASH images were obtained immediately, 30 s and 480 s and T2WTSE images 10 min after injection. Signal intensity of the liver, spleen, and malignant liver lesions before and after SPIO was measured with operator-defined regions of interest. The effects of ferumoxides and SHU-555A were measured as the percentage signal intensity change (PSIC) and in the malignant liver lesions additionally as changes in lesion-to-liver contrast-to-noise ratio (deltaDCNR). On T2W TSE images, there was no significant difference between the two agents in signal loss of liver parenchyma (p > 0.05). The signal loss in the spleen produced by ferumoxides was greater than with SHU-555A (p < 0.05). Both SPIO agents produced a significant increase in the CNR of malignant liver lesions. Delta CNR was slightly greater with ferumoxides than with SHU-555A (p < 0.05). On T1WGRE FLASH images, a slight decrease of liver SI induced by both agents was found on late post-SPIO images. No significant difference of liver PSIC between the two SPIO agents was noted on T1W images. The SI of spleen was significantly increased with both agents on T1W images and no difference in PSIC of spleen was noted (p > 0.05). The T1 and T2 effects produced by ferumoxides and SHU-555A were comparable in the liver although ferumoxides produced a stronger T2 effect in the spleen.     

Quantitative liver iron measurement by magnetic resonance imaging: in vitro and in vivo assessment of the liver to muscle signal intensity and the R2* methods

Purpose

To evaluate the liver-to-muscle signal intensity and R2* methods to gain a transferable, clinical application for liver iron measurement.

Materials and Methods

Sixteen liver phantoms and 33 human subjects were examined using three 1.5-T MRI scanners from two different vendors. Phantom-to-muscle and liver-to-muscle signal intensity ratios were analyzed to determine MRI estimated phantom and hepatic iron concentration (M-PIC and M-HIC, respectively). R2* was calculated for the phantoms and the liver of human subjects. Seven patients' biochemical hepatic iron concentration was obtained.

Results

M-PIC and R2* results of three scanners correlated linearly to phantom iron concentrations (r=0.984 to 0.989 and r=0.972 to 0.981, respectively), and no significant difference between the scanners was found (P=.482 and P=.846, respectively) in vitro. The patients' R2* correlated linearly to M-HIC of the standard scanner (r=0.981). M-HIC values did not differ from those obtained from the biopsy specimens (P=.230). The difference in M-HIC was significant, but the difference in R2* was not significant between the scanners (P<.0001 and P=.505, respectively) in vivo.

Conclusion

Both methods, M-HIC and R2*, are reliable iron concentration indicators with linear dependence on iron concentration in vivo and in vitro. The R2* method was found to be comparable among different scanners. Transferability testing is needed for the use of the methods at various scanners.     

Prominent signal intensity of T1/T2 prolongation in subcortical white matter of the anterior temporal region on conventional screening MRI of late preterm infants with normal development

Purpose

This study discusses prominent signal intensity of T₁/T₂ prolongation of subcortical white matter within the anterior temporal region in premature infant brains that radiologists may encounter when interpreting conventional screening MRIs.

Materials and Methods

T₁- and T₂-weighted images of 69 preterm and term infants with no neurological abnormalities or developmental delays were evaluated retrospectively for areas of prominent signal intensity of T₁/T₂ prolongation in white matter. We measured signal intensities of anterior temporal white matter, deep temporal white matter, frontopolar white matter and subcortical white matter of the precentral gyrus. We accessed chronological changes in signal intensity in the anterior and deep temporal white matter. We also analyzed variance tests among the signal intensity ratios to the ipsilateral thalamus of white matter areas by gestational age.

Results

There was high frequency of prominent signal intensity of T₁/T₂ prolongation in the temporal tip, particularly at a gestational age of 36–38 weeks. Signal intensity ratio of the anterior temporal white matter was lower on T₁-weighted images and higher on T₂-weighted images, and the finding became less prominent with increasing gestational age. The signal intensity ratios of anterior temporal white matter at a gestational age of 36–37 weeks and 38–39 weeks were significantly different from other regions.

Conclusion

Prominent signal intensity of T₁/T₂ prolongation of subcortical white matter of the anterior temporal region is seen in normal premature infants, especially those at 36–39 gestational weeks. Although it is a prominent finding, radiologists should understand that these findings do not represent a pathological condition.