Influence of age on gadoxetic acid disodium-induced transient respiratory motion artifacts in pediatric liver MRI.

Azadeh Hojreh,Ahmed Ba-Ssalamah,Wolf-Dietrich Huber,Dietmar Tamandl,Christian Lang,Sarah Poetter-Lang,Xi Chen

doi:10.1371/journal.pone.0264069

Azadeh Hojreh, Ahmed Ba-Ssalamah + Show 5 more

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https://doi.org/10.1371/journal.pone.0264069

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Abstract

Gd-EOB-DTPA-enhanced liver MRI is frequently compromised by transient severe motion artifacts (TSM) in the arterial phase, which limits image interpretation for the detection and differentiation of focal liver lesions and for the recognition of the arterial vasculature before and after liver transplantation. The purpose of this study was to investigate which patient factors affect TSM in children who undergo Gd-EOB-DTPA-enhanced liver MRI and whether younger children are affected as much as adolescents. One hundred and forty-eight patients (65 female, 83 male, 0.1-18.9 years old), who underwent 226 Gd-EOB-DTPA-enhanced MRIs were included retrospectively in this single-center study. The occurrence of TSM was assessed by three readers using a four-point Likert scale. The relation to age, gender, body mass index, indication for MRI, requirement for sedation, and MR repetition was investigated using uni- and multivariate logistic regression analysis. In Gd-EOB-DTPA-enhanced MRIs, TSM occurred in 24 examinations (10.6%). Patients with TSM were significantly older than patients without TSM (median 14.3 years; range 10.1-18.1 vs. 12.4 years; range 0.1-18.9, p<0.001). TSM never appeared under sedation. Thirty of 50 scans in patients younger than 10 years were without sedation. TSM were not observed in non-sedated patients younger than 10 years of age (p = 0.028). In a logistic regression analysis, age remained the only cofactor independently associated with the occurrence of TSM (hazard ratio 9.152, p = 0.049). TSM in Gd-EOB-DTPA-enhanced liver MRI do not appear in children under the age of 10 years.

Highlights

MRI is the preferred imaging modality for the assessment of liver pathologies in daily clinical practice, both for adults, and increasingly, for pediatric patients [1, 2]
In Gd-EOB-DTPA-enhanced MRIs, transient severe motion artifacts (TSM) occurred in 24 examinations (10.6%)
In a logistic regression analysis, age remained the only cofactor independently associated with the occurrence of TSM

Summary

Introduction

MRI is the preferred imaging modality for the assessment of liver pathologies in daily clinical practice, both for adults, and increasingly, for pediatric patients [1, 2]. Gadoxetate disodium (Gd-EOB-DTPA, Primovist or Eovist1) has improved liver magnetic resonance imaging due to its superior performance in diffuse and focal liver diseases [3–8], with the benefit of superior lesion detection and characterization, and the possibility to perform an assessment of liver function [3, 9], which is applicable in children [7, 10, 11]. For the detection and differentiation of focal liver lesions, the image quality of the arterial phase in Gd-EOB-DTPA-enhanced liver MRI is essential [12–14], and proper assessment of the arterial vasculature is required for patients before and after liver transplantation [15–17]. The image quality of Gd-EOB-DTPA-enhanced liver MRI is sometimes limited by transient severe motion (TSM) artifacts in the arterial phase, which are the result of acute transient dyspnea and reduced breath-holding capacity [18–20]. It is known from pediatric patients that sedation appears to have a protective effect against TSM, yet other confounders, such as age, have not been studied in detail as yet [27, 28]

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