Objective: The purpose of this study was to optimize a new rapid-acquisition MR pulse sequence, called fast multiplanar spoiled gradient-recalled (FMPSPGR) imaging, for breath-hold imaging of the liver and to compare unenhanced and contrast-enhanced FMPSPGR with standard spin-echo imaging in detecting liver tumors.
Materials and methods: The pulse sequence was optimized at 1.5 T with a healthy volunteer. Various scanning parameters were evaluated, and liver-spleen signal difference/noise measurements were used to estimate lesion contrast-to-noise ratios. We examined 24 patients with hepatic masses using the optimized sequence with spin-echo T1-weighted and T2-weighted imaging as well as unenhanced and gadopentetate dimeglumine-enhanced FMPSPGR imaging. The contrast-to-noise ratio for the hepatic tumors was determined for each sequence. Three radiologists who did not know the biopsy or test results reviewed all images for lesion conspicuity, lesion tissue specificity, and overall image quality.
Results: A comparison of unenhanced FMPSPGR images with spin-echo T1-weighted images showed a 40% improvement in mean contrast-to-noise ratio and a 70% improvement in liver signal-to-noise ratio for the FMPSPGR images. A comparison of gadopentetate dimeglumine-enhanced FMPSPGR images with spin-echo T1- and T2-weighted images showed a superior contrast-to-noise ratio for the enhanced FMPSPGR images in 17 (68%) of 25 hepatic lesions, which included all hepatic cysts (n = 3) and all hepatomas (n = 6), and in six of 12 patients with other liver tumors. The results of contrast-to-noise ratio for four patients with hemangiomas were mixed. For the remaining eight lesions, the contrast-to-noise ratio for spin-echo T1- and T2-weighted images predominated in three and five cases, respectively. Contrast-enhanced FMPSPGR images revealed a 40% and 300% increase in contrast-to-noise ratio compared with T2- and T1-weighted images, respectively. All three radiologists preferred the contrast-enhanced FMPSPGR images for overall image quality. For lesion conspicuity and specificity, however, the three radiologists differed, with a preference for the FMPSPGR images in 52%, 80%, and 40% of cases for lesion conspicuity and in 68%, 40%, and 60% of cases for lesion specificity.
Conclusion: FMPSPGR is a new, ultrafast MR sequence that provides T1-weighted images of the liver during suspended respiration. Contrast-to-noise ratio and liver signal-to-noise ratio are significantly improved over those on conventional spin-echo T1-weighted images. The combination of breath-hold FMPSPGR with gadopentetate dimeglumine is an excellent technique that can be used to rapidly evaluate the liver with superior overall image quality. Contrast-to-noise ratios are generally superior to T2-weighted spin-echo images, making this technique a useful adjunct to conventional spin-echo MR imaging.